Medical costs of a low skeletal muscle mass are modulated by dietary diversity and physical activity in community-dwelling older Taiwanese: a longitudinal study.

BACKGROUND: Age-related loss of skeletal muscle mass (SMM) and function (sarcopenia) are associated with poor health outcomes and an economic burden on health care services. An appropriate diet and physical activity have been proposed for prevention and treatment of sarcopenia. Nevertheless, the effects on medical service utilization and costs remain unclear. This study determined the effects of SMM in conjunction with diet quality and physical activity on medical service utilization and expenditure in community-dwelling older Taiwanese. METHODS: In total, 1337 participants from the Elderly Nutrition and Health Survey in Taiwan (1999-2000) were enrolled. An SMM index [SMMI, calculated by dividing SMM (kg) by height (m2)] was used as the marker of sarcopenia. Participants with the lowest SMMI quartiles (<11.4 kg/m2 for men and 8.50 kg/m2 for women) comprised the high-risk group, and the remainder comprised the low-risk group. Dietary information (dietary diversity: low and high) and physical activity (low and moderate) were obtained at baseline. Annual medical service utilization and expenditure were calculated from National Health Insurance claims until December 31, 2006. Generalized linear models were used to determine the association between the SMMI and annual medical service utilization and costs in conjunction with dietary diversity or physical activity. RESULTS: After 8 follow-up years, regardless of gender, participants in the high-risk group reported significantly more hospitalization (days and expenditure) and total medical expenditure. Participants in the high-risk group who had low dietary diversity made fewer annual outpatient (14%), preventive care (19%), and dental (40%) visits, but exhibited longer hospitalization (102%) than did those who had a low SMMI and high dietary diversity. Similar patterns were observed in the corresponding medical expenditures. The findings were similar when considering physical activity. Being in the low-risk group in conjunction with having high dietary diversity or more physical activity was associated with the lowest annual adjusted mean hospitalization days with expenditure, and also total expenditure. CONCLUSIONS: A lower SMMI was associated with more hospitalization days and costs. However, high dietary diversity and more physical activity can attenuate the effects of lower SMMI on medical service utilization and expenditure.

Mandibular disto-lingual root: a consideration in periodontal therapy.

BACKGROUND: Developmental and morphological abnormalities may contribute to the progression of localized periodontal disease. Although the presence of a disto-lingual root in the mandibular first molar is rare, its role in periodontal destruction has not been examined. The purpose of this study was to evaluate whether the presence of this root contributes to localized periodontal destruction. METHODS: The presence of the disto-lingual root was identified by examination of two periapical radiographs in each of 197 Taiwanese patients with 332 mandibular first molars. Regression analysis was used to evaluate the relationship between the presence of the root and probing depth, gingival recession, and periodontal attachment loss at the disto-buccal and disto-lingual sites of the molars. The adjusted variables included patient characteristics (age, gender, diagnosis, and general periodontal conditions), tooth (right and left location, tooth mobility, and periodontal category of the molar), and site (bleeding on probing and adjacent furcation involvement). RESULTS: A disto-lingual root was present in 26.9% of patients and in 21.7% of molars examined. A significant interaction between periodontal category and the presence of disto-lingual root on probing depth and attachment loss at disto-lingual but not disto-buccal sites was observed. Multivariable regression analysis showed a significantly higher probing depth and attachment loss at the disto-lingual site in molars with the disto-lingual root than in molars without the root in teeth classified as having advanced periodontitis. CONCLUSIONS: Greater probing depth and attachment loss occurred at disto-lingual sites of molars with the roots. The presence of a disto-lingual root may contribute to localized periodontal destruction.

Combined Effects of Chewing Ability and Dietary Diversity on Medical Service Use and Expenditures.

OBJECTIVES: To examine whether chewing ability affects healthcare use and expenditure and whether improving dietary quality alleviates any such effects. DESIGN: Prospective cohort. SETTING: The Elderly Nutrition and Health Survey in Taiwan (1999-2000), a nationwide community-based survey of people aged 65 and older. PARTICIPANTS: Individuals aged 65 and older (N = 1,793; 903 men, 890 women). MEASUREMENTS: Chewing ability (satisfactory or unsatisfactory) was assessed using a questionnaire, and dietary quality was assessed using a 24-hour dietary recall as a dietary diversity score. Data on annual medical use and expenditures from the interview date until December 31, 2006, were collected from National Health Insurance claims. Generalized linear models were used to assess the associations between chewing ability, dietary quality, and annual medical usage or expenditure. RESULTS: After 8 years of follow-up, older adults with unsatisfactory chewing ability had considerably higher emergency, hospitalization, and total medical expenditures. Older adults with unsatisfactory chewing ability and a poor diet used fewer annual preventive care and dental services than those with satisfactory chewing ability but had longer hospital stays and higher expenditures. After adjusting for covariates, unsatisfactory chewing ability resulted in significantly longer hospital stays in participants with a poor diet (ß = 2.34, 95% confidence interval = 2.02-2.71, P < .001). CONCLUSION: Unsatisfactory chewing ability and a less-diverse diet together are associated with longer hospital stays and higher medical expenditures.

Dietary diversity predicts type of medical expenditure in elders.

OBJECTIVES: To assess the association between Dietary Diversity Scores (DDSs, range: 0-6 points) and medical service utilization and expenditures. STUDY DESIGN: Prospective cohort study. METHODS: The Elderly Nutrition and Health Survey in Taiwan (1999-2000) provided a 24-hour dietary recall for DDSs. National Health Insurance claims were linked for 1650 eligible elders. Generalized linear models were used to appraise the association between DDS and annual medical utilization and expenditures. RESULTS: Those with a higher DDS had lower medical service utilization and expenditures for emergencies and hospitalization. After adjustment for potential confounders, emergency and hospitalization expenditures for elders with a DDS of 6 were lower than those with a DDS of 3 or lower. However, for preventive care and dental services, the highest DDS of 6 predicted greater utilization (0.25 and 0.5 times) and expenditure (270 and 420 Taiwanese new dollars). Findings remained unchanged when those who died in the first year or had any medical utilizations and expenditures1 year prior to death were excluded. CONCLUSIONS: Greater dietary diversity is associated with lower emergency and hospitalization utilization and expenditures, but not lower use of ambulatory services. There is a need for health services to develop a nutrition policy for nutritionally disadvantaged groups.

Increased medical costs in elders with the metabolic syndrome are most evident with hospitalization of men.

BACKGROUND: Little is known about health care costs associated with the metabolic syndrome (MetS). OBJECTIVE: We assessed annualized health care costs and health outcomes for both genders in different health care settings among representative Taiwanese elders. METHODS: The Nutrition and Health Survey in Taiwan (1999-2000) provided 1378 individuals aged 65 years or older with known MetS status. Nutrition and Health Survey in Taiwan files were linked to National Health Insurance records (1999-2006). Student t tests and multiple regression models were used to assess expenditures in total and in 6 services: inpatient, ambulatory care, dental care, traditional Chinese medicine, emergency care, and contracted pharmacy. The Cox model was used to assess gender effect on all-cause mortality and cardiovascular disease mortality, whereas logistic regression was used for that on cardiovascular disease hospitalization. The 5 MetS component costs were evaluated by multiple regressions. RESULTS: MetS affected 29% of men and 48% of women. After full adjustment, those with MetS had 1.30 (95% CI, 1.11-1.52), men had 1.43 (95% CI, 1.20-1.70), and women had 1.19 (95% CI, 0.93-1.52) times higher costs than those without MetS. Compared with no MetS, MetS costs were increased 2.94-fold for inpatient care (95% CI, 1.23-7.10) and 1.30-fold for ambulatory care for men (95% CI, 1.12-1.52), whereas ambulatory MetS costs were increased 1.28-fold for women (95% CI, 1.05-1.57). MetS was associated with higher risk of cardiovascular disease hospitalization in men (adjusted odds ratio, 1.76; 95% CI, 1.20-2.58) but not in women (adjusted odds ratio, 1.08; 95% CI, 0.67-1.75). Among those with MetS, all-cause and cardiovascular mortality were comparable between men and women. Of the MetS components, low HDL cholesterol had the greatest affect on costs, more so in men (2.23-fold) than women (1.58-fold). CONCLUSIONS: In people with MetS, service costs were greater overall, significantly for men, but not women, and these increased costs were evident for men who experienced hospitalization, but not women. At the same time, cardiovascular and all-cause mortalities were not significantly different by gender in regard to MetS in Taiwanese elders.