Diagnostic accuracy of lip force and tongue strength for sarcopenic dysphagia in older inpatients: A cross-sectional observational study
Diagnostic accuracy of lip force and tongue strength for sarcopenic dysphagia in older inpatients: A cross-sectional observational study
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DOI：
10.1016/j.clnu.2018.01.016
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发表时间：
2019-02-01
影响因子：
6.3
通讯作者：
Ueda, Koichiro
中科院分区：
文献类型：
--
作者：
Sakai, Kotomi;Nakayama, Enri;Ueda, Koichiro
背景与目的：老年人的吞咽困难可由肌肉减少症引起。尽管有报道称肌肉减少性吞咽困难与舌力低有关，但舌力是否可作为肌肉减少性吞咽困难的诊断指标尚不清楚。此外，肌肉减少性吞咽困难与唇部力量之间的关系尚不清楚。本研究的目的是澄清唇力和舌力与肌肉减少性吞咽困难的关系，以及它们对肌肉减少性吞咽困难的诊断准确性。方法：对245例（166例女性）年龄bb0 = 65岁急性期后住院患者进行横断面研究。评估肌肉减少性吞咽困难、唇力和舌力的存在。还评估了其他因素：认知功能、营养状况、合并症、口服摄入量、闭塞状态、身体功能和炎症状态。以肌减少性吞咽困难为因变量，进行多变量logistic回归分析。用受试者工作特征曲线下面积（AUC）评估唇力和舌力，以明确肌肉减少性吞咽困难的诊断准确性。此外，根据性别确定唇力和舌力的临界值，以识别肌肉减少性吞咽困难。结果：86例患者（35.1%）出现肌肉减少性吞咽困难。患有肌肉减少性吞咽困难的男性和女性的下唇力量和舌头力量都比没有吞咽困难或肌肉减少性吞咽困难的男性和女性低（p < 0.001）。在多变量logistic回归分析中，肌肉减少性吞咽困难与唇部力量（OR = 0.63, 95% CI 0.53-0.74, p < 0.001）和舌部力量（OR = 0.92, 95% CI 0.87-0.98, p = 0.011）显著相关。肌肉减少性吞咽困难患者的唇力auc男性为0.88 (CI 0.81-0.95, p < 0.001)，女性为0.84 （CI 0.77-0.90, p < 0.001）。男性舌头强度的auc为0.79 (CI 0.69-0.89, p < 0.001)，女性为0.74 （CI 0.65-0.82, p < 0.001）。男性肌肉萎缩性吞咽困难的临界值为唇力10.4 N，舌力24.3 kPa；女性为唇力8.5 N，舌力23.9 kPa。结论：在怀疑有肌少症功能障碍的老年住院患者中，唇力和舌力可作为诊断肌少症性吞咽困难的独立有用指标，可能是预防和改善肌少症性吞咽困难的因素。(C) 2018爱思唯尔有限公司和欧洲临床营养与代谢学会。版权所有。
Background & aims: Dysphagia can be caused by sarcopenia in older adults. Although sarcopenic dysphagia has been reported to be associated with low tongue strength, whether tongue strength can be useful as a diagnostic index for sarcopenic dysphagia remains unclear. In addition, the association between sarcopenic dysphagia and lip force is unknown. The aim of the present study was to clarify the association of lip force and tongue strength with sarcopenic dysphagia, and their diagnostic accuracy for sarcopenic dysphagia.Methods: A cross-sectional study was conducted in consecutive 245 (166 women) inpatients aged >= 65 years in the post-acute phase of illness. The presence of sarcopenic dysphagia, lip force, and tongue strength were assessed. Additional factors were also assessed: cognitive function, nutritional status, comorbidity, oral intake level, occlusion status, physical function, and inflammatory status. Multivariable logistic regression analysis was conducted with the presence of sarcopenic dysphagia as a dependent variable. Lip force and tongue strength were assessed with the area under the receiver operating characteristic curve (AUC) to clarify diagnostic accuracy for sarcopenic dysphagia. In addition, the cut-off values of lip force and tongue strength for identifying sarcopenic dysphagia were determined according to sex.Results: In total, 86 patients (35.1%) had sarcopenic dysphagia. Both men and women with sarcopenic dysphagia had lower lip force and tongue strength than men and women without dysphagia or sarcopenic dysphagia (p < 0.001 for all). In multivariable logistic regression analysis, sarcopenic dysphagia was significantly associated with lip force (OR = 0.63, 95% CI 0.53-0.74, p < 0.001) and tongue strength (OR = 0.92, 95% CI 0.87-0.98, p = 0.011). The AUCs for lip force in patients with sarcopenic dysphagia were 0.88 (CI 0.81-0.95, p < 0.001) for men and 0.84 (CI 0.77-0.90" p < 0.001) for women. The AUCs for tongue strength were 0.79 (CI 0.69-0.89, p < 0.001) for men and 0.74 (CI 0.65-0.82, p < 0.001) for women. The cut-off values for sarcopenic dysphagia in men were 10.4 N for lip force and 24.3 kPa for tongue strength: the cut-off values in women were 8.5 N for lip force and 23.9 kPa for tongue strength.Conclusion: In older inpatients who are suspected as having dysfunction due to sarcopenia, lip force and tongue strength can be independently useful indices for diagnosing sarcopenic dysphagia, and may be factors that prevent and improve sarcopenic dysphagia. (C) 2018 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.