地域在住高齢者におけるサルコペニアと口腔機能との関連性：横断的研究

Association between sarcopenia and oral functions in community-dwelling older adults: A cross-sectional study.

抄録

背景:

サルコペニアの高齢者の口腔機能の状態を調べた研究はほとんどない。そこで、地域在住のサルコペニア高齢者の口腔機能を多角的に評価し、潜在的に低い口腔機能を明らかにした。

BACKGROUND: Few studies have examined the state of oral function in older adults with sarcopenia. We assessed the oral functions of community-dwelling older adults with sarcopenia from multiple perspectives to clarify their potentially low oral function.

方法論:

合計1517名（86.2％；女性990名、男性527名；平均年齢76.1±7.6歳）の参加者が本研究に参加されました。握力、歩行速度、骨格筋量指数を評価し、サルコペニアはAsian Working Group for Sarcopenia 2019の基準に従って評価した。舌苔の程度、口腔内水分、咬合力、舌唇運動機能、舌圧、咀嚼機能、嚥下機能などを評価した。口腔機能の評価には、口腔機能低下症（複数の口腔機能低下が重なった疾患）の基準を使用した。統計解析は、各口腔機能を従属変数、サルコペニアを独立変数の1つとして、Kolmogorov-Smirnov検定、無対t検定、Mann-Whitney U検定、χ検定、単変量および多変量ロジスティック回帰分析で行った。有意水準はP<0.05とした。

METHODS: A total of 1517 (86.2%; 990 women, 527 men; mean age 76.1 ± 7.6 years) participants were included in this study. Grip strength, gait speed and skeletal muscle mass index were assessed, and sarcopenia was evaluated according to the criteria of the Asian Working Group for Sarcopenia 2019. The degree of tongue coating, oral moisture, occlusal force, tongue-lip motor function, tongue pressure, masticatory function and swallowing function were assessed. The criteria for oral hypofunction (a disease that is a combination of multiple low oral functions) were used to assess oral function. Statistical analyses were performed using Kolmogorov-Smirnov test, unpaired t-test, Mann-Whitney U test, χ test, and univariate and multivariable logistic regression analyses, with each oral function as the dependent variable and sarcopenia as one of the independent variables. The significance level was set at P < 0.05.

結果:

サルコペニアの有病率は14.2％、重度のサルコペニアの有病率は3.8％であった。口腔機能低下症の有病率は39.9％であった。頑健群と比較して、サルコペニア群および重度サルコペニア群では、咬合力低下、舌唇運動機能低下、舌圧低下、咀嚼機能低下、嚥下機能低下、口腔機能低下の構成要素の頻度が高い傾向にあった（いずれもP＜0.01）。単変量ロジスティック回帰分析により、サルコペニアは低咬合力、低舌唇運動機能、低舌圧、低咀嚼機能、低嚥下機能、口腔機能低下と関連していることが示された。各口腔機能に対するサルコペニアのオッズ比と95％信頼区間は、それぞれ2.62 [2.00, 3.43], 2.21 [1.69, 2.89], 3.66 [2.79, 4.81], 3.23 [2.46, 4.25], 1.66 [1.26, 2.20] and 3.59 [2.72, 4.72] でした。多変量ロジスティック回帰分析の結果、サルコペニアは、低咬合力（1.63 [1.10, 2.40] ）、低舌圧（2.28 [1.65, 3.15] ）、低咀嚼機能、（ 1.94 [1.27, 2.97] ）、低嚥下機能（ 1.64 [1.17, 2.28] ）および口腔低機能（ 2.17 [1.52, 3.09] ）と関連していたことがわかった．

RESULTS: The prevalence rates of sarcopenia and severe sarcopenia were 14.2% and 3.8%, respectively. The prevalence of oral hypofunction was 39.9%. Compared with the robust group, the sarcopenia and severe sarcopenia groups tended to have a higher frequency of the following components (all P < 0.01): low occlusal force, low tongue-lip motor function, low tongue pressure, low masticatory function, low swallowing function and oral hypofunction. Univariate logistic regression analysis showed that sarcopenia was associated with low occlusal force, low tongue-lip motor function, low tongue pressure, low masticatory function, low swallowing function and oral hypofunction. The odds ratios and 95% confidence intervals of sarcopenia for each oral function were 2.62 [2.00, 3.43], 2.21 [1.69, 2.89], 3.66 [2.79, 4.81], 3.23 [2.46, 4.25], 1.66 [1.26, 2.20] and 3.59 [2.72, 4.72], respectively. Multivariable logistic regression analysis showed that sarcopenia was associated with low occlusal force (1.63 [1.10, 2.40]), low tongue pressure (2.28 [1.65, 3.15]), low masticatory function, (1.94 [1.27, 2.97]), low swallowing function (1.64 [1.17, 2.28]) and oral hypofunction (2.17 [1.52, 3.09]).

結論:

本研究では、サルコペニアの地域在住高齢者において、口腔機能の複数の側面が低いことが示されました。サルコペニア高齢者における口腔機能の潜在的な低下は、これまで見過ごされてきた可能性がある。本研究は、サルコペニア高齢者への介入に歯科的視点が必要であること、歯科専門医への受診を促す必要性を示している。

CONCLUSIONS: This study demonstrated that multiple aspects of oral function were low among community-dwelling older adults with sarcopenia. The potential decline in oral functions in older adults with sarcopenia may have been overlooked until now. This study indicates the need for dental perspectives in intervening with older adults with sarcopenia and the need to encourage them to see dental professionals.