Development of a multiple masticatory function model based on the evaluation of sarcopenia: A cross-sectional survey of the Otassha study.

OBJECTIVE: The masticatory function is intricately linked to several factors like natural teeth count, occlusion, masticatory muscles, and tongue coordination. This study's goal was to formulate a comprehensive masticatory function model, considering sarcopenia's conceptual structure, and subsequently validate its measurement efficacy. DESIGN: The study encompassed 753 participants (59.1 % women; mean age: 73.0 ± 5.1 years) from an urban community. The model amalgamated masseter muscle mass, occlusal force, and mixing ability. Based on the Asian Working Group for Sarcopenia 2019 classification, participants were categorized into a multiple masticatory dysfunction (MMD) or severe MMD (S-MMD) group. Logistic regression analysis gauged the model's validity, using serum albumin levels and self-reported chewing difficulties as dependent variables. RESULTS: Of the total, 61 (8.1 %) participants exhibited MMD, while 24 (3.2 %) had S-MMD. S-MMD was correlated with low serum albumin levels (odds ratio: 3.62; 95 % confidence interval: 1.07-12.29) and heightened self-reported chewing difficulties (odds ratio: 2.82; 95 % confidence interval: 1.09-7.28). CONCLUSIONS: Our multiple masticatory function model offers a straightforward approach for assessing MMD. Furthermore, the study establishes a link between S-MMD, nutritional vulnerability, and self-reported chewing challenges, thus affirming the model's credibility.

Development of a simple method to measure masseter muscle mass.

OBJECTIVE: To develop a simple method to estimate masseter muscle mass. BACKGROUND: The masseter muscle is important for optimal oral function. A decrease in the masseter muscle mass may affect the oral and physical function of the whole body; therefore, it is an important entity to measure. However, to date, no easy measurement method has been developed for the same. Herein, we devised a simple method to estimate masseter muscle mass. In addition, we compared our method with magnetic resonance imaging (MRI) and skeletal muscle mass (SMM) to verify its validity. MATERIALS AND METHODS: We recorded the age, sex, masseter muscle mass (by MRI), number of retained natural teeth, number of functional teeth, length and thickness of masseter muscle, and skeletal muscle mass in 53 community-dwelling elderly people (21 men and 32 women, average age 72.9 ± 4.5 years). The estimated masseter muscle mass was calculated by multiplying the length, width and thickness of the muscle. RESULTS: The correlation coefficient between masseter muscle mass and estimated masseter muscle mass was r = .903; thus, a strong correlation was recognised. The correlation coefficient between the estimated masseter muscle mass and SMM was r = .279, considering age and sex. CONCLUSION: We obtained substantial results using our method for estimating the masseter muscle mass and verified its validity by comparing it with masseter muscle mass measured by MRI and SMM. We believe that our proposed technique is simple and useful for estimating masseter muscle mass.

Relationship between mortality and Council of Nutrition Appetite Questionnaire scores in Japanese nursing home residents.

OBJECTIVE: This 1-y cohort study examined whether Council of Nutrition Appetite Questionnaire (CNAQ) scores predicted mortality in 316 elderly Japanese residents of five nursing homes (60 men, 256 women; mean age: 84.9 ± 8.3 y). METHODS: The baseline survey included participant characteristics (e.g., age, sex, height, weight, and medical history), and Barthel Index (BI), Clinical Dementia Rating (CDR), Mini Nutritional Assessment-Short Form (MNA®-SF), CNAQ, Simplified Nutritional Appetite Questionnaire (SNAQ; simplified CNAQ), and SNAQ for the Japanese elderly (SNAQ-JE) scores. RESULTS: Following the baseline survey, mortality data were collected for 1 y; during this time, 62 participants (19.6%) died. The deceased group's CNAQ scores (25.1 ± 4.8) were significantly lower than those of the survival group (28 ± 3.6; P < 0.001). After adjusting for age, sex, medical history, BI, CDR, and MNA®-SF scores in Cox proportional regression, CNAQ (hazard ratio [HR], 0.91; 95% confidence interval [CI], 0.85-0.97; P = 0.004), SNAQ (HR, 0.84; 95% CI, 0.75-0.93; P = 0.001), and SNAQ-JE (HR, 0.84; 95% CI, 0.76-0.92; P < 0.001) scores were related to mortality. CONCLUSIONS: This study showed that CNAQ scores were inversely associated with 1-y mortality. Furthermore, appetite assessment using the CNAQ predicted the death of Japanese nursing home residents. Similarly, the SNAQ and SNAQ-JE scores were inversely associated with 1-y mortality.

The relationship between masseter muscle thickness and appendicular skeletal muscle mass in Japanese community-dwelling elders: A cross-sectional study.

PURPOSE OF THE STUDY: Sarcopenia has been identified as a health hazard in elderly people. Although the association between sarcopenia and a decrease in masticatory function has been reported, the mechanism underlying this association has not been widely reported. Therefore, in order to elucidate the relationship between sarcopenia and masticatory function, we examined whether the masseter muscle thickness (MMT), which is a factor influencing masticatory function, in community-dwelling elders is associated with the appendicular skeletal muscle index (SMI), a diagnostic criterion for sarcopenia. MATERIALS AND METHODS: MMT was measured in 774 community-dwelling elders aged 65 years or older at resting state via ultrasonography, and SMI was measured with the bioelectrical impedance method. The relationships were investigated by calculating Pearson's correlation coefficients. Multiple regression analyses adjusted for age and sex, SMI, and oral-related items were performed to determine the association between these factors. RESULTS: There was a significant correlation between the MMT and the SMI. The multiple regression analysis indicated that SMI was significantly associated with a decrease in MMT. CONCLUSIONS: The reduction in whole-body skeletal muscle mass in sarcopenia may be involved in the reduction in MMT. Prevention of sarcopenia may be an important factor for maintaining masticatory function in the elderly.

Oral function as an indexing parameter for mild cognitive impairment in older adults.

AIM: To investigate the association between mild cognitive impairment (MCI) and oral status, and to develop an oral-based screening index for MCI. METHODS: A cross-sectional study was carried out in a total of 5104 community-dwelling adults (aged ≥65 years) from the Obu Study of Health Promotion for the Elderly. Screening for MCI included a standardized personal interview, Mini-Mental State Examination, Geriatrics and Gerontology-Functional Assessment Tool (which included 8 tasks used to assess logical memory, word list memory, attention and executive function, processing speed, and visuospatial skill) and oral status. RESULTS: In our study, 930 individuals were diagnosed with MCI, whereas the remaining 2669 were not. Both men and women with MCI showed a significantly lower number of functional and present teeth, poorer oral diadochokinesis, and less palpation of masseter muscle tension (P < 0.01). Discriminant analysis of participants with MCI, between categories of pertinence and non-pertinence, showed significant associations for age, sex, educational background, handgrip strength, Geriatric Depression Scale score, Mini-Mental State Examination score, history of heart disease, albumin level and oral diadochokinesis representing oral motor skill. Although the diagnosis rate of our screening index for MCI was not high, it was in the acceptable range as a screening index. CONCLUSIONS: Oral motor skill, such as lip movement, might be impaired in patients with MCI. Detecting decreasing oral motor dexterity supports the early detection of MCI, and might be key to improve the prognosis of dementia. Geriatr Gerontol Int 2018; 18: 790-798.

Factors affecting masticatory function of community-dwelling older people: Investigation of the differences in the relevant factors for subjective and objective assessment.

OBJECTIVE: This study aimed to examine relevant factors for subjective and objective assessment of masticatory functions and elucidate any differences between the two methods. BACKGROUND: Previous studies have reported that the results of subjective and objective assessment of masticatory function in older people do not necessarily agree. MATERIALS AND METHODS: This study included 487 community-dwelling Japanese older people (205 male and 282 female; mean age 74.1±6.3 years) who participated in a comprehensive geriatric health examination. Basic information (gender and age), higher level of competence in daily living, depression, subjective masticatory function (SMF) and objective masticatory function (OMF) assessments, cognitive function, skeletal muscle mass, handgrip strength, gait speed and oral status (number of remaining and functional teeth, mouth dryness and occlusal force) were recorded. RESULTS: Multiple logistic regression analysis showed that depression (odds ratio [OR]: 1.181, 95% confidence interval [CI]: 1.094-1.275), mouth dryness (OR: 2.037, CI: 1.212-3.423) and occlusal force (OR: 0.997, CI: 0.996-0.999) were significantly associated with SMF, whereas higher level of competence in daily living (OR: 0.730 CI: 0.586-0.910), skeletal muscle mass (OR: 0.521 CI: 0.283-0.960), number of functional teeth (OR: 0.862 CI: 0.775-0.959), number of remaining teeth (OR: 0.868 CI: 0.810-0.930) and occlusal force (OR: 0.994, CI: 0.991-0.998) were associated with OMF. CONCLUSION: Subjective masticatory functionSMF and OMF were associated with different factors, suggesting that both mental and physical factors should be taken into consideration when treating decreased masticatory function.

Relationship Between Frailty and Oral Function in Community-Dwelling Elderly Adults.

OBJECTIVES: To determine the standard values of and age-related changes in objective oral function of healthy older people; compare oral function of robust, prefrail, and frail older people; and determine the association between oral function and frailty. DESIGN: Cross-sectional analysis. SETTING: General community. PARTICIPANTS: Elderly adults (≥65) from the Obu Study of Health Promotion for the Elderly were included and assigned to the robust, prefrail, and frail groups (N = 4,720). MEASUREMENTS: Each participant underwent detailed physical testing to assess frailty. The frailty phenotype was defined according to the presence of limitations in three or more of the following five domains: mobility, strength, endurance, physical activity, and nutrition. The numbers of present teeth and functional teeth were counted, and occlusal force, masseter muscle thickness, and oral diadochokinesis (ODK) rate were measured, along with sociodemographic and functional status, comorbidities, and blood chemistry. RESULTS: The number of present teeth, occlusal force, masseter muscle thickness, and ODK rate decreased with age. The frail group had significantly fewer present teeth (women aged ≥70), lower occlusal force (women aged ≥70; men aged ≥80), lower masseter muscle thickness, and lower ODK rate than the robust group. Multivariate analysis indicated that age, Geriatric Depression Scale score, skeletal muscle mass index, Mini-Mental State Examination score, hypertension, diabetes mellitus, albumin and triglyceride levels, and oral function were significantly associated with frailty. CONCLUSION: Age-related differences in oral function were found in older adults. Moreover, frail older individuals had significantly poorer oral function than prefrail and robust individuals. The risk of frailty was associated with lower occlusal force, masseter muscle thickness, and ODK rate.

Relationship between chewing ability and sarcopenia in Japanese community-dwelling older adults.

AIM: It has been reported that if nutrient intake is unbalanced, muscle mass, muscle strength and physical performance declines, and therefore it is important to maintain chewing ability to keep a balanced nutrient intake. However, the relationship between chewing ability and sarcopenia has not been previously reported. Therefore, the present study investigated the relationship between chewing ability and sarcopenia in addition to known sarcopenia-related factors. METHODS: We examined 761 participants (average age 73.0 ± 5.1 years), who lived in the Itabashi city of Tokyo. Our research was designed to examine the relationship between chewing ability and sarcopenia. We carried out regression analysis to analyze the relationship with sarcopenia-related factors with consideration of the age of the participants. RESULTS: The 761 participants were divided into two groups in terms of the stage of sarcopenia according to whether there was a deterioration of muscle strength or physical performance. Furthermore, we carried out logistic regression analyses on the value as a dependent variable, including known sarcopenia-related factors. There were significant correlations of sarcopenia with age (odds ratio 2.37, 95% confidence interval 1.52-3.70), body mass index (odds ratio 0.75, 95% confidence interval 0.69-0.81) and chewing ability (odds ratio 2.18, 95% confidence interval 1.21-3.93). CONCLUSIONS: The present study shows that chewing ability is related to sarcopenia, which is equal to the relationship with the known factor of age by odds ratio.

Efficient drug delivery of Paclitaxel glycoside: a novel solubility gradient encapsulation into liposomes coupled with immunoliposomes preparation.

Although the encapsulation of paclitaxel into liposomes has been extensively studied, its significant hydrophobic and uncharged character has generated substantial difficulties concerning its efficient encapsulation into the inner water core of liposomes. We found that a more hydrophilic paclitaxel molecule, 7-glucosyloxyacetylpaclitaxel, retained tubulin polymerization stabilization activity. The hydrophilic nature of 7-glucosyloxyacetylpaclitaxel allowed its efficient encapsulation into the inner water core of liposomes, which was successfully accomplished using a remote loading method with a solubility gradient between 40% ethylene glycol and Cremophor EL/ethanol in PBS. Trastuzumab was then conjugated onto the surface of liposomes as immunoliposomes to selectively target human epidermal growth factor receptor-2 (HER2)-overexpressing cancer cells. In vitro cytotoxicity assays revealed that the immunoliposomes enhanced the toxicity of 7-glucosyloxyacetylpaclitaxel in HER2-overexpressing cancer cells and showed more rapid suppression of cell growth. The immunoliposomes strongly inhibited the tumor growth of HT-29 cells xenografted in nude mice. Notably, mice survived when treated with the immunoliposomes formulation, even when administered at a lethal dose of 7-glucosyloxyacetylpaclitaxel in vivo. This data successfully demonstrates immunoliposomes as a promising candidate for the efficient delivery of paclitaxel glycoside.

Risk factors for postoperative dysphagia in oral cancer.

With the founding of its Oral Cancer Center at the Ichikawa General Hospital, Tokyo Dental College established a support system for patients and family members that not only provides surgery and other conventional cancer-oriented treatments, but also palliative care, nutritional support, rehabilitation, and discharge support. With this in mind, the present study sought to examine the nature of support for oral cancer patients with postoperative eating and swallowing disorders by investigating these disorders and identifying their risk factors. The study population comprised 75 surviving oral cancer patients (46 men and 29 women) discharged from the Tokyo Dental College Oral Cancer Center following treatment over a 2-year period from April 2009 to March 2011. Risk factors affecting eating and swallowing function were identified by statistical analysis. Mean age of the patients was 67.3±13.7 years. Fifteen patients had stage I cancer, while 25 had stage II, 13 had stage III, and 22 had stage IV. The feeding route at the time of discharge was oral feeding in 74 patients and a combination of oral and gastrostomy tube feeding in 1 patient. The Tokyo Dental College Ichikawa General Hospital has standardized the expert evaluation and rehabilitation of oral cancer patients with eating and swallowing disorders by establishing a multidisciplinary support system from the preoperative stage onwards. In this context, the results of our analysis of factors influencing the ability of oral cancer patients to orally ingest food after treatment suggest that preoperative cancer stage classification, neck dissection, and tracheotomy are all influential factors. Patients affected by these factors require further multidisciplinary treatment, which in turn necessitates more extensive coordination with other medical professionals and community health care providers.

Method-dependent HbA1c values in a family with hemoglobin Himeji.

BACKGROUND: Hb Himeji is variant hemoglobin associated with increased glycation in a mutated ß chain. We measured HbA1c using various methods in a family with Hb Himeji. METHODS: The proband was a 42-y female. While receiving treatment for Graves' disease, an oral glucose tolerance test showed normal glucose tolerance, but HbA1c by enzymatic assay was abnormally elevated (11.6%). Hemoglobin gene analysis identified Hb Himeji [ß140 (H18) Ala→Asp]. RESULTS: HbA1c values measured by high-performance liquid chromatography (HPLC; HLC-723G8 and HA-8160 instruments), immunoassay, enzymatic assay, affinity method, and electrospray ionization/mass spectrometry were 3.2%, 5.2%, 11.5%, 9.7%, 7.2%, and 9.6%, respectively. Glycation product of the variant hemoglobin measured by HPLC, using HLC-723G8 and HA-8160, was 9.1% and 4.5%, respectively. The proband's father with type 2 diabetes was the first reported case of Hb Himeji. HbA1c by affinity method was markedly elevated (18.0%), but it was 5.3% by HPLC. The proband's two sisters also had Hb Himeji variant and similar method-dependent discrepancies in HbA1c values were observed. CONCLUSIONS: In the patients with Hb Himeji, discrepancies occur between plasma glucose and HbA1c with all measurement methods because of differences in HPLC mobility, increased glycation, and antigenic changes of the variant ß chain.

Reduction of cadmium uptake in spinach (Spinacia oleracea L.) by soil amendment with animal waste compost.

A field experiment was conducted to evaluate the efficacy of animal waste compost (AWC) in reducing Cd uptake by spinach (Spinacia oleracea L.). Spinach was grown in a field that had been treated by having cattle, swine, or poultry waste compost incorporated into the soil before each crop throughout 4 years of rotational vegetable production. Cadmium concentration was 34-38% lower in spinach harvested from the AWC-treated soils than in the chemical fertilizer-treated soil. Although the repeated application of swine and poultry compost caused significant P accumulation in the cropped soils, that of cattle compost did not. These results indicate that cattle compost with high affinity for Cd and low P content should be the preferred soil amendment when used to reduce Cd uptake by spinach.

Phytoextraction by rice capable of accumulating Cd at high levels: reduction of Cd content of rice grain.

In accordance with a new international standard set by the Codex Alimentarius Commission for cadmium (Cd) contentin rice grain, Japan must perform large-scale remediation of paddy fields polluted with lowto moderate levels of Cd. Phytoextraction using hyperaccumulating wild plants has been proposed as a low-cost, environmentally friendly restoration technology. However, because of difficulties with sowing, weed and disease control, and harvesting, hyperaccumulators may not be suitable for large-scale phytoextraction in polluted paddy fields. Here, we demonstrated phytoextraction using Indica-type rice cultivars capable of accumulating Cd at high levels. Phytoextraction with the Indica rice Chokoukoku grown for 2 years without irrigation after drainage removed 883 g Cd ha(-1), reduced the total soil Cd content by 38%, and reduced the grain Cd content in subsequently grown Japonica food rice by 47% without decreasing yield. The results suggest that phytoextraction with Chokoukoku can remove Cd from paddy fields polluted with low to moderate levels of Cd and reduce the grain Cd concentration of Japonica food rice cultivars to below the Codex standard within a reasonable time frame. This approach will help reduce the risk of Cd contamination of rice from paddy fields.

Potential for phytoextraction of copper, lead, and zinc by rice (Oryza sativa L.), soybean (Glycine max [L.] Merr.), and maize (Zea mays L.).

Phytoextraction by hyperaccumulators has been proposed for decreasing toxic-metal concentrations of contaminated soils. However, hyperaccumulators have several shortcomings to introduce these species into Asian Monsoon's agricultural fields contaminated with low to moderate toxic-metals. To evaluate the phytoextraction potential, maize (Gold Dent), soybean (Enrei and Suzuyutaka), and rice (Nipponbare and Milyang 23) were pot-grown under aerobic soil conditions for 60d on the Andosol or Fluvisol with low to moderate copper (Cu), lead (Pb), and zinc (Zn) contamination. After 2 months cultivation, the Gold Dent maize and Milyang 23 rice shoots took up 20.2-29.5% and 18.5-20.2% of the 0.1molL(-1) HCl-extractable Cu, 10.0-37.3% and 8.5-34.3% of the DTPA-extractable Cu, and 2.4-6.5% and 2.1-5.9% of the total Cu, respectively, in the two soils. Suzuyutaka soybean shoot took up 23.0-29.4% of the 0.1molL(-1) HCl-extractable Zn, 35.1-52.6% of the DTPA-extractable Zn, and 3.8-5.3% of the total Zn in the two soils. Therefore, there is a great potential for Cu phytoextraction by the Gold Dent maize and the Milyang 23 rice and for Zn phytoextraction by the Suzuyutaka soybean from paddy soils with low to moderate contamination under aerobic soil conditions.

Phytoextraction by a high-Cd-accumulating rice: reduction of Cd content of soybean seeds.

Soybeans (Glycine max (L) Merr.) are the major summer crop grown in Japanese upland fields (characterized by aerobic soil) that have been converted from paddies. To evaluate the effect of phytoextraction by rice on the seed cadmium (Cd) content of soybeans grown subsequently, we grew Milyang 23, a high-Cd-accumulating rice cultivar, and then grew soybeans in three paddy soils contaminated with moderate Cd concentrations (2.50-4.27 mg Cd kg(-1)). The rice accumulated 7-14% of the total soil Cd in its shoots. The soybean seed Cd contents were 24-46% less than those grown on control soils. Phytoextraction by Milyang 23 rice is thus a promising remediation method for reducing seed Cd contents of soybeans grown on paddy soils under aerobic soil conditions.