Relationship between nutritional biomarkers and occlusal status in gastric cancer patients using the Eichner Index: A cross sectional study

Abstract Background Systemic inflammatory responses and nutritional status are useful prognostic factors in patients with gastric cancer. Because oral hypofunction is a cause of undernutrition, we cross-sectionally investigated whether some nutritional biomarkers were affected by occlusal supporting zone status. Methods The study included 114 patients (85 men and 29 women) diagnosed with gastric cancer at Nagoya Ekisaikai Hospital between September 2014 and March 2019. Gastric cancer stage, body mass index (BMI), albumin levels, total lymphocyte counts, cholesterol levels, and C-reactive protein levels were evaluated in preoperative blood tests. Four kinds of nutritional biomarkers were evaluated; they are the Glasgow prognostic score (GPS), neutrophil-lymphocyte ratio (NLR), prognostic nutrition index (PNI), and controlling nutritional status (CONUT). Oral conditions were assessed by determining the number of remaining teeth, occlusal supporting status based on the Eichner classification. Patients were assigned into three groups per their occlusal status, and mean values were compared using the Kruskal-Wallis test. Results The mean age and BMI were 72.2 ± 8.5 (50–89) years and 22.0 ± 3.6 (14.8–33.4), respectively. There were here were 42, 39, 23, and 10 stages I, II, III, and IV patients, respectively. The mean number of remaining teeth was 18.1 ± 9.5 teeth. According to the Eichner classification, there were 45, 42, and 27 patients in groups A, B, and C, respectively. There were significant differences in the GPS and NLR values, and CONUT frequencies between groups A and C (P = 0.033, P = 0.00097, P = 0.04, respectively) (Mann-Whitney U test). PNI values were lower in Group C with poor occlusal support zones than in Group A with stable occlusal support zones. Conclusions Reductions in occlusal supporting zones were associated with undernutrition. Notably, patients in Eichner Class C with few occlusal supporting zones had poor GPS, PNI, and CONUT values, and were found to be undernourished. Thus, patients with markedly reduced occlusal contacts are often undernourished and have advanced systemic inflammation, which may affect prognosis. Patients in the Eichner Class C group need interventions to improve nutritional status such as dietary counseling due to potential nutritional deficits experienced by this group of patients.