Gastric emptying rate in subjects with experimentally shortened dental arches: a pilot study

Effects of food bar chewing duration on the physiologic, metabolic, and perceptual responses to moderate-intensity running

PURPOSE

Chewing duration can affect food particle size, gastric processing, and postprandial glycemia, but these effects have not been investigated with exercise. This study examined how the chewing duration of a food bar impacts glycemic and metabolic responses, gastrointestinal (GI) symptoms, psychological affect, and performance during endurance running.

METHODS

This randomized, unblinded, crossover study had 15 males (35.2 ± 7.4 years, VO2peak: 56.1 ± 5.2 ml/kg/min) attend three laboratory visits. Visit 1 required a VO2peak test, 10 min familiarization run at 60% VO2peak, and familiarization time-to-exhaustion (TTE) test (10 min at 90% VO2peak, followed by TTE at 100% VO2peak). Visits 2 and 3 consisted of a 60 min run at 60% VO2peak, followed by TTE testing. Participants were fed 45 g of a bar (180 kcal, 4 g fat, 33 g carbohydrate, 3 g protein, 1 g fiber) in 9 g servings 30 min before running, and 27 g of bar in 9 g servings at three timepoints during the 60 min run. Participants consumed the servings in 20 (20CHEW) or 40 (40CHEW) masticatory cycles, at 1 chew/second. Outcomes included blood glucose, substrate use, GI symptoms, perceived exertion (RPE), overall feeling, and TTE.

RESULTS

Post-prandial blood glucose, GI symptoms, and RPE increased over time, but there were no significant between-condition or condition-by-time effects. TTE showed no significant between-condition effect (20CHEW: 288 ± 133 s; 40CHEW: 335 ± 299 s; p = 0.240). Overall feeling demonstrated a time-by-condition effect (p = 0.006), suggesting possible better maintenance over time with 40CHEW.

CONCLUSION

Cumulatively, the results suggest that extended chewing minimally impacts physiology, perceptions, and performance during 60 min moderate-intensity running.

Chewing and its influence on swallowing, gastrointestinal and nutrition-related factors: a systematic review

The study aimed to evaluate the hypothesis that chewing is a mechanical and physiological contributor to swallowing, physiologic/pathologic processes of the gastrointestinal tract (GIT), and nutrition-related factors. A search strategy was applied to three different databases to investigate if chewing function in adults affects the swallowing, physiologic/pathologic processes of the GIT, and nutrition-related factors compared to controls with no exposure. The included studies were evaluated for methodological quality and risk of bias and certainty of evidence. The results showed 71 eligible studies. Overall, the results showed that 46 studies supported the hypothesis while 25 refuted it. However, the GRADE analysis showed low to very low certainty of the evidence to support the hypothesis that chewing is an important contributor in the swallowing process, and physiologic/pathologic processes in the GIT. The GRADE analysis also showed a moderate to very low certainty of the evidence to suggest that chewing function contributes to nutrition-related parameters. The overall results of the current study showed that a majority (64.7%) of the studies (46 out of 71) supported the hypothesis. However, robust studies with proper design, adequate sample size, and well-defined outcome parameters are needed to establish conclusive evidence.

Association between masticatory dysfunction and gastroesophageal reflux disease: A population-based study in the elderly

BACKGROUND

Caries and periodontal disease may cause tooth losses and chewing difficulty, especially in the elderly. Ingesting poorly chewed food may delay gastric emptying and favour the development of gastroesophageal reflux disease (GERD).

OBJECTIVE

This study investigated the association between masticatory dysfunction and GERD in the elderly from a rural area in southern Brazil.

METHODS

This census invited all 489 elderly from a city to participate. The study used a GERD symptoms questionnaire, followed by an oral examination. Masticatory dysfunction was analysed based on the chewing difficulty for some food groups. Tooth loss and chewing self-perception were also considered as exposure variables. Poisson regression determined the association among variables by calculating the prevalence ratio [PR (95% confidence interval)].

RESULTS

The response rate was 93.1% (n = 455, average age of 70.9 years, 50.5% men). The prevalence of GERD in this population was 36.9%. GERD was associated with chewing difficulty for vegetables (PR = 1.54), meats (PR = 1.34) and cereals (PR = 1.43) but not with poor chewing self-perception (PR = 0.80) and tooth loss (PR = 1.22). GERD was also associated with xerostomia (PR = 1.63) and the female gender (PR = 1.35).

CONCLUSION

Elderly people from a rural area with a reduced number of teeth present chewing difficulty and a high prevalence of GERD, indicating an association between GERD and masticatory dysfunction.

Gastric emptying rate of a solid meal in patients with anterior open bite malocclusion: A preliminary study

Objectives:

The objective of the study was to investigate the relationship between anterior open bite (AOB) malocclusion and digestion by evaluating mastication and gastric emptying (GE) of a solid meal.

Material and Methods:

We recruited 26 female participants and divided them into two groups according to their occlusion status: The control group with normal occlusion (n = 11; age: 25.2 ± 2.8 years; and body mass index [BMI]: 21.1 ± 1.9 kg/m2) and the AOB group with AOB malocclusion (n = 15; age: 23.2 ± 5.5 years; BMI: 21.0 ± 1.6 kg/m2). GE, chewing, and occlusion were assessed simultaneously. A food questionnaire survey was also administered on the same day.

Results:

A significant positive correlation was noted between open bite and the occlusal analysis findings. Negative correlations were found between the food questionnaire score and both the open bite and occlusal analysis findings, which confirmed that AOB affects mastication. However, no significant difference in the GE rate parameters was observed between the two groups.

Conclusion:

Adaptive mechanisms may have a compensatory effect on the GE rate. However, the lack of tooth contact in the anterior occlusal region resulted in reduced masticatory ability. Orthodontic treatment should thus be considered, regardless of the presence of digestive problems, to improve mastication.

Deciphering the protein digestion of meat products for the elderly by in vitro food oral processing and gastric dynamic digestion, peptidome analysis and modeling

The elderly population will increase sharply in the future, along with an emerging range of specific nutritional needs that include adapted food. We aimed to develop a workflow to study the fate of a food, objectify the bioavailability of nutrients in the case of the digestive physiology of the elderly, and model the fate of proteins in the stomach. Pork frankfurters were subjected to in vitro normal and deficient mastication and gastric digestion, mimicking adult and elderly food oral and digestive processing. Swallowable food boluses were characterized for granulometric and rheological properties. Biochemical analyses were conducted on the bolus and on the digesta. Macronutrients, label-free peptide quantification and identification were performed, and modeling was applied to protein digestion kinetics. After deficient mastication, the food bolus was harder with more large particles, lower free iron release and more protein oxidation. The amount of peptides released in the stomach progressively increased, but to a lower extent for the elderly digestive condition and irrespective of masticatory efficiency. 592 peptides were identified from 67 proteins. Different trajectories were observed for adult and elderly digestive conditions, and two groups of meat proteins were identified based on the rate of hydrolysis. Designing suitable foods requires in vitro tools to evaluate the possible benefit for the elderly. Besides the well-known notion of Food Oral Processing (FOP), our work broadens the concept by extending oral activity to digestion when working in a nutritional context. This new concept is named Food Oral and Digestive Processing, FODP.

Assessment of the relationship between masticatory performance, occlusal contact area, chewing time and cycles, and gastric emptying scintigraphy in dentate subjects

BACKGROUND

Good mastication is thought to help digestion in the stomach, hence promoting the health of the gastrointestinal system. However, the correlation between masticatory and gastric function has been controversial. This is partly explained by different food types used to assess the performance of the two organs. Recently, frankfurter sausage has been proposed to be suitable for both masticatory performance and gastric emptying tests.

OBJECTIVES

To examine the relationship between masticatory performance, occlusal contact area, chewing time and cycles, and gastric emptying scintigraphy parameters in healthy dentate adults.

MATERIALS AND METHODS

Forty healthy subjects (15 men: 25 women, age 23.9 ± 3.8 years) underwent masticatory performance tests and gastric emptying scintigraphy using frankfurter sausage as a test food. Masticatory performance was calculated as the median particle size (MPS) of chewed frankfurter sausage cubes after 30 chewing cycles. Gastric emptying scintigraphy was performed using frankfurter sausage mixed with technetium-99 m-labelled microwaved egg meal. Cumulative occlusal areas of contact-near contact (cACNC) were determined by silicone bite registration and image-analysed. Chewing time and cycles before swallowing were also recorded.

RESULTS

No significant differences in MPS, cACNC, chewing time and cycles, or gastric emptying parameters were observed between gender. Bivariate correlation showed masticatory performance, occlusal contact area, chewing time and cycles were not correlated with gastric emptying parameters (P > 0.05).

CONCLUSION

Using the same test food to assess the masticatory and gastric function in dentate subjects, the present study showed that masticatory performance, occlusal contacts, chewing time and cycles did not affect gastric emptying.

Gastric and masticatory performances in full-arch immediate loading rehabilitated patients

Full-arch immediate loading implant rehabilitations provide patients with compromised dentition an effective treatment to improve their aesthetic and function. Aim of this prospective cohort study was to investigate the correlation between masticatory ability and gastric emptying rates among these patients. Ten subjects (five men and five women) with compromised dentition were tested in two occasions: before treatment and 30 days after the immediate loading rehabilitation. Masticatory ability was evaluated using the sieves test, and the gastric half emptying time (T(1/2)) was assessed by means of the 13C-octanoic acid breath test. A statistically significant increment (P < 0.005) in masticatory ability was found only in reference to the particles smaller than or equal to 4.75 mm, whereas the gastric emptying rate showed a statistically significant reduction between pre- and post-treatment (P = 0.003). A moderate negative correlation (rho = 0.64, P = 0.048) between the percentage change in masticatory ability and the percentage change in gastric emptying rate was evidenced. Patients with compromised dentition rehabilitated with full-arch immediate implant prostheses present a significant improvement of the gastric process.

The impact of self-perceived masticatory function on nutrition and gastrointestinal complaints in the elderly

OBJECTIVES

Impaired masticatory function is generally considered to be a contributing factor in the development of malnutrition (1, 2). Furthermore, the exclusion of essential and high-fibre foods from the subjects' diets, due to chewing problems, may induce gastrointestinal disorders (3-5).

OBJECTIVE

The impact of masticatory function on malnutrition and gastrointestinal symptoms was evaluated.

DESIGN, SETTING, AND PARTICIPANTS

This prospective cross-sectional study was conducted in four nursing homes in Berlin, Germany. 119 residents (mean 86, ± 8.0 years, 62-102) took part in the study.

MEASUREMENTS

Dental status, denture quality, prosthetic condition as well as masticatory ability and gastrointestinal symptoms were evaluated by clinical examination or interview. Nutritional state was determined according to Mini Nutritional Assessment (MNA).

RESULTS

The mean Body Mass Index was 24.4, ±4.9 kg/m² (17% < 20 kg/m²). The mean MNA was 22.5, ±4.3, 51.3% below normal. 54.5% of the dentures were poorly fitting. No significant relationships were found between the MNA and dental parameters except loose fit of dentures. However, there was significantly more food avoidance among the subjects with stated chewing problems, discomfort with dentures or ill-fitting dentures and there were significantly more digestive complaints among this group.

CONCLUSIONS

Impairments of masticatory function may lead to food avoidance and to a higher incidence of digestive complaints.

Mastication Suppresses Initial Gastric Emptying by Modulating Gastric Activity

Because various mastication-related factors influence gastric activity, the functional relationship between mastication and gastric function has not been fully elucidated. To investigate the influence of mastication on gastric emptying and motility, we conducted a randomized trial to compare the effects of mastication on gastric emptying and gastric myoelectrical activity under conditions that excluded the influences of food comminution, taste, and olfaction. A 13C-acetate breath test with electrogastrography and electrocardiography was performed in 14 healthy men who ingested a test meal with or without chewing gum. Autonomic nerve activity was evaluated by fluctuation analysis of heart rate. Gastric emptying was significantly delayed in the ‘ingestion with mastication’ group. Gastric myoelectrical activity was significantly suppressed during mastication and increased gradually in the post-mastication phase. A decrease in the high-frequency power of heart rate variability was observed coincidentally with gastric myoelectrical activity suppression. These findings suggest that initial gastric emptying is suppressed by mastication, and that the suppression is caused by mastication-induced inhibition of gastric activity (UMIN Clinical Trial Registration no. UMIN000005351).

Occlusion and Temporomandibular Function among Subjects with Mandibular Distal Extension Removable Partial Dentures

Objective. To quantify effects on occlusion and temporomandibular function of mandibular distal extension removable partial dentures in shortened dental arches. Methods. Subjects wearing mandibular extension removable partial dentures (n = 25) were compared with subjects with shortened dental arches without extension (n = 74) and with subjects who had worn a mandibular extension removable partial denture in the past (n = 19). Subjects with complete dentitions (n = 72) were controls. Data were collected at baseline and at 3-, 6-, and 9-year observations. Results. Occlusal activity in terms of reported awareness of bruxism and occlusal tooth wear of lower anterior teeth did not differ significantly between the groups. In contrast, occlusal tooth wear of premolars in shortened dental arches with or without extension dentures was significantly higher than in the controls. Differences amongst groups with respect to signs and symptoms related to temporomandibular disorders were not found. Occlusal support of the dentures did not influence anterior spatial relationship. Occlusal contacts of the denture teeth decreased from 70% for second premolars via 50% for first molars, to 30% for second molars. Conclusions. Mandibular distal extension removable partial dentures in moderate shortened dental arches had no effects on occlusion and temporomandibular function.

Relationship between non-ulcerative functional dyspepsia, occlusal pairs and masticatory performance in partially edentulous elderly persons

OBJECTIVE

To relate occlusal state, masticatory performance and non-ulcerative functional dyspepsia.

BACKGROUND

In spite of the relationship between gastric disturbances and number of present teeth being recognised, the influence of the number of occlusal pairs and masticatory performance, expressed as median particle size, has not been considered.

MATERIALS AND METHODS

Thirty-eight subjects (mean age = 71.8 ± 7.7 years) diagnosed with non-ulcerative functional dyspepsia were selected. A further 38 healthy subjects (mean age = 71.9 ± 7.0 years) acted as controls. Subjects were subdivided according to their number of occlusal pairs: (1) 0-4, (2) 5-9 and (3) 10-14. Masticatory performance was evaluated by using the sieving method. Data were analysed using 2-way anova and Bonferroni post-hoc, Chi-square and Odd ratio tests.

RESULTS

Subjects presenting with non-ulcerative functional dyspepsia and 0-4 occlusal pairs showed the lowest masticatory performance (p < 0.01). No association between the dyspepsia and the number of occlusal pairs (χ(2) = 0.48, p = 0.785) was observed, however results showed association between functional dyspepsia and masticatory performance (χ(2) = 4.07, p = 0.0437) presenting an odds ratio = 3.46 (Confidence Interval = 0.99-12.10).

CONCLUSION

Changes in masticatory performance were associated with the presence of non-ulcerative functional dyspepsia.