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第38巻 第2号 >

高齢者におけるオーラルフレイルの診断とサルコペニアおよびメタボリック・シンドロームとの関連について

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Title: 高齢者におけるオーラルフレイルの診断とサルコペニアおよびメタボリック・シンドロームとの関連について
Other Titles: Relationship of oral frailty to sarcopenia and metabolic syndrome in community-dwelling elderly
Authors: 安倍, 嘉彦1 Browse this author
高橋, 収2 Browse this author
本多, 丘人3 Browse this author →KAKEN DB
兼平, 孝4 Browse this author →KAKEN DB
竹原, 順次5 Browse this author →KAKEN DB
今村, 理子6 Browse this author
澤飯, 順子7 Browse this author
菊田, 有美8 Browse this author
花田, 優里子9 Browse this author
齊藤, 麻美10 Browse this author
河口, 明人11 Browse this author →KAKEN DB
Authors(alt): Abe, Yoshihiko1
Takahashi, Osamu2
Honda, Okahito3
Kanehira, Takashi4
Takehara, Junji5
Imamura, Riko6
Sawai, Junko7
Kikuta, Yumi8
Hanada, Yuriko9
Saitoh, Asami10
Kawaguchi, Akito11
Keywords: オーラルフレイル
サルコペニア
メタボリック・シンドローム
インスリン抵抗性
診断基準
Oral frailty
Sarcopenia
Metabolic syndrome
Insulin reisistance
Diagnostic criteria
Issue Date: Mar-2018
Publisher: 北海道歯学会
Journal Title: 北海道歯学雑誌
Volume: 38
Issue: 2
Start Page: 234
End Page: 242
Abstract: 高齢者におけるオーラルフレイル(OF)に対する早期スクリーニングを可能にする指標を考案し,OF分布の検討及びサルコペニアおよびメタボリック・シンドロームとの関連性を検討した.喜茂別町の65歳以上高齢者111名を対象とし,Eichner分類B4以上(61.0%),RSST3回未満(64.4%)かつ口腔湿潤度29.0未満(50.5%)の者をOFとした時,OF群は24名(21.6%)で,非OF群87名と比較して高齢だったが,性別には差はなかった.OF群では上顎残存歯数が有意に少なく(P <.05),上・下顎FD頻度が高く(P <.05),自覚症状として「固いものが食べにくい」という回答に差があった(P <.05).OF群とNon-OF群との身体組成(BIA法)の比較では,除脂肪量に差はなかったが,体脂肪量をはじめ,肥満指標としてのBMI,腹部周囲径,内臓脂肪面積,ウエストヒップ比がOF群で有意に高かった.さらに血清生化学指標においても,メタボリック・シンドロームの特徴的な代謝病態であるトリグリセリド高値,HDL-C低値の脂質異常を示し,インスリン抵抗性の指標としてのHOMA-Rが有意に高かった.一方,高齢者の筋力減弱症としてのサルコペニア(筋量減少,筋力低下,遂行機能低下)の指標である,筋量指標としての四肢骨格筋量指標,筋力の指標としての握力,および遂行機能の評価項目としての歩行速度そのものには両群では差はなかったが,サルコペニア該当数は7名(29.2%)でOF群に有意に多かった(P <.05).またOFの診断にこだわらず,自覚症状の「固いもの困難」群とそれ以外との検討においても,固いものが困難と答えた群は,身体遂行機能としての歩行速度が有意に遅く,サルコペニアの傾向にあることが明らかとなった.本研究では,咬合・咀嚼機能としてのEichner分類,嚥下機能低下,口腔湿潤度低下を診断項目としたOFに該当する高齢者は,同時にメタボリック・シンドロームおよびサルコペニアの傾向をもつことを示し,OFが全身的な病態と関連していることを明らかにするとともに,本研究のOFの診断方法と診断基準の妥当性が示唆された.
Background : Poor oral health is associated with morbidity of cardiovascular disease and mortality through certain risk factors. However, a definition of oral frailty has not been established, and little is known about how oral frailty is related to systemic vulnerability, such as sarcopenia and metabolic syndrome. Methods : One -hundred and eleven elderly people living in a rural community (M/F : 43/68, 77.9 ± 7.1) were recruited with the cooperation of the local government on the basis of a written consent form. After definition of an OF based on three items, which are the dysfunction of articulation/mastication (Eichner’s classification ≧ B4), the dysfunction of swallowing (RSST < 3), and decreased oral moistness (< 29.0 : measurement by “MucusR”), we compared clinical aspects between the elderly in our group with, and without OF. Sarcopenia was diagnosed by the criteria : decreased hand grip (M : < 26 kg, F : <18 kg) or lowered gait speed (0.8 m/sec) as a premise of loss of muscle mass (M : < 6.6 kg/m2, F : < 5.0 g/ m2). HOMA-R as an index of insulin resistance was calculated as fasting blood sugar (FBS) × fasting IRI divided by 405. Results : More than 60 % of the elderly group had dysfunction of articulation/mastication (61.0 %) and dysfunction of swallowing (64.4 %) and half of them had dry mouth (decreased oral moistness). Twenty-four were (M/F : 10/14) diagnosed as OF by the above criteria and were older than without OF (P < .01). The group with OF had a smaller number of remaining-teeth in maxilla, and complained of difficulty in chewing hard foods. For those with components of sarcopenia, there were no different values in the skeletal muscle mass index (SMI), hand grip, and gait speed between the elderly group with OF and without OF. However, a diagnoses of sarcopenia was distributed higher in the group with OF than without OF. The group with OF were obese, because of higher waist girth, visceral fat and waist-hip ratio, but no difference of fat free mass. Biochemical analysis showed an increased TG and decreased HDL-C level, those are characteristic aspects of metabolic syndrome. Although no difference of fasting blood sugar and HbA1c, the group with OF had increased fasting IRI, resulting in higher HOMA-R as an index of insulin resistance. Conclusion : The group of elderly people selected for this study with oral frailty diagnosed by the three factors showed a likeliness to have characteristic clinical aspects such as metabolic syndrome and sarcopenia. It is suggested that oral frailty is linked to systemic pathogenesis.
Type: article
URI: http://hdl.handle.net/2115/68809
Appears in Collections:北海道歯学雑誌 = Hokkaido Journal of Dental Science > 第38巻 第2号

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