Relationship between prosthodontic status and nutritional intake in the elderly in Korea: National Health and Nutrition Examination Survey (NHANES IV)

The Association of Oral Processing Factors and Nutrient Intake in Community-Dwelling Older Adults: A Systematic Review and Meta-Analysis

CONTEXT

Oral health and food oral-processing issues emerge with functional decline in the older adult population, potentially increasing the risk of malnutrition. Impairment of oral health is associated with poorer nutrition status; however, the relationship between oral factors and the intake of each nutrient remains poorly understood.

OBJECTIVE

The associations between different oral factors and nutrient intakes among community-dwelling older adults were investigated.

DATA SOURCES

A literature search from 5 databases (Web of Science, Scopus, Cochrane Library, Ovid [MEDLINE and Embase], and CINAHL) was completed on February 1, 2022. The search was limited to peer-reviewed articles published between the years 2012 and 2022.

DATA EXTRACTION

Six cross-sectional studies were included in the meta-analysis. Two authors independently completed the data extraction and summarized the study characteristics, factors adjusted for in the statistical analysis, the outcome, and summary statistics of the results.

DATA ANALYSIS

Meta-analyses showed evidence of a significant association between compromised oral factors (namely, denture status, chewing ability, and the number of teeth) with lower energy (weighted mean difference [WMD], -107 kcal d-1 (95% CI, -132 to -81), protein (WMD, -5.2 g d-1; 95% CI, -6.6 to -3.8), fat (WMD, -4.6 g d-1; 95% CI, -6.7 to -2.6), carbohydrate (WMD, -8.8 g d-1; 95% CI, -13.9 to -3.7), and vitamin C intakes (WMD, -12.9 mg d-1; 95% CI, -16.6 to -9.2) in older adults.

CONCLUSION

Oral health can be an indicator of compromised daily energy, protein, fat, carbohydrate, and vitamin C intakes in older adults. However, the small sample size of the studies included in this review and the heterogeneity among macronutrient studies should be considered. Because of the lack of studies covering all aspects of food oral processing (eg, salivary flow rate, tongue pressure), the associations between oral processing and nutrient intake were not thoroughly explored.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42022308823.

The effect of prosthetic rehabilitation with or without dietary advice on nutritional status in elderly patients: a systematic review

BACKGROUND

Elderly people frequently report tooth loss, affecting their nutritional status. There is a gap in the scientific evidence about the influence of prosthodontic rehabilitation on nutritional status.

OBJECTIVE

To investigate the influence of prosthodontic rehabilitation combinates or not with dietary advice on nutritional status in elderly patients.

METHODS

A systematic literature search was conducted in three electronic databases to identify randomized clinical trials that evaluated the effect of prosthetic rehabilitation on nutritional status in subjects aged 60 years or older, with a follow-up of at least 1 month after prosthesis rehabilitation.

RESULTS

Of the 1517 articles identified in the initial search, 12 were selected for the final review. No significant difference between the types of prosthesis were found regarding the chewing by the elderly population. Although patients who received prosthetic treatment had significant improvement in chewing ability, a consistent pattern of improvement in nutritional status was not observed when they did not receive dietary advice. In addition, the association between the condition of the dentition, the masticatory performance and nutritional change of elderly patients has been found. Studies that evaluated simultaneous complete denture treatment and simple dietary advice showed an improvement of nutrient intake in elderly patients.

CONCLUSIONS

Isolated prosthetic rehabilitation may not have the effect of exerting a change in nutritional status of edentulous elderly patients. In general, simultaneous dietary consulting and prosthetic treatment in combination may improve dietary habits, since masticatory capacity and efficiency are not the only factors that influence the nutritional status of a patient.

Nutritional Assessment of Denture Wearers Using Matched Electronic Dental-Health Record Data

Purpose

To assess the nutritional profile of denture wearers through a retrospective cohort study using nutritional biomarkers from matched electronic dental and health record (EDR‐EHR) data.

Materials and methods

The case group (denture wearers) included matched EDR‐EHR data of patients who received removable partial, complete, and implant‐supported prosthodontic treatments between January 1, 2010 and December 31, 2018, study time. The control (nondenture wearers) group did not have recorded denture treatments and included patient records within 1 year of the denture index date (first date of case patients’ receiving complete or partial denture) of the matching cases. The qualified patients’ EDR were matched with their EHR based on the availability of laboratory reports within 2 years of receiving the dentures (index date). Nutritional biomarkers were selected from laboratory reports for complete blood count, comprehensive and basic metabolic profile, lipid, and thyroid panels. Summary statistics were performed, and general linear mixed effect models were used to evaluate the rate of change over time (slope) of nutritional biomarkers before and after the index date. Likelihood ratio tests were performed to determine the differences between dentures and controls.

Results

The final cohort included 10,481 matched EDR‐EHR data with 3,519 denture wearers and 6,962 controls that contained laboratory results within the study time. The denture wearers’ mean age was 57 ±10 years and the control group was 56 ±10 years with 55% females in both groups. Pre‐post analysis among denture wearers revealed decreased serum albumin (p = 0.002), calcium (p = 0.039), creatinine (p < 0.001) during the post‐index time. Hemoglobin (Hb) was higher pre‐index, and was decreasing during the time period but did not change post‐index (p < 0.001). Among denture wearers, completely edentulous patients had a significant decrease in serum albumin, creatinine, blood urea nitrogen (BUN), but increased estimated glomerular filtration rate (eGFR). In partially edentulous patients, total cholesterol decreased (p = 0.018) and TSH (p = 0.004), BUN (p < 0.001) increased post‐index. Patients edentulous in either upper or lower arch had decreased BUN and eGFR during post‐index. Compared to controls, denture wearers showed decreased serum albumin and protein (p = 0.008), serum calcium (p = 0.001), and controls showed increased Hb (p = 0.035) during post‐index.

Conclusions

The study results indicate nutritional biomarker variations among denture wearers suggesting a risk for undernutrition and the potential of using selected nutritional biomarkers to monitor nutritional profile.

Does poor dental health predict becoming homebound among older Japanese?

Background

Being homebound is an important risk factor of functional disability in older people. There is a possibility of bidirectional relationship between homeboundness and dental health. This prospective cohort study examined the association of dental health, which includes social function, on homeboundness in the future.

Methods

The participants were ≥ 65 years, responded to two postal surveys conducted in 2006 and 2010, and were not homebound at baseline. Logistic regression analysis was used to estimate the odds ratios for homeboundness, defined as going out of one’s home less than once weekly. Self-reported baseline dental status was used as the main predictor. Age, sex, marital status, educational attainment, income, comorbidity, depression, walking time, living alone, and area of residence were used as covariates.

Results

Among 4390 non-homebound respondents, 7.4 % were homebound four years later. The proportions of homebound respondents with < 20 teeth without dentures, < 20 teeth with dentures, and ≥ 20 teeth were 9.7, 8.8, and 4.4 %, respectively. The odds for being homebound in the 65–74-year age group, adjusted for covariates, was 1.78 (95 % CI: 1.01–3.13; p < 0.05) times higher for respondents with < 20 teeth and no dentures than that for respondents with ≥ 20 teeth. Among the participants in the ≥ 75-year age group, a significant association of homeboundness and dental health was not observed.

Conclusions

Among the young-old population, poor dental health predicted future onset of homeboundness, while depressive symptoms did not show any significant association.