Department of Rehabilitation Medicine, Setagaya Memorial Hospital, Tokyo, Japan; Department of Dysphagia Rehabilitation, Nihon University School of Dentistry, Tokyo, Japan.
Department of Dysphagia Rehabilitation, Nihon University School of Dentistry, Tokyo, Japan.
Clin Nutr. 2019 Feb;38(1):303-309. doi: 10.1016/j.clnu.2018.01.016. Epub 2018 Feb 15.
BACKGROUND & AIMS: Dysphagia can be caused by sarcopenia in older adults. Although sarcopenic dysphagia has been reported to be associated with low tongue strength, whether tongue strength can be useful as a diagnostic index for sarcopenic dysphagia remains unclear. In addition, the association between sarcopenic dysphagia and lip force is unknown. The aim of the present study was to clarify the association of lip force and tongue strength with sarcopenic dysphagia, and their diagnostic accuracy for sarcopenic dysphagia.
A cross-sectional study was conducted in consecutive 245 (166 women) inpatients aged ≥65 years in the post-acute phase of illness. The presence of sarcopenic dysphagia, lip force, and tongue strength were assessed. Additional factors were also assessed: cognitive function, nutritional status, comorbidity, oral intake level, occlusion status, physical function, and inflammatory status. Multivariable logistic regression analysis was conducted with the presence of sarcopenic dysphagia as a dependent variable. Lip force and tongue strength were assessed with the area under the receiver operating characteristic curve (AUC) to clarify diagnostic accuracy for sarcopenic dysphagia. In addition, the cut-off values of lip force and tongue strength for identifying sarcopenic dysphagia were determined according to sex.
In total, 86 patients (35.1%) had sarcopenic dysphagia. Both men and women with sarcopenic dysphagia had lower lip force and tongue strength than men and women without dysphagia or sarcopenic dysphagia (p < 0.001 for all). In multivariable logistic regression analysis, sarcopenic dysphagia was significantly associated with lip force (OR = 0.63, 95% CI 0.53-0.74, p < 0.001) and tongue strength (OR = 0.92, 95% CI 0.87-0.98, p = 0.011). The AUCs for lip force in patients with sarcopenic dysphagia were 0.88 (CI 0.81-0.95, p < 0.001) for men and 0.84 (CI 0.77-0.90, p < 0.001) for women. The AUCs for tongue strength were 0.79 (CI 0.69-0.89, p < 0.001) for men and 0.74 (CI 0.65-0.82, p < 0.001) for women. The cut-off values for sarcopenic dysphagia in men were 10.4 N for lip force and 24.3 kPa for tongue strength; the cut-off values in women were 8.5 N for lip force and 23.9 kPa for tongue strength.
In older inpatients who are suspected as having dysfunction due to sarcopenia, lip force and tongue strength can be independently useful indices for diagnosing sarcopenic dysphagia, and may be factors that prevent and improve sarcopenic dysphagia.
吞咽困难可由老年人的肌肉减少症引起。虽然已经报道了肌肉减少性吞咽困难与舌力降低有关，但舌力是否可作为肌肉减少性吞咽困难的诊断指标尚不清楚。此外，肌肉减少性吞咽困难与唇力之间的关系尚不清楚。本研究旨在阐明唇力和舌力与肌肉减少性吞咽困难的关系，以及它们对肌肉减少性吞咽困难的诊断准确性。
本研究为连续纳入 245 名（166 名女性）年龄≥65 岁、疾病后急性期的住院患者的横断面研究。评估存在肌肉减少性吞咽困难、唇力和舌力。还评估了其他因素：认知功能、营养状况、合并症、口腔摄入水平、咬合状态、身体功能和炎症状态。以存在肌肉减少性吞咽困难为因变量进行多变量逻辑回归分析。使用受试者工作特征曲线（ROC）下面积（AUC）评估唇力和舌力对肌肉减少性吞咽困难的诊断准确性。此外，根据性别确定唇力和舌力用于识别肌肉减少性吞咽困难的截断值。
共有 86 名患者（35.1%）患有肌肉减少性吞咽困难。有肌肉减少性吞咽困难的男性和女性的唇力和舌力均低于无吞咽困难或无肌肉减少性吞咽困难的男性和女性（均 p<0.001）。在多变量逻辑回归分析中，肌肉减少性吞咽困难与唇力（比值比 [OR] = 0.63，95%置信区间 [CI] 0.53-0.74，p<0.001）和舌力（OR = 0.92，95%CI 0.87-0.98，p=0.011）显著相关。患有肌肉减少性吞咽困难的男性患者的唇力 AUC 为 0.88（95%CI 0.81-0.95，p<0.001），女性为 0.84（95%CI 0.77-0.90，p<0.001）。男性患者的舌力 AUC 为 0.79（95%CI 0.69-0.89，p<0.001），女性为 0.74（95%CI 0.65-0.82，p<0.001）。男性肌肉减少性吞咽困难的截断值为唇力 10.4 N，舌力 24.3 kPa；女性的截断值为唇力 8.5 N，舌力 23.9 kPa。
在疑似因肌肉减少症导致功能障碍的老年住院患者中，唇力和舌力可作为独立的诊断肌肉减少性吞咽困难的有用指标，可能是预防和改善肌肉减少性吞咽困难的因素。
