高齢者の咀嚼能力と栄養状態

高齢者で咀嚼能力と栄養状態の関連をみた論文を紹介します。

Okada K, Enoki H, Izawa S, Iguchi A, Kuzuya M. Association between masticatory performance and anthropometric measurements and nutritional status in the elderly. Geriatr Gerontol Int. 2010 Jan;10(1):56-63.

リサーチクエスチョンは以下の通りです。

P：高齢者（外来通院および回復期リハ病棟入院患者）で
E：栄養状態がよいと
C：栄養状態が悪い場合と比較して
O：咀嚼能力が高い
D：横断研究

咀嚼能力は色が変化するチューイングガムで評価しています。栄養状態は体重、BMI、上腕周囲長、TSF、握力、血清アルブミン値で評価して、同時に身体・認知機能、抑うつ状態、歯の状態も評価しています。

結果ですが、多変量解析では、咀嚼運動周期、歯の状態、体重、上腕周囲長が咀嚼能力と有意な関連を認めました。また、年齢、咀嚼能力、握力、性別が血清アルブミン値と関連していました。これより咀嚼能力は口腔状態だけでなく栄養状態と関連するという結論です。

咀嚼筋にもサルコペニアは生じると考えています。そうすると栄養状態が悪ければ咀嚼筋の筋肉量・筋力も低下します。その結果さらに咀嚼能力が低下して栄養状態が悪化する悪循環になる可能性があります。嚥下だけでなく栄養の視点でも、咀嚼の評価とリハ栄養介入が重要だと考えます。

Abstract
AIM: The association between chewing ability and physical constitution and nutritional status remains uncertain in the elderly. We examined the relationships between chewing ability and anthropometric measurements or nutritional status in the elderly.

METHODS: A total of 200 subjects (78 men and 122 women; mean age +/- standard deviation, 76.6 +/- 7.1) were enrolled from geriatric clinical settings. Chewing ability was evaluated by color-changeable chewing gum. Bodyweight, body mass index, mid-upper-arm circumference (MAC), and triceps skinfold, grip strength, serum albumin, physical and cognitive functions, depressive status, and dental status were determined.

RESULTS: Correlations were found between chewing ability and bodyweight, MAC, dental status, physical and cognitive functions, and depressive status after adjusting for age and sex. The concentrations of serum albumin were well-correlated with chewing ability and anthropometric measurements. Stepwise linear regression analyses revealed that the masticatory cycle, dental status, bodyweight and MAC are predictors of chewing ability, and that age, chewing ability, grip strength and sex are predictors of serum albumin concentrations.

CONCLUSION: Chewing ability is associated with not only oral health status but also the physical constitution of the elderly. In addition, chewing ability may add to the regulation of the nutritional status in the elderly.