Skip to main content
SpringerLink
Log in

Association between Oral Frailty and Nutritional Status Among Community-Dwelling Older Adults: The Takashimadaira Study

  • Published:
The journal of nutrition, health & aging

Abstract

Objectives

Recently, the concept of oral frailty, defined as accumulated deficits in oral health, has been introduced in Japan. However, data about its association with nutritional status are limited. Thus, this cross-sectional study aimed to investigate the association between oral frailty and malnutrition among community-dwelling older adults.

Design

Cross-sectional study.

Setting

Community.

Participants

One thousand and fifty-four individuals (428 men and 626 women, mean age: 77.0 years) from the Takashimadaira Study.

Measurements

Based on a multifaceted oral health assessment, oral frailty was defined as greater than or equal to three of the following components: (1) low number of remaining teeth, (2) decreased masticatory performance, (3) reduced articulatory oral motor skill, (4) low tongue pressure, and difficulties in (5) eating and (6) swallowing. The nutritional status was evaluated using the Mini Nutritional Assessment®-Short Form (MNA®-SF) and serum albumin. An ordinal logistic regression model was used to evaluate the association between oral frailty and nutritional status.

Results

Oral frailty was observed in 217 (20.4%) participants. After adjusting for potential confounders, the participants with oral frailty had higher odds of more severe malnutrition evaluated using MNA®-SF (adjusted odds ratio: 2.17; 95% confidence interval: 1.58–2.98) and serum albumin level (adjusted odds ratio: 1.59; 95% confidence interval: 1.10–2.31).

Conclusion

Oral frailty was associated with nutritional status among Japanese older adults. Maintaining comprehensive oral health and function may be effective for malnutrition prevention in community-dwelling older adults. However, further studies must be conducted to validate the generalizability of the results of the current study.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Correia MI, Waitzberg DL. The impact of malnutrition on morbidity, mortality, length of hospital stay and costs evaluated through a multivariate model analysis. Clin Nutr 2003;22:235–239. doi: https://doi.org/10.1016/s0261-5614(02)00215-7.

    Article  Google Scholar 

  2. Kaiser MJ, Bauer JM, Ramsch C, et al. Frequency of malnutrition in older adults: a multinational perspective using the mini nutritional assessment. J Am Geriatr Soc 2010;58:1734–1738. doi: https://doi.org/10.1111/j.1532-5415.2010.03016.x.

    Article  Google Scholar 

  3. Sahyoun NR, Jacques PF, Dallai G, Russell RM. Use of albumin as a predictor of mortality in community dwelling and institutionalized elderly populations. J Clin Epidemiol 1996;49:981–988. doi: https://doi.org/10.1016/0895-4356(96)00135-7.

    Article  CAS  Google Scholar 

  4. Higashiguchi M, Nakaya N, Ohmori K, et al. Malnutrition and the risk of long-term care insurance certification or mortality A cohort study of the Tsurugaya project. Nihon Koshu Eisei Zasshi 2008;55:433–439.

    Google Scholar 

  5. Chen CC, Schilling LS, Lyder CH. A concept analysis of malnutrition in the elderly. J Adv Nurs 2001;36:131–142. doi: https://doi.org/10.1046/j.1365-2648.2001.01950.x.

    Article  CAS  Google Scholar 

  6. Iwasaki M, Sato M, Yoshihara A, Miyazaki H. Malnutrition and oral disease in the elderly—is there any bidirectional relationship? Curr Oral Health Rep 2017;4:70–78. doi: https://doi.org/10.1007/s40496-017-0127-1.

    Article  Google Scholar 

  7. Petersen PE, Yamamoto T. Improving the oral health of older people: the approach of the WHO Global Oral Health Programme. Community Dent Oral Epidemiol 2005;33:81–92. doi: https://doi.org/10.1111/j.1600-0528.2004.00219.x.

    Article  Google Scholar 

  8. De Marchi RJ, Hugo FN, Hilgert JB, Padilha DM. Association between oral health status and nutritional status in south Brazilian independent-living older people. Nutrition 2008;24:546–553. doi: https://doi.org/10.1016/j.nut.2008.01.054.

    Article  Google Scholar 

  9. Kikutani T, Yoshida M, Enoki H, et al. Relationship between nutrition status and dental occlusion in community-dwelling frail elderly people. Geriatr Gerontol Int 2013;13:50–54. doi: https://doi.org/10.1111/j.1447-0594.2012.00855.x.

    Article  Google Scholar 

  10. Okabe Y, Furuta M, Akifusa S, et al. Swallowing function and nutritional status in Japanese elderly people receiving home-care services: A 1-year Longitudinal Study. J Nutr Health Aging 2016;20:697–704. doi: https://doi.org/10.1007/s12603-015-0645-2.

    Article  CAS  Google Scholar 

  11. Syrjala AM, Pussinen PI, Komulainen K, et al. Salivary flow rate and risk of malnutrition — a study among dentate, community-dwelling older people. Gerodontology 2013;30:270–275. doi: https://doi.org/10.1111/j.1741-2358.2012.00679.x

    Article  Google Scholar 

  12. Japan Dental Association. Manual for oral frailty at dental clinics 2019. Available at: https://www.jda.or.jp/dentist/oral_flail/pdf/manual_all.pdf Accessed 28.04.2020.

  13. Tanaka T, Takahashi K, Hirano H, et al. Oral Frailty as a Risk Factor for Physical Frailty and Mortality in Community-Dwelling Elderly. J Gerontol A Biol Sci Med Sci 2018;73:1661–1667. doi: https://doi.org/10.1093/gerona/glx225.

    Article  Google Scholar 

  14. Taniguchi Y, Watanabe Y, Osuka Y, et al. Characteristics for gait parameters of community-dwelling elderly Japanese with lower cognitive function. PLoS One 2019;14:e0212646. doi: https://doi.org/10.1371/journal.pone.0212646.

    Article  CAS  Google Scholar 

  15. Nokubi T, Yasui S, Yoshimuta Y, et al. Fully automatic measuring system for assessing masticatory performance using beta-carotene-containing gummy jelly. J Oral Rehabil 2013;40:99–105. doi: https://doi.org/10.1111/j.1365-2842.2012.02344.x.

    Article  CAS  Google Scholar 

  16. Ito K, Yoshihara A, Takano N, et al. A comparison of methods for the measurement of oral diadochokinesis. Ronen Shika Igaku 2009;24:48–54.

    Google Scholar 

  17. Tsuga K, Yoshikawa M, Oue H, et al. Maximal voluntary tongue pressure is decreased in Japanese frail elderly persons. Gerodontology 2012;29:e1078–1085. doi: https://doi.org/10.1111/j.1741-2358.2011.00615.x.

    Article  Google Scholar 

  18. Machida N, Tohara H, Hara K, et al. Effects of aging and sarcopenia on tongue pressure and jaw-opening force. Geriatr Gerontol Int. 2017;17:295–301. doi: https://doi.org/10.1111/ggi.12715.

    Article  Google Scholar 

  19. the Ministry of Health, Labour and Welfare. The manuals of the evaluation for ability to perform daily activities on preventive care. Available at: https://www.mhlw.go.jp/topics/2007/03/dl/tp0313-1a-11.pdf. Accessed 28.04.2020.

  20. Rubenstein LZ, Harker JO, Salva A, Guigoz Y, Vellas B. Screening for undernutrition in geriatric practice: developing the short-form mi ni-nutritional assessment (MNA-SF). J Gerontol A Biol Sci Med Sci 2001;56:M366–M372. doi: https://doi.org/10.1093/gerona/56.6.m366.

    Article  CAS  Google Scholar 

  21. Montejano Lozoya R, Martinez-Alzamora N, Clemente Marin G, Guirao-Goris SJA, Ferrer-Diego RM. Predictive ability of the Mini Nutritional Assessment Short Form (MNA-SF) in a free-living elderly population: a cross-sectional study. PeerJ 2017;5:e3345. doi: https://doi.org/10.7717/peerj.3345.

    Article  Google Scholar 

  22. Wilson MM, Thomas DR, Rubenstein LZ, et al. Appetite assessment: simple appetite questionnaire predicts weight loss in community-dwelling adults and nursing home residents. Am J Clin Nutr 2005;82:1074–1081. doi: https://doi.org/10.1093/ajcn/82.5.1074.

    Article  CAS  Google Scholar 

  23. Kobayashi E, Fujiwara Y, Fukaya T, Nishi M, Saito M, Shinkai S. Social support availability and psychological well-being among the socially isolated elderly. Differences by living arrangement and gender. Nihon Koshu Eisei Zasshi 2011;58:446–456.

    Google Scholar 

  24. Iwasa H, Masui Y, Inagaki H, et al. Assessing competence at a higher level among older adults: development of the Japan Science and Technology Agency Index of Competence (JST-IC). Aging Clin Exp Res 2018;30:383–393. doi: https://doi.org/10.1007/s40520-017-0786-8.

    Article  Google Scholar 

  25. Schreiner AS, Hayakawa H, Morimoto T, Kakuma T. Screening for late life depression: cut-off scores for the Geriatric Depression Scale and the Cornell Scale for Depression in Dementia among Japanese subjects. Int J Geriatr Psychiatry 2003;18:498–505. doi: https://doi.org/10.1002/gps.880.

    Article  Google Scholar 

  26. Masnoon N, Shakib S, Kalisch-Ellett L, Caughey GE. What is polypharmacy? A systematic review of definitions. BMC Geriatr 2017;17:230. doi: https://doi.org/10.1186/s12877-017-0621-2.

    Article  Google Scholar 

  27. Awata S, Sugiyama M, Ito K, et al. Development of the dementia assessment sheet for community-based integrated care system. Geriatr Gerontol Int 16 Suppl 2016;1:123–131. doi: https://doi.org/10.1111/ggi.12727.

    Article  Google Scholar 

  28. Brant R. Assessing proportionality in the proportional odds model for ordinal logistic regression. Biometrics 1990;46:1171–1178. doi: https://doi.org/10.2307/2532457.

    Article  CAS  Google Scholar 

  29. Chavarro-Carvajal D, Reyes-Ortiz C, Samper-Ternent R, Arciniegas AJ, Gutierrez CC. Nutritional assessment and factors associated to malnutrition in older adults: a cross-sectional study in Bogota, Colombia. J Aging Health 2015;27:304–319. doi: https://doi.org/10.1177/0898264314549661.

    Article  Google Scholar 

  30. Boulos C, Salameh P, Barberger-Gateau P. Factors associated with poor nutritional status among community dwelling Lebanese elderly subjects living in rural areas: results of the AMEL study. J Nutr Health Aging 2014;18:487–494. doi: https://doi.org/10.1007/s12603-014-0463-y.

    Article  CAS  Google Scholar 

  31. Favaro-Moreira NC, Krausch-Hofmann S, Matthys C, et al. Risk Factors for Malnutrition in Older Adults: A Systematic Review of the Literature Based on Longitudinal Data. Adv Nutr 2016;7:507–522. doi: https://doi.org/10.3945/an.115.011254.

    Article  CAS  Google Scholar 

  32. Boulos C, Salameh P, Barberger-Gateau P. Social isolation and risk for malnutrition among older people. Geriatr Gerontol Int 2017;17:286–294. doi: https://doi.org/10.1111/ggi.12711.

    Article  Google Scholar 

  33. Savoca MR, Arcury TA, Leng X, et al. Association between dietary quality of rural older adults and self-reported food avoidance and food modification due to oral health problems. J Am Geriatr Soc 2010;58:1225–1232. doi: https://doi.org/10.1111/j.1532-5415.2010.02909.x.

    Article  Google Scholar 

  34. Yoshihara A, Watanabe R, Nishimuta M, Hanada N, Miyazaki H. The relationship between dietary intake and the number of teeth in elderly Japanese subjects. Gerodontology 2005;22:211–218. doi: https://doi.org/10.1111/j.1741-2358.2005.00083.x.

    Article  Google Scholar 

  35. Ritchie CS, Joshipura K, Hung HC, Douglass CW. Nutrition as a mediator in the relation between oral and systemic disease: Associations between specific measures of adult oral health and nutrition outcomes. Critical Reviews in Oral Biology & Medicine 2002;13:291–300. doi: https://doi.org/10.1177/154411130201300306.

    Article  Google Scholar 

  36. Nakamura M, Ojima T, Nakade M, et al. Poor oral health and diet in relation to weight loss, stable underweight, and obesity in community-dwelling older adults: A cross-sectional study from the JAGES 2010 Project. J Epidemiol 2016;26:322–329. doi: https://doi.org/10.2188/jea.JE20150144.

    Article  Google Scholar 

  37. Iwasaki M, Kimura Y, Yoshihara A, et al. Association between dental status and food diversity among older Japanese. Community Dent Health 2015;32:104–110.

    CAS  Google Scholar 

  38. Iwasaki M, Taylor GW, Manz MC, et al. Oral health status: relationship to nutrient and food intake among 80-year-old Japanese adults. Community Dent Oral Epidemiol 2014;42:441–450. doi: https://doi.org/10.1111/cdoe.12100.

    Article  Google Scholar 

  39. Iwasaki M, Yoshihara A, Ito K, et al. Hyposalivation and dietary nutrient intake among community-based older Japanese. Geriatr Gerontol Int 2016;16:500–507. doi: https://doi.org/10.1111/ggi.12500.

    Article  Google Scholar 

  40. Iwasaki M, Yoshihara A, Ogawa H, et al. Longitudinal association of dentition status with dietary intake in Japanese adults aged 75 to 80 years. J Oral Rehabil 2016;43:737–744. doi: https://doi.org/10.1111/joor.12427.

    Article  CAS  Google Scholar 

  41. Linden GJ, Lyons A, Scannapieco FA. Periodontal systemic associations: review of the evidence. Journal of clinical peri odontology 2013;40Suppl 14:S8–S19. doi: https://doi.org/10.1111/jcpe.12064.

    Article  Google Scholar 

  42. Watanabe Y, Hirano H, Arai H, et al. Relationship between frailty and oral function in community-dwelling elderly adults. J Am Geriatr Soc 2017;65:66–76. doi: https://doi.org/10.1111/jgs.14355.

    Article  Google Scholar 

  43. Komiyama T, Ohi T, Tomata Y, et al. Dental status is associated with incident functional disability in community-dwelling older Japanese: A prospective cohort study using propensity score matching. J Epidemiol 2020;30:84–90. doi: https://doi.org/10.2188/jea.JE20180203.

    Article  Google Scholar 

  44. Adolph M, Darnaud C, Thomas F, et al. Oral health in relation to all-cause mortality: the IPC cohort study. Sci Rep 2017;7:44604. doi: https://doi.org/10.1038/srep44604.

    Article  Google Scholar 

  45. Ota A, Kondo N, Murayama N, et al. Serum albumin levels and economic status in Japanese older adults. PLoS One 2016;11:e0155022. doi: https://doi.org/10.1371/journal.pone.0155022.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Tokyo Metropolitan Institute of Gerontology, 35-2 Sakae-cho, Itabashi-Ku, Tokyo, 173-0015, Japan

    Masanori Iwasaki, K. Motokawa, Y. Watanabe, M. Shirobe, H. Inagaki, A. Edahiro, Y. Ohara, S. Shinkai & S. Awata

  2. Gerodontology, Department of Oral Health Science, Faculty of Dental Medicine, Hokkaido University, Sapporo, Japan

    Y. Watanabe

  3. Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan

    H. Hirano

  4. Kagawa Nutrition University, Saitama, Japan

    S. Shinkai

Authors
  1. Masanori Iwasaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. K. Motokawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Y. Watanabe
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M. Shirobe
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. H. Inagaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. A. Edahiro
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Y. Ohara
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. H. Hirano
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. S. Shinkai
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. S. Awata
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Masanori Iwasaki.

Ethics declarations

The current study was conducted in accordance with the ethical principles of the Declaration of Helsinki and was approved by the ethics committee of the Tokyo Metropolitan Institute of Gerontology (approval number 9 and 31 in 2016). All participants provided a written informed consent prior to participating in the current study.

Additional information

Conflict of Interest

The authors declare they have no conflict of interest with respect to this research study and paper. This work was supported by the Tokyo Metropolitan Government, the Tokyo Metropolitan Institute of Gerontology, ARKRAY, Inc., and a Research Funding for Longevity Sciences (19–42) from the National Center for Geriatrics and Gerontology. We received grants from the Japan Agency for Medical Research and Development [Grant Numbers: JP18dk0110019h0003 and JP18dk0110018h0003], the Ministry of Health, Labor and Welfare of Japan [Grant Number: H27-Choju-Ippan-005], and JSPS KAKENHI [Grant Numbers: 16K11908, 17H02187, 17K13239, 18K09874, and 18K09919].

Electronic supplementary material

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Iwasaki, M., Motokawa, K., Watanabe, Y. et al. Association between Oral Frailty and Nutritional Status Among Community-Dwelling Older Adults: The Takashimadaira Study. J Nutr Health Aging 24, 1003–1010 (2020). https://doi.org/10.1007/s12603-020-1511-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12603-020-1511-4

Key words

Search

Navigation