TY - JOUR T1 - The relationship between salivary flow rate, oral health and malnutrition in elderly; a cross-sectional study TT - Yaşlılarda tükürük akış hızı, ağız sağlığı ve malnütrisyon arasındaki ilişki; kesitsel bir çalışma AU - Yurtdaş Depboylu, Gamze AU - Akkurnaz, Gizem AU - Kaner, Gülşah PY - 2024 DA - January Y2 - 2023 DO - 10.31362/patd.1365966 JF - Pamukkale Medical Journal JO - Pam Med J PB - Pamukkale Üniversitesi WT - DergiPark SN - 1308-0865 SP - 105 EP - 115 VL - 17 IS - 1 LA - en AB - Purpose: This study aimed to evaluate the association between salivary flow rate (SFR), oral health and nutritional status in the elderly.Materials and methods: The study included 63 elderly people (20 men, 43 women, age: 70.83±6.42 years) who applied to a private dental clinic. Data were collected by face-to-face interview, and participants’ sociodemographic characteristics, employment status information and lifestyle habits were recorded in the questionnaire. To determine nutritional status, 3-day food consumption records were taken, the Mini Nutritional Assessment Test (MNA) was performed and anthropometric parameters were measured. To assess oral health, the decayed teeth (DMFT) index and oral health impact scale (OHIP-14) were used, and unstimulated SFR was measured.Results: According to MNA, 23.8% of the elderly were malnourished or at risk of malnutrition. The mean SFR of the elderly was 0.40±0.31 mL/min and 15.9% of them had low SFR. The mean SFR of the elderly with normal body weight was higher than that of the obese (p<0.05). There was a negative correlation between SFR and Body Mass Indexs (r=-0.291, p=0.021), calf circumference (r=-0.260, p=0.014), Mid-Upper Arm Circumference (r=-0.254, p=0.044) and body fat percentage (r=-0.308, p=0.014), and a negative correlation between energy (r=0.345, p=0.006), carbohydrate (r=0.251, p=0.047), protein (r=0.326, p=0.009), fat (r=0.354, p=0.006) and phosphorus (r=0.287, p=0.023) intake. Conclusion: No significant evidence was found regarding to a direct association between SFR, DMFT index, and OHIP-14 scores with malnutrition. However, an assaciation was found between low SFR and obesity. This suggests that there might be a potential link between SFR and nutritional status, which requires further investigation. To gain a better understanding of the relationship between SFR and malnutrition in the elderly, it is recommended to conduct multicenter clinical trials. KW - Elderly KW - salivary flow rate KW - oral health KW - malnutrition N2 - Amaç: Bu çalışmanın amacı; yaşlılarda tükürük akış hızı, ağız sağlığı ve beslenme durumu arasındaki ilişkinin değerlendirilmesidir.Gereç ve yöntem: Çalışmaya, özel diş hekimi kliniğine başvuran 63 (20 erkek, 43 kadın, yaş: 70,83±6,42 yıl) yaşlı dahil edildi. Veriler yüz yüze görüşme yöntemiyle toplanmış olup katılımcıların sosyodemografik özellikleri, çalışma durumuna ilişkin bilgileri ve yaşam tarzı alışkanlıkları ankete kaydedildi. Beslenme durumu saptanması için 3 günlük besin tüketim kaydı alındı, Mini Nütrisyonel Değerlendirme Testi (MNA) uygulandı; antropometrik ölçümler yapıldı. Ağız sağlığını değerlendirmek için çürük dişler indeksi (DMFT) ve ağız sağlığı etki ölçeği (OHİP-14); tükürük akış hızını saptamak için uyarımsız tükürük akış hızı hesaplaması kullanıldı.Bulgular: MNA’ya göre yaşlıların %23,8’inin malnutrisyonlu veya malnütrisyon riski altında olduğu belirlenmiştir. Yaşlıların tükürük akış hızı ortalamaları 0,40±0,31 mL/dk olarak bulunmuş olup %15,9’unun düşük tükürük akış hızına sahip olduğu saptanmıştır. Normal vücut ağırlığına sahip yaşlıların tükürük akış hız ortalaması obezlerdendaha yüksektir (p<0,05). Tükürük akış hızı ile beden kütle indeksi (r=-0,291, p=0,021), baldır çevresi (r=-0,260, p=0,014), üst orta kol çevresi (r=-0,254, p=0,044) ve vücut yağ oranı (r=-0,308, p=0,014) arasında negatif yönlü, diyetle enerji (r=0,345, p=0,006), karbonhidrat (r=0,251, p=0,047), protein (r=0,326, p=0,009), yağ (r=0,354, p=0,006) ve fosfor (r=0,287, p=0,023) alımı arasında pozitif yönlü anlamlı ilişki mevcuttur.Sonuç: Tükürük akış hızı, DMFT indeksi ve OHİP-14 skorları ile malnütrisyon arasında doğrudan bir ilişki olduğuna dair anlamlı bir kanıt bulunmamıştır. Bununla birlikte, düşük SFR ile obezite arasında bir ilişki tespit edilmiştir. Bu durum, SFR ile beslenme durumu arasında daha fazla araştırma gerektiren potansiyel bir bağlantı olabileceğini düşündürmektedir. Yaşlılarda tükürük akış hızı ve malnütrisyon arasındaki ilişkinin daha iyi anlaşılması için çok merkezli klinik çalışmaların yapılması önerilmektedir. CR - 1. Cederholm T, Barazzoni R, Austin P, et al. ESPEN guidelines on definitions and terminology of clinical nutrition. Clin Nutr 2017;36:49-64. https://doi.org/10.1016/j.clnu.2016.09.004 CR - 2. Karahan İ, Çifci A. Malnütrisyonun tanımı ve hastaların yönetimi. J Med Palliat Care 2020;1:5-9. CR - 3. Krishnamoorthy Y, Vijayageetha M, Kumar SG, Rajaa S, Rehman T. Prevalence of malnutrition and its associated factors among elderly population in rural Puducherry using mini-nutritional assessment questionnaire. J Family Med Prim Care 2018;7:1429-1433. https://doi.org/10.4103/jfmpc.jfmpc_22_18 CR - 4. Mezemir Y, Egata G, Geset D, Lambebo A. Nutritional status and associated factors among the community-dwelling elderly population in Debre Berhan town, North Shewa Zone, Ethiopia. Nutrition and Dietary Supplements 2020;12:289-299. https://doi.org/10.2147/NDS.S280589 CR - 5. Catikkas NM. Malnutrition and related factors in older adults. Eur J Geriatr Gerontol 2020;2:36-40. https://doi.org/10.4274/ejgg.galenos.2020.2221 CR - 6. Dent E, Wright ORL, Woo J, Hoogendijk EO. Malnutrition in older adults. Lancet 2023;401:951-966. https://doi.org/10.1016/S0140-6736(22)02612-5 CR - 7. Van Lancker A, Verhaeghe S, Van Hecke A, Vanderwee K, Goossens J, Beeckman D. The association between malnutrition and oral health status in elderly in long-term care facilities: a systematic review. Int J Nurs Stud 2012;49:1568-1581. https://doi.org/10.1016/j.ijnurstu.2012.04.001 CR - 8. Pina GMS, Mota Carvalho R, Silva BSF, Almeida FT. Prevalence of hyposalivation in older people: A systematic review and meta-analysis. Gerodontology 2020;37:317-331. https://doi.org/10.1111/ger.12497 CR - 9. Vandenberghe Descamps M, Labouré H, Prot A, et al. Salivary flow decreases in healthy elderly people independently of dental status and drug intake. J Tex Stud 2016;47:353-360. https://doi.org/10.1111/jtxs.12191 CR - 10. Soini H, Muurinen S, Routasalo P, et al. Oral and nutritional status--Is the MNA a useful tool for dental clinics. J Nutr Health Aging 2006;10:495-499. CR - 11. Syrjälä 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. https://doi.org/10.1111/j.1741-2358.2012.00679.x CR - 12. Proctor GB, Shaalan AM. Disease-induced changes in salivary gland function and the composition of saliva. J Dent Res 2021;100:1201-1209. https://doi.org/10.1177/00220345211004842 CR - 13. Başol ME, Karaağaçlıoğlu L, Yılmaz B. Türkçe ağız sağlığı etki ölçeğinin geliştirilmesi-OHIP-14-TR. Turkiye Klinikleri J Dental Sci 2014;20:85-92. CR - 14. World Health Organization. Oral health surveys: Basic methods. 5th ed. Geneva: WHO, 2013;1-125. CR - 15. Pekcan G. Assessment of nutrition status of patient. In: Baysal A, ed. Diet handbook. 4th ed. Ankara: Hatiboğlu Publishing, 2002;65-116. CR - 16. Rakıcıoglu N, Acar NT, Ayaz A, Pekcan G. Photo catalog of food and nutrition-measurements and quantities. Ankara: Ata Ofset Publishing, 2014;1-132. CR - 17. Ebispro for Windows, Stuttgart, Germany; Turkish Version (BeBiS 8.2), Pasifik Elektirik Elektronik Ltd. Şti. (www.bebis.com.tr); Istanbul, 2019. CR - 18. Guigoz Y, Lauque S, Vellas BJ. Identifying the elderly at risk for malnutrition. The mini nutritional assessment. Clin Geriatr Med 2002;18:737-757. https://doi.org/10.1016/s0749-0690(02)00059-9 CR - 19. Sørensen CE, Hansen NL, Mortensen EL, Lauritzen M, Osler M, Pedersen AML. Hyposalivation and poor dental health status are potential correlates of age-related cognitive decline in late midlife in Danish men. Front Aging Neurosci 2018;10:10. https://doi.org/10.3389/fnagi.2018.00010 CR - 20. Sreebny LM. Saliva in health and disease: an appraisal and update. Int Dent J 2000;50:140-161. https://doi.org/10.1111/j.1875-595x.2000.tb00554.x CR - 21. Ohara Y, Kawai H, Shirobe M, et al. Association between anorexia and hyposalivation in community-dwelling older adults in Japan: a 6-year longitudinal study. BMC Geriatr 2020;20:504. https://doi.org/10.1186/s12877-020-01905-0 CR - 22. Tonetti MS, Bottenberg P, Conrads G, et al. Dental caries and periodontal diseases in the ageing population: call to action to protect and enhance oral health and well-being as an essential component of healthy ageing - Consensus report of group 4 of the joint EFP/ORCA workshop on the boundaries between caries and periodontal diseases. J Clin Periodontol 2017;44:135-144. https://doi.org/10.1111/jcpe.12681 CR - 23. Khoury C, Samot J, Helmer C, et al. The association between oral health and nutritional status in older adults: a cross-sectional study. BMC Geriatr 2022;22:499. https://doi.org/10.1186/s12877-022-03133-0 CR - 24. Hatipoğlu Ö, Önsüren AS, Hatipoğlu FP, Kurt A. Caries-related salivary parameters and oral microbial flora in patients with type 1 diabetes: a meta-analysis. Diabetes Metab Res Rev 2022;38:e3527. https://doi.org/10.1002/dmrr.3527 CR - 25. Hatipoğlu Ö, Pertek Hatipoğlu F. Association between asthma and caries-related salivary factors: a meta-analysis. J Asthma 2022;59:38-53. https://doi.org/10.1080/02770903.2020.1826045 CR - 26. Hatipoglu O, Maras E, Hatipoglu FP, Saygin AG. Salivary flow rate, pH, and buffer capacity in the individuals with obesity and overweight; A meta-analysis. Niger J Clin Pract 2022;25:1126-1142. https://doi.org/10.4103/njcp.njcp_1760_21 CR - 27. Ikebe K, Matsuda K, Morii K, et al. Impact of dry mouth and hyposalivation on oral health-related quality of life of elderly Japanese. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007;103:216-222. https://doi.org/10.1016/j.tripleo.2005.12.001 CR - 28. 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. https://doi.org/10.1111/ggi.12500 CR - 29. Mese H, Matsuo R. Salivary secretion, taste and hyposalivation. J Oral Rehabil 2007;34:711-723. https://doi.org/10.1111/j.1365-2842.2007.01794.x CR - 30. Muñoz González C, Vandenberghe Descamps M, Feron G, Canon F, Labouré H, Sulmont Rossé C. Association between salivary hypofunction and food consumption in the elderlies. A systematic literature review. J Nutr Health Aging 2018;22:407-419. https://doi.org/10.1007/s12603-017-0960-x CR - 31. Dodds MWJ, Johnson DA, Yeh CK. Health benefits of saliva: a review. J Dent 2005;33:223-233. https://doi.org/10.1016/j.jdent.2004.10.009 CR - 32. Singh N, Bansal K, Chopra R, Kaur Dharmani CK. Association of nutritional status on salivary flow rate, dental caries status and eruption pattern in pediatric population in India. Indian J Dent Sci 2018;10:78-82. https://doi.org/10.5005/jp-journals-10005-1706 CR - 33. Dormenval V, Budtz Jørgensen E, Mojon P, Bruyère A, Rapin CH. Associations between malnutrition, poor general health and oral dryness in hospitalized elderly patients. Age Ageing 1998;27:123-128. https://doi.org/10.1093/ageing/27.2.123 CR - 34. Flink H, Bergdahl M, Tegelberg A, Rosenblad A, Lagerlöf F. Prevalence of hyposalivation in relation to general health, body mass index and remaining teeth in different age groups of adults. Community Dent Oral Epidemiol 2008;36:523-531. https://doi.org/10.1111/j.1600-0528.2008 CR - 35. Mendes MSS, Chester LN, Fernandes Dos Santos JF, Chen X, Caplan DJ, Marchini L. Self-perceived oral health among institutionalized older adults in Taubate, Brazil. Spec Care Dentist 2020;40:49-54. https://doi.org/10.1111/scd.12430 CR - 36. Stankeviciene I, Aleksejuniene J, Puriene A, Stangvaltaite Mouhat L. Association between diet and xerostomia: is xerostomia a barrier to a healthy eating pattern? Nutrients 2021;13:4235. https://doi.org/10.3390/nu13124235 CR - 37. Loesche WJ, Bromberg J, Terpenning MS, et al. Xerostomia, xerogenic medications and food avoidances in selected geriatric groups. J Am Geriatr Soc 1995;43:401-407. https://doi.org/10.1111/j.1532-5415.1995.tb05815.x CR - 38. Rhodus NL, Brown J. The association of xerostomia and inadequate intake in older adults. J Am Diet Assoc 1990;90:1688-1692. https://doi.org/10.1016/S0002-8223(21)01876-9 CR - 39. Lee KA, Park JC, Park YK. Nutrient intakes and medication use in elderly individuals with and without dry mouths. Nutr Res Pract 2020;14:143-151. https://doi.org/10.4162/nrp.2020.14.2 CR - 40. Volkert D, Beck AM, Cederholm T, et al. ESPEN practical guideline: clinical nutrition and hydration in geriatrics. Clin Nutr 2022;41:958-989. https://doi.org/10.1016/j.clnu.2022.01.024 UR - https://doi.org/10.31362/patd.1365966 L1 - https://dergipark.org.tr/tr/download/article-file/3431780 ER -