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Erschienen in: The journal of nutrition, health & aging 7/2016

18.12.2015

Swallowing function and nutritional status in Japanese elderly people receiving home-care services: A 1-year longitudinal study

verfasst von: Y. Okabe, M. Furuta, S. Akifusa, K. Takeuchi, M. Adachi, T. Kinoshita, T. Kikutani, S. Nakamura, Yoshihisa Yamashita

Erschienen in: The journal of nutrition, health & aging | Ausgabe 7/2016

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Abstract

Objectives

Malnutrition is a serious health concern for frail elderly people. Poor oral function leading to insufficient food intake can contribute to the development of malnutrition. In the present study, we explored the longitudinal association of malnutrition with oral function, including oral health status and swallowing function, in elderly people receiving home nursing care.

Design

Prospective observational cohort study with 1-year follow-up.

Setting

Two mid-sized cities in Fukuoka, Japan from November 2010 to March 2012.

Participants

One hundred and ninety-seven individuals, aged ≥ 60 years, living at home and receiving homecare services because of physical disabilities, without malnutrition.

Measurements

Oral health status, swallowing function, taking modified-texture diets such as minced or pureed foods, nutritional status, cognitive function, and activities of daily living were assessed at baseline. The associations between malnutrition at 1-year follow-up and these related factors were analyzed using a logistic regression model.

Results

Swallowing disorders [risk ratio (RR): 5.21, 95% confidence interval (95% CI): 1.65–16.43] were associated with malnutrition. On the other hand, oral health status did not have a direct association with malnutrition.

Conclusion

Swallowing disorders may be associated with the incidence of malnutrition in elderly people receiving home-care. The findings indicate that maintaining swallowing function may contribute to the prevention of malnutrition in frail elderly people.
Literatur
1.
Zurück zum Zitat Statistical Burear Ministry of Internal Affairs and Communications. Population Estimates, Monthly Report. http://www.stat.go.jp/english/data/jinsui/tsuki/index.htm. Accessed 13 March 2015 Statistical Burear Ministry of Internal Affairs and Communications. Population Estimates, Monthly Report. http://​www.​stat.​go.​jp/​english/​data/​jinsui/​tsuki/​index.​htm.​ Accessed 13 March 2015
2.
Zurück zum Zitat Cabinet office goverment of Japan. Heisei 26 nenn kourei syakai hakusho. http://www8.cao.go.jp/kourei/whitepaper/w-2014/zenbun/s1_2_3.html. Accessed 13 March 2015 Cabinet office goverment of Japan. Heisei 26 nenn kourei syakai hakusho. http://​www8.​cao.​go.​jp/​kourei/​whitepaper/​w-2014/​zenbun/​s1_​2_​3.​html.​ Accessed 13 March 2015
3.
Zurück zum Zitat Kuzuya M, Kanda S, Koike T, Suzuki Y, Satake S, Iguchi A. Evaluation of Mini-Nutritional Assessment for Japanese frail elderly. Nutrition 2005;21:498–503.CrossRefPubMed Kuzuya M, Kanda S, Koike T, Suzuki Y, Satake S, Iguchi A. Evaluation of Mini-Nutritional Assessment for Japanese frail elderly. Nutrition 2005;21:498–503.CrossRefPubMed
4.
Zurück zum Zitat Agarwal E, Ferguson M, Banks M, Batterham M, Bauer J, Capra S, et al. Malnutrition and poor food intake are associated with prolonged hospital stay, frequent readmissions, and greater in-hospital mortality: Results from the Nutrition Care Day Survey 2010. Clin Nutr 2013;32:737–745.CrossRefPubMed Agarwal E, Ferguson M, Banks M, Batterham M, Bauer J, Capra S, et al. Malnutrition and poor food intake are associated with prolonged hospital stay, frequent readmissions, and greater in-hospital mortality: Results from the Nutrition Care Day Survey 2010. Clin Nutr 2013;32:737–745.CrossRefPubMed
5.
Zurück zum Zitat Martyn CN, Winter PD, Coles SJ, Edington J. Effect of nutritional status on use of health care resources by patients with chronic disease living in the community. 1998;:119–123. Martyn CN, Winter PD, Coles SJ, Edington J. Effect of nutritional status on use of health care resources by patients with chronic disease living in the community. 1998;:119–123.
6.
Zurück zum Zitat Bollwein J, Volkert D, Diekmann R, Kaiser MJ, Uter W, Vidal K, et al. Nutritional status according to the mini nutritional assessment (MNA®) and frailty in community dwelling older persons: a close relationship. J Nutr Health Aging, 2013;17:351–6.CrossRefPubMed Bollwein J, Volkert D, Diekmann R, Kaiser MJ, Uter W, Vidal K, et al. Nutritional status according to the mini nutritional assessment (MNA®) and frailty in community dwelling older persons: a close relationship. J Nutr Health Aging, 2013;17:351–6.CrossRefPubMed
7.
Zurück zum Zitat Paillaud E, Herbaud S, Caillet P, Lejonc J-L, Campillo B, Bories P-N. Relations between undernutrition and nosocomial infections in elderly patients. Age Ageing 2005;34:619–25.CrossRefPubMed Paillaud E, Herbaud S, Caillet P, Lejonc J-L, Campillo B, Bories P-N. Relations between undernutrition and nosocomial infections in elderly patients. Age Ageing 2005;34:619–25.CrossRefPubMed
8.
Zurück zum Zitat Schneider SM, Veyres P, Pivot X, Soummer A-M, Jambou P, Filippi J, et al. Malnutrition is an independent factor associated with nosocomial infections. Br J Nutr 2004;92:105–11.CrossRefPubMed Schneider SM, Veyres P, Pivot X, Soummer A-M, Jambou P, Filippi J, et al. Malnutrition is an independent factor associated with nosocomial infections. Br J Nutr 2004;92:105–11.CrossRefPubMed
9.
Zurück zum Zitat Corish CA, Kennedy NP. Protein-energy undernutrition in hospital in-patients. Br J Nutr 2000;83:575–91.CrossRefPubMed Corish CA, Kennedy NP. Protein-energy undernutrition in hospital in-patients. Br J Nutr 2000;83:575–91.CrossRefPubMed
10.
Zurück zum Zitat Persson MD, Brismar KE, Katzarski KS, Nordenström J, Cederholm TE. Nutritional status using mini nutritional assessment and subjective global assessment predict mortality in geriatric patients. J Am Geriatr Soc 2002;50:1996–2002.CrossRefPubMed Persson MD, Brismar KE, Katzarski KS, Nordenström J, Cederholm TE. Nutritional status using mini nutritional assessment and subjective global assessment predict mortality in geriatric patients. J Am Geriatr Soc 2002;50:1996–2002.CrossRefPubMed
11.
Zurück zum Zitat Okamura T, Hayakawa T, Hozawa A, Kadowaki T, Murakami Y, Kita Y, et al. Lower Levels of Serum Albumin and Total Cholesterol Associated with Decline in Activities of Daily Living and Excess Mortality in a 12-Year Cohort Study of Elderly Japanese. J Am Geriatr Soc 2008;56:529–535.CrossRefPubMed Okamura T, Hayakawa T, Hozawa A, Kadowaki T, Murakami Y, Kita Y, et al. Lower Levels of Serum Albumin and Total Cholesterol Associated with Decline in Activities of Daily Living and Excess Mortality in a 12-Year Cohort Study of Elderly Japanese. J Am Geriatr Soc 2008;56:529–535.CrossRefPubMed
12.
Zurück zum Zitat Izawa S, Kuzuya M, Okada K, Enoki H, Koike T, Kanda S, et al. The nutritional status of frail elderly with care needs according to the mini-nutritional assessment. Clin Nutr 2006;25:962–7.CrossRefPubMed Izawa S, Kuzuya M, Okada K, Enoki H, Koike T, Kanda S, et al. The nutritional status of frail elderly with care needs according to the mini-nutritional assessment. Clin Nutr 2006;25:962–7.CrossRefPubMed
13.
Zurück zum Zitat Soini H, Muurinen S, Routasalo P, Sandelin E, Savikko N, Suominen M, et al. Oral and nutritional status—Is the MNA a useful tool for dental clinics. J Nutr Health Aging 2006;10:495–499; discussion 500–501.PubMed Soini H, Muurinen S, Routasalo P, Sandelin E, Savikko N, Suominen M, et al. Oral and nutritional status—Is the MNA a useful tool for dental clinics. J Nutr Health Aging 2006;10:495–499; discussion 500–501.PubMed
14.
Zurück zum Zitat Takeuchi K, Aida J, Ito K, Furuta M, Yamashita Y, Osaka K. Nutritional status and dysphagia risk among community-dwelling frail older adults. J Nutr Health Aging 2014;18:352–7.CrossRefPubMed Takeuchi K, Aida J, Ito K, Furuta M, Yamashita Y, Osaka K. Nutritional status and dysphagia risk among community-dwelling frail older adults. J Nutr Health Aging 2014;18:352–7.CrossRefPubMed
15.
Zurück zum Zitat Naka O, Anastassiadou V, Pissiotis A. Association between functional tooth units and chewing ability in older adults: a systematic review. Gerodontology 31:166–77. Naka O, Anastassiadou V, Pissiotis A. Association between functional tooth units and chewing ability in older adults: a systematic review. Gerodontology 31:166–77.
16.
Zurück zum Zitat Furuta M, Yamashita Y. Oral Health and Swallowing Problems. Curr Phys Med Rehabil reports 2013;1:216–222.CrossRef Furuta M, Yamashita Y. Oral Health and Swallowing Problems. Curr Phys Med Rehabil reports 2013;1:216–222.CrossRef
17.
Zurück zum Zitat Dion N, Cotart J-L, Rabilloud M. Correction of nutrition test errors for more accurate quantification of the link between dental health and malnutrition. Nutrition 2007;23:301–7.CrossRefPubMed Dion N, Cotart J-L, Rabilloud M. Correction of nutrition test errors for more accurate quantification of the link between dental health and malnutrition. Nutrition 2007;23:301–7.CrossRefPubMed
18.
Zurück zum Zitat Vanderwee K, Clays E, Bocquaert I, Gobert M, Folens B, Defloor T. Malnutrition and associated factors in elderly hospital patients: a Belgian cross-sectional, multicentre study. Clin Nutr 2010;29:469–76.CrossRefPubMed Vanderwee K, Clays E, Bocquaert I, Gobert M, Folens B, Defloor T. Malnutrition and associated factors in elderly hospital patients: a Belgian cross-sectional, multicentre study. Clin Nutr 2010;29:469–76.CrossRefPubMed
19.
Zurück zum Zitat Cabre M, Serra-Prat M, Palomera E, Almirall J, Pallares R, Clavé P. Prevalence and prognostic implications of dysphagia in elderly patients with pneumonia. Age Ageing 2010;39:39–45.CrossRefPubMed Cabre M, Serra-Prat M, Palomera E, Almirall J, Pallares R, Clavé P. Prevalence and prognostic implications of dysphagia in elderly patients with pneumonia. Age Ageing 2010;39:39–45.CrossRefPubMed
20.
Zurück zum Zitat Lindroos E, Saarela RKT, Soini H, Muurinen S, Suominen MH, Pitkälä KH. Caregiver-reported swallowing difficulties, malnutrition, and mortality among older people in assisted living facilities. J Nutr Health Aging 2014;18:718–22.CrossRefPubMed Lindroos E, Saarela RKT, Soini H, Muurinen S, Suominen MH, Pitkälä KH. Caregiver-reported swallowing difficulties, malnutrition, and mortality among older people in assisted living facilities. J Nutr Health Aging 2014;18:718–22.CrossRefPubMed
21.
Zurück zum Zitat Beck AM. Weight loss, mortality and associated potentially modifiable nutritional risk factors among nursing home residents—a Danish follow-up study. J Nutr Health Aging 2015;19:96–101.CrossRefPubMed Beck AM. Weight loss, mortality and associated potentially modifiable nutritional risk factors among nursing home residents—a Danish follow-up study. J Nutr Health Aging 2015;19:96–101.CrossRefPubMed
22.
Zurück zum Zitat Yong V, Saito Y. National long-term care insurance policy in Japan a decade after implementation: some lessons for aging countries. Ageing Int 2012;37:271–84.CrossRef Yong V, Saito Y. National long-term care insurance policy in Japan a decade after implementation: some lessons for aging countries. Ageing Int 2012;37:271–84.CrossRef
23.
Zurück zum Zitat Ministry of Health, Labour and Welfare Kaigo kyufuhi jittai tyousa kekka no gaikyou. Accessed 13 March 2015. URL http://www.mhlw.go.jp/toukei/list/45-1b. html Ministry of Health, Labour and Welfare Kaigo kyufuhi jittai tyousa kekka no gaikyou. Accessed 13 March 2015. URL http://​www.​mhlw.​go.​jp/​toukei/​list/​45-1b.​ html
24.
Zurück zum Zitat Furuta M, Komiya-Nonaka M, Akifusa S, Shimazaki Y, Adachi M, Kinoshita T, et al. Interrelationship of oral health status, swallowing function, nutritional status, and cognitive ability with activities of daily living in Japanese elderly people receiving home care services due to physical disabilities. Community Dent Oral Epidemiol 2013;41:173–81.CrossRefPubMed Furuta M, Komiya-Nonaka M, Akifusa S, Shimazaki Y, Adachi M, Kinoshita T, et al. Interrelationship of oral health status, swallowing function, nutritional status, and cognitive ability with activities of daily living in Japanese elderly people receiving home care services due to physical disabilities. Community Dent Oral Epidemiol 2013;41:173–81.CrossRefPubMed
25.
Zurück zum Zitat Kaiser MJ, Bauer JM, Ramsch C, Uter W, Guigoz Y, Cederholm T, et al. Validation of the Mini Nutritional Assessment short-form (MNA-SF): a practical tool for identification of nutritional status. J Nutr Health Aging 2009;13:782–8.CrossRefPubMed Kaiser MJ, Bauer JM, Ramsch C, Uter W, Guigoz Y, Cederholm T, et al. Validation of the Mini Nutritional Assessment short-form (MNA-SF): a practical tool for identification of nutritional status. J Nutr Health Aging 2009;13:782–8.CrossRefPubMed
26.
Zurück zum Zitat Suzuki R, Kikutani T, Yoshida M, Yamashita Y, Hirayama Y. Prognosis-related factors concerning oral and general conditions for homebound older adults in Japan. Geriatr Gerontol Int, 2014;15:1001–6.CrossRefPubMed Suzuki R, Kikutani T, Yoshida M, Yamashita Y, Hirayama Y. Prognosis-related factors concerning oral and general conditions for homebound older adults in Japan. Geriatr Gerontol Int, 2014;15:1001–6.CrossRefPubMed
27.
Zurück zum Zitat Zenner PM, Losinski DS, Mills RH. Using cervical auscultation in the clinical dysphagia examination in long-term care. Dysphagia 1995;10:27–31.CrossRefPubMed Zenner PM, Losinski DS, Mills RH. Using cervical auscultation in the clinical dysphagia examination in long-term care. Dysphagia 1995;10:27–31.CrossRefPubMed
28.
Zurück zum Zitat FIM, DW. B. Functional evaluation: the barthel index. Md State Med J 1965;14:61–5. FIM, DW. B. Functional evaluation: the barthel index. Md State Med J 1965;14:61–5.
29.
Zurück zum Zitat Morris JC. The Clinical Dementia Rating (CDR): current version and scoring rules. Neurology 1993;43:2412–4.CrossRefPubMed Morris JC. The Clinical Dementia Rating (CDR): current version and scoring rules. Neurology 1993;43:2412–4.CrossRefPubMed
30.
Zurück zum Zitat Charlson ME, Pompei P, Ales KL, MacKenzie R. A new method of classifying prognostic in longitudinal studies: development and validation. J Chronic Dis 1987;40:373–383.CrossRefPubMed Charlson ME, Pompei P, Ales KL, MacKenzie R. A new method of classifying prognostic in longitudinal studies: development and validation. J Chronic Dis 1987;40:373–383.CrossRefPubMed
31.
Zurück zum Zitat Christensen S, Johansen MB, Christiansen CF, Jensen R, Lemeshow S. Comparison of Charlson comorbidity index with SAPS and APACHE scores for prediction of mortality following intensive care. Clin Epidemiol 2011;3:203–11.CrossRefPubMedPubMedCentral Christensen S, Johansen MB, Christiansen CF, Jensen R, Lemeshow S. Comparison of Charlson comorbidity index with SAPS and APACHE scores for prediction of mortality following intensive care. Clin Epidemiol 2011;3:203–11.CrossRefPubMedPubMedCentral
32.
Zurück zum Zitat Chang C-C, Roberts BL. Feeding difficulty in older adults with dementia. J Clin Nurs 2008;17:2266–74.CrossRefPubMed Chang C-C, Roberts BL. Feeding difficulty in older adults with dementia. J Clin Nurs 2008;17:2266–74.CrossRefPubMed
33.
Zurück zum Zitat Pedersen AM, Bardow A, Jensen SB, Nauntofte B. Saliva and gastrointestinal functions of taste, mastication, swallowing and digestion. Oral Dis 2002;8:117–29.CrossRefPubMed Pedersen AM, Bardow A, Jensen SB, Nauntofte B. Saliva and gastrointestinal functions of taste, mastication, swallowing and digestion. Oral Dis 2002;8:117–29.CrossRefPubMed
34.
Zurück zum Zitat Beck AM. Weight loss, mortality and associated potentially modifiable nutritional risk factors among nursing home residents—a Danish follow-up study. J Nutr Health Aging 2015;19:96–101.CrossRefPubMed Beck AM. Weight loss, mortality and associated potentially modifiable nutritional risk factors among nursing home residents—a Danish follow-up study. J Nutr Health Aging 2015;19:96–101.CrossRefPubMed
35.
Zurück zum Zitat Kikutani T, Yoshida M, Enoki H, Yamashita Y, Akifusa S, Shimazaki Y, et al. Relationship between nutrition status and dental occlusion in community-dwelling frail elderly people. Geriatr Gerontol Int 2013;13:50–4.CrossRefPubMed Kikutani T, Yoshida M, Enoki H, Yamashita Y, Akifusa S, Shimazaki Y, et al. Relationship between nutrition status and dental occlusion in community-dwelling frail elderly people. Geriatr Gerontol Int 2013;13:50–4.CrossRefPubMed
36.
Zurück zum Zitat Cook IJ, Kahrilas PJ. AGA technical review on management of oropharyngeal dysphagia. Gastroenterology 1999;116:455–478.CrossRefPubMed Cook IJ, Kahrilas PJ. AGA technical review on management of oropharyngeal dysphagia. Gastroenterology 1999;116:455–478.CrossRefPubMed
37.
Zurück zum Zitat Miura H, Kariyasu M, Yamasaki K, Arai Y. Evaluation of chewing and swallowing disorders among frail community-dwelling elderly individuals. J Oral Rehabil 2007;34:422–7.CrossRefPubMed Miura H, Kariyasu M, Yamasaki K, Arai Y. Evaluation of chewing and swallowing disorders among frail community-dwelling elderly individuals. J Oral Rehabil 2007;34:422–7.CrossRefPubMed
38.
Zurück zum Zitat Pan W-H, Yeh W-T, Chen H-J, Chuang S-Y, Chang H-Y, Chen L, et al. The U-shaped relationship between BMI and all-cause mortality contrasts with a progressive increase in medical expenditure: a prospective cohort study. Asia Pac J Clin Nutr 2012;21:577–87.PubMed Pan W-H, Yeh W-T, Chen H-J, Chuang S-Y, Chang H-Y, Chen L, et al. The U-shaped relationship between BMI and all-cause mortality contrasts with a progressive increase in medical expenditure: a prospective cohort study. Asia Pac J Clin Nutr 2012;21:577–87.PubMed
39.
Zurück zum Zitat Kikutani T, Kodama M, Nishiwaki K, Fukui T, Inaba S, Yoneyama T. The relationship of oral, physical and mental functions to the nutritional status in the frail elderly. Japanese Soc Gerodontology 2003;18:10–16. Kikutani T, Kodama M, Nishiwaki K, Fukui T, Inaba S, Yoneyama T. The relationship of oral, physical and mental functions to the nutritional status in the frail elderly. Japanese Soc Gerodontology 2003;18:10–16.
40.
Zurück zum Zitat Grieger JA, Nowson CA. Nutrient intake and plate waste from an Australian residential care facility. Eur J Clin Nutr 2007;61:655–63.PubMed Grieger JA, Nowson CA. Nutrient intake and plate waste from an Australian residential care facility. Eur J Clin Nutr 2007;61:655–63.PubMed
41.
Zurück zum Zitat Saletti A, Johansson L, Yifter-Lindgren E, Wissing U, Osterberg K, Cederholm T. Nutritional status and a 3-year follow-up in elderly receiving support at home. Gerontology 200751:192–8.CrossRef Saletti A, Johansson L, Yifter-Lindgren E, Wissing U, Osterberg K, Cederholm T. Nutritional status and a 3-year follow-up in elderly receiving support at home. Gerontology 200751:192–8.CrossRef
42.
Zurück zum Zitat Karlsson P, Apelgren J, Brismar K, Karlstrom B, Lindblad L, Cederholm T. Nutritional status and food intake in a 1-year follow-up in a group of elderly residents in adopted housing. Scand J Nutr 1999;43:70–73. Karlsson P, Apelgren J, Brismar K, Karlstrom B, Lindblad L, Cederholm T. Nutritional status and food intake in a 1-year follow-up in a group of elderly residents in adopted housing. Scand J Nutr 1999;43:70–73.
43.
Zurück zum Zitat Tsai AC, Ho C-S, Chang M-C. Assessing the prevalence of malnutrition with the Mini Nutritional Assessment (MNA) in a nationally representative sample of elderly Taiwanese. J Nutr Health Aging, 2008;12:239–43.CrossRefPubMed Tsai AC, Ho C-S, Chang M-C. Assessing the prevalence of malnutrition with the Mini Nutritional Assessment (MNA) in a nationally representative sample of elderly Taiwanese. J Nutr Health Aging, 2008;12:239–43.CrossRefPubMed
44.
Zurück zum Zitat Tamura BK, Bell CL, Masaki KH, Amella EJ. Factors associated with weight loss, low BMI, and malnutrition among nursing home patients: a systematic review of the literature. J Am Med Dir Assoc 2013;14:649–55.CrossRefPubMed Tamura BK, Bell CL, Masaki KH, Amella EJ. Factors associated with weight loss, low BMI, and malnutrition among nursing home patients: a systematic review of the literature. J Am Med Dir Assoc 2013;14:649–55.CrossRefPubMed
45.
Zurück zum Zitat Castel H, Shahar D, Harman-Boehm I. Gender differences in factors associated with nutritional status of older medical patients. J Am Coll Nutr 2006;25:128–34.CrossRefPubMed Castel H, Shahar D, Harman-Boehm I. Gender differences in factors associated with nutritional status of older medical patients. J Am Coll Nutr 2006;25:128–34.CrossRefPubMed
46.
Zurück zum Zitat Dionne I, Després JP, Bouchard C, Tremblay A. Gender difference in the effect of body composition on energy metabolism. Int J Obes Relat Metab Disord 1999;23:312–9.CrossRefPubMed Dionne I, Després JP, Bouchard C, Tremblay A. Gender difference in the effect of body composition on energy metabolism. Int J Obes Relat Metab Disord 1999;23:312–9.CrossRefPubMed
47.
Zurück zum Zitat Alves LMT, Cassiani R A, Santos CM, Dantas RO. Gender effect on the clinical measurement of swallowing. Arq Gastroenterol 1999;44:227–9.CrossRef Alves LMT, Cassiani R A, Santos CM, Dantas RO. Gender effect on the clinical measurement of swallowing. Arq Gastroenterol 1999;44:227–9.CrossRef
48.
Zurück zum Zitat Pirlich M, Schütz T, Kemps M, Luhman N, Minko N, Lübke HJ, et al. Social risk factors for hospital malnutrition. Nutrition 2005;21:295–300.CrossRefPubMed Pirlich M, Schütz T, Kemps M, Luhman N, Minko N, Lübke HJ, et al. Social risk factors for hospital malnutrition. Nutrition 2005;21:295–300.CrossRefPubMed
49.
Zurück zum Zitat James WP, Nelson M, Ralph A, Leather S. Socioeconomic determinants of health. The contribution of nutrition to inequalities in health. BMJ 1997;314:1545–9.PubMed James WP, Nelson M, Ralph A, Leather S. Socioeconomic determinants of health. The contribution of nutrition to inequalities in health. BMJ 1997;314:1545–9.PubMed
Metadaten
Titel
Swallowing function and nutritional status in Japanese elderly people receiving home-care services: A 1-year longitudinal study
verfasst von
Y. Okabe
M. Furuta
S. Akifusa
K. Takeuchi
M. Adachi
T. Kinoshita
T. Kikutani
S. Nakamura
Yoshihisa Yamashita
Publikationsdatum
18.12.2015
Verlag
Springer Paris
Erschienen in
The journal of nutrition, health & aging / Ausgabe 7/2016
Print ISSN: 1279-7707
Elektronische ISSN: 1760-4788
DOI
https://doi.org/10.1007/s12603-015-0645-2

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