Relationship between oral health, nutrient intake and nutritional status in a sample of Brazilian elderly people

Development of a Predictive Model for Chewing Difficulty Using EuroQol-5 Dimension Among Korean Older Adults

OBJECTIVES

We aimed to develop a predictive model for chewing difficulty using the EuroQol-5 dimension measure (EQ-5D).

METHODS

We included 6643 individuals aged ≥ 65 years (mean age: 72.6 ± 4.96 years; women: 3761 [56.6%]) who had completed the sixth (2013-2015) and seventh (2016-2018) Korea National Health and Nutrition Examination Survey (KNHANES). The participants were further divided into young-old (65-74 years) and old-old (≥ 75 years) adults. Data from the sixth KNHANES were used to establish an internal validation model (overall, young-old and old-old adult populations were 3472, 2271 and 1201, respectively). Data from the seventh KNHANES were used to establish an external validation model (overall, young-old and old-old adult populations were 3171, 1879 and 1292 participants, respectively). We evaluated chewing difficulty using the EQ-5D (Model 1) and comparative models, subjective oral health status indicators (SOHSI) and objective oral health status indicators (OOHSI).

RESULTS

Compared with SOHSI and OOHSI, EQ-5D showed similar predictive utility for chewing difficulty in both the internal and external validation models.

CONCLUSIONS

Effect sizes, quantified using Cohen's d, indicated that EQ-5D parameters had a moderate impact on the prediction accuracy for chewing difficulties.

Association of oral health status with overweight and obesity in older adults aged ≥ 65 years- evidence from Chinese communities

OBJECTIVES

To evaluate the association of poor oral health conditions, such as caries, tooth loss, and tooth loss, with overweight and obesity in older adults and to complement evidence from the Chinese community to confirm this association. Additionally, we evaluated the sociodemographic characteristics, health status, and impact of health-related behavior on the BMI of older adults.

METHODS

This retrospective study involved health examination and follow-up data of 953 older adults from the Sichuan Province of China from 2021 to 2023. The caries status assessed by the Decayed, Missing, and Filled Teeth (DMFT) index, was used as the exposure factor, whereas body mass index (BMI) was used as the outcome indicator. The influence of confounding variables, namely the sociodemographic characteristics, health status, and oral health-related behavior, was controlled. BMI changes in older adults with different levels of oral health over 3 years were retrospectively followed up. Additionally, a Cox proportional hazard model was used to determine the association.

RESULTS

Overweight and obesity were prevalent in 29.3% and 20.4% of older adults with poor and good oral health status, respectively (P < 0.01). After controlling for the confounding factors, the Cox proportional hazards model demonstrated that the DMFT index was associated with overweight or obesity (BMI) (hazards ratio = 1.86, 95% confidence interval: 1.52-2.28). Overweight and obesity were less prevalent in older adults with fewer chronic diseases, higher frequency of physical exercise, and better oral health-related behaviors.

CONCLUSIONS

Oral health status is positively associated with overweight and obesity in older adults, particularly in older adults presenting with caries, missing teeth, and tooth loss as their primary symptoms.

Association between occlusal supports and nutritional status in older adults: A systematic review

Background/purpose

Impaired masticatory performance results in nutritional deficiencies in older adults. This systematic review aims to investigate the following clinical question (CQ): Do occlusal supports impact nutritional intake or nutritional status in older individuals?

Materials and methods

An extensive systematic literature search was performed to summarize the currently available knowledge to address the CQ. The cohort and intervention studies with participants of ≧60 years old or a mean age of 65 years performed before May 2021 were included. Studies were required to measure the parameters related to occluding tooth pairs/occlusal units and food/nutrient intake and/or nutritional status. Bias risk was assessed using the Risk of Bias Assessment Tool for Nonrandomized Studies.

Results

After an independent screening of 1130 initial records, 24 reports from 22 studies were included. Participants (n = 8684) in the included studies were mainly residents of nursing homes or community-dwelling individuals. Following the assessment of bias risk, it is revealed that all studies had methodological weaknesses. Over half of the studies concluded that there was an association between occlusal support and nutritional intake or status. However, it was also revealed that various confounding factors are involved in the association between occlusal support and nutrition.

Conclusion

This systematic review concludes that occlusal support might be associated with nutritional intake or nutritional status in the older population, although there are methodological limitations of each study. The evidence is still insufficient, and more well-designed studies are required.

Effect of vitamin D supplementation on cardiac-metabolic risk factors in elderly: a systematic review and meta-analysis of clinical trials

BACKGROUND

There has been a longstanding interest in the potential effect of vitamin D in preventing cardiac-metabolic diseases. However, there are divergent results regarding the impact of vitamin D supplementation (VDS) on managing cardiac-metabolic outcomes in the elderly population.

MATERIAL AND METHOD

We systematically searched electronic databases; Web of Science, PubMed, Scopus, EMBASE, Cochrane, and ProQuest. We included all trials that evaluated the effect of VDS on cardiac-metabolic risk factors in the elderly population, which were published until 30 September 2021. The effects of VDS on cardiac-metabolic outcomes were assessed using standardized mean difference (SMD). A random-effect model was used to pool the SMD and 95% confidence interval (CI).

RESULT

The literature search identified 4409 studies, of which 12 trials met inclusion criteria. Results of random effect meta-analysis indicated a significant reduction in total cholesterol (TC) (SMD: - 0.14 mg/dl; 95% CI: - 0.25, - 0.02) and triglyceride (TG) (SMD: - 0.45 mg/dl; 95% CI: - 0.86, - 0.04) with VDS compared to the placebo. The subgroup analyses revealed that the reduction of TG in patients with diabetes and vitamin D deficiency was significant. Furthermore, short-term intervention (≤ 6 months) induced a significantly lower level of TG and insulin in comparison to longer duration (> 6 months).

CONCLUSION

The study suggests that VDS could improve insulin concentration and dyslipidemia in the elderly population. The systematic review was registered in Alborz university of medical sciences with 2060-01-03-1397 number and the Ethics council IR.ABZUMS.REC.1397.207 number.

Associations between the composition of functional tooth units and nutrient intake in older men: the Concord Health and Ageing in Men Project

OBJECTIVE

Inadequate nutrient intakes have been linked with poor dentition in older adults. The aim of this study was to investigate the associations between the composition of functional tooth units (FTU) and nutrient intakes in older men.

DESIGN

A cross-sectional study with a standardised validated diet history assessment and comprehensive oral health assessments. FTU were categorised by dentition type: (i) Group A (Natural FTU Only), (ii) Group B (Natural and Replaced FTU) and (iii) Group C (No Natural FTU). Attainment of nutrient reference values (NRV) for sixteen micronutrients was incorporated into a micronutrient risk variable, dichotomised 'good' (≥ 12) or 'poor' (≤ 11), and for seven macronutrients into a macronutrient risk variable, dichotomised 'good' (≥ 5) or 'poor' (≤ 4).

SETTING

Subjects selected from the local Sydney geographical areas.

PARTICIPANTS

Community-dwelling older men (n 608).

RESULTS

32 % (n 197) of participants were categorised as Group A, 27 % (n 167) as Group B and 40 % (n 244) as Group C. In adjusted logistic regression analysis, being in Group C, compared with Group A, was associated with intakes below NRV recommendations for fibre (OR: 2·30, 95 % CI 1·30, 4·05). Adjusted analysis also showed that men in Group C, compared with Group A, were more likely to have poor intake of macronutrients (OR: 2·00, 95 % CI 1·01, 3·94).

CONCLUSIONS

Our study shows statistically significant associations between the composition of FTU and poor macronutrient intakes. Maintaining natural pairs of occluding FTU may be important for attaining adequate nutrient intakes in older men.

Poor dental condition is a factor of imbalance of the nutritional status at the outset of management of head and neck cancer

OBJECTIVES

To determine whether deterioration of dental condition at the outset of management of head and neck cancer (HNC) is a nutritional risk and whether social deprivation is a cause of the poor dental condition observed in HNC patients.

MATERIAL AND METHODS

A nutritional assessment form (NAF) and the Nutrition Risk Index (NRI) were used to standardize the nutritional status of 108 patients at the outset of management of HNC (2017-2019). The NAF includes assessment of weight loss over the past 3 months, the amount and difficulty of food intake, and the presence of digestive disorders. Dental condition was assessed by the decayed, filled, and missing teeth acopre (DFM) index and the masticatory coefficient (MC). Dental status and social deprivation were correlated with the EPICES score.

RESULTS

A correlation was found between the extent of weight loss and dental condition. The MC was higher in absence of weight loss (46% vs. 27%, p = 0.03) and the DMF lower when weight loss was less than 5% (22.3 vs. 26.9 if > 5% loss of weight, p = 0.005). No correlation was found between dental status and nutritional status. Social deprivation was associated with a lower MC (26% vs. 50%, p < 0.001).

CONCLUSION

Dental condition is a risk factor for weight loss at the outset of management of HNC but is not a determinant of nutritional status. Clinical relevance Dental condition is no longer considered simply as a source of potential complications after radiotherapy but also as an important factor for nutritional status.

Evaluation of Oral Nutritional Supplementation in the Management of Frailty among the Elderly at Facilities of Community Care for the Elderly

Adequate nutritional intake in elderly individuals improves frailty. Elderly individuals may exhibit improvements in frailty with the use of community care facilities. Therefore, this study evaluated the effects of nutritional intervention in elderly subjects at community care facilities receiving oral nutritional supplements (ONSs) and determined their nutritional status. Sixty-two elderly individuals using community care facilities were divided into the experimental group (EG) (before [n = 31]/after [n = 28]) and control group (CG) (before [n = 31]/after [n = 25]). Subjects in both groups were treated with ONSs (200 mL/200 kcal) for 90 days. However, those in the EG received the product with increased protein; vitamins A, C, D, and E; phosphorus; calcium; and zinc. The data collected included anthropometric data, dietary assessment findings, frailty status (Korean version of the Fatigue, Resistance, Ambulation, Illnesses, and Loss of weight questionnaire), and nutritional status (Mini Nutritional Assessment, MNA). The changes in the two groups were analyzed using the Mann-Whitney U Wilcoxon signed-rank test. Nutritional intervention increased the weight, body mass index, and lean body mass in the EG (p < 0.05). Protein, calcium, and iron levels increased only in the EG (p < 0.05). The MNA score increased and sum of frailty indicators improved in the EG, and the increase in the MNA score in the EG was greater than that in the CG. This study verified the improved anthropometric data and dietary intake in the EG. Thus, the higher number of pre-frailty elderly individuals at facilities of community care indicates the need for adequate nutritional supplementation for frailty management.

Predictors for oral and general health outcomes and quality of life among older people attending general practice clinics in South Australia

BACKGROUND

As the proportion and number of older people in Australia continue to grow, innovative means to tackle primary care and prevention are necessary to combat the individual, social and economic challenges of non-communicable diseases.

OBJECTIVE

To assess risk factors (or predictors) for oral and general health outcomes and quality of life of older people (75+ years.) attending general practice (GP) clinics in South Australia.

METHODS

Data were collected from older people attending 48 GP clinics in metropolitan South Australia. Age, sex, education, living arrangement, material standards, chronic conditions and nutrition were assessed as risk factors. Global self-rated oral and general health and quality of life (OHIP Severity and EQ-5D Utility) were included as outcome measures.

RESULTS

A total of 459 participants completed the study; response rate was 78%. In the adjusted models, high satisfaction with material standards and good nutritional health were positively associated with all four oral and general health measures. Sex (β = -0.08), age (β = -0.09) and number of chronic conditions (β = -0.12) were negatively associated with EQ-5D, while living arrangement (β = 0.07) was positively associated. Further, having four or more chronic conditions (RR:1.47) was significantly associated with self-rated general health.

CONCLUSION

Satisfaction with material standards and nutritional risk were consistent predictors for oral and general health outcomes and quality of life of older people visiting GP clinics.

Factors associated with oral health-related quality of life of institutionalized elders

This study aimed to evaluate the correlation between two Oral Health-Related Quality of Life (OHRQoL) questionnaires (the Oral Health Impact Profile (OHIP-14) and the Geriatric Oral Health Assessment Index (GOHAI)) and to investigate the factors associated with the OHRQoL of institutionalized elderly individuals. A cross-sectional multicenter study was performed with 344 institutionalized elderly individuals residing in two Brazilian cities. Six trained researchers interviewed the elderly individuals. Sociodemographic data were collected from medical records. Dental caries experience and the use of and need for dentures were recorded through oral examination performed by two trained examiners. A Likert scale (1-5 points) was used to assess general health and self-perceived oral health. The number of chewing cycles needed to chew a portion of peanuts was used to assess the swallowing threshold. The OHIP-14 and GOHAI were used to evaluate OHRQoL, and statistically significant correlations were assessed using Spearman's correlation test (p < 0.05). Poisson regression (p < 0.05) was used to investigate the association of OHRQoL with independent variables. Scores on the OHIP-14 (7.57 ± 8.63) and GOHAI (32.46 ± 3.85) were strongly and inversely correlated (r2 = -0.671, p < 0.001), although these measures were associated with different factors. A higher OHIP-14 total score (worse OHRQoL) was associated with female gender, a greater number of healthy teeth, worse self-perceived general health and oral health, and a lower swallowing threshold (p < 0.05). A higher GOHAI total score (better OHRQoL) was associated with a greater number of filled teeth, better self-perceived oral health and a greater swallowing threshold (p < 0.05). In conclusion, worse OHRQoL among institutionalized elderly individuals is associated with worse self-perceived oral health and a greater swallowing threshold.

The Association Between the Number of Natural Remaining Teeth and Appendicular Skeletal Muscle Mass in Korean Older Adults

Background

The aim of this study was to examine the correlation between the number of remaining natural teeth (NRT) and the appendicular skeletal muscle mass index (SMI) in older adults.

Methods

This study was based on data from the 2008–2010 Korea National Health and Nutritional Examination Surveys. The participants were 2,378 older participants (984 men and 1,394 women) aged over 65 years. Survey dentists conducted oral health examinations, and ASM was measured using dual-energy X-ray absorptiometry.

Results

The participants with NRT≥20 had more ASM and SMI than those with NRT<20 in both sexes. SMI was correlated with NRT in men (r=0.018, p<0.001) and in women (r=−0.007, p<0.001). The positive correlation between the NRT and SMI remained significant in men even after adjusting for age, marital status, income, smoking, drinking, physical activity, protein intake, energy intake, calcium intake, body mass index, fasting blood glucose level, medications, and prostheses (β=0.011, p=0.001). In women, the correlation disappeared after adjustment for smoking, alcohol, physical activity, protein intake, energy intake, calcium intake, marital status, income, fasting basal glucose, medication administration, and prostheses.

Conclusion

This study showed a correlation between NRT and SMI in those ≥65 years of age in Korea. The relationship persisted in men, but not in women, even after adjusting for confounders.

Satisfaction with dietary life affects oral health-related quality of life and subjective well-being in very elderly people

Age-related deterioration in physical and oral health reduces healthy life expectancy and is thus an important problem for very elderly people. We investigated the effects of satisfaction with dietary life (SDL) in everyday life on oral health-related quality of life (OHRQoL) and subjective well-being and examined associations between these factors. We evaluated 426 elders aged 85 years or older. All participants completed a questionnaire that inquired about age, gender, drinking status, body mass index, cognitive function, disability, and comorbidities, among other covariates. Oral, physical, and mental health conditions were also examined. Associations of questionnaire results for SDL with items on subjective well-being (Philadelphia Geriatric Center Morale Scale [PGC] and World Health Organization-5 [WHO-5]) and OHRQoL (Geriatric Oral Health Assessment Index [GOHAI]) were confirmed with multiple logistic regression analysis. In a multivariate model adjusted for various confounders, participants with self-reported "enjoyable" SDL had significantly lower risks for having the lowest scores on the GOHAI, PGC, and WHO-5 (odds ratio [OR] = 0.460, 95% confidence interval [CI] = 0.277-0.762; OR = 0.589, 95% CI = 0.348-0.996; and OR = 0.452, 95% CI = 0.263-0.775, respectively). These associations remained after further adjustment for number of teeth.

Lifestyle factors are significantly associated with the locomotive syndrome: a cross-sectional study

Background

The Japanese Orthopedic Association first proposed the concept of “locomotive syndrome” in 2007. It refers to circumstances in which elderly people need nursing care services or are at high risk of requiring such services within a short time. Recently, the public health burden of providing nursing care for elderly individuals has increased. Therefore, locomotive syndrome, and the means of preventing it, are a major public health focus in Japan. The purpose of this study was to investigate the relationships of lifestyle factors, such as smoking, alcohol consumption, sleep duration, and dental health, with locomotive syndrome.

Methods

We conducted a cross-sectional study using an internet panel survey. The participants comprised 747 individuals aged 30–90 years. Factors related to demographics (age, sex), general health (number of teeth, presence of periodontal disease), and lifestyle (smoking, alcohol consumption, sleep duration) were assessed. We also used the 25-question Geriatric Locomotive Function Scale to determine whether each participant had locomotive syndrome. Multivariate analysis was conducted using logistic regression to investigate the independent relationships between locomotive syndrome and lifestyle factors after adjusting for sex and age.

Results

A greater proportion of women (17.7%) than men (11.2%) had locomotive syndrome (p < 0.05). Participants aged ≥65 years showed significantly higher percentages (men: 21.4%, women: 75.7%) of locomotive syndrome compared with those aged <65 years (p < 0.05). Logistic regression analysis revealed that older age (≥ 65 years), sex, current smoking status, number of existing teeth, and presence of periodontal disease were associated with locomotive syndrome, whereas sleep duration was not. The frequency of alcohol consumption, except for daily drinking, was also associated with locomotive syndrome.

Conclusion

Our study indicates that lifestyle factors, such as smoking and number of existing teeth, may partly affect the prevalence of locomotive syndrome. Hence, lifestyle modifications, such as improving oral hygiene and promoting cessation of smoking, are important means to reduce the risk of locomotive syndrome and should be promoted by public health staff.

Utilization of tooth filling services by people with disabilities in Taiwan

BACKGROUND

The oral condition of people with disabilities has considerable influence on their physical and mental health. However, nationwide surveys regarding this group have not been conducted. For this study, we used the National Health Insurance Research Database to explore the tooth filling utilization among people with disabilities.

METHODS

Using the database of the Ministry of the Interior in 2008 which included people with disabilities registered, we merged with the medical claims database in 2008 of the Bureau of National Health Insurance to calculate the tooth filling utilization and to analyze relative factors. We recruited 993,487 people with disabilities as the research sample.

RESULTS

The tooth filling utilization was 17.53 %. The multiple logistic regression result showed that the utilization rate of men was lower than that of women (OR = 0.78, 95 % CI = 0.77-0.79) and older people had lower utilization rates (aged over 75, OR = 0.22, 95 % CI = 0.22-0.23) compared to those under the age of 20. Other factors that significantly influenced the low tooth filling utilization included a low education level, living in less urbanized areas, low economic capacity, dementia, and severe disability.

CONCLUSION

We identified the factors that influence and decrease the tooth-filling service utilization rate: male sex, old age, low education level, being married, indigenous ethnicity, residing in a low urbanization area, low income, chronic circulatory system diseases, dementia, and severe disabilities. We suggest establishing proper medical care environments for high-risk groups to maintain their quality of life.

Anthropometric measurements and periodontal diseases in children and adolescents: a systematic review and meta-analysis

The aim of this systematic review was to identify and summarize evidence of the association between anthropometric measurements and periodontal status in children and adolescents. We searched PubMed, Institute for Scientific Information Web of Knowledge, Cochrane Library, and 7 additional databases, following the guidance of Preferred Reporting Items for Systematic Reviews and Meta-Analyses, up to December 2014. Observational studies reporting data on the association between anthropometric measurements and periodontal diseases in 2-18-y-old participants were included. An initial search identified 4191 papers; 278 potentially effective studies (k = 0.82) and 16 effective studies (k = 0.83) were included after screening. The mean quality of evidence among the studies was 20.3, according to the Strengthening the Reporting of Observational studies in Epidemiology checklist (k = 0.79). Meta-analyses showed that obesity (measured by body mass index) was significantly associated with visible plaque index (OR: 4.75; 95% CI: 2.42, 9.34), bleeding on probing (OR: 5.41; 95% CI: 2.75, 10.63), subgingival calculus (OR: 3.07; 95% CI: 1.10, 8.62), probing depth (OR: 14.15; 95% CI: 5.10, 39.25) and flow rate of salivary secretion (standardized mean difference: -0.89; 95% CI: -1.18, -0.61). However, various results were reported in the effective studies that were not included in meta-analyses. In conclusion, obesity is associated with some signs of periodontal disease in children and adolescents. Further studies with a comprehensive prospective cohort design and more potential variables are recommended.

Nutritional status and eating habits of the institutionalised elderly in Turkey: a follow-up study

BACKGROUND

As the elderly population increases in Turkey, so do the associated health and nutritional problems. The main purpose of the present study was to determine the nutritional status of elderly individuals who live in institutions.

METHODS

A total of 102 elderly volunteers was recruited from seven residential homes of the Ministry of Family and Social Policies in Ankara. In the consecutive years of 2007, 2008 and 2009, dietary intake was assessed using a 24-h food recall. Nutritional status was screened using a questionnaire from the Mini-Nutritional Assessment, basic characteristics were determined and anthropometric measurements were assessed.

RESULTS

The percentage of elderly participants who were malnourished or at risk for malnutrition increased by the completion of the follow-up (P < 0.05). It was found that energy, total protein, animal proteins, carbohydrates, niacin, vitamin C, vitamin E and zinc intake of men decreased significantly over the years studied (P < 0.05). A significant decrease occurred among women in animal protein, vitamin B1 , niacin and the percentage of energy from proteins (P < 0.05); however, an increase in energy from fat (P < 0.05) was determined. Within the years studied, the percentage of nutrients meeting the Turkish recommended daily allowances decreased from 2007 to 2009 both in men and women. During the years 2007 to 2009, the percentage of waist circumferences >102 cm for men was 46.4%, 45.6% and 48.1%, respectively, and the percentage of waist circumferences for women >88 cm was 75.6%, 75.6% and 81.8%, respectively.

CONCLUSIONS

During the follow-up, significant nutritional changes were determined. To prevent malnutrition, periodical screening of nutritional status should be a priority and a standard policy for elderly people, especially for those institutionalised.

Dentition, nutritional status and adequacy of dietary intake among older residents in assisted living facilities

OBJECTIVE

We examined the relationships between dentition, nutritional status and dietary intakes of energy, protein and micronutrients among older people in assisted living facilities in Helsinki.

BACKGROUND

Poor dentition is associated with malnutrition. Less is known about how dentition is associated with detailed nutrient intakes in institutionalised older people.

MATERIALS AND METHODS

This cross-sectional study assessed 343 participants (mean age 83 years). Dentition was assessed by trained ward nurses and divided into edentulous participants without dentures (group 1), edentulous participants with removable dentures (group 2) and those with any natural teeth (group 3). Nutritional status was assessed by Mini Nutritional Assessment (MNA). The energy, protein and nutrient intakes were calculated from detailed 1-day food diaries and compared with the recommendations of the Finnish National Nutrition Council as a measure of dietary adequacy. Assessment included also participants' cognitive and functional status.

RESULTS

Of the participants, 8.2, 39.1 and 52.8% were in groups 1, 2 and 3, respectively. Altogether 22% were malnourished according to MNA. Group 1 had the poorest nutritional status. A large proportion of participants consumed less than the recommended amounts of energy, protein or micronutrients. Half of the participants consumed <60 g/day of protein. The intake of protein was significantly lower in group 1 than in other two groups.

CONCLUSION

Malnutrition and inadequate protein intake were very common and associated with dentition among older people with multiple disabilities in assisted living facilities. Assessment of dental status should be part of good nutritional care in long-term care.

Factors associated with missing teeth in the Brazilian elderly institutionalised population

OBJECTIVE

Identify factors associated with missing teeth in the elderly institutionalised population in Brazil.

METHODOLOGY

Cross-sectional study of elderly institutionalised Brazilians with 1192 subjects. A questionnaire was applied as well as an epidemiological survey of oral health conditions in accordance with WHO. Factorial analysis was carried out with variables related to missing teeth, as well as the Fisher's exact test, chi-squared test and multiple logistic regression.

RESULTS

Mean age was 76.3 (± 9.8), 53.5% (638) of subjects were women and 717 (60.2) were dependent. Mean of Decayed Missing and Filled Teeth Index (DMFT index) was 29.4 (± 4.9). The subjects that did not use upper and lower dentures were 61.5% (732) and 79.2% (944), respectively. Median number of missing teeth per person was 27.88 (± 6.8) with a mean of 4 (± 6.6) teeth present and 2.4 (± 4.5) caries-free teeth. Factors associated with missing teeth following multivariate analysis were: age, sex, self-assessment of oral health, access to health services, type of institution and area of the country.

CONCLUSIONS

High level of tooth loss and low level of rehabilitation demonstrate precarious oral health. It is therefore necessary to improve institutional access mechanisms to public health facilities for the institutionalised elderly.

Effect of oral health dental state and risk of malnutrition in elderly people

AIM

To determine the risk of malnutrition in both institutionalized and non-institutionalized elderly people of the region of Murcia in Spain.

METHODS

A cross-sectional study was carried out on 465 participants (213 men and 252 women) aged 65 years or older, and representative of the population of the region of Murcia in Spain. The nutritional condition was determined with the Mini Nutritional Assessment screening tool. The following clinical oral health variables were recorded: number of teeth in the mouth, use of removable dentures and hygiene.

RESULTS

The prevalence of malnutrition was 7% in the study population, whereas the risk of malnutrition was 49%. A greater prevalence was recorded in the older and in the institutionalized participants. There were no significant differences in terms of malnutrition or the risk of malnutrition between the participants with or without dentures or between the dentate or edentulous participants.

CONCLUSIONS

Age and institutionalization are parameters to be taken into account for detecting the risk of malnutrition in elderly people.

Relation between oral health and nutritional condition in the elderly

Oral health is a prerequisite for a good chewing function, which may have an impact on food choices and nutritional well-being.

OBJECTIVE

This study was designed to evaluate the relationship between oral health status and nutritional status in the elderly.

MATERIAL AND METHODS

In this cross-sectional study, 33 elderly people from the Group for the Elderly Interdisciplinary Geriatrics and Gerontology Program, at Fluminense Federal University, Niteroi, RJ, Brazil, completed a questionnaire to collect information on socioeconomic status, eating habits, physical activity and health habits, undertook a clinical oral examination, blood test, and anthropometric measurements, and were allocated into groups according to age. The oral health status was assessed using the index for decayed, missing and filled teeth (DMFT). The nutritional status was assessed using hemoglobin, hematocrit and albumin concentrations in blood, anthropometric values and the body mass index.

RESULTS

Tooth loss was the biggest nuisance to the elderly subjects (57.6%), followed by the use of dentures (30.3%) and ill-fitting dentures (33.3%). 66.6% of patients had difficulty in chewing, and 54.5% reported this to be due to prostheses and 13.6% to the absence of teeth. A significant correlation was found between DMFT and the value of suprailiac skinfold thickness (rho=0.380, p=0.029).

CONCLUSION

The results support the temporal association between tooth loss and detrimental changes in anthropometry, which could contribute to increased risk of developing chronic diseases.

The effect of aging and dental status on the frequency of eating out

Although many studies have investigated the effect of impaired dentition on eating habits and social expression, very few studies have evaluated the effect of age and dental status on the frequency of eating out, which was the purpose of the present study. A sample of 161 community-dwelling adults aged between 20 and 94 years of age was interviewed and then clinically examined to record dental and denture status. The bivariate analyses revealed that those who were eating out less often were more likely older, widowed, pensioners, with elementary or less than elementary education, suffering from hypertension, overweight or obese, with bad self-rated health, complaining for xerostomia, with difficulties chewing hard food and with fewer natural teeth. Multiple logistic regression analysis identified as significant predictors for less frequently eating out older age and low educational level. These results suggest that in the particular cultural environment the dental status is not an independent predictor of the frequency of eating out, but other biological and social factors play a more significant role.

Oral manifestations of hematologic and nutritional diseases

Oral manifestations of hematologic and nutritional deficiencies can affect the mucous membranes, teeth, periodontal tissues, salivary glands, and perioral skin. This article reviews common oral manifestations of hematologic conditions starting with disorders of the white blood cells including cyclic hematopoiesis (cyclic neutropenia), leukemias, lymphomas, plasma cell dyscrasias, and mast cell disorders; this is followed by a discussion of the impact of red blood cell disorders including anemias and less common red blood cell dyscrasias (sickle cell disease, hemochromatosis, and congenital erythropoietic porphyria) as well as thrombocytopenia. Several nutritional deficiencies exhibit oral manifestations. The authors specifically discuss the impact of water-soluble vitamins (B2, B3, B6, B9, B12, and C), fat-soluble vitamins (A, D, and K) and the eating disorders anorexia nervosa and bulimia nervosa on the oral mucosa.

The relationship between nutrient intake, dental status and family cohesion among older Brazilians

The aim of this study was to investigate the relationship between inadequate nutrient intake, oral health and family cohesion. This was a cross-sectional study with a sample of 887 non-institutionalized elderly people from Vitória, Espírito Santo State, Brazil. Oral examination was performed by trained and calibrated examiners and three measurements were considered: number of posterior occluding pairs of natural teeth (POP), number of teeth and overall dental status. Nutrient intake was assessed by a 24-hour diet recall interview. The elderly person's perception of family cohesion was assessed using the family adaptability and cohesion scale. People with no POP were more likely than those with 5 or more POP to have inadequate intake of vitamin C (OR = 2.79; 95%CI: 1.16-6.71), calcium (OR = 3.74; 95%CI: 1.69-8.25), riboflavin (OR = 2.49; 95%CI: 1.10-5.64) and zinc (OR = 3.43; 95%CI: 1.07-10.94). There was no association between elderly people's perceptions of family cohesion and inadequate intakes. It was concluded that oral health is related to inadequate intake of important nutrients among non-institutionalized elderly people.

Nutrition and oral mucosal diseases

Oral manifestations of nutritional deficiencies can affect the mucous membranes, teeth, periodontal tissue, salivary glands, and perioral skin. This contribution reviews how the water-soluble vitamins (B(2), B(3), B(6), B(12), C, and folic acid), fat-soluble vitamins (A, D, and E), and minerals (calcium, fluoride, iron, and zinc) can affect the oral mucosa.

Salud oral y déficit nutricional en adultos mayores no institucionalizados en Londrina, Paraná, Brasil

OBJETIVO: Examinar la asociación entre el déficit nutricional y problemas de salud oral en adultos mayores no institucionalizados de una comunidad en Brasil. MÉTODOS: En este estudio transversal fueron obtenidos datos de 267 adultos mayores (160 mujeres y 107 hombres) con edad entre los 60 y 74 años provenientes del censo del área de cobertura de un Equipo del Programa Salud de la Familia de Londrina, Brasil. El déficit nutricional fue identificado con la Mini Evaluación Nutricional (< 24 puntos). La valoración odontológica incluyó exploración bucodental, medición del flujo salivar estimulado y aplicación del Geriatric Oral Health Assessment Index para la percepción oral. Los análisis multivariantes fueron ajustados por variables sociodemográficas, depresión y consumo de medicamentos. RESULTADOS: El déficit nutricional fue detectado en 58 ancianos (21,7%). Entre las variables odontológicas, la ausencia de oclusión posterior (Odds Ratio, OR: 2,18; Intervalo de Confianza, IC95%: 1,06 - 4,45), el flujo salivar estimulado < 0,7 ml/minuto (OR: 2,18, IC95%: 1,06 - 4,50), la enfermedad periodontal avanzada (OR: 6,54; IC95%: 2,03 -21,00) y la percepción negativa de la salud oral (OR: 3,41; IC95%: 1,59 - 7,33) se asociaron al déficit nutricional de modo independiente del sexo, edad, clase económica, escolaridad, consumo de tabaco, depresión y uso de medicamentos. CONCLUSIONES: El deterioro de la salud oral se asoció al déficit nutricional, y por lo tanto se requiere mayor integración entre odontología y nutrición en la promoción de salud en adultos mayores, especialmente en la prevención de la pérdida dental y en la rehabilitación oclusal posterior, evitándose obstáculos para una dieta adecuada.

Association between chronic periodontal disease and obesity: a systematic review and meta-analysis

BACKGROUND

Obesity is increasing in prevalence and is a major contributor to worldwide morbidity. One consequence of obesity might be an increased risk for periodontal disease, although periodontal inflammation might, in turn, exacerbate the metabolic syndrome, of which obesity is one component. This review aims to systematically compile the evidence of an obesity-periodontal disease relationship from epidemiologic studies and to derive a quantitative summary of the association between these disease states.

METHODS

Systematic searches of the MEDLINE, SCOPUS, BIOSIS, LILACS, Cochrane Library, and Brazilian Bibliography of Dentistry databases were conducted with the results and characteristics of relevant studies abstracted to standardized forms. A meta-analysis was performed to obtain a summary measure of association.

RESULTS

The electronic search identified 554 unique citations, and 70 studies met a priori inclusion criteria, representing 57 independent populations. Nearly all studies matching inclusion criteria were cross-sectional in design with the results of 41 studies suggesting a positive association. The fixed-effects summary odds ratio was 1.35 (Shore-corrected 95% confidence interval: 1.23 to 1.47), with some evidence of a stronger association found among younger adults, women, and non-smokers. Additional summary estimates suggested a greater mean clinical attachment loss among obese individuals, a higher mean body mass index (BMI) among periodontal patients, and a trend of increasing odds of prevalent periodontal disease with increasing BMI. Although these results are highly unlikely to be chance findings, unmeasured confounding had a credible but unknown influence on these estimates.

CONCLUSIONS

This positive association was consistent and coherent with a biologically plausible role for obesity in the development of periodontal disease. However, with few quality longitudinal studies, there is an inability to distinguish the temporal ordering of events, thus limiting the evidence that obesity is a risk factor for periodontal disease or that periodontitis might increase the risk of weight gain. In clinical practice, a higher prevalence of periodontal disease should be expected among obese adults.