日補綴会誌 Ann Jpn Prosthodont Soc 11 : 206-214, 2019 206 栄養・運動と全身の健康の架け橋を担う歯科補綴 ─ 咀嚼機能回復と保健指導の組み合わせは,体組成と代謝指標を改善する ─ 武内博朗 a, b ,花田信弘 a Nutrition, Physical Exercise and Dental Prosthesis: Essential Components of Healthy Aging – Masticatory Function Recovery Combined with Health Guidance Improves Body Composition and Metabolic Parameters – Hiroaki Takeuchi, DDS, PhD a,b and Nobuhiro Hanada, DDS, PhD a 依頼論文 ◆企画:九州支部学術大会 「栄養・運動と全身の健康の架け橋を担う歯科補綴」 抄 録 歯を喪失すると咀嚼機能が低下する.咀嚼機能が低下した状態では,糖質の摂取量が増加する.一方で低 GI 食品,タンパク質,抗酸化物質,食物繊維,ビタミン群,ミネラル群などの摂取量が低下する.ブドウ糖負荷 の増加およびタンパク質エネルギー低栄養の状態はメタボリック症候群やフレイル,さらには非感染性疾患 Non Communicable Diseases(NCDs)の発症リスクを上昇させる. 本稿は,歯科補綴治療による咀嚼機能回復と栄養指導を中心とする保健指導の集中運用が体組成や代謝指標 にもたらす健康増進効果について症例を提示し紹介する. 大臼歯欠損者 71 名を対象に歯科補綴治療介入前後の咀嚼機能値を評価した.また,71 名の症例のうち歯科 補綴と同時に保健指導を実施した 25 名について,歯科補綴治療介入前および保健指導 90 日後に体組成,血圧 測定,血液検査を行い,体組成・代謝について数値を比較評価した. 歯科補綴による咀嚼機能向上が 71 名の全症例で認められた.保健指導を実施した 25 名の全症例で基礎代謝 基準値(骨格筋量),BMI,体脂肪率,内臓脂肪レベル,タンパク質充足率が改善した.HbA1c は保健指導群 のうち測定した 7 例全例で改善した. 咀嚼機能低下者における NCDs の発症予防,重症化予防のためには,歯科補綴による咀嚼機能回復と同時に 行う保健指導が有効と考えられた. キーワード 咀嚼機能,糖質代謝,タンパク質エネルギー低栄養,体組成,フレイル, 非感染性疾患 Non-Communicable Diseases (NCDs) ABSTRACT Tooth loss causes a decrease in masticatory function. The condition of masticatory dysfunction induces high carbohydrate diet, while decreasing the intake of low Glycemic Index (GI) foods and nutrients such as protein, dietary fiber, antioxidants, vitamins, and minerals. Increase in the Glycemic Load (GL) and the condition of Protein-Energy Malnutrition (PEM) may increase a risk of metabolic syndrome, frailty, and Non-Communicable Diseases (NCDs). Here we present some case reports about the effect of health promotion shown in indexes of body composition and metabolism by the recovery of masticatory function with dental prostheses combined with intensive operation of health guidance, focusing on nutritional advice. Masticatory ability levels of 71 subjects with tooth loss were evaluated before and after intervention of prosthodontic treatment. Body composition, blood pressure, and some blood data were investigated for 25 of the 71 subjects, with both prosthodontic treatment and health guidance, before the intervention and 90 days after the guidance for comparative evaluation. Improvement in masticatory function by prosthodontic treatment was observed in all the 71 cases. Moreover, improvement in basal metabolism standard value (skeletal muscle mass), Body Mass Index (BMI), body fat percentage, visceral fat level, and protein sufficiency rate was observed in all the 25 cases of health guidance group. HbA1c was measured for seven subjects out of the health guidance group, and the value was improved in all seven cases.
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Nutrition, Physical Exercise and Dental Prosthesis ...Tooth loss causes a decrease in masticatory function. The condition of masticatory dysfunction induces high The condition of masticatory
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Nutrition, Physical Exercise and Dental Prosthesis: Essential Components of Healthy Aging– Masticatory Function Recovery Combined with Health Guidance Improves Body Composition and
Metabolic Parameters –
Hiroaki Takeuchi, DDS, PhDa,b and Nobuhiro Hanada, DDS, PhDa
ABSTRACTTooth loss causes a decrease in masticatory function. The condition of masticatory dysfunction induces high carbohydrate diet, while decreasing the intake of low Glycemic Index (GI) foods and nutrients such as protein, dietary fiber, antioxidants, vitamins, and minerals. Increase in the Glycemic Load (GL) and the condition of Protein-Energy Malnutrition (PEM) may increase a risk of metabolic syndrome, frailty, and Non-Communicable Diseases (NCDs). Here we present some case reports about the effect of health promotion shown in indexes of body composition and metabolism by the recovery of masticatory function with dental prostheses combined with intensive operation of health guidance, focusing on nutritional advice.Masticatory ability levels of 71 subjects with tooth loss were evaluated before and after intervention of prosthodontic treatment. Body composition, blood pressure, and some blood data were investigated for 25 of the 71 subjects, with both prosthodontic treatment and health guidance, before the intervention and 90 days after the guidance for comparative evaluation.Improvement in masticatory function by prosthodontic treatment was observed in all the 71 cases. Moreover, improvement in basal metabolism standard value (skeletal muscle mass), Body Mass Index (BMI), body fat percentage, visceral fat level, and protein sufficiency rate was observed in all the 25 cases of health guidance group. HbA1c was measured for seven subjects out of the health guidance group, and the value was improved in all seven cases.
a 鶴見大学歯学部探索歯学講座b 医療法人社団武内歯科医院a Department of Translational Research, School of Dental Medicine, Tsurumi University, Kanagawa, Japanb Takeuchi Dental Clinic, Kanagawa, Japan
It seems that tailor-made health guidance, conducted simultaneously with the restoration of masticatory function with dental prosthesis, is effective in preventing onset and deterioration of NCDs for patients with masticatory dysfunction.
図 4 a 歯科補綴患者向けの食育・食習慣改善のためのテキスト b 歯科医療者向けの保健指導マニュアル
表 2 各対象者に共通する保健指導の内容食事指導 糖質の種類と血糖値の上昇について
主食を全粒粉のパンや雑穀のような低 GI 糖質に置き換える指導脂質の種類と摂取頻度飽和脂肪酸・不飽和脂肪酸の違いトランス脂肪酸を避けることn-3 系の摂取の推奨ビタミン・ミネラル・食物繊維の供給源となる野菜の摂り方食物繊維の摂取と咀嚼機能との関係(摂取方法・調理方法など)栄養を無視したカロリー制限だけのダイエットは失敗することの理解
図 6各被験者の介入前後における咀嚼機能値の変動と主な体組成・代謝マーカーの変動との関係を示す. a 咀嚼機能回復と保健指導後の基礎代謝基準値の推移(n=25) b 咀嚼機能回復と保健指導後の BMI の推移(n=25) c 咀嚼機能回復と保健指導後の体脂肪率の推移(n=25) d 咀嚼機能回復と保健指導後の内臓脂肪レベルの推移(n=25) e 咀嚼機能回復と保健指導後のタンパク質充足率の推移(n=21) f 咀嚼機能回復と保健指導後の HbA1c の推移(n=7)
6a 6d
6b 6e
6c 6f
212 日補綴会誌 11 巻 3 号(2019)
食べる,雑穀米や全粒粉パンに置き換える(低 GI 食品の推奨),運動習慣がなく体重制御が困難であったので,基礎代謝量の目標を上げた.脂肪燃焼しやすい身体づくりのため,メッツについて理解を促し,より強度の高い生活活動の実践を勧めた. 日常生活動作を週 20 メッツを処方,レコーディングダイエット19)の実践.
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