Relationship between Oral Diadochokinesis and Nutritional Risk / Diet Modification in Older Hospitalized Patients with Suspected Dysphagia

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  • SHIGEMOTO Shimpei
    Aidu Chuo Hospital Dental and Oral Medical Center
  • HORI Kazuhiro
    Division of Comprehensive Prosthodontics, Niigata University Graduate School of Medical and Dental Sciences
  • TAKAHASHI Junko
    Aidu Chuo Hospital Dental and Oral Medical Center
  • OKAWA Jumpei
    Division of Comprehensive Prosthodontics, Niigata University Graduate School of Medical and Dental Sciences
  • ONO Takahiro
    Division of Comprehensive Prosthodontics, Niigata University Graduate School of Medical and Dental Sciences Department of Geriatric Dentistry, Osaka Dental University
  • MIYAJIMA Hisashi
    Aidu Chuo Hospital Dental and Oral Medical Center

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Other Title
  • 嚥下障害が疑われた総合病院入院高齢者における舌口唇運動機能と栄養リスクおよび食形態との関連性
  • エンカ ショウガイ ガ ウタガワレタ ソウゴウ ビョウイン ニュウイン コウレイシャ ニ オケル ゼツ コウシン ウンドウ キノウ ト エイヨウ リスク オヨビ ショク ケイタイ ト ノ カンレンセイ

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<p>　Background:　Functional deterioration of the tongue and lips causes hypoplasia of the bolus, limits the diet that can be ingested, and leads to malnutrition, but there have been few reports on the relationship. In this study, we considered that the oral diadochokinesis of patients admitted to general hospitals could be used as an index to grasp nutritional status and diet modification, and investigated the relationship.</p><p>　Methods:　The subjects were patients referred to the Department of Oral and Maxillofacial Surgery of a general hospital for swallowing function evaluation, and 259 inpatients aged 65 years or older (135 males, average age 84.4±8.0) who ingested orally and were able to perform an oral diadochokinesis test. Using the Geriatric Nutritional Risk Index, we classified them into two groups: a high nutritional risk group and a moderate / mild / none group. The diet modification was determined based on the results of a swallowing function evaluation and swallowing endoscopy, and was divided into two groups: a soft diet / paste diet group and a regular diet / chopped diet group. Differences in oral diadochokinesis between groups were compared, and the ROC curve was used to calculate the cutoff values for malnutrition and diet modification.</p><p>　Results:　158 out of 259 were classified into the severe nutritional risk group, and their oral diadochokinesis (/pa/ 3.6 times/s, /ta/ 3.6 times/s, /ka/ 3.3 times/s) was moderate/mild/no nutritional risk. It was significantly lower than the moderate/mild/no group (/pa/ 4.4 times/s, /ta/ 4.2 times/s, /ka/ 3.9 times/s). If the cutoff values are /pa/ 4.7 times/s, /ta/ 4.7 times/s, and /ka/ 4.3 times/s according to the ROC curve, the sensitivity / specificity (severe nutritional risk group) is 75.3% / 44.6%, 77.8% / 42.6%, 74.7% / 43.6%. On the other hand, in terms of diet modification, 142 people ate normal diet or chopped diet. Oral diadochokinesis was significantly lower in the soft / paste diet (JSDR2021 code: 3,2) group (/pa/ 3.5, /ta/ 3.4, /ka/ 3.1) than in the normal diet / chopped diet (JSDR2021 code: 4,3) group (/pa/ 4.3, /ta/ 4.1, /ka / 3.9). If the cutoff values are /pa/ 4.5, /ta/ 4.7, /ka/ 4.3 according to the ROC curve, the sensitivity /specificity (soft food / paste food group) is 76.9% / 46.5%, 81.2% / 39.4%, 79.5% / 42.3%.</p><p>　Conclusion:　Oral diadochokinesis values of 4 times/s or less of older inpatients admitted to a general hospital may be a predictive indicator of malnutrition and low diet modification.</p>

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