Age-related declines in the swallowing muscle strength of men and women aged 20–89 years: A cross-sectional study on tongue pressure and jaw-opening force in 980 subjects
Introduction
Sarcopenia is defined as a progressive and systemic decrease in skeletal muscle mass and strength, accompanied by physical impairment, deterioration in patients’ quality of life, and death (Cruz-Jentoft et al., 2010). The reduction in muscle mass and strength causes frailty and disability in elderly individuals (Xue, Bandeen-Roche, Varadhan, Zhou, & Fried, 2008). In general, muscle strength peaks in the fourth decade, then declines steadily with age (Lindle et al., 1997). In a study of 2468 Japanese individuals aged over 40 years, hand grip strength (HGS) began to decline in men in their sixties and in women in their fifties (Yoshimura et al., 2011). Thus, muscle strength deterioration and weakness already occur in middle age; however, it declines at a faster rate in old age.
In addition, sarcopenia reduces the strength of the muscles involved in swallowing, causing dysphagia in elderly individuals (Butler, Stuart, Leng et al., 2011; Butler, Stuart, Wilhelm et al., 2011; Iinuma et al., 2012; Machida et al., 2017). A relationship between tongue strength and aging has been reported (Butler, Stuart, Leng et al., 2011; Machida et al., 2017; Nicosia et al., 2000), as the tongue plays an important role not only in speech, but also in propelling the bolus into the pharynx and pushing it into the esophagus by contacting the pharyngeal muscles (Felton, Gaige, Reese, Wedeen, & Gilbert, 2007). Although maximal tongue strength decreases gradually with aging, tongue strength during swallowing does not (Nicosia et al., 2000). Furthermore, a study comparing maximum tongue pressure (TP) among age groups concluded that TP was greater in men than in women in the second to fourth decades of life (Utanohara et al., 2008). In addition, TP started to decline sooner in men than in women.
Suprahyoid muscle contraction plays an important role in elevating the hyoid bone, contributing to upper esophageal sphincter opening with cricopharyngeal muscle relaxation (Cook et al., 1989). Decreased suprahyoid muscle contraction results in decreased hyoid elevation, which can cause pharyngeal residue, leading to aspiration after swallowing (Eisenhuber et al., 2002). Recently, we developed a jaw-opening sthenometer to measure suprahyoid strength, as the suprahyoid muscle is a jaw-opening muscle, and showed that the jaw-opening force (JOF) is a useful screening measure for dysphagia (Hara et al., 2014). The JOF is associated with the cross-sectional area of the geniohyoid muscle, which is the one of the suprahyoid muscles (Kajisa et al., 2018). Therefore, the JOF can be used as an indicator of suprahyoid muscle strength. Furthermore, a previous study demonstrated that a low JOF leads to a lower position of the hyoid bone in the neck during resting, resulting in a compensatory larger displacement of the hyoid bone during swallowing (Shinozaki et al., 2017). In addition, we previously demonstrated that the JOF is significantly lower in men with sarcopenia than in men without sarcopenia (Machida et al., 2017). However, data regarding the deterioration of JOF among sex and age groups are lacking. Therefore, in the present study, we investigated the age at which different indices of muscle strength (HGS, TP, and JOF) decline and whether sex effects exist, comparing declines in TP and JOF to those of HGS, as a standard of skeletal muscle strength.
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Participants
Data from 980 healthy participants (379 men, 601 women) who agreed to undergo the measurements listed below were collected from a database system in a Kobayashi dental clinic between April 2015 and March 2017. All participants were Japanese and citizens of Tokyo metropolis. Most of them live in Edogawa-ku, which is located in Tokyo metropolis, that has an estimated population of 682,418. The participants were able to consume regular food and did not complain of dysphagia. The participants
HGS, TP, and JOF among age groups
In both men and women, ANOVAs were performed to evaluate age-group effects on the HGS and TP, while the Kruskal-Wallis test was performed to evaluate the effect of age-group on the JOF (Table 1). Significant age-group differences in the HGS and TP were observed in both men and women, with a large effect size, and in the JOF in men, with a small effect size. Post-hoc analyses demonstrated that the HGS in men in their 60 s was significantly lower than that in men in their 20 s (r = 0.39, medium
Decline in TP with aging
Numerous reports have shown that TP declines with age (Butler, Stuart, Leng et al., 2011; Nicosia et al., 2000; Utanohara et al., 2008). However, only one study on age-related TP deterioration has reported that TP becomes significantly weaker in men in their 60 s and women in their 70 s (Utanohara et al., 2008). In the present study, TP declines significantly in women in their 50 s with a small effect and in men in their 60 s with a medium effect. Reasons for this sex-specific age difference at
Funding
This work was supported by a grant from the Japanese Dental Science Federation (JDSF-DSP1-2017-116-2).
Declaration of interest
None.
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