Low tongue pressure in peritoneal dialysis patients as a risk factor for malnutrition and sarcopenia: A cross-sectional study

Background: Low tongue pressure contributes to oral frailty. It is a condition in which the pressure between the tongue, palate, and food decreases due to a decrease in tongue muscle function. Low tongue pressure interferes with chewing and swallowing and causes bloating, increasing the risk of malnutrition and aspiration pneumonia due to decreased intake. Its causes include aging, neuromuscular disease, trauma, sequelae, low nutrition, and sarcopenia. Although quantitative evaluation of tongue function has been reported to be useful for prevention of low tongue pressure, there is no report of the evaluation's effectiveness in patients with high-risk renal failure. This study aimed to evaluate the prevalence of low tongue pressure and to clarify the relationship between the tongue pressure value and sarcopenia in peritoneal dialysis (PD) patients. Methods: A cross-sectional study of 105 PD patients (67 ± 13.5 years old, 73.3% men, 26.7% women; 26.7% with diabetes) was conducted in our hospital. At the start of the study, clinical backgrounds were investigated from the patients' medical records. Sarcopenia was diagnosed by muscle mass, grip strength, and walking speed. Inflammatory, nutritional, and cardiovascular markers were measured. Univariate and multivariate analyses with muscle and nutrition markers were performed to determine the low tongue pressure prevalence rate in PD patients. Results: Low tongue pressure prevalence rate was 55.2% in patients under 65 and 64.1% in patients 65 and over. Significantly lower tongue pressure (p = 0.019) was observed in the patients in the sarcopenic group. The tongue pressure value was positively correlated with albumin (p = 0.0003), pre-Albumin (p = 0.006), body mass index (p = 0.004), grip strength (p < 0.0001), and muscle mass (p = 0.004) and negatively correlated with age (p < 0.0001). Multiple linear regression analysis indicated that age (p = 0.034) and grip strength (p = 0.007) were the independent factors that affected tongue pressure. Conclusions: We found low tongue pressure prevalence in PD patients and an association between this condition and sarcopenia. Further studies are needed to support these findings, including intervention studies. © 2018 The Author(s).