Swallowing Related Muscular and Oral Health Characteristics Associated with Sarcopenic Dysphagia in Older Adults: A Cross Sectional Observational Study

Swallowing Related Muscular and Oral Health Characteristics Associated with Sarcopenic Dysphagia in Older Adults: A Cross Sectional Observational Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Swallowing Related Muscular and Oral Health Characteristics Associated with Sarcopenic Dysphagia in Older Adults: A Cross Sectional Observational Study Na-Kyoung Hwang, Eun-Jung Park, NaMi Han, Gihyoun Lee, Ji-Su Park This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8846182/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 13 You are reading this latest preprint version Abstract Background Sarcopenic dysphagia is a condition characterized by difficulty swallowing that results from age-related loss of skeletal muscle mass and strength, known as sarcopenia. With population aging, sarcopenic dysphagia has emerged as a major health concern due to its links with poor nutrition, aspiration, and mortality. Methods This cross-sectional observational study aimed to investigate the risk of sarcopenic dysphagia in healthy community-dwelling older adults and to analyze its association with myophysiological factors related to swallowing function as well as oral health factors. A total of 113 community-dwelling adults aged 65 years and older were classified into no, possible, and probable sarcopenic dysphagia groups based on a diagnostic algorithm for sarcopenic dysphagia. Orofacial muscle strength, tongue and masseter thicknesses, and maximum occlusal force were measured. Dysphagia severity, oral health-related quality of life (QOL), and oral mucosal moisture were assessed. Results Approximately 47% of healthy older adults in the community were at risk of sarcopenic dysphagia (possible risk = 22.1%, probable risk = 25.7%). The logistic regression model, adjusted for sociodemographic factors, revealed that decreases in tongue strength (OR = 0.494, 95%CI = 0.293–0.833) and thickness (OR = 0.588, 95%CI = 0.423–0.818), buccinator strength (OR = 0.846, 95%CI = 0.717–0.969), oral mucosal moisture (OR = 0.508, 95% CI = 0.369-0.700), and oral health-related QOL (OR = 1.190, 95%CI = 1.094–1.294) were identified as major factors associated with the risk of sarcopenic dysphagia. Conclusion Nearly half of healthy community-dwelling older adults were at risk of sarcopenic dysphagia. Tongue strength and thickness, buccinator strength, oral mucosal moisture, and oral health-related QOL were key factors. Comprehensive screening of localized oral muscles and oral health indicators may aid in early detection. sarcopenic dysphagia older adult orofacial muscle strength tongue thickness oral health Figures Figure 1 Figure 2 Background Sarcopenia is a progressive and generalized skeletal muscle disorder characterized by loss of muscle mass, strength, and function [ 1 ]. It is primarily associated with aging but can also be influenced by factors, such as physical inactivity, malnutrition, and chronic diseases. Sarcopenia is a major contributor to frailty, increased risk of falls, reduced mobility, decreased quality of life, dyspnea, and dysphagia in older adults [ 2 ]. Dysphagia is defined as difficulty in safely and effectively transiting food or liquid from the oral cavity to the esophagus and can cause serious health problems, such as malnutrition, dehydration, choking, aspiration pneumonia, and death [ 3 ]. Globally, the prevalence of dysphagia is approximately 43.8% and increases with age, reaching about 80% among patients with dementia, Alzheimer’s disease, and stroke [ 4 ]. Additionally, the reported prevalence of dysphagia among community-dwelling older adults ranges from 3% to 63%, depending on the diagnostic criteria, assessment tools, and characteristics of the study population [ 5 , 6 ]. Dysphagia resulting from sarcopenia, termed sarcopenic dysphagia, arises from progressive loss of swallowing-related muscle mass and strength and is an emerging health concern in the aging population [ 7 , 8 ]. Age-related reduction in swallowing muscle mass can manifest as a decrease in the thickness of the tongue [ 9 ], suprahyoid muscles [ 10 ], and pharyngeal wall, along with an increase in the pharyngeal lumen size [ 11 ]. These changes affect tongue strength, reduce tongue range of motion, weaken pharyngeal muscle contraction, and decrease endurance of the swallowing muscles, all of which are risk factors for dysphagia. Identifying the risk factors associated with sarcopenic dysphagia is essential for its early detection and prevention. The potential risk factors include demographic variables (e.g., age, sex), nutritional status, lifestyle factors, and comorbidities such as stroke [ 12 , 13 ]. Social determinants, such as living conditions and access to health care, also play a critical role in the prevalence and progression of this condition [ 12 ]. In addition to these factors, growing evidence suggests that swallowing and oral health parameters are closely linked to sarcopenic dysphagia. Parameters such as tongue pressure [ 14 ], lip and cheek strength [ 15 , 16 ], number of functional teeth, mucosal moisture, and self-rated oral health can significantly affect the swallowing process [ 17 ]. Moreover, poor oral function can compromise nutritional intake [ 18 ], thereby exacerbating muscle loss and contributing to the vicious cycle of sarcopenia and dysphagia [ 19 ]. Despite growing recognition of sarcopenic dysphagia as a critical health issue, research on community-dwelling older adults remains limited. Most existing studies have been conducted in clinical settings such as hospitals or long-term care facilities, often relying on screening or self-reported measures rather than standardized instrumental assessments [ 20 , 21 ]. Considerable heterogeneity across study settings and diagnostic methods suggests that the extent and characteristics of this condition in the general older population remain unclear. [ 20 , 21 ]. Sarcopenic dysphagia is a growing public health concern, and as South Korea is among the fastest-aging countries worldwide [ 22 ], region-specific data are essential to guide effective prevention and early detection strategies for community-dwelling older adults. Understanding the factors associated with the risk of its risk can aid in the development of preventive measures, early detection strategies, and personalized interventions, ultimately enhancing quality of life and reducing the healthcare burden among older adults. Therefore, this study aimed to examine the risk of sarcopenic dysphagia in community-dwelling older adults, explore its association with swallowing-related muscle physiological factors, and identify key predictors of dysphagia risk. Methods Participants A cross-sectional study included older adults aged ≥ 65 years enrolled in four welfare facilities in Sasang-gu, Busan, South Korea, between May and August 2024. Participants were recruited using convenience sampling from four community-based day care facilities for older adults located in Sasang District, Busan, South Korea. These facilities provide daytime care and activities for community-dwelling older adults, and none of the participants were hospitalized or residing in long-term care facilities. This study was conducted on adults aged ≥ 65 years who visited the selected facilities from May 1 to August 31, 2024, and agreed to participate. The inclusion criteria were as follows: aged ≥ 65 years; ability to walk at least 50 m independently without assistance or using a walking aid; Korean version of the Mini-Mental State Examination score of ≥ 24 points that reflects mildly impaired or normal cognitive functioning; and no history of diseases known to affect oral strength and swallowing, such as stroke, Parkinson’s disease, head and neck cancer, and temporomandibular joint disorder, and all upper and lower central incisors to measure oral strength. The exclusion criteria were as follows: ill-fitting dentures or mobile incisors and chronic respiratory diseases, such as chronic obstructive pulmonary disease that can be diagnosed as dysphagia due to the lack of coordination between breathing and swallowing, rather than low oral strength caused by sarcopenia. We recruited 120 participants without comorbidities; seven were excluded owing to the following reasons: Korean version of the Mini-Mental State Examination score < 24 points (n = 3), need assistance to walk (n = 1), and missing values in the questionnaire (n = 3). Finally, 113 participants aged 66–84 years were included in this study. We conducted this study according to the Declaration of Helsinki and included in the questionnaire a document confrming that informed consent was obtained from all participants. We also obtained confrmation of informed consent and agreement to participate in the study from all participants. This study was reviewed and approved by the Public Institutional Review Board, operated by the Korea National Institute for Bioethics Policy (KoNIBP), Republic of Korea (IRB No. P01-202505-01-029). Written informed consent was obtained from all participants prior to participation. Sarcopenic dysphagia assessment Sarcopenia was diagnosed if the participants had low skeletal muscle mass and strength according to the criteria of the Asian Working Group for Sarcopenia [ 23 ]. Participants with generalized sarcopenia and dysphagia, but no evident causative disease of dysphagia, were diagnosed with sarcopenic dysphagia and were divided into the “possible sarcopenic dysphagia” and “probable sarcopenic dysphagia” groups based on tongue pressure. Participants without sarcopenia or dysphagia were included in the “no sarcopenic dysphagia” group [ 7 , 24 ]. The flow chart of sarcopenic dysphagia classification in this study is presented in Fig. 1 . To assess sarcopenic factors, handgrip strength and general muscle mass were measured. The grip strength of the dominant hand was measured using a grip strength dynamometer (Sammons Preston, Bolingbrook, IL, USA), and the cut-off values for determining sarcopenia were < 26 kg for men and < 18 kg for women [ 23 ]. General muscle mass was measured using a bioimpedance analysis (BIA) device (InBody 770; Biospace Co., Ltd., Seoul, Korea), and the cut-off values were 7.0 kg/m 2 for men and 5.4 kg/m 2 for women [ 23 ]. Swallowing function was assessed using the 100-mL water swallow test (WST). The participants were instructed to drink 100 mL of water as quickly and uninterruptedly as possible following a signal from the investigator. Swallowing time was measured using a stopwatch from the start to the end of the last swallow, and visual indications were provided for the return of the thyroid cartilage to its resting position. The swallowing speed (mL/s) was calculated by dividing the amount of water swallowed by the swallowing time. In addition, coughs from the start of the test to 1 min after the test and post-test wet voices were identified and recorded. Participants with an abnormal swallowing speed (< 10 mL/s), coughing, or wet hoarse voices were considered to have dysphagia according to the WST criteria [ 25 ]. To assess swallowing muscle strength, tongue pressure was measured using the Iowa Oral Performance Instrument (IOPI) (IOPI Medical, Redmond, WA, USA), with a cutoff value of < 20 kPa. If tongue pressure was < 20 kPa, “probable sarcopenic dysphagia” was diagnosed; if it was not low or difficult to measure, “possible sarcopenic dysphagia” was diagnosed [ 7 , 24 ]. Measurement We collected three types of data: demographic characteristics (age, sex, educational level), general health-related features (smoking status, chronic disease), myophysiological characteristics related to swallowing function (strength, muscle thickness), and swallowing and oral health-related characteristics (dysphagia severity, perceived oral health condition). Myophysiological characteristics related to swallowing function Myophysiological factors related to swallowing function included the strength of the orofacial muscles (tongue, buccinator, and lip), thickness of the tongue and masseter muscles, and maximum occlusal force. Factors were measured and analyzed by a blinded investigator using ultrasonography. Maximal isometric orofacial muscle strength was assessed by measuring the anterior tongue elevation, buccinator, and lip pressure using the IOPI (IOPI Medical, Redmond, WA, USA). Anterior tongue elevation was assessed following the standard IOPI protocol [ 26 ], which has demonstrated sufficient reliability in elderly adults [ 27 ]. Buccinator and lip strength were measured using the method described by Clark and Solomon [ 28 ]. While previous studies support the feasibility of using IOPI for these measurements [ 29 , 30 ], their test–retest reliability has not been fully established. The participants were instructed to sit comfortably on a chair with a backrest. To measure the anterior tongue elevation strength, a balloon-shaped pressure sensor (bulb) was placed on the hard palate behind the alveolar ridge, and the participant was instructed to close the mouth slightly and press the bulb as hard as possible with the anterior part of the tongue. To measure the buccinator strength, the bulb was placed between the lateral cheek and the buccal surface of the teeth. The participants were instructed to slightly clench their teeth and squeeze the cheek muscles around the bulb. To measure lip strength, the bulb was placed between the lips at the midline of the teeth. The participants were instructed to close their lips slightly, protrude their lips slightly, and squeeze the bulb as hard as possible with the lips. Measurements were performed thrice consecutively for 5 s each, with a 30-s rest between each measurement. The highest value of the three measurements was recorded as the maximum strength of each muscle. The thicknesses of the tongue and masseter muscles were measured using a portable ultrasound device (SONON300L; Healcerion, Seoul, Korea) equipped with a 10 MHz linear and convex array transducer. Participants were seated upright in a chair with the head maintained in a neutral position, and instructed to keep their jaws relaxed during the measurement. To measure tongue thickness, an ultrasound probe was positioned horizontally just below the participant’s mandible and directed toward the anterior portion of the tongue. The tongue thickness was determined by measuring the distance between the upper and lower surfaces of the tongue muscle in a plane perpendicular to the Frankfort horizontal plane of the frontal section. Vertical distance was measured from the surface of the mylohyoid muscle to the dorsal surface of the tongue [ 31 ]. To measure the thickness of the masseter muscle, the probe was positioned at an angle parallel to the line connecting the external auditory canal and acanthion. The probe was then moved downward by 2–3 cm toward the midpoint between the corner of the mouth, zygomatic arch, and mandibular angle to measure the thickness of the masseter muscle [ 32 ]. The muscle thickness was determined at the thickest part of the image. The relaxed state was defined as when the upper and lower teeth were lightly touching both ends, and the contracted state was defined as when the upper and lower molars were forcefully closed, causing maximum muscle contraction. The maximum occlusal force was measured using an InnoByte (Kube Innovation Inc., Montreal, Qc, Canada). When force was applied to the mouthpiece-shaped sensor, it was transmitted through the medium and recorded. The participants were instructed to sit upright. The measurement sensor was inserted into the oral cavity between the arches, and the central notch was positioned between the patient’s central incisors. The participants were instructed to bite hard with maximum voluntary clenching. Measurements were performed thrice, with a 10-s rest period between measurements [ 33 ]. Parameters related to swallowing and oral health Dysphagia severity was assessed using the Eating Assessment Tool, which evaluates the symptoms of dysphagia. It consists of 10 items, rated on a 5-point scale from “0” (no problem) to “4” (severe problem). The total score ranges from 0 to 40, and a score of ≥ 3 indicates a risk of dysphagia. Oral-related quality of life was assessed using the Korean version of the Oral Health Impact Profile (KOHIP-14), which consists of eight subdomains, functional limitation, physical pain, psychological discomfort, physical disability, psychological disability, social disability, and handicap, and 14 items. The assessment is scored on a 5-point scale ranging from 0 (almost never) to 4 (very often), with a lower score indicating a higher quality of life. Oral mucosal moisture levels were measured using Mucus (Life Co., Saitama, Japan). Participants were seated upright with the head in a neutral position and instructed to keep their mouths slightly open and relaxed during the measurement. The device probe was placed on the participant’s tongue (approximately 1 cm from the tip) and buccal mucosa (midway between the corner of the mouth and the first molar) for measurement [ 34 ]. The recorded values were calculated as averages of three measurements. The measured mucosal moisture values were classified as normal if ≥ 30%, borderline if 29–30%, mild dryness if 27–29%, moderate dryness if 25–27%, and severe if < 25% [ 35 ]. Other parameters related to oral health included the number of remaining teeth and use of dentures. Statistical analyses Statistical analyses were performed using SPSS version 21 (IBM Corp., Armonk, NY, USA), and p < 0.05 was considered statistically significant. One-way analysis of variance was performed to analyze the differences in demographic characteristics, general health-related features, oral health-related characteristics, and myophysiological characteristics related to swallowing function according to the sarcopenic dysphagia risk groups. Bonferroni correction was applied for multiple comparisons to reduce the likelihood of Type I error. Logistic regression analysis was performed to identify the factors associated with the risk of sarcopenic dysphagia. The independent variables included oral health-related characteristics and myophysiological characteristics associated with swallowing function. The dependent variable was set as a binary variable, with groups categorized as “no sarcopenic dysphagia” and “sarcopenic dysphagia risk (possible + probable)”. To control for potential confounders, logistic regression models were adjusted for age, sex, smoking status, and alcohol consumption, as these factors are known to be associated with both sarcopenia and dysphagia. Results A total of 113 participants (74 women and 39 men) were included in this study. Among them, 62 individuals (54.8%) had low hand grip strength, and 59 individuals (52.2%) had low muscle mass, as measured by BIA. A total of 56 participants (49.5%) met the criteria for systemic sarcopenia, defined as having both low grip strength and low muscle mass. The sarcopenia assessment revealed that males had a higher mean grip strength (27.0 ± 5.5 kg) than females (17.9 ± 4.8 kg). Similarly, the mean BIA-derived muscle mass was higher in males (6.9 ± 0.6 kg/m²) compared to females (5.4 ± 0.6 kg/m²) (Fig. 2 ). The no sarcopenic dysphagia group included 59 (52.2%) participants; the possible sarcopenic dysphagia group, 25 (22.1%) participants; and the probable sarcopenic dysphagia group, 29 (25.7%) participants (Table 1). The mean hand grip strength was 22.7 ± 5.5 kg in the no dysphagia group, 17.2 ± 4.2 kg in the possible dysphagia group, and 16.5 ± 4.2 kg in the probable dysphagia group. Post-hoc analysis indicated that the no dysphagia group had significantly higher grip strength than both the possible and probable groups. Similarly, the mean BIA values were 6.6 ± 0.8 kg/m² in the no dysphagia group, 5.7 ± 0.7 kg/m² in the possible group, and 5.5 ± 0.7 kg/m² in the probable group. Post-hoc comparisons revealed that the no dysphagia group had significantly higher BIA values than the possible and probable groups (Fig. 2 ). Among the participants classified into the sarcopenic dysphagia risk groups, seven showed abnormal swallowing speed (possible: 2, probable: 6) and 47 showed responses such as coughing and wet voice (possible: 23, probable: 24) in the 100 mL WST. Table 1 presents the demographic characteristics and general health-related features of the study participants. There were no significant differences between the groups in terms of demographic characteristics, except for employment status. There were no significant differences between groups in terms of general health-related features. Table 2 shows myophysiological characteristics related to swallowing function according to the risk of sarcopenic dysphagia. There were significant differences between the groups in all measured items, including tongue, buccinator, and lip muscle strength ( p < 0.001, all), tongue and masseter muscle thickness ( p < 0.001and p < 0.05, respectively), and occlusal force ( p = 0.009). Table 3 shows swallowing and oral health-related characteristics according to the risk of sarcopenic dysphagia. There was a significant difference between the groups in the dysphagia severity, perceived oral health condition, and oral mucosal moisture level ( p = 0.001, < 0.001, and < 0.001, respectively), but there was no significant difference between the groups in the number of teeth lost and denture use ( p = 0.240 and 0.904, respectively). Logistic regression analysis revealed that sarcopenic dysphagia was significantly associated with tongue muscle strength (odds ratio [OR] = 0.494, p = 0.008), buccinator strength (OR = 0.846, p = 0.048), tongue thickness (OR = 0.588, p = 0.026), and oral-health related QOL (OR = 1.190, p < 0.001), and oral mucosal moisture level (OR = 0.508, p < 0.001) after controlling for the demographic characteristics of the participants (Table 4). The model’s 2LL was 46.751, x 2 was 98.680 (df = 8, p < 0.01), Nagelkerke’s R 2 was 0.853, and the Hosmer–Lemeshow test results revealed a good fit. Discussion Sarcopenic dysphagia risk in community-dwelling older adults In this study, 47% of participants were identified as having sarcopenic dysphagia risk, including 22% in the probable group and 25% in the possible group. Previous studies have reported that the prevalence of dysphagia among community-dwelling older adults in Korea ranges from 22.9% to 48.4% [ 36 , 37 ]. Although the community-dwelling older population includes healthy older adults and those with mild health problems or functional limitations, the participants in this study were relatively healthy older adults without neurological disorders who could walk independently and scored within the normal range on dementia screening tests. Despite their health status, a considerable proportion of participants were at risk of sarcopenic dysphagia. In the present study, sex-related differences were observed in hand grip strength and muscle mass as measured by BIA, with males generally exhibiting higher values than females. Given that women are more likely to experience age-related muscle loss and have a higher prevalence of sarcopenia [ 38 , 39 ], it is possible that female participants were more susceptible to sarcopenic changes contributing to swallowing difficulties. Dysphagia symptoms in community-dwelling older individuals appear gradually, are often overlooked as part of the aging process, and delay early diagnosis in the absence of severe conditions, such as cerebrovascular disease, degenerative disease, or community-acquired pneumonia [ 12 ]. As the older population grows, the prevalence of dysphagia is expected to increase, increasing healthcare costs and the demand for social support [ 40 ]. Identifying the swallowing characteristics and contributing factors in community-dwelling older adults is therefore essential for improving their health and quality of life while reducing the social and economic burden. Myophysiological factors associated with sarcopenic dysphagia risk This study identified tongue strength and thickness as the major factors associated with sarcopenic dysphagia, with significant differences observed among the no, possible, and probable dysphagia groups. Tongue strength, which is strongly associated with the swallowing ability, is crucial for preventing aspiration and maintaining nutrition [ 41 ]. A previous study reported that weakened tongue pressure, which is common in sarcopenia, indicated impaired swallowing muscles and served as an early marker of subclinical dysphagia [ 42 ]. Similarly, tongue thickness is associated with nutritional status and swallowing efficiency, with thinner muscles correlating with impaired swallowing, making tongue thickness a diagnostic marker and an intervention target [ 43 ]. Significant differences in lip and buccinator strengths were observed between the groups, especially in buccinator strength between the possible and probable dysphagia group. While reduced lip and buccinator strength primarily reflects oral-phase weakness rather than directly influencing pharyngeal bolus transit, these muscles play important roles in oral-phase functions such as bolus containment and manipulation [ 15 ]. Nonetheless, decreases in lip and buccinator strength may indicate generalized oropharyngeal muscle weakness and an increased risk of dysphagia. Notably, buccinator strength emerged as a major associated factor of sarcopenic dysphagia in this study, suggesting its potential utility as a predictive indicator. This finding aligns with previous reports showing that buccinator muscle weakness is strongly associated with dysphagia risk [ 15 , 44 ]. Decreased masseter muscle thickness is associated with decreased occlusal force and chewing ability [ 45 ], which may lead to dysphagia [ 46 ] and consequently to an increased risk of malnutrition [ 47 ]. These previous studies support the results of this study. In this study, the probable sarcopenic dysphagia group showed significantly reduced masseter thickness compared to the possible group, and significantly lower maximal bite force than the no-risk group. Wallace et al. reported that the cross-sectional area of the masseter muscle was a stronger predictor of sarcopenia and 2-year mortality than that of the psoas muscle, which is an objective indicator of sarcopenia [ 48 ]. Therefore, maintaining masseter muscle thickness is critical for preserving the chewing function and preventing malnutrition in older individuals with sarcopenia. Swallowing and oral health factors associated with sarcopenic dysphagia risk Individuals at a higher risk of sarcopenic dysphagia often have a heightened awareness of the severity of their dysphagia owing to the compounded effects on their health, such as underlying physiological issues or health concerns [ 49 ]. In this study, the probable group showed significantly greater awareness of dysphagia severity than the group without dysphagia. This was likely because the probable group, which exhibited more advanced or clinically evident symptoms of dysphagia, perceived more pronounced symptoms concerning the severity of dysphagia, making them distinguishable from the group without dysphagia. Dysphagia can affect oral hygiene, increase the risk of dental problems, and lead to changes in food texture or the frequency of consumption [ 50 ]. These factors can negatively affect KOHIP-14 scores, even in the two dysphagia risk groups. Even in the early risk stages of dysphagia (possible group), individuals may experience subtle but meaningful disruptions in their oral health-related quality of life. These disruptions may include discomfort, changes in eating habits, or concerns about oral health, which may account for the significant differences in scores compared with those without dysphagia. In addition, the KOHIP-14 score was significantly associated with the risk of sarcopenic dysphagia. This finding suggests that reduced oral health-related quality of life may play a meaningful role in the development of sarcopenic dysphagia, highlighting the importance of maintaining good oral health in older populations. Tooth loss, dry mouth, and a decline in oral sensorimotor ability are associated with the risk of dysphagia in older adults [ 51 ]. Okamoto et al. reported that the risk of dysphagia was higher in older adults who had difficulty chewing because of tooth loss but did not use dentures [ 52 ]. Unlike in previous studies, tooth loss and denture use did not show significant differences between the groups. This result may be because other factors, such as sarcopenia and tongue muscle weakness, played a more dominant role in the diagnostic algorithm for sarcopenic dysphagia in the study population; thus, differences in dental factors may not have been revealed. A dry mouth slows saliva flow in the oral cavity [ 53 ]. The incidence rate of dysphagia is higher in older individuals with dry mouth than in those without dry mouth [ 52 , 54 ]. In this study, oral moisture levels were significantly lower in the dysphagia risk groups and were a major factor associated with the risk of sarcopenic dysphagia. Monitoring oral hydration levels, which reflect the salivary gland function and oral muscle activity, can help predict sarcopenic dysphagia [ 55 , 56 ]. Interventions such as hydration strategies and oral muscle-strengthening exercises may effectively manage and reduce the risk of developing sarcopenic dysphagia. Limitations First, participants were recruited through convenience sampling from four community-based day care centers for older adults in Sasang District, Busan. This recruitment approach may limit the representativeness of the sample, as individuals attending such facilities could represent a relatively frail subgroup of community-dwelling older adults. In addition, the modest sample size may have reduced the ability to detect small effects and limited the generalizability of the findings. Future studies should include larger and more diverse populations to enhance external validity. Second, the uneven sex distribution of the participants may have affected the results related to myophysiological characteristics, including orofacial muscle strength. Therefore, it is necessary to incorporate stratified analyses based on sex into future study designs, considering the potential differences in myophysiological characteristics between sexes. Third, this was a cross-sectional study, making it difficult to confirm the causal relationship between myophysiological variables, swallowing- and oral health-related variables, and sarcopenic dysphagia. Finally, although the study participants were excluded from older individuals with diseases that cause oral muscle weakness and dysphagia, they did not reflect various common health conditions that may cause dysphagia, including gastrointestinal disorders and esophageal inflammation. Therefore, a longitudinal study is required to identify potential risk factors for sarcopenia and dysphagia in healthy older individuals living in the community. Conclusion This study found that approximately 47% of healthy older adults living in the community were at risk of sarcopenic dysphagia. The myophysiological factors associated with sarcopenic dysphagia include reduced strength of the orofacial muscles, such as the tongue, buccinator, and lips; decreased thickness of the tongue and masseter; and reduced occlusal force. Swallowing and oral health-related factors associated with sarcopenic dysphagia include a higher perception of dysphagia severity, poorer oral health conditions, and reduced oral mucosal moisture levels. Additionally, tongue strength and thickness, buccinator strength, oral mucosal moisture levels, and perceived oral health condition were identified as influential factors. Given the cross-sectional design and limited sample of this study, causal relationships cannot be established. However, the findings suggest that comprehensive assessments considering both systemic and localized muscle conditions, along with oral health indicators, may help identify individuals at greater risk. Future longitudinal and interventional studies are needed to validate these associations and guide effective strategies for early detection and management of sarcopenic dysphagia in community-dwelling older adults. Declarations Competing interests The authors declare no competing interests. Competing interests The authors declare no competing interests. Clinical trial number Clinical trial number: not applicable. Human Ethics and Consent to Participate All procedures performed in studies involving human participants were conducted in accordance with the ethical standards of the national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This study was reviewed and approved by the Public Institutional Review Board, operated by the Korea National Institute for Bioethics Policy (KoNIBP), Republic of Korea (IRB No. P01-202505-01-029). Written informed consent was obtained from all individual participants prior to participation. Funding This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT) (RS-2025-23142969 and RS-2022-NR072244). Author Contribution Conception and design of the study (JSP, GHL, NKH, NMH and EJP), data collection and analysis (JSP, GHL and NKH), initial drafting of the manuscript (JSP, NMH and EJP), critical review of the manuscript (NKH, GHL and EJP). All the authors provided final approval of the submitted manuscript. Data Availability The data that support the findings of this study are available from the corresponding author, upon reasonable request. References Hwang NK, Yoon TH, Park JS. Application of orofacial muscle strength measurement to screen for penetration/aspiration risk in older adults with sarcopenia: a diagnostic accuracy study. J Oral Rehabil. 2025;52:817–24. Nagano A, et al. 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Prevalence of and risk factors for dysphagia in the community-dwelling elderly: a systematic review. J Nutr Health Aging. 2016;20:806–15. Liu X, Zhang X, Feng Q. Dynamic change in the thickness of the masseter muscle between contraction and relaxation is associated with masticatory function in older adults: a cross-sectional study. Ann Palliat Med. 2022;11:3755–63. Lee DS, Kim HE, Choi JS. Factors associated with dysphagia risk among healthy community-dwelling older Korean adults: a pilot study. Healthcare. 2024;12:267. Lee JH, et al. The relationship between tongue pressure and oral dysphagia in stroke patients. Ann Rehabil Med. 2016;40:620–8. Lee DS, Kim JY, Choi JS. Orofacial muscle strength and associated potential factors in healthy Korean community-dwelling older adults: a pilot cross-sectional study. Appl Sci. 2024;14:10560. Mann T, Heuberger R, Wong H. The association between chewing and swallowing difficulties and nutritional status in older adults. Aust Dent J. 2013;58:200–6. Veldee MS, Peth LD. Can protein-calorie malnutrition cause dysphagia? Dysphagia. 1992;7:86–101. Rivelsrud MC, Hartelius L, Bergström L, Løvstad M, Speyer R. Prevalence of oropharyngeal dysphagia in adults in different healthcare settings: a systematic review and meta-analyses. Dysphagia. 2023;38:76–121. Doan TN, et al. Prevalence and methods for assessment of oropharyngeal dysphagia in older adults: a systematic review and meta-analysis. J Clin Med. 2022;11:2605. Kim KW, Kim OS. Super aging in South Korea unstoppable but mitigatable: a sub-national scale population projection for best policy planning. Spat Demogr. 2020;8:155–73. Chen LK, et al. Asian Working Group for Sarcopenia: 2019 consensus update on sarcopenia diagnosis and treatment. J Am Med Dir Assoc. 2020;21:300–7. Mori T, et al. Development, reliability, and validity of a diagnostic algorithm for sarcopenic dysphagia. JCSM Clin Rep. 2017;2:1–10. Wu MC, Chang YC, Wang TG, Lin LC. Evaluating swallowing dysfunction using a 100-ml water swallowing test. Dysphagia. 2004;19:43–7. Robin DA, Somodi LB, Luschei ES. Measurement of tongue strength and endurance in normal and articulation-disordered subjects. In: Moore C, Yorkston K, Beukelman D, editors. Dysarthria and apraxia of speech: perspectives on management. Baltimore: Paul H. Brookes; 1991. Adams V, Mathisen B, Baines S, Lazarus C, Callister R. Reliability of measurements of tongue and hand strength and endurance using the Iowa Oral Performance Instrument with healthy adults. Dysphagia. 2014;29:83–95. Clark HM, Solomon NP. Age and sex differences in orofacial muscle strength. Dysphagia. 2012;27:2–9. Park JS, You SJ, Kim JY, Yeo SG, Lee JH. Differences in orofacial muscle strength according to age and sex in East Asian healthy adults. Am J Phys Med Rehabil. 2015;94:677–86. Van Lierde KM, et al. Oral strength in subjects with a unilateral cleft lip and palate. Int J Pediatr Otorhinolaryngol. 2014;78:1306–10. Park JS, et al. Effects of lingual strength training on oropharyngeal muscles in South Korean adults. J Oral Rehabil. 2019;46:1036–41. Yamaguchi K, et al. Factors associated with masseter muscle quality assessed from ultrasonography in community-dwelling elderly individuals: a cross-sectional study. Arch Gerontol Geriatr. 2019;82:128–32. Ciavarella D, et al. Evaluation of occlusal force in Class II subdivision malocclusion. J Oral Rehabil. 2024;51:1813–20. Takahashi F, Koji T, Morita O. Oral dryness examinations: use of an oral moisture checking device and a modified cotton method. Prosthodont Res Pract. 2006;5:26–30. Takahashi F, Takahashi M, Toya S, Koji T, Morita O. Clinical usefulness of an oral moisture checking device (Mucus®). Prosthodont Res Pract. 2006;5:214–8. Cha SW, et al. Sarcopenia is an independent risk factor for dysphagia in community-dwelling older adults. Dysphagia. 2019;34:692–7. Ahn SC. (2016) Swallowing function and nutritional status in community-dwelling elders: comparison with community-dwelling young adults. Master’s thesis, Chungnam National University, Daejeon. Hwang J, Park S. Gender-specific risk factors and prevalence for sarcopenia among community-dwelling young-old adults. Int J Environ Res Public Health. 2022;19:7232. Yang Y, et al. Prevalence of sarcopenia was higher in women than in men: a cross-sectional study from a rural area in eastern China. PeerJ. 2022;10:e13678. Kim MJ, et al. Effects of chewing exercises on occlusal force and masseter muscle thickness in community-dwelling Koreans aged 65 years and older: a randomised assessor-blind trial. J Oral Rehabil. 2020;47:1103–9. Butler SG, et al. The relationship of aspiration status with tongue and handgrip strength in healthy older adults. J Gerontol Biol Sci Med Sci. 2011;66:452–8. Chen KC, et al. Assessment of tongue strength in sarcopenia and sarcopenic dysphagia: a systematic review and meta-analysis. Front Nutr. 2021;8:684840. Ogawa N, et al. Ultrasonography to measure swallowing muscle mass and quality in older patients with sarcopenic dysphagia. J Am Med Dir Assoc. 2018;19:516–22. Ko CH, Chao CL, Hung CH, Du JK, Feng MC. Nutritional status, frailty, oral health, and oral motor functions in long-term care residents with swallowing dysfunction. J Clin Med. 2024;14:62. Müller F, et al. Masseter muscle thickness, chewing efficiency and bite force in edentulous patients with fixed and removable implant-supported prostheses: a cross-sectional multicenter study. Clin Oral Implants Res. 2012;23:144–50. Saarela RK, et al. Dentition, nutritional status and adequacy of dietary intake among older residents in assisted living facilities. Gerodontology. 2016;33:225–32. Kikutani T, et al. Relationship between nutritional status and dental occlusion in community-dwelling frail elderly people. Geriatr Gerontol Int. 2013;13:50–4. Wallace JD, et al. Sarcopenia as a predictor of mortality in elderly blunt trauma patients: comparing the masseter to the psoas using computed tomography. J Trauma Acute Care Surg. 2017;82:65–72. de Sire A, et al. Sarcopenic dysphagia, malnutrition, and oral frailty in elderly: a comprehensive review. Nutrients. 2022;14:982. Furuta M, Yamashita Y. Oral health and swallowing problems. Curr Phys Med Rehabil Rep. 2013;1:216–22. Drancourt N, El Osta N, Decerle N, Hennequin M. Relationship between oral health status and oropharyngeal dysphagia in older people: a systematic review. Int J Environ Res Public Health. 2022;19:13618. Okamoto N, et al. Relationship between swallowing problems and tooth loss in community-dwelling independent elderly adults: the Fujiwara-kyo study. J Am Geriatr Soc. 2012;60:849–53. Poisson P, Laffond T, Campos S, Dupuis V, Bourdel-Marchasson I. Relationships between oral health, dysphagia and undernutrition in hospitalised elderly patients. Gerodontology. 2016;33:161–8. Inui A, et al. Oral conditions and dysphagia in Japanese community-dwelling middle- and older-aged adults independent in daily living. Clin Interv Aging. 2017;12:515–21. Millsop JW, Wang EA, Fazel N. Etiology, evaluation, and management of xerostomia. Clin Dermatol. 2017;35:468–76. Tanasiewicz M, Hildebrandt T, Obersztyn I. Xerostomia of various etiologies: a review of the literature. Adv Clin Exp Med. 2016;25:199–206. Tables Table 1. Demographic characteristics and general health-related features according to the risk of sarcopenic dysphagia Total (n=113) No (n=59) Possible (n=25) Probable (n=29) x 2/ F p n (%) or M±SD (Range) n (%) or M±SD (Range) n (%) or M±SD (Range) n (%) or M±SD (Range) Demographic characteristics Sex Women Men 74 (65.5) 3 7(62.7) 18 (72.0) 19 (65.5) 0.7 .715 39 (34.5) 22(37.3) 7 (28.0) 10 (34.5) Age (year) 73.8±4.6 (66-84) 73.4±4.7 (66-83) 74.4±4.5 (67-84) 74.2±4.4 (67-84) 0.5 .589 Education level Elementary 10 (8.8) 6 (10.2) 2 (8.0) 2 (6.9) 4.3 .630 Middle 38 (33.6) 20 (33.9) 8 (32.0) 10 (34.5) High school 56 (49.6) 31 (52.5) 11 (44.0) 14 (48.3) College 9 (8.0) 2 (3.4) 4 (16.0) 3 (10.3) Employment status Non-worker 96 (85.0) 56 (94.9) 17 (68.0) 23 (79.3) 10.9 .004** Worker 17 (15.0) 3 (5.1) 8 (32.0) 6 (20.7) Living status Alone 34 (30.1) 12 (20.3) 10 (40.0) 12 (41.4) 8.8 .067 With spouse 61 (54.0) 39 (66.1) 9 (36.0) 13 (44.8) With children 18 (15.9) 8 (13.6) 6 (24.0) 4 (13.8) General health-related features Smoking status Non-smoker 105 (92.9) 53 (89.8) 25 (100) 27 (93.1) 2.8 .251 Smoker(former & current) 8 (7.1) 6 (10.2) 0 (0.0) 2 (6.9) Alcohol consumption Non-drinker 67 (59.3) 35 (59.3) 13 (52.0) 19 (65.5) 1.1 .602 Drinker 46 (40.7) 24 (40.7) 12 (48.0) 10 (34.5) ** p < .01 Table 2. Myophysiological characteristics related to swallowing function according to the risk of sarcopenic dysphagia Total (n=113) No (n=59) Possible (n=25) Probable (n= 29) F p M±SD M±SD M±SD M±SD Strength (kPa) Tongue 25.8±9.5 32.1±8.4 a 22.9±2.4 b 15.5±2.6 c 70.0 <.001*** Buccinator 20.0±4.8 22.1±3.5 a 19.3±4.4 b 16.2±5.2 c 19.6 <.001*** Lip 15.7±4.9 20.83±3.5 a 17.8±4.2 b 15.7±4.9 b 16.1 <.001*** Muscle thickness (mm) Tongue 28.4±9.5 34.7±8.2 a 25.2±3.9 b 18.4±3.8 c 64.0 <.001*** Masseter; rest 8.2±1.1 8.2±0.9 8.4±1.4 a 7.7±0.9 b 4.7 .011* Masseter; contraction 9.7±1.5 9.8±1.4 10.0±1.5 a 9.1±1.2 b 3.2 .044* Maximum occlusal force (N) 469.8±173.4 514.6±154.5 a 447.1±173.1 398.4±187.5 b 5.0 .009** M: Mean, SD: Standard deviation, * p <0.05, ** p <0.01, *** p <0.001 Note., Means not sharing subscript differ significantly at p <0.05, as indicated by post hoc Scheffé’s test Table 3. Swallowing and oral health related characteristics according to the risk of sarcopenic dysphagia Total (n=113) No (n=59) Possible (n=25) Probable (n=29) F/ x 2 p n (%) or M±SD (Range) n (%) or M±SD (Range) n (%) or M±SD (Range) n (%) or M±SD (Range) EAT-10 8.5±7.0 6.4±4.6 a 8.9±7.6 12.4±8.7 b 8.1 .001** KOHIP-14 26.1±11.0 19.8±7.3 a 30.8±8.8 b 34.8±11.3 b 32.7 <.001*** Oral mucosal moisture level 24.8±3.0 26.4±2.4 a 23.0±2.6 b 22.8±2.2 b 28.8 <.001*** No. of teeth lost 3.0±1.6 (0-8) 2.9±1.5(1-8) 2.8±1.9(0-7) 3.5±1.7(1-8) 1.4 .240 Denture use Yes 41(36.3) 21(35.6) 10(40.0) 10(34.5) 0.2 .904 No 72(63.7) 38(64.4) 15(60.0) 19(65.5) KOHIP-14: Korean oral health impact profile-14, M: Mean, SD: Standard deviation, * p <0.05, ** p <0.01, *** p <0.001 Note: Means not sharing subscript differ significantly at p <0.05, as indicated by post hoc Scheffé’s test Table 4. Factors influencing the risk of sarcopenic dysphagia OR (95% CI) p Tongue strength 0.494(0.293-0.833) .008** Buccinator strength 0.846(0.717-0.969) .048* Lip strength 0.835(0.687-2.014) .069 Tongue thickness 0.588(0.423-0.818) .026* Masseter thickness; rest 0.976(0.865-2.696) .070 Masseter thickness; contraction 0.983(0.941-3.748) .362 Maximum occlusal force 0.998(0.993-1.002) .318 EAT-10 1.083(0.999-1.174) .054 KOHIP-14 1.190(1.094-1.294) <.001*** Oral mucosal moisture level 0.508(0.369-0.700) <.001*** No. of teeth lost 0.915(0.576-1.454) .706 Denture use 0.489(0.126-1.900) .301 OR, odds ratio; CI, 95% confidence interval, * p <0.05, ** p <0.01, *** p <0.001 Note. Factors with p <0.05 in the bivariate analysis were used in the model as independent variables. Additional Declarations No competing interests reported. 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It is primarily associated with aging but can also be influenced by factors, such as physical inactivity, malnutrition, and chronic diseases. Sarcopenia is a major contributor to frailty, increased risk of falls, reduced mobility, decreased quality of life, dyspnea, and dysphagia in older adults [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDysphagia is defined as difficulty in safely and effectively transiting food or liquid from the oral cavity to the esophagus and can cause serious health problems, such as malnutrition, dehydration, choking, aspiration pneumonia, and death [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Globally, the prevalence of dysphagia is approximately 43.8% and increases with age, reaching about 80% among patients with dementia, Alzheimer\u0026rsquo;s disease, and stroke [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Additionally, the reported prevalence of dysphagia among community-dwelling older adults ranges from 3% to 63%, depending on the diagnostic criteria, assessment tools, and characteristics of the study population [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDysphagia resulting from sarcopenia, termed sarcopenic dysphagia, arises from progressive loss of swallowing-related muscle mass and strength and is an emerging health concern in the aging population [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Age-related reduction in swallowing muscle mass can manifest as a decrease in the thickness of the tongue [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], suprahyoid muscles [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], and pharyngeal wall, along with an increase in the pharyngeal lumen size [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. These changes affect tongue strength, reduce tongue range of motion, weaken pharyngeal muscle contraction, and decrease endurance of the swallowing muscles, all of which are risk factors for dysphagia.\u003c/p\u003e \u003cp\u003eIdentifying the risk factors associated with sarcopenic dysphagia is essential for its early detection and prevention. The potential risk factors include demographic variables (e.g., age, sex), nutritional status, lifestyle factors, and comorbidities such as stroke [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Social determinants, such as living conditions and access to health care, also play a critical role in the prevalence and progression of this condition [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. In addition to these factors, growing evidence suggests that swallowing and oral health parameters are closely linked to sarcopenic dysphagia. Parameters such as tongue pressure [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], lip and cheek strength [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], number of functional teeth, mucosal moisture, and self-rated oral health can significantly affect the swallowing process [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Moreover, poor oral function can compromise nutritional intake [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], thereby exacerbating muscle loss and contributing to the vicious cycle of sarcopenia and dysphagia [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDespite growing recognition of sarcopenic dysphagia as a critical health issue, research on community-dwelling older adults remains limited. Most existing studies have been conducted in clinical settings such as hospitals or long-term care facilities, often relying on screening or self-reported measures rather than standardized instrumental assessments [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Considerable heterogeneity across study settings and diagnostic methods suggests that the extent and characteristics of this condition in the general older population remain unclear. [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Sarcopenic dysphagia is a growing public health concern, and as South Korea is among the fastest-aging countries worldwide [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e], region-specific data are essential to guide effective prevention and early detection strategies for community-dwelling older adults. Understanding the factors associated with the risk of its risk can aid in the development of preventive measures, early detection strategies, and personalized interventions, ultimately enhancing quality of life and reducing the healthcare burden among older adults. Therefore, this study aimed to examine the risk of sarcopenic dysphagia in community-dwelling older adults, explore its association with swallowing-related muscle physiological factors, and identify key predictors of dysphagia risk.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eParticipants\u003c/h2\u003e \u003cp\u003eA cross-sectional study included older adults aged\u0026thinsp;\u0026ge;\u0026thinsp;65 years enrolled in four welfare facilities in Sasang-gu, Busan, South Korea, between May and August 2024. Participants were recruited using convenience sampling from four community-based day care facilities for older adults located in Sasang District, Busan, South Korea. These facilities provide daytime care and activities for community-dwelling older adults, and none of the participants were hospitalized or residing in long-term care facilities. This study was conducted on adults aged\u0026thinsp;\u0026ge;\u0026thinsp;65 years who visited the selected facilities from May 1 to August 31, 2024, and agreed to participate. The inclusion criteria were as follows: aged\u0026thinsp;\u0026ge;\u0026thinsp;65 years; ability to walk at least 50 m independently without assistance or using a walking aid; Korean version of the Mini-Mental State Examination score of \u0026ge;\u0026thinsp;24 points that reflects mildly impaired or normal cognitive functioning; and no history of diseases known to affect oral strength and swallowing, such as stroke, Parkinson\u0026rsquo;s disease, head and neck cancer, and temporomandibular joint disorder, and all upper and lower central incisors to measure oral strength. The exclusion criteria were as follows: ill-fitting dentures or mobile incisors and chronic respiratory diseases, such as chronic obstructive pulmonary disease that can be diagnosed as dysphagia due to the lack of coordination between breathing and swallowing, rather than low oral strength caused by sarcopenia. We recruited 120 participants without comorbidities; seven were excluded owing to the following reasons: Korean version of the Mini-Mental State Examination score\u0026thinsp;\u0026lt;\u0026thinsp;24 points (n\u0026thinsp;=\u0026thinsp;3), need assistance to walk (n\u0026thinsp;=\u0026thinsp;1), and missing values in the questionnaire (n\u0026thinsp;=\u0026thinsp;3). Finally, 113 participants aged 66\u0026ndash;84 years were included in this study. We conducted this study according to the Declaration of Helsinki and included in the questionnaire a document confrming that informed consent was obtained from all participants. We also obtained confrmation of informed consent and agreement to participate in the study from all participants. This study was reviewed and approved by the Public Institutional Review Board, operated by the Korea National Institute for Bioethics Policy (KoNIBP), Republic of Korea (IRB No. P01-202505-01-029). Written informed consent was obtained from all participants prior to participation.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSarcopenic dysphagia assessment\u003c/h3\u003e\n\u003cp\u003eSarcopenia was diagnosed if the participants had low skeletal muscle mass and strength according to the criteria of the Asian Working Group for Sarcopenia [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Participants with generalized sarcopenia and dysphagia, but no evident causative disease of dysphagia, were diagnosed with sarcopenic dysphagia and were divided into the \u0026ldquo;possible sarcopenic dysphagia\u0026rdquo; and \u0026ldquo;probable sarcopenic dysphagia\u0026rdquo; groups based on tongue pressure. Participants without sarcopenia or dysphagia were included in the \u0026ldquo;no sarcopenic dysphagia\u0026rdquo; group [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. The flow chart of sarcopenic dysphagia classification in this study is presented in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eTo assess sarcopenic factors, handgrip strength and general muscle mass were measured. The grip strength of the dominant hand was measured using a grip strength dynamometer (Sammons Preston, Bolingbrook, IL, USA), and the cut-off values for determining sarcopenia were \u0026lt;\u0026thinsp;26 kg for men and \u0026lt;\u0026thinsp;18 kg for women [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. General muscle mass was measured using a bioimpedance analysis (BIA) device (InBody 770; Biospace Co., Ltd., Seoul, Korea), and the cut-off values were 7.0 kg/m\u003csup\u003e2\u003c/sup\u003e for men and 5.4 kg/m\u003csup\u003e2\u003c/sup\u003e for women [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Swallowing function was assessed using the 100-mL water swallow test (WST). The participants were instructed to drink 100 mL of water as quickly and uninterruptedly as possible following a signal from the investigator. Swallowing time was measured using a stopwatch from the start to the end of the last swallow, and visual indications were provided for the return of the thyroid cartilage to its resting position. The swallowing speed (mL/s) was calculated by dividing the amount of water swallowed by the swallowing time. In addition, coughs from the start of the test to 1 min after the test and post-test wet voices were identified and recorded. Participants with an abnormal swallowing speed (\u0026lt;\u0026thinsp;10 mL/s), coughing, or wet hoarse voices were considered to have dysphagia according to the WST criteria [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. To assess swallowing muscle strength, tongue pressure was measured using the Iowa Oral Performance Instrument (IOPI) (IOPI Medical, Redmond, WA, USA), with a cutoff value of \u0026lt;\u0026thinsp;20 kPa. If tongue pressure was \u0026lt;\u0026thinsp;20 kPa, \u0026ldquo;probable sarcopenic dysphagia\u0026rdquo; was diagnosed; if it was not low or difficult to measure, \u0026ldquo;possible sarcopenic dysphagia\u0026rdquo; was diagnosed [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003eMeasurement\u003c/h3\u003e\n\u003cp\u003eWe collected three types of data: demographic characteristics (age, sex, educational level), general health-related features (smoking status, chronic disease), myophysiological characteristics related to swallowing function (strength, muscle thickness), and swallowing and oral health-related characteristics (dysphagia severity, perceived oral health condition).\u003c/p\u003e\n\u003ch3\u003eMyophysiological characteristics related to swallowing function\u003c/h3\u003e\n\u003cp\u003eMyophysiological factors related to swallowing function included the strength of the orofacial muscles (tongue, buccinator, and lip), thickness of the tongue and masseter muscles, and maximum occlusal force. Factors were measured and analyzed by a blinded investigator using ultrasonography.\u003c/p\u003e \u003cp\u003eMaximal isometric orofacial muscle strength was assessed by measuring the anterior tongue elevation, buccinator, and lip pressure using the IOPI (IOPI Medical, Redmond, WA, USA). Anterior tongue elevation was assessed following the standard IOPI protocol [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], which has demonstrated sufficient reliability in elderly adults [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Buccinator and lip strength were measured using the method described by Clark and Solomon [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. While previous studies support the feasibility of using IOPI for these measurements [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e], their test\u0026ndash;retest reliability has not been fully established. The participants were instructed to sit comfortably on a chair with a backrest. To measure the anterior tongue elevation strength, a balloon-shaped pressure sensor (bulb) was placed on the hard palate behind the alveolar ridge, and the participant was instructed to close the mouth slightly and press the bulb as hard as possible with the anterior part of the tongue. To measure the buccinator strength, the bulb was placed between the lateral cheek and the buccal surface of the teeth. The participants were instructed to slightly clench their teeth and squeeze the cheek muscles around the bulb. To measure lip strength, the bulb was placed between the lips at the midline of the teeth. The participants were instructed to close their lips slightly, protrude their lips slightly, and squeeze the bulb as hard as possible with the lips. Measurements were performed thrice consecutively for 5 s each, with a 30-s rest between each measurement. The highest value of the three measurements was recorded as the maximum strength of each muscle.\u003c/p\u003e \u003cp\u003eThe thicknesses of the tongue and masseter muscles were measured using a portable ultrasound device (SONON300L; Healcerion, Seoul, Korea) equipped with a 10 MHz linear and convex array transducer. Participants were seated upright in a chair with the head maintained in a neutral position, and instructed to keep their jaws relaxed during the measurement. To measure tongue thickness, an ultrasound probe was positioned horizontally just below the participant\u0026rsquo;s mandible and directed toward the anterior portion of the tongue. The tongue thickness was determined by measuring the distance between the upper and lower surfaces of the tongue muscle in a plane perpendicular to the Frankfort horizontal plane of the frontal section. Vertical distance was measured from the surface of the mylohyoid muscle to the dorsal surface of the tongue [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. To measure the thickness of the masseter muscle, the probe was positioned at an angle parallel to the line connecting the external auditory canal and acanthion. The probe was then moved downward by 2\u0026ndash;3 cm toward the midpoint between the corner of the mouth, zygomatic arch, and mandibular angle to measure the thickness of the masseter muscle [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. The muscle thickness was determined at the thickest part of the image. The relaxed state was defined as when the upper and lower teeth were lightly touching both ends, and the contracted state was defined as when the upper and lower molars were forcefully closed, causing maximum muscle contraction.\u003c/p\u003e \u003cp\u003eThe maximum occlusal force was measured using an InnoByte (Kube Innovation Inc., Montreal, Qc, Canada). When force was applied to the mouthpiece-shaped sensor, it was transmitted through the medium and recorded. The participants were instructed to sit upright. The measurement sensor was inserted into the oral cavity between the arches, and the central notch was positioned between the patient\u0026rsquo;s central incisors. The participants were instructed to bite hard with maximum voluntary clenching. Measurements were performed thrice, with a 10-s rest period between measurements [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003eParameters related to swallowing and oral health\u003c/h3\u003e\n\u003cp\u003eDysphagia severity was assessed using the Eating Assessment Tool, which evaluates the symptoms of dysphagia. It consists of 10 items, rated on a 5-point scale from \u0026ldquo;0\u0026rdquo; (no problem) to \u0026ldquo;4\u0026rdquo; (severe problem). The total score ranges from 0 to 40, and a score of \u0026ge;\u0026thinsp;3 indicates a risk of dysphagia.\u003c/p\u003e \u003cp\u003eOral-related quality of life was assessed using the Korean version of the Oral Health Impact Profile (KOHIP-14), which consists of eight subdomains, functional limitation, physical pain, psychological discomfort, physical disability, psychological disability, social disability, and handicap, and 14 items. The assessment is scored on a 5-point scale ranging from 0 (almost never) to 4 (very often), with a lower score indicating a higher quality of life.\u003c/p\u003e \u003cp\u003e Oral mucosal moisture levels were measured using Mucus (Life Co., Saitama, Japan). Participants were seated upright with the head in a neutral position and instructed to keep their mouths slightly open and relaxed during the measurement. The device probe was placed on the participant\u0026rsquo;s tongue (approximately 1 cm from the tip) and buccal mucosa (midway between the corner of the mouth and the first molar) for measurement [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. The recorded values were calculated as averages of three measurements. The measured mucosal moisture values were classified as normal if\u0026thinsp;\u0026ge;\u0026thinsp;30%, borderline if 29\u0026ndash;30%, mild dryness if 27\u0026ndash;29%, moderate dryness if 25\u0026ndash;27%, and severe if\u0026thinsp;\u0026lt;\u0026thinsp;25% [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Other parameters related to oral health included the number of remaining teeth and use of dentures.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analyses\u003c/h2\u003e \u003cp\u003eStatistical analyses were performed using SPSS version 21 (IBM Corp., Armonk, NY, USA), and \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant. One-way analysis of variance was performed to analyze the differences in demographic characteristics, general health-related features, oral health-related characteristics, and myophysiological characteristics related to swallowing function according to the sarcopenic dysphagia risk groups. Bonferroni correction was applied for multiple comparisons to reduce the likelihood of Type I error. Logistic regression analysis was performed to identify the factors associated with the risk of sarcopenic dysphagia. The independent variables included oral health-related characteristics and myophysiological characteristics associated with swallowing function. The dependent variable was set as a binary variable, with groups categorized as \u0026ldquo;no sarcopenic dysphagia\u0026rdquo; and \u0026ldquo;sarcopenic dysphagia risk (possible\u0026thinsp;+\u0026thinsp;probable)\u0026rdquo;. To control for potential confounders, logistic regression models were adjusted for age, sex, smoking status, and alcohol consumption, as these factors are known to be associated with both sarcopenia and dysphagia.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 113 participants (74 women and 39 men) were included in this study. Among them, 62 individuals (54.8%) had low hand grip strength, and 59 individuals (52.2%) had low muscle mass, as measured by BIA. A total of 56 participants (49.5%) met the criteria for systemic sarcopenia, defined as having both low grip strength and low muscle mass. The sarcopenia assessment revealed that males had a higher mean grip strength (27.0\u0026thinsp;\u0026plusmn;\u0026thinsp;5.5 kg) than females (17.9\u0026thinsp;\u0026plusmn;\u0026thinsp;4.8 kg). Similarly, the mean BIA-derived muscle mass was higher in males (6.9\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6 kg/m\u0026sup2;) compared to females (5.4\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6 kg/m\u0026sup2;) (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The no sarcopenic dysphagia group included 59 (52.2%) participants; the possible sarcopenic dysphagia group, 25 (22.1%) participants; and the probable sarcopenic dysphagia group, 29 (25.7%) participants (Table\u0026nbsp;1). The mean hand grip strength was 22.7\u0026thinsp;\u0026plusmn;\u0026thinsp;5.5 kg in the no dysphagia group, 17.2\u0026thinsp;\u0026plusmn;\u0026thinsp;4.2 kg in the possible dysphagia group, and 16.5\u0026thinsp;\u0026plusmn;\u0026thinsp;4.2 kg in the probable dysphagia group. Post-hoc analysis indicated that the no dysphagia group had significantly higher grip strength than both the possible and probable groups. Similarly, the mean BIA values were 6.6\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8 kg/m\u0026sup2; in the no dysphagia group, 5.7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7 kg/m\u0026sup2; in the possible group, and 5.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7 kg/m\u0026sup2; in the probable group. Post-hoc comparisons revealed that the no dysphagia group had significantly higher BIA values than the possible and probable groups (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Among the participants classified into the sarcopenic dysphagia risk groups, seven showed abnormal swallowing speed (possible: 2, probable: 6) and 47 showed responses such as coughing and wet voice (possible: 23, probable: 24) in the 100 mL WST.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;1 presents the demographic characteristics and general health-related features of the study participants. There were no significant differences between the groups in terms of demographic characteristics, except for employment status. There were no significant differences between groups in terms of general health-related features.\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;2 shows myophysiological characteristics related to swallowing function according to the risk of sarcopenic dysphagia. There were significant differences between the groups in all measured items, including tongue, buccinator, and lip muscle strength (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001, all), tongue and masseter muscle thickness (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001and \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05, respectively), and occlusal force (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.009).\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;3 shows swallowing and oral health-related characteristics according to the risk of sarcopenic dysphagia. There was a significant difference between the groups in the dysphagia severity, perceived oral health condition, and oral mucosal moisture level (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001, \u0026lt;\u0026thinsp;0.001, and \u0026lt;\u0026thinsp;0.001, respectively), but there was no significant difference between the groups in the number of teeth lost and denture use (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.240 and 0.904, respectively).\u003c/p\u003e \u003cp\u003eLogistic regression analysis revealed that sarcopenic dysphagia was significantly associated with tongue muscle strength (odds ratio [OR]\u0026thinsp;=\u0026thinsp;0.494, p\u0026thinsp;=\u0026thinsp;0.008), buccinator strength (OR\u0026thinsp;=\u0026thinsp;0.846, p\u0026thinsp;=\u0026thinsp;0.048), tongue thickness (OR\u0026thinsp;=\u0026thinsp;0.588, p\u0026thinsp;=\u0026thinsp;0.026), and oral-health related QOL (OR\u0026thinsp;=\u0026thinsp;1.190, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and oral mucosal moisture level (OR\u0026thinsp;=\u0026thinsp;0.508, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) after controlling for the demographic characteristics of the participants (Table\u0026nbsp;4). The model\u0026rsquo;s 2LL was 46.751, \u003cem\u003ex\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e was 98.680 (df\u0026thinsp;=\u0026thinsp;8, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01), Nagelkerke\u0026rsquo;s R\u003csup\u003e2\u003c/sup\u003e was 0.853, and the Hosmer\u0026ndash;Lemeshow test results revealed a good fit.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eSarcopenic dysphagia risk in community-dwelling older adults\u003c/h2\u003e \u003cp\u003eIn this study, 47% of participants were identified as having sarcopenic dysphagia risk, including 22% in the probable group and 25% in the possible group. Previous studies have reported that the prevalence of dysphagia among community-dwelling older adults in Korea ranges from 22.9% to 48.4% [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. Although the community-dwelling older population includes healthy older adults and those with mild health problems or functional limitations, the participants in this study were relatively healthy older adults without neurological disorders who could walk independently and scored within the normal range on dementia screening tests. Despite their health status, a considerable proportion of participants were at risk of sarcopenic dysphagia. In the present study, sex-related differences were observed in hand grip strength and muscle mass as measured by BIA, with males generally exhibiting higher values than females. Given that women are more likely to experience age-related muscle loss and have a higher prevalence of sarcopenia [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e], it is possible that female participants were more susceptible to sarcopenic changes contributing to swallowing difficulties. Dysphagia symptoms in community-dwelling older individuals appear gradually, are often overlooked as part of the aging process, and delay early diagnosis in the absence of severe conditions, such as cerebrovascular disease, degenerative disease, or community-acquired pneumonia [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. As the older population grows, the prevalence of dysphagia is expected to increase, increasing healthcare costs and the demand for social support [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. Identifying the swallowing characteristics and contributing factors in community-dwelling older adults is therefore essential for improving their health and quality of life while reducing the social and economic burden.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eMyophysiological factors associated with sarcopenic dysphagia risk\u003c/h2\u003e \u003cp\u003eThis study identified tongue strength and thickness as the major factors associated with sarcopenic dysphagia, with significant differences observed among the no, possible, and probable dysphagia groups. Tongue strength, which is strongly associated with the swallowing ability, is crucial for preventing aspiration and maintaining nutrition [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. A previous study reported that weakened tongue pressure, which is common in sarcopenia, indicated impaired swallowing muscles and served as an early marker of subclinical dysphagia [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. Similarly, tongue thickness is associated with nutritional status and swallowing efficiency, with thinner muscles correlating with impaired swallowing, making tongue thickness a diagnostic marker and an intervention target [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSignificant differences in lip and buccinator strengths were observed between the groups, especially in buccinator strength between the possible and probable dysphagia group. While reduced lip and buccinator strength primarily reflects oral-phase weakness rather than directly influencing pharyngeal bolus transit, these muscles play important roles in oral-phase functions such as bolus containment and manipulation [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Nonetheless, decreases in lip and buccinator strength may indicate generalized oropharyngeal muscle weakness and an increased risk of dysphagia. Notably, buccinator strength emerged as a major associated factor of sarcopenic dysphagia in this study, suggesting its potential utility as a predictive indicator. This finding aligns with previous reports showing that buccinator muscle weakness is strongly associated with dysphagia risk [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDecreased masseter muscle thickness is associated with decreased occlusal force and chewing ability [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e], which may lead to dysphagia [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e] and consequently to an increased risk of malnutrition [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]. These previous studies support the results of this study. In this study, the probable sarcopenic dysphagia group showed significantly reduced masseter thickness compared to the possible group, and significantly lower maximal bite force than the no-risk group. Wallace et al. reported that the cross-sectional area of the masseter muscle was a stronger predictor of sarcopenia and 2-year mortality than that of the psoas muscle, which is an objective indicator of sarcopenia [\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e]. Therefore, maintaining masseter muscle thickness is critical for preserving the chewing function and preventing malnutrition in older individuals with sarcopenia.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eSwallowing and oral health factors associated with sarcopenic dysphagia risk\u003c/h2\u003e \u003cp\u003eIndividuals at a higher risk of sarcopenic dysphagia often have a heightened awareness of the severity of their dysphagia owing to the compounded effects on their health, such as underlying physiological issues or health concerns [\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn this study, the probable group showed significantly greater awareness of dysphagia severity than the group without dysphagia. This was likely because the probable group, which exhibited more advanced or clinically evident symptoms of dysphagia, perceived more pronounced symptoms concerning the severity of dysphagia, making them distinguishable from the group without dysphagia.\u003c/p\u003e \u003cp\u003eDysphagia can affect oral hygiene, increase the risk of dental problems, and lead to changes in food texture or the frequency of consumption [\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e]. These factors can negatively affect KOHIP-14 scores, even in the two dysphagia risk groups. Even in the early risk stages of dysphagia (possible group), individuals may experience subtle but meaningful disruptions in their oral health-related quality of life. These disruptions may include discomfort, changes in eating habits, or concerns about oral health, which may account for the significant differences in scores compared with those without dysphagia. In addition, the KOHIP-14 score was significantly associated with the risk of sarcopenic dysphagia. This finding suggests that reduced oral health-related quality of life may play a meaningful role in the development of sarcopenic dysphagia, highlighting the importance of maintaining good oral health in older populations.\u003c/p\u003e \u003cp\u003eTooth loss, dry mouth, and a decline in oral sensorimotor ability are associated with the risk of dysphagia in older adults [\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e]. Okamoto et al. reported that the risk of dysphagia was higher in older adults who had difficulty chewing because of tooth loss but did not use dentures [\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e]. Unlike in previous studies, tooth loss and denture use did not show significant differences between the groups. This result may be because other factors, such as sarcopenia and tongue muscle weakness, played a more dominant role in the diagnostic algorithm for sarcopenic dysphagia in the study population; thus, differences in dental factors may not have been revealed. A dry mouth slows saliva flow in the oral cavity [\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e]. The incidence rate of dysphagia is higher in older individuals with dry mouth than in those without dry mouth [\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e, \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e]. In this study, oral moisture levels were significantly lower in the dysphagia risk groups and were a major factor associated with the risk of sarcopenic dysphagia. Monitoring oral hydration levels, which reflect the salivary gland function and oral muscle activity, can help predict sarcopenic dysphagia [\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e, \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e]. Interventions such as hydration strategies and oral muscle-strengthening exercises may effectively manage and reduce the risk of developing sarcopenic dysphagia.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eFirst, participants were recruited through convenience sampling from four community-based day care centers for older adults in Sasang District, Busan. This recruitment approach may limit the representativeness of the sample, as individuals attending such facilities could represent a relatively frail subgroup of community-dwelling older adults. In addition, the modest sample size may have reduced the ability to detect small effects and limited the generalizability of the findings. Future studies should include larger and more diverse populations to enhance external validity. Second, the uneven sex distribution of the participants may have affected the results related to myophysiological characteristics, including orofacial muscle strength. Therefore, it is necessary to incorporate stratified analyses based on sex into future study designs, considering the potential differences in myophysiological characteristics between sexes. Third, this was a cross-sectional study, making it difficult to confirm the causal relationship between myophysiological variables, swallowing- and oral health-related variables, and sarcopenic dysphagia. Finally, although the study participants were excluded from older individuals with diseases that cause oral muscle weakness and dysphagia, they did not reflect various common health conditions that may cause dysphagia, including gastrointestinal disorders and esophageal inflammation. Therefore, a longitudinal study is required to identify potential risk factors for sarcopenia and dysphagia in healthy older individuals living in the community.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study found that approximately 47% of healthy older adults living in the community were at risk of sarcopenic dysphagia. The myophysiological factors associated with sarcopenic dysphagia include reduced strength of the orofacial muscles, such as the tongue, buccinator, and lips; decreased thickness of the tongue and masseter; and reduced occlusal force. Swallowing and oral health-related factors associated with sarcopenic dysphagia include a higher perception of dysphagia severity, poorer oral health conditions, and reduced oral mucosal moisture levels. Additionally, tongue strength and thickness, buccinator strength, oral mucosal moisture levels, and perceived oral health condition were identified as influential factors. Given the cross-sectional design and limited sample of this study, causal relationships cannot be established. However, the findings suggest that comprehensive assessments considering both systemic and localized muscle conditions, along with oral health indicators, may help identify individuals at greater risk. Future longitudinal and interventional studies are needed to validate these associations and guide effective strategies for early detection and management of sarcopenic dysphagia in community-dwelling older adults.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eCompeting interests\u003c/h2\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003ch2\u003eCompeting interests\u003c/h2\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003ch2\u003eClinical trial number\u003c/h2\u003e\n\u003cp\u003eClinical trial number: not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHuman Ethics and Consent to Participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll procedures performed in studies involving human participants were conducted in accordance with the ethical standards of the national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This study was reviewed and approved by the Public Institutional Review Board, operated by the Korea National Institute for Bioethics Policy (KoNIBP), Republic of Korea (IRB No. P01-202505-01-029). Written informed consent was obtained from all individual participants prior to participation.\u003c/p\u003e\n\u003ch2\u003eFunding\u003c/h2\u003e\n\u003cp\u003eThis work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT) (RS-2025-23142969 and RS-2022-NR072244).\u003c/p\u003e\n\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\n\u003cp\u003eConception and design of the study (JSP, GHL, NKH, NMH and EJP), data collection and analysis (JSP, GHL and NKH), initial drafting of the manuscript (JSP, NMH and EJP), critical review of the manuscript (NKH, GHL and EJP). All the authors provided final approval of the submitted manuscript.\u003c/p\u003e\n\u003ch2\u003eData Availability\u003c/h2\u003e\n\u003cp\u003eThe data that support the findings of this study are available from the corresponding author, upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eHwang NK, Yoon TH, Park JS. Application of orofacial muscle strength measurement to screen for penetration/aspiration risk in older adults with sarcopenia: a diagnostic accuracy study. J Oral Rehabil. 2025;52:817\u0026ndash;24.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNagano A, et al. Respiratory sarcopenia and sarcopenic respiratory disability: concepts, diagnosis, and treatment. J Nutr Health Aging. 2021;25:507\u0026ndash;15.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMorisaki N. 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Adv Clin Exp Med. 2016;25:199\u0026ndash;206.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1. Demographic characteristics and general health-related features according to the risk of sarcopenic dysphagia\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003cp\u003e(n=113)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003cp\u003e(n=59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003ePossible\u003c/p\u003e\n \u003cp\u003e(n=25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003eProbable\u003c/p\u003e\n \u003cp\u003e(n=29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cem\u003ex\u003c/em\u003e2/\u003cem\u003eF\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003en (%) or M\u0026plusmn;SD (Range)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003en (%) or M\u0026plusmn;SD (Range)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003en (%) or M\u0026plusmn;SD (Range)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003en (%) or M\u0026plusmn;SD (Range)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"16\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eDemographic characteristics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eWomen\u003c/p\u003e\n \u003cp\u003eMen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e74 (65.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e3 7(62.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e18 (72.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e19 (65.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e.715\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e39 (34.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e22(37.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e7 (28.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e10 (34.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eAge (year)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e73.8\u0026plusmn;4.6\u003c/p\u003e\n \u003cp\u003e(66-84)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e73.4\u0026plusmn;4.7\u003c/p\u003e\n \u003cp\u003e(66-83)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e74.4\u0026plusmn;4.5\u003c/p\u003e\n \u003cp\u003e(67-84)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e74.2\u0026plusmn;4.4\u003c/p\u003e\n \u003cp\u003e(67-84)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e.589\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eEducation level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eElementary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e10 (8.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e6 (10.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e2 (8.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e2 (6.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e4.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e.630\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eMiddle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e38 (33.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e20 (33.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e8 (32.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e10 (34.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eHigh school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e56 (49.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e31 (52.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e11 (44.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e14 (48.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eCollege\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e9 (8.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e2 (3.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e4 (16.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e3 (10.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eEmployment status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eNon-worker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e96 (85.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e56 (94.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e17 (68.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e23 (79.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e10.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e.004**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eWorker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e17 (15.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e3 (5.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e8 (32.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e6 (20.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eLiving status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eAlone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e34 (30.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e12 (20.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e10 (40.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e12 (41.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e8.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e.067\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eWith spouse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e61 (54.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e39 (66.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e9 (36.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e13 (44.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eWith children\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e18 (15.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e8 (13.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e6 (24.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e4 (13.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"6\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eGeneral health-related features\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eSmoking status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eNon-smoker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e105 (92.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e53 (89.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e25 (100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e27 (93.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e2.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e.251\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eSmoker(former \u0026amp; current)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e8 (7.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e6 (10.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e2 (6.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eAlcohol consumption\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eNon-drinker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e67 (59.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e35 (59.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e13 (52.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e19 (65.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e.602\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eDrinker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e46 (40.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e24 (40.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e12 (48.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e10 (34.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e**\u003cem\u003ep\u003c/em\u003e\u0026lt; .01\u003c/p\u003e\n\u003cp\u003eTable 2. Myophysiological characteristics related to swallowing function according to the risk of sarcopenic dysphagia\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003cp\u003e(n=113)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003cp\u003e(n=59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003ePossible\u003c/p\u003e\n \u003cp\u003e(n=25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eProbable\u003c/p\u003e\n \u003cp\u003e(n= 29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cem\u003eF\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eM\u0026plusmn;SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eM\u0026plusmn;SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eM\u0026plusmn;SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eM\u0026plusmn;SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eStrength (kPa)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eTongue\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e25.8\u0026plusmn;9.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e32.1\u0026plusmn;8.4\u003csub\u003ea\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e22.9\u0026plusmn;2.4\u003csub\u003eb\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e15.5\u0026plusmn;2.6\u003csub\u003ec\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e70.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u0026lt;.001***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eBuccinator\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e20.0\u0026plusmn;4.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e22.1\u0026plusmn;3.5\u003csub\u003ea\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e19.3\u0026plusmn;4.4\u003csub\u003eb\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e16.2\u0026plusmn;5.2\u003csub\u003ec\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e19.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u0026lt;.001***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eLip\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e15.7\u0026plusmn;4.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e20.83\u0026plusmn;3.5\u003csub\u003ea\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e17.8\u0026plusmn;4.2\u003csub\u003eb\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e15.7\u0026plusmn;4.9\u003csub\u003eb\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e16.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u0026lt;.001***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eMuscle thickness (mm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eTongue\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e28.4\u0026plusmn;9.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e34.7\u0026plusmn;8.2\u003csub\u003ea\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e25.2\u0026plusmn;3.9\u003csub\u003eb\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e18.4\u0026plusmn;3.8\u003csub\u003ec\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e64.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u0026lt;.001***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eMasseter; rest\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e8.2\u0026plusmn;1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e8.2\u0026plusmn;0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e8.4\u0026plusmn;1.4\u003csub\u003ea\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e7.7\u0026plusmn;0.9\u003csub\u003eb\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e4.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e.011*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eMasseter; contraction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e9.7\u0026plusmn;1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e9.8\u0026plusmn;1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e10.0\u0026plusmn;1.5\u003csub\u003ea\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e9.1\u0026plusmn;1.2\u003csub\u003eb\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e3.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e.044*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eMaximum occlusal force (N)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e469.8\u0026plusmn;173.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e514.6\u0026plusmn;154.5\u003csub\u003ea\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e447.1\u0026plusmn;173.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e398.4\u0026plusmn;187.5\u003csub\u003eb\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e5.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e.009**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eM: Mean, SD: Standard deviation, *\u003cem\u003ep\u003c/em\u003e\u0026lt;0.05, **\u003cem\u003ep\u003c/em\u003e\u0026lt;0.01, ***\u003cem\u003ep\u003c/em\u003e\u0026lt;0.001\u003c/p\u003e\n\u003cp\u003eNote., Means not sharing subscript differ significantly at \u003cem\u003ep\u003c/em\u003e\u0026lt;0.05, as indicated by post hoc Scheff\u0026eacute;\u0026rsquo;s test\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 3. Swallowing and oral health related characteristics according to the risk of sarcopenic dysphagia\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003cp\u003e(n=113)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003cp\u003e(n=59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003ePossible\u003c/p\u003e\n \u003cp\u003e(n=25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003eProbable\u003c/p\u003e\n \u003cp\u003e(n=29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cem\u003eF/\u003c/em\u003e\u003cem\u003e\u0026nbsp;x\u003c/em\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003en (%) or M\u0026plusmn;SD (Range)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003en (%) or M\u0026plusmn;SD (Range)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003en (%) or M\u0026plusmn;SD (Range)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003en (%) or M\u0026plusmn;SD (Range)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eEAT-10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e8.5\u0026plusmn;7.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e6.4\u0026plusmn;4.6\u003csub\u003ea\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e8.9\u0026plusmn;7.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e12.4\u0026plusmn;8.7\u003csub\u003eb\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e8.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e.001**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eKOHIP-14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e26.1\u0026plusmn;11.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e19.8\u0026plusmn;7.3\u003csub\u003ea\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e30.8\u0026plusmn;8.8\u003csub\u003eb\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e34.8\u0026plusmn;11.3\u003csub\u003eb\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e32.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u0026lt;.001***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eOral mucosal moisture level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e24.8\u0026plusmn;3.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e26.4\u0026plusmn;2.4\u003csub\u003ea\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e23.0\u0026plusmn;2.6\u003csub\u003eb\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e22.8\u0026plusmn;2.2\u003csub\u003eb\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e28.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u0026lt;.001***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eNo. of teeth lost\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e3.0\u0026plusmn;1.6 (0-8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e2.9\u0026plusmn;1.5(1-8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e2.8\u0026plusmn;1.9(0-7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e3.5\u0026plusmn;1.7(1-8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e.240\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eDenture use\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e41(36.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e21(35.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e10(40.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e10(34.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e.904\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e72(63.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e38(64.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e15(60.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e19(65.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eKOHIP-14: Korean oral health impact profile-14, M: Mean, SD: Standard deviation, *\u003cem\u003ep\u003c/em\u003e\u0026lt;0.05, **\u003cem\u003ep\u003c/em\u003e\u0026lt;0.01, ***\u003cem\u003ep\u003c/em\u003e\u0026lt;0.001\u003c/p\u003e\n\u003cp\u003eNote: Means not sharing subscript differ significantly at \u003cem\u003ep\u003c/em\u003e\u0026lt;0.05, as indicated by post hoc Scheff\u0026eacute;\u0026rsquo;s test\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eTable 4. Factors influencing the risk of sarcopenic dysphagia\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003eOR (95% CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003eTongue strength\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003e0.494(0.293-0.833)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003e.008**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003eBuccinator strength\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003e0.846(0.717-0.969)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003e.048*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003eLip strength\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003e0.835(0.687-2.014)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003e.069\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003eTongue thickness\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003e0.588(0.423-0.818)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003e.026*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003eMasseter\u0026nbsp;thickness; rest\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003e0.976(0.865-2.696)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003e.070\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003eMasseter\u0026nbsp;thickness;\u0026nbsp;contraction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003e0.983(0.941-3.748)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003e.362\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003eMaximum occlusal force\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003e0.998(0.993-1.002)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003e.318\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003eEAT-10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003e1.083(0.999-1.174)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003e.054\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003eKOHIP-14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003e1.190(1.094-1.294)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003e\u0026lt;.001***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003eOral mucosal moisture level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003e0.508(0.369-0.700)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003e\u0026lt;.001***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003eNo. of teeth lost\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003e0.915(0.576-1.454)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003e.706\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003eDenture use\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003e0.489(0.126-1.900)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003e.301\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eOR, odds ratio; CI, 95% confidence interval, *\u003cem\u003ep\u003c/em\u003e\u0026lt;0.05, **\u003cem\u003ep\u003c/em\u003e\u0026lt;0.01, ***\u003cem\u003ep\u003c/em\u003e\u0026lt;0.001\u003c/p\u003e\n\u003cp\u003eNote. Factors with \u003cem\u003ep\u003c/em\u003e\u0026lt;0.05 in the bivariate analysis were used in the model as independent variables.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-oral-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ohea","sideBox":"Learn more about [BMC Oral Health](http://bmcoralhealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ohea/default.aspx","title":"BMC Oral Health","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"sarcopenic dysphagia, older adult, orofacial muscle strength, tongue thickness, oral health","lastPublishedDoi":"10.21203/rs.3.rs-8846182/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8846182/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eSarcopenic dysphagia is a condition characterized by difficulty swallowing that results from age-related loss of skeletal muscle mass and strength, known as sarcopenia. With population aging, sarcopenic dysphagia has emerged as a major health concern due to its links with poor nutrition, aspiration, and mortality.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis cross-sectional observational study aimed to investigate the risk of sarcopenic dysphagia in healthy community-dwelling older adults and to analyze its association with myophysiological factors related to swallowing function as well as oral health factors. A total of 113 community-dwelling adults aged 65 years and older were classified into no, possible, and probable sarcopenic dysphagia groups based on a diagnostic algorithm for sarcopenic dysphagia. Orofacial muscle strength, tongue and masseter thicknesses, and maximum occlusal force were measured. Dysphagia severity, oral health-related quality of life (QOL), and oral mucosal moisture were assessed.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eApproximately 47% of healthy older adults in the community were at risk of sarcopenic dysphagia (possible risk\u0026thinsp;=\u0026thinsp;22.1%, probable risk\u0026thinsp;=\u0026thinsp;25.7%). The logistic regression model, adjusted for sociodemographic factors, revealed that decreases in tongue strength (OR\u0026thinsp;=\u0026thinsp;0.494, 95%CI\u0026thinsp;=\u0026thinsp;0.293\u0026ndash;0.833) and thickness (OR\u0026thinsp;=\u0026thinsp;0.588, 95%CI\u0026thinsp;=\u0026thinsp;0.423\u0026ndash;0.818), buccinator strength (OR\u0026thinsp;=\u0026thinsp;0.846, 95%CI\u0026thinsp;=\u0026thinsp;0.717\u0026ndash;0.969), oral mucosal moisture (OR\u0026thinsp;=\u0026thinsp;0.508, 95% CI\u0026thinsp;=\u0026thinsp;0.369-0.700), and oral health-related QOL (OR\u0026thinsp;=\u0026thinsp;1.190, 95%CI\u0026thinsp;=\u0026thinsp;1.094\u0026ndash;1.294) were identified as major factors associated with the risk of sarcopenic dysphagia.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eNearly half of healthy community-dwelling older adults were at risk of sarcopenic dysphagia. Tongue strength and thickness, buccinator strength, oral mucosal moisture, and oral health-related QOL were key factors. Comprehensive screening of localized oral muscles and oral health indicators may aid in early detection.\u003c/p\u003e","manuscriptTitle":"Swallowing Related Muscular and Oral Health Characteristics Associated with Sarcopenic Dysphagia in Older Adults: A Cross Sectional Observational Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-09 12:52:07","doi":"10.21203/rs.3.rs-8846182/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-04-20T08:56:21+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-19T16:13:59+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"50091454934879218088280721632900971393","date":"2026-04-13T10:27:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"283108759618982895909545069860711152773","date":"2026-04-13T00:18:51+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-10T23:09:55+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"158519309498496821930446168694564073609","date":"2026-04-10T22:46:37+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"56361614451764182556780388290776076494","date":"2026-04-10T16:44:50+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"145452007342942798800896401888331401277","date":"2026-04-03T13:10:41+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-03T13:07:22+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-05T15:49:10+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-13T07:05:38+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-13T06:57:54+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Oral Health","date":"2026-02-11T01:59:33+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-oral-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ohea","sideBox":"Learn more about [BMC Oral Health](http://bmcoralhealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ohea/default.aspx","title":"BMC Oral Health","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"bcc5a295-4c88-4be9-9f6e-f922b9d4fa8c","owner":[],"postedDate":"April 9th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-09T12:52:07+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-09 12:52:07","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8846182","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8846182","identity":"rs-8846182","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}