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Ultrasonographic Measurement of Masseter Muscle Thickness Associates with Oral Phase Dysphagia in Institutionalized Elderly Individuals

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Abstract

Background & Aims

Oral phase dysphagia is dependent on ability to chew. As people age, general muscle atrophy contributes to decreased masseter strength. The main objective of this study was to assess the relationship between the thickness of the masseter muscle measured by ultrasonography and the presence of dysphagia in a group of institutionalized elderly people. As a secondary objective, we aimed to establish cutoff points of masseters muscle thickness (MMT) to identify elderly individuals at risk of oral dysphagia.

Methods

Cross-sectional study of all residents from 3 nursing homes. All individuals underwent ultrasonographic measurements of left and right MMT and were classified according to the presence of dysphagia assessed by both the EAT-10 screening questionnaire and the volume‐viscosity swallow test (V‐VST).

Results

469 patients (69% women, mean age 84.7 yrs) were recruited. Dysphagia was present in 41.6% and 26% of individuals according the EAT-10 and V-VST, respectively. Multivariate logistic regression showed that 1 mm increase in MMT reduced the risk of dysphagia by 21% according to the EAT-10 tool and by 30% using the V-VST after adjusting for age, sex, mini-nutritional assessment score, and body mass index. We used receiver operative characteristic (ROC) curves to identify cutoff points of MMT to detect dysphagic individuals according to either EAT-10 or V-VST.

Conclusions

The MMT measured by ultrasonography is reduced in elderly individuals with dysphagia. Based on MMT, clinicians may be better informed about the patients'´ ability to masticate solid foods and identify potential nutrient deficiencies in geriatric settings

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Acknowledgements

We thank Prof. J.L. Lopez, J.J. Lanuza, and J.Prieto (Ixo R.) for their support and critical observations.

Funding

JMA-M is partially supported by the project PI17/02268 (Instituto de Salud Carlos III), by Fondo Europeo de Desarrollo Regional (FEDER): “Una manera de hacer Europa,” and by the DGA Group Biology of adipose tissue and metabolic complications (B03_20R), co-financed with the FEDER Aragón 2014-2020: “Construyendo Europa desde Aragón.”

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Authors and Affiliations

  1. Department of Nutrition, University Hospital Miguel Servet, Zaragoza, Spain

    Mikel González-Fernández & Alejandro Sanz-Paris

  2. Instituto de Investigacion Sanitaria Aragon (IIS-Aragon), Zaragoza, Spain

    Jose M. Arbones-Mainar & Alejandro Sanz-Paris

  3. Adipocyte and Fat Biology Laboratory (AdipoFat), Translational Research Unit, University Hospital Miguel Servet, Instituto Aragones de Ciencias de la Salud (IACS), 50009, Zaragoza, Spain

    Jose M. Arbones-Mainar

  4. Centro de Investigacion Biomedica en Red Fisiopatología Obesidad Y Nutricion (CIBERObn), Instituto Salud Carlos III, Madrid, Spain

    Jose M. Arbones-Mainar

  5. Department of Radiology and Ultrasound, University Hospital Miguel Servet, Zaragoza, Spain

    Eduardo Ferrer-Lahuerta

  6. Geriatric Unit, Elias Martinez Nursing Home, Zaragoza, Spain

    Javier Perez-Nogueras

  7. Geriatric Unit, Casa Amparo Nursing Home, Zaragoza, Spain

    Antonio Serrano-Oliver

  8. Geriatric Unit, Romareda Nursing Home, Zaragoza, Spain

    Elena Torres-Anoro

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  1. Mikel González-Fernández
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Contributions

AS-P, MG-F, EF-L, JP-N, AS-L, and ET-A designed the study and collected the data. AS-P, MG-F, and JMA-M analyzed the data. AS-P, MG-F, and JMA-M wrote the manuscript. All authors approved the final manuscript and take public responsibility for the content of the article.

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Correspondence to Jose M. Arbones-Mainar.

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González-Fernández, M., Arbones-Mainar, J.M., Ferrer-Lahuerta, E. et al. Ultrasonographic Measurement of Masseter Muscle Thickness Associates with Oral Phase Dysphagia in Institutionalized Elderly Individuals. Dysphagia 36, 1031–1039 (2021). https://doi.org/10.1007/s00455-020-10234-8

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