Oral health determinants of incident malnutrition in community-dwelling older adults

Eva Kiesswetter; Linda M. Hengeveld; Bart JF Keijser; Dorothee Volkert; Marjolein Visser

doi:10.1016/j.jdent.2019.05.017

Oral health determinants of incident malnutrition in community-dwelling older adults

Eva Kiesswetter^*, Linda M. Hengeveld, Bart JF Keijser, Dorothee Volkert, Marjolein Visser

^*Corresponding author for this work

Research output: Contribution to Journal › Article › Academic › peer-review

Abstract

Objective: Poor oral health might be a modifiable determinant of malnutrition in older age. We aimed to investigate the associations of multiple oral health characteristics with incident malnutrition in community-dwelling older adults. Methods: This exploratory analysis is based on prospective data from 893 participants, aged 55–80 years without malnutrition in 2005/06 from the Longitudinal Aging Study Amsterdam. In 2007, 19 oral health characteristics from the domains teeth/dentures, oral hygiene, oral problems, and self-rated oral health were assessed by questionnaire. Incident malnutrition was defined as presence of low body mass index (<20 kg/m² in people <70 years, <22 kg/m² ≥70 years) and/or self-reported involuntary weight loss ≥5% in previous 6 months at any of the follow-ups (2008/09, 2012/13, 2015/16). Associations of oral aspects with incident malnutrition were analyzed by cox proportional hazard models and adjusted for confounders. Results: The 9-year incidence of malnutrition was 13.5%. Sixteen of 19 oral health aspects were not associated with incident malnutrition in the crude models. Adjusted hazard ratios for incident malnutrition were 2.14 (1.10–4.19, p = 0.026) for toothache while chewing, 2.10 (0.88–4.98, p = 0.094) for an unhealthy oral health status, and 1.99 (0.93–4.28, p = 0.077) for xerostomia in edentulous participants, however, the two latter ones failing to reach statistical significance. Conclusions: We identified toothache while chewing as determinant of incident malnutrition in community-dwelling older adults, and found indications that poor oral health and xerostomia in combination with having no teeth may play a role in developing malnutrition. However, these outlined tendencies need to be proven in further studies. Clinical Significance: Regarding the development of strategies to prevent malnutrition in older people toothache while chewing, xerostomia, and self-rated oral health would be of specific interest as these factors are modifiable and can be easily assessed by self-reports.

Original language	English
Pages (from-to)	73-80
Number of pages	8
Journal	Journal of Dentistry
Volume	85
Early online date	11 May 2019
DOIs	https://doi.org/10.1016/j.jdent.2019.05.017
Publication status	Published - Jun 2019

Funding

The Longitudinal Aging Study Amsterdam (LASA) is largely supported by a grant from the Netherlands Ministry of Health, Welfare and Sports, Directorate of Long-Term Care . The questionnaire on oral health was developed in cooperation with experts on oral health from the Academic Centre for Dentistry Amsterdam (ACTA) and the Netherlands Organization for Applied Scientific Research (TNO). Development of the questionnaire and data entry was supported in part through a grant from the Dutch Ministry for Economic Affairs (grant nr. 031.20339 ). EK received a research fellowship from the German Research Foundation (DFG) to conduct this project (project number 398462750 ). MV and LMH were supported by the European Horizon 2020 PROMISS Project ‘PRevention Of Malnutrition In Senior Subjects in the EU’ , grant agreement no. 678,732. The content only reflects the author’s view and the Commission is not responsible for any use that may be made of the information it contains. MV and DV were supported by the MalNutrition in the ELderly (MaNuEL) knowledge hub, the Joint Programming Initiative ‘Healthy Diet for a Healthy Life’. The funding agencies supporting this work are: Germany: German Federal Ministry of Food and Agriculture (BMEL) through the Federal Office for Agriculture and Food (BLE), grant number 2815ERA09E ; The Netherlands: The Netherlands Organisation for Health Research and Development (ZonMw) . Appendix A

Funders	Funder number
Academic Centre for Dentistry Amsterdam
Dutch Ministry for Economic Affairs	031.20339
European Horizon 2020
Federal Office for Agriculture and Food
German Federal Ministry of Food and Agriculture
Netherlands Ministry of Health, Welfare and Sports, Directorate of Long-Term Care
Netherlands Organization for Applied Scientific Research
TNO
Horizon 2020 Framework Programme
European Commission
Deutsche Forschungsgemeinschaft	398462750
ZonMw
Bundesministerium für Ernährung und Landwirtschaft
Horizon 2020	678732
Bundesanstalt für Landwirtschaft und Ernährung	2815ERA09E

Keywords

Aged
Community
Dentures
Nutritional status
Tooth
Xerostomia

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.jdent.2019.05.017

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title = "Oral health determinants of incident malnutrition in community-dwelling older adults",

abstract = "Objective: Poor oral health might be a modifiable determinant of malnutrition in older age. We aimed to investigate the associations of multiple oral health characteristics with incident malnutrition in community-dwelling older adults. Methods: This exploratory analysis is based on prospective data from 893 participants, aged 55–80 years without malnutrition in 2005/06 from the Longitudinal Aging Study Amsterdam. In 2007, 19 oral health characteristics from the domains teeth/dentures, oral hygiene, oral problems, and self-rated oral health were assessed by questionnaire. Incident malnutrition was defined as presence of low body mass index (<20 kg/m² in people <70 years, <22 kg/m² ≥70 years) and/or self-reported involuntary weight loss ≥5% in previous 6 months at any of the follow-ups (2008/09, 2012/13, 2015/16). Associations of oral aspects with incident malnutrition were analyzed by cox proportional hazard models and adjusted for confounders. Results: The 9-year incidence of malnutrition was 13.5%. Sixteen of 19 oral health aspects were not associated with incident malnutrition in the crude models. Adjusted hazard ratios for incident malnutrition were 2.14 (1.10–4.19, p = 0.026) for toothache while chewing, 2.10 (0.88–4.98, p = 0.094) for an unhealthy oral health status, and 1.99 (0.93–4.28, p = 0.077) for xerostomia in edentulous participants, however, the two latter ones failing to reach statistical significance. Conclusions: We identified toothache while chewing as determinant of incident malnutrition in community-dwelling older adults, and found indications that poor oral health and xerostomia in combination with having no teeth may play a role in developing malnutrition. However, these outlined tendencies need to be proven in further studies. Clinical Significance: Regarding the development of strategies to prevent malnutrition in older people toothache while chewing, xerostomia, and self-rated oral health would be of specific interest as these factors are modifiable and can be easily assessed by self-reports.",

keywords = "Aged, Community, Dentures, Nutritional status, Tooth, Xerostomia",

author = "Eva Kiesswetter and Hengeveld, {Linda M.} and Keijser, {Bart JF} and Dorothee Volkert and Marjolein Visser",

year = "2019",

month = jun,

doi = "10.1016/j.jdent.2019.05.017",

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AU - Hengeveld, Linda M.

AU - Keijser, Bart JF

AU - Volkert, Dorothee

AU - Visser, Marjolein

PY - 2019/6

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N2 - Objective: Poor oral health might be a modifiable determinant of malnutrition in older age. We aimed to investigate the associations of multiple oral health characteristics with incident malnutrition in community-dwelling older adults. Methods: This exploratory analysis is based on prospective data from 893 participants, aged 55–80 years without malnutrition in 2005/06 from the Longitudinal Aging Study Amsterdam. In 2007, 19 oral health characteristics from the domains teeth/dentures, oral hygiene, oral problems, and self-rated oral health were assessed by questionnaire. Incident malnutrition was defined as presence of low body mass index (<20 kg/m² in people <70 years, <22 kg/m² ≥70 years) and/or self-reported involuntary weight loss ≥5% in previous 6 months at any of the follow-ups (2008/09, 2012/13, 2015/16). Associations of oral aspects with incident malnutrition were analyzed by cox proportional hazard models and adjusted for confounders. Results: The 9-year incidence of malnutrition was 13.5%. Sixteen of 19 oral health aspects were not associated with incident malnutrition in the crude models. Adjusted hazard ratios for incident malnutrition were 2.14 (1.10–4.19, p = 0.026) for toothache while chewing, 2.10 (0.88–4.98, p = 0.094) for an unhealthy oral health status, and 1.99 (0.93–4.28, p = 0.077) for xerostomia in edentulous participants, however, the two latter ones failing to reach statistical significance. Conclusions: We identified toothache while chewing as determinant of incident malnutrition in community-dwelling older adults, and found indications that poor oral health and xerostomia in combination with having no teeth may play a role in developing malnutrition. However, these outlined tendencies need to be proven in further studies. Clinical Significance: Regarding the development of strategies to prevent malnutrition in older people toothache while chewing, xerostomia, and self-rated oral health would be of specific interest as these factors are modifiable and can be easily assessed by self-reports.

AB - Objective: Poor oral health might be a modifiable determinant of malnutrition in older age. We aimed to investigate the associations of multiple oral health characteristics with incident malnutrition in community-dwelling older adults. Methods: This exploratory analysis is based on prospective data from 893 participants, aged 55–80 years without malnutrition in 2005/06 from the Longitudinal Aging Study Amsterdam. In 2007, 19 oral health characteristics from the domains teeth/dentures, oral hygiene, oral problems, and self-rated oral health were assessed by questionnaire. Incident malnutrition was defined as presence of low body mass index (<20 kg/m² in people <70 years, <22 kg/m² ≥70 years) and/or self-reported involuntary weight loss ≥5% in previous 6 months at any of the follow-ups (2008/09, 2012/13, 2015/16). Associations of oral aspects with incident malnutrition were analyzed by cox proportional hazard models and adjusted for confounders. Results: The 9-year incidence of malnutrition was 13.5%. Sixteen of 19 oral health aspects were not associated with incident malnutrition in the crude models. Adjusted hazard ratios for incident malnutrition were 2.14 (1.10–4.19, p = 0.026) for toothache while chewing, 2.10 (0.88–4.98, p = 0.094) for an unhealthy oral health status, and 1.99 (0.93–4.28, p = 0.077) for xerostomia in edentulous participants, however, the two latter ones failing to reach statistical significance. Conclusions: We identified toothache while chewing as determinant of incident malnutrition in community-dwelling older adults, and found indications that poor oral health and xerostomia in combination with having no teeth may play a role in developing malnutrition. However, these outlined tendencies need to be proven in further studies. Clinical Significance: Regarding the development of strategies to prevent malnutrition in older people toothache while chewing, xerostomia, and self-rated oral health would be of specific interest as these factors are modifiable and can be easily assessed by self-reports.

KW - Aged

KW - Community

KW - Dentures

KW - Nutritional status

KW - Tooth

KW - Xerostomia

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Oral health determinants of incident malnutrition in community-dwelling older adults

Abstract

Funding

Keywords

UN SDGs

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