Is poor chewing ability a risk factor for malnutrition? A six-year longitudinal study of older adults in Sweden

Abstract

Objective: To investigate if poor chewing ability increases the risk of malnutrition and to compare its impact with other contributing factors.

Design: Longitudinal observational study.

Setting: Population-based survey.

Participants: 1,596 community dwelling individuals aged 60 years or older who participated in the Swedish National Study on Aging and Care at Kungsholmen in 2001-2004 (baseline) and in 2007-2011 (follow-up) and were not at risk for malnutrition nor malnourished at baseline.

Measurements: The exposures were baseline chewing ability and change in chewing ability at follow-up. The primary outcome was malnutrition risk or being malnourished, as assessed by the Mini Nutritional Assessment Short-Form. The secondary outcome was weight loss over 10% at follow-up. Logistic regressions assessed the associations between the exposures and the outcomes. The average marginal effects (percentage points) compared the effect of the exposure versus covariates on outcome probability.

Results: 150 (9.4%) reported having difficulty chewing hard food, while 191 (12.0%) had persistent difficulties chewing hard food or lost the ability during the follow-up. At the time of follow-up, 212 (13.3%) were at risk or malnourished, while 179 (11.2%) had weight loss of more than 10%. Self-reported difficulty chewing hard food increased the odds of being at risk or malnourished at follow-up (OR = 1.64, 95% CI = 1.06, 2.53) and having weight loss of more than 10% (OR = 1.72, 95% CI = 1.10, 2.68). Individuals who had persistent difficulty chewing hard food or lost the ability to chew hard food during the follow-up period were more likely to be at risk or malnourished (OR = 1.87, 95% CI = 1.26, 2.79) or had a weight loss of more than 10% (OR = 1.73, 95% CI = 1.12, 2.65). Having difficulty chewing hard food at baseline increased the probability of the two outcomes by approximately 6 percentage points, whereas the covariates increased or decreased the probabilities by 4-16 percentage points.

Conclusion: Poor chewing ability may be a low-risk factor for malnutrition in older individuals. Self-reported difficulty chewing hard food during dental visits should be addressed.

Keywords: Living arrangement; Longitudinal study; Masticatory; Nutritional status; Oral health; Weight loss.