Department of Community Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
Department of Cardiovascular Disease Prevention, Osaka Center for Cancer and Cardiovascular Disease Prevention, Osaka, Japan.
Geriatr Gerontol Int. 2018 Jan;18(1):183-186. doi: 10.1111/ggi.13152. Epub 2017 Aug 23.
Recent geriatric studies have focused on maximum voluntary tongue pressure against the palate (MTP) as a diagnostic value for dysphagia, as dysphagia causes aspiration pneumonia. Dysphagia can also cause water intake difficulties, resulting in hypernatremia by indicating the presence of hyperosmotic dehydration. However, no studies have reported on a possible association between reduced MTP and serum sodium levels.
To evaluate hyperosmotic dehydration within the normal range as an indicator of reduced MTP, we carried out a cross-sectional study of 655 older Japanese community-dwelling men (age ≥60 years) who undertook a general health check-up from 2015 to 2016. As a high concentration of glucose influences serum osmolarity, which might act as a strong confounding factor on this association, the additional analysis was limited to individuals without diabetes. Reduced MTP is defined as a tongue pressure at or under the 20th percentile of the study population (≤24.0 kPa).
Independent of classical cardiovascular risk factors, the adjusted odds ratio of reduced MTP for a 1-standard deviation increment of serum sodium (2.21 mEq/L) was 1.29 (95% confidence interval 1.10-1.52). When the analysis was limited to individuals without diabetes, the association became slightly stronger, with an adjusted corresponding value of 1.59 (95% confidence interval 1.21-2.10).
Serum sodium level within the normal range is independently associated with reduced MTP in older Japanese men. This finding suggests that measuring the MTP is clinically relevant for estimating the pathophysiological values (such as dysphagia risks and aspiration pneumonia risks) in daily clinical practice. Geriatr Gerontol Int 2018; 18: 183-186.
最近的老年医学研究集中于最大自主舌压（MTP）作为吞咽困难的诊断价值，因为吞咽困难会导致吸入性肺炎。吞咽困难还会导致饮水困难，通过表明存在高渗性脱水而导致高钠血症。然而，尚无研究报道 MTP 降低与血清钠水平之间可能存在关联。
为了评估正常范围内的高渗性脱水作为 MTP 降低的指标，我们对 2015 年至 2016 年期间接受一般健康检查的 655 名年龄在 60 岁及以上的日本社区居住的老年男性（年龄≥60 岁）进行了横断面研究。由于葡萄糖浓度升高会影响血清渗透压，这可能是该关联的一个强烈混杂因素，因此，额外的分析仅限于没有糖尿病的个体。MTP 降低定义为舌压等于或低于研究人群的第 20 百分位数（≤24.0 kPa）。
独立于经典心血管危险因素，血清钠每增加 1 个标准差（2.21 mEq/L），MTP 降低的调整比值比为 1.29（95%置信区间 1.10-1.52）。当分析仅限于没有糖尿病的个体时，该关联变得稍强，调整后的相应值为 1.59（95%置信区间 1.21-2.10）。
正常范围内的血清钠水平与日本老年男性的 MTP 降低独立相关。这一发现表明，在日常临床实践中，测量 MTP 对于估计生理病理值（如吞咽困难风险和吸入性肺炎风险）具有临床相关性。老年医学与老年病学国际 2018；18：183-186。
