Relationship Between Oral Function Measurement and Malnutrition Following Oral Cancer Treatment: A Single-Center Cross-Sectional Study

Relationship Between Oral Function Measurement and Malnutrition Following Oral Cancer Treatment: A Single-Center Cross-Sectional 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 Relationship Between Oral Function Measurement and Malnutrition Following Oral Cancer Treatment: A Single-Center Cross-Sectional Study Reon Morioka, Yuhei Matsuda, Akira Kato, Tatsuo Okui, Satoe Okuma, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-1392203/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 11 You are reading this latest preprint version Abstract Objectives Oral dysfunction and dysphagia after oral cancer treatment have been linked to a decrease in nutritional status. This study aimed to identify specific oral functions related to nutritional status. Patients and Methods : We conducted a cross-sectional study from September 2019 to December 2021. We recruited 75 participants (median age: 72.0 years), including 52 (69.3%) males and 23 (30.7%) females, collected background data, and evaluated oral function. The Mini Nutritional Assessment-Short Form (MNA-SF) scores were divided into three groups (normal nutritional status, at risk of malnutrition, and malnourished), and a multi-group comparison was conducted for each oral function measurement (microorganisms, oral dryness, occlusal force, tongue pressure, masticatory function, and Eating Assessment Tool [EAT-10]). Results The primary tumor site was the tongue in 31 patients (41.3%), gingiva in 30 (40.0%), and others in 14 (18.7%). Multiple comparisons revealed significant differences in occlusal force, tongue pressure, masticatory function, and EAT-10 level between each MNA-SF group (P < 0.05). Multiple regression analysis showed a statistically significant association with MNA-SF in terms of masticatory function and EAT-10 levels. Conclusion Decreased masticatory function and EAT-10 levels are risk factors for malnutrition. Nutritional instructions and oral-maxillofacial prosthetic treatment should be adapted to changes in oral function. Figures Figure 1 Figure 2 Introduction The disease-specific survival rates of oral cancer patients have been increased with the development of surgical techniques, molecular targeted drugs, and immune checkpoint inhibitors, as well as the application of radiotherapy, represented by intensity-modulated radiation therapy [ 1 ]. With an increase in the number of oral cancer patients due to the increased survival rate after treatment and the aging of the population, the number of oral cancer patients living with the sequelae of oral cancer treatment is increasing [ 2 ]. According to the current National Comprehensive Cancer Network (NCCN) guidelines, resection is often the first-line treatment for oral cancer [ 3 ]. Thus, there is a wide range of sequelae after oral cancer treatment, such as xerostomia, dysphagia, speech disorder, tooth loss, chronic pain, body image concerns, anxiety/depression, trismus, and malnutrition; it was also reported that the quality of life of patients with oral cancer deteriorated after treatment [ 4 ]. In particular, restriction of food intake is a sequela that can lead to malnutrition. Approximately one-quarter of patients who have undergone oral cancer treatment experience a decrease in food intake [ 5 , 6 ]. The swallowing process is remarkably complex, involving six cranial nerves, multiple muscle groups, and cortical and subcortical brain signals that must be precisely coordinated within a few seconds [ 7 ]. In recent years, swallowing behavior has often been described using process models (Fig. 1 ) [ 8 ]. A four-phase continuous model of swallowing and process models are used to understand dysphagia caused by dementia, stroke, amyotrophic lateral sclerosis, and oral cancer [ 9 ]. In oral cancer treatment, sudden anatomical structural displacement and lack of motor sequence lead to postoperative impairment of oral function, which impairs Stage I transport, processing, and Stage II transport. Hence, there is a need for more suitable methods to evaluate postoperative dysphagia in oral cancer patients. The Matsuda–Kanno classification of postoperative oral dysfunction is useful for comprehending different types of swallowing dysfunction, as previously reported [ 10 ]. Briefly, three components were identified using principal component analysis in the Matsuda–Kanno classification [ 10 ]. Type 1 postoperative oral dysfunction (transport type) includes masticatory function, Eating Assessment Tool (EAT-10), and tongue pressure. It is widely considered a conceptual disorder that affects both Stage I and Stage II transport. Type 2 postoperative oral dysfunction (oral hygiene type) consists of items related to bacterial counts, oral health perception, and oral dryness. Oral dryness as an oral function has been reported to be an accelerator for an increased number of oral microorganisms [ 11 ]. Type 3 postoperative oral dysfunction (occlusal type) consists of occlusal force alone. This component is thought to be an independent component because its elements are very different from those of other components [ 10 ]. Therefore, recent studies have clarified the details of postoperative oral function following evidence-based oral cancer treatment guided by the NCCN guidelines [ 3 ]. However, there are still some problems with nutritional instructions for oral cancer patients. Although there are reports that early intervention by a dietitian may improve the nutritional status of patients with oral cancer, two randomized controlled trials could not confirm the effectiveness of this intervention [ 12 , 13 ]. Therefore, we hypothesized that different types of postoperative oral dysfunction require different nutritional guidance and conducted a study to clarify the relationship between various postoperative oral functions and nutritional status. Methods Data collection Participants in this cross-sectional study were enrolled according to the following criteria: (1) patients diagnosed and treated for oral squamous cell carcinoma based on NCCN guidelines by a single surgical team in a single center; (2) patients who visited the Department of Oral and Maxillofacial Surgery/Oral Care Center at Shimane University Hospital (Shimane, Japan); (3) patients aged 20 years or older; and (4) patients who could understand the questions and answer the questionnaire. No exclusion criteria were set [ 3 ]. All data were collected just before the patient was discharged from the hospital. The study period lasted from September 2019 to December 2021, and data were collected using a sequential sampling method. This study was approved by the Institutional Review Board of the Ethics Committee of the Shimane University Faculty of Medicine (approval number: 4041). Also, all methods were performed in accordance with Declarations of Helsinki. Written informed consent was obtained from each participant prior to participation in the study. Background data We sampled the following variables as background data: sex, age (years), body mass index (BMI, kg/m 2 ), drinking habit (regular drinker or not), Brinkman index, Eastern Cooperative Oncology Group performance status, primary tumor site, cancer stage based on the criteria of the Union for International Cancer Control (version 8), treatment methods (surgery/surgery and adjuvant radiotherapy/surgery and adjuvant chemoradiotherapy), presence of neck dissection, presence of reconstructive surgery, and number of teeth. Oral function measurement The method recommended by the Japanese Society of Gerodontology in its position paper was adopted to measure oral function [ 14 ]. However, tongue-lip motor function could not be assessed in patients with tongue defects caused by oral cancer treatment; therefore, it was removed from the assessment items. Microorganisms The number of microorganisms was measured by collecting samples from the center of the tongue dorsum using a bacterial counter (Panasonic Healthcare Co., Ltd., Tokyo, Japan). The number of microorganisms indicated by the bacterial counter and the grade were recorded. Oral dryness Oral dryness was measured using an oral moisture checker (Mucus, Life Co., Ltd., Saitama, Japan), and the median of three measurements on the dorsum of the tongue was taken as the data. Measurements were taken on the healthy side if there was a reconstructed flap due to a defect in the tongue, and in the middle of the flap if a total resection had been performed. Occlusal force The occlusal force was measured using a pressure-sensitive paper (Dental Prescale Occluzer, GC Corporation, Tokyo, Japan) by clenching for 3 s at the intercuspal position. If the subject had a denture, the occlusal force was measured with the denture in place. Tongue pressure Tongue pressure was measured at the center of the dorsum of the tongue using a JMS tongue pressure measuring instrument (TPM-01, JMS Co., Ltd., Hiroshima, Japan). Masticatory function Masticatory function was measured using a masticatory ability testing system (Gluco Sensor GS-II, GC Corporation, Tokyo, Japan). EAT-10 Swallowing function was assessed using a 10-question questionnaire measured on a 5-point Likert scale (0 = no problem; 4 = severe problem) developed by Belafsky in 2008 [ 15 ]. The EAT-10 has a maximum total score of 40, with higher scores indicating poor swallowing function. Swallowing function measurement Functional oral intake scale The functional oral intake scale (FOIS) has a maximum total score of 40, with higher scores indicating poor swallowing function [ 16 ]. Mini Nutritional Assessment-Short Form Nutritional status was assessed using the Mini Nutritional Assessment-Short Form (MNA-SF), which consists of six items with a maximum score of 14 and a minimum score of 0 [ 17 ]. The MNA-SF scores can also be classified into three groups (normal nutritional status [scores 12–14], at risk of malnutrition [scores 8–11], and malnourished [scores 0–7]). Matsuda–Kanno classification The Matsuda–Kanno classification was used as a reference for classifying postoperative oral dysfunctions. The classification can be divided into three types: transport, oral hygiene, and occlusal. In this study, the cut-off values of each oral function measurement were used as references (Table 1 ) [ 10 ]. Table 1 Matsuda–Kanno classification of postoperative oral dysfunction and cut-off values for oral function measurements Types Names Definition Reference values for diagnostic criteria I Transport type A condition in which dysfunction occurs during the oral preparatory and transit phases of swallowing due to treatment-induced damage to the tongue, palate, buccal mucosa, or oral floor. Masticatory function (cut-off value: 83 mg/dL) EAT-10 (cut-off value: 12) Tongue pressure (cut-off value: 14 kPa) II Oral hygiene type A condition in which the self-cleaning and antibacterial moisturizing functions of the oral cavity are impaired by treatment. Number of microorganisms (cut-off value: 10 6.5 or more) Oral dryness (cut-off value: 27.0) Chief complaint of subjective oral health perception III Occlusion type A condition in which occlusion is impaired due to loss of maxilla and mandible or teeth from treatment. Occlusal force (cut-off value: 230 N) EAT-10: Eating Assessment Tool Statistical analysis Descriptive analyses were used to calculate the median, interquartile range (IQR), and relative frequency. For group comparisons, we used the chi-square test and Mann–Whitney U test with Bonferroni correction after the Kruskal–Wallis test as a multiple comparison method. In addition, a trend test (Jonckheere–Terpstra test) was performed. Finally, a multiple regression analysis was conducted with the total MNA-SF score as the objective variable. Statistical analyses were performed using SPSS version 26 (SPSS Japan Inc., Tokyo, Japan). We calculated two-tailed P-values for all analyses, and the alpha level of significance was set at P < 0.05. Results Patient characteristics Patient characteristics are summarized in Table 2 . This survey included 75 patients who were treated for oral cancer, 52 (69.3%) of whom were male and 23 (30.7%) were female. The median age of the patients was 72.0 years (IQR: 64.0–78.0 years). In addition, 59 (78.7%) patients had a performance status of 0. The tongue was the most frequent primary tumor site, and 31 (41.3%) patients had early stage cancer. Surgery alone was the most common treatment (40 patients, 53.3%). Neck dissection and reconstruction were performed in 48 (64.0%) and 47 (62.7%) patients, respectively. The median number of teeth was 16.0 (IQR: 3.0–24.0). The median (IQR) values of oral function measurements were 3.0 (2.0–5.0), 24.8 (21.3–26.7), 245.6 (18.0–443.6), 17.1 (7.5–23.6), 75.0 (15.0–150.0), and 15.0 (4.0–25.0) for microorganisms (grade), oral dryness, occlusal force (N), tongue pressure (kPa), masticatory function (mg/dL), and EAT-10, respectively. The median FOIS score was 5.0 (IQR: 5.0–6.0), and the median MNA-SF score (malnourished) was 28 (37.3%). Table 2 Demographic and clinical characteristics (N = 75) Variables Categories N (%), median (25–75 percentile) Sex Male 52 (69.3) Female 23 (30.7) Age (years) 72.0 (64.0–78.0) Body mass index (kg/m²) 20.4 (18.6–23.6) Brinkman index 0.0 (0.0–440.0) Drinking habit Regular drinker 34 (45.3) Social drinker 7 (9.3) None 34 (45.3) Number of teeth 16.0 (3.0–24.0) Systemic disease (yes) Diabetes mellitus 17 (22.7) Hypertension 27 (36.0) Cardiovascular disease 8 (10.7) Cerebrovascular disease 5 (6.7) Liver disease 4 (5.3) Pulmonary disease 8 (10.7) Kidney disease 5 (6.7) Orthopedic disease 8 (10.7) Psychiatric disease 6 (8.0) Cancer (except oral cancer) 6 (8.0) Performance status 0 59 (78.7) 1 9 (12.0) 2 1 (1.3) 3 6 (8.0) Primary tumor site Tongue 31 (41.3) Upper gingiva 16 (21.3) Lower gingiva 16 (21.4) Palate 3 (4.0) Oral floor 5 (6.7) Buccal mucosa 3 (4.0) Lip 1 (1.3) Tumor stage Stage I 17 (22.7) Stage II 9 (12.0) Stage III 12 (16.0) Stage IV 37 (49.3) Treatment Surgery 40 (53.3) Surgery + Radiotherapy 10 (13.3) Surgery + Chemoradiotherapy 25 (33.3) Neck dissection (yes) 48 (64.0) Reconstruction (yes) 47 (62.7) Oral function mesurement Microorganisms (grade) 3.0 (2.0–5.0) Oral dryness 24.8 (21.3–26.7) Occulusal force (N) 245.6 (18.0–443.6) Tongue pressure (kPa) 17.1 (7.5–23.6) Masticatory function (mg/dL) 75.0 (15.0–150.0) EAT-10 15.0 (4.0–25.0) Functional oral intake scale 1 6 (8.0) 2 4 (5.3) 3 0 (0.0) 4 8 (10.7) 5 22 (29.3) 6 25 (33.3) 7 10 (13.3) MNA-SF Total score 9.0 (7.0–11.0) Normal nutritional status 16 (21.3) At risk of malnutrition 31 (41.3) Malnourished 28 (37.3) MNA-SF: Mini Nutritional Assessment-Short Form Multiple group comparisons of MNA-SF scores and related factors Multiple group comparisons of MNA-SF scores and related factors are summarized in Table 3 . There were significant differences in age (P = 0.03), body mass index (P < 0.01), number of teeth (P = 0.02), performance status (P < 0.01), tumor stage (P = 0.04), and treatment methods (surgery/surgery and adjuvant radiotherapy/surgery and adjuvant chemoradiotherapy; P < 0.01). Table 3 Group comparisons of MNA-SF and related factors (N = 75) Variables Categories MNA-SF (N [%], mean [SD], or median [25–75 percentile]) Normal nutritional status At risk of malnutrition Malnourished P-values Sex Male 14 (18.7) 20 (26.7) 18 (24.0) 0.21 Female 2 (2.7) 11 (14.7) 10 (13.3) Age (years) 70 (63.0–73.0) 71.0 (64.0–74.0) 77.5 (71.0–86.0) 0.03* Body mass index (kg/m²) 23.5 (20.2–24.8) 21.1 (19.3–23.7) 19.0 (17.0–86.0) < 0.01* Brinkman index 200.0 (0.0–440.0) 0.0 (0.0–400.0) 0.0 (0.0–525.0) 0.31 Number of teeth 21.0 (10.5–26.0) 20.0 (8.0–26.0) 6.5 (0.0–21.5) 0.02* Performance status 0.0 (0.0–0.0) 0.0 (0.0–0.0) 0.0 (0.0–1.0) < 0.01* Primary tumor site Tongue 6 (8.0) 13 (17.3) 12 (16.0) 0.94 Gingiva 5 (6.7) 14 (18.7) 11 (14.7) 0.65 Others 5 (6.7) 4 (5.3) 5 (6.7) 0.31 Tumor stage 3.0 (1.0–4.0) 3.0 (1.0–4.0) 4.0 (3.0–4.0) 0.04* Treatment Surgery 12 (16.0) 21 (28.0) 7 (9.3) < 0.01* Surgery + Radiotherapy 1 (1.3) 1 (1.3) 8 (10.7) Surgery + Chemoradiotherapy 3 (4.0) 9 (12.0) 13 (17.3) Neck dissection (yes) 10 (13.3) 17 (22.7) 21 (28.0) 0.27 Reconstruction (yes) 9 (12.0) 18 (24.0) 20 (26.7) 0.48 MNA-SF: Mini Nutritional Assessment-Short Form; SD: standard deviation *P < 0.05 Multiple group comparisons of MNA-SF scores and oral function measurements Multiple group comparisons of MNA-SF scores and oral function measurements are shown in Fig. 2 . There were significant differences in occlusal force, tongue pressure, masticatory function, and EAT-10 levels (P < 0.05). Relationship between MNA-SF and oral function measurement using multiple regression analysis Multiple regression analysis showed a statistically significant association with MNA-SF in terms of masticatory function (β = 0.28, P = 0.01) and EAT-10 levels (β = -0.32, P = 0.01; Table 4 ). Table 4 Relationship between MNA-SF and oral function measurement using multiple regression analysis Variables β B 95% confidence interval P-value Adjusted R 2 Lower Upper Microorganisms (grade) 0.06 0.12 -0.34 0.58 0.60 0.27 Oral dryness 0.13 0.09 -0.06 0.23 0.23 0.28 Occulusal force (N) 0.21 < 0.01 < 0.01 < 0.01 0.07 0.30 Tongue pressure (kPa) 0.19 0.05 -0.01 0.11 0.09 0.29 Masticatory function (mg/dL) 0.28 0.01 0.003 0.02 0.01* 0.33 EAT-10 -0.32 -0.09 -0.15 -0.03 0.01* 0.34 In the multiple regression analysis, analyses were separated for each oral function, and sex, age, tumor stage, treatment, and primary tumor site were simultaneously forced into the model equation for each analysis to adjust for confounding factors. MNA-SF, Mini Nutritional Assessment-Short Form; β, standardized partial regression coefficient; B, partial regression coefficient. *P < 0.05 Discussion The major finding of this study is that multiple oral dysfunctions have an impact on nutritional status. Of these, masticatory function and EAT-10 levels were found to be independent and distinct oral dysfunctions in our previous studies [ 10 ]. In addition, the EAT-10 swallowing assessment has traditionally been associated with nutritional status in healthy individuals [ 18 ]. Therefore, our hypothesis that “different types of postoperative oral dysfunction require different nutritional guidance” is likely to be correct, and our results were reasonable. Masticatory function and EAT-10 constitute type I postoperative oral dysfunction. Arthur et al. reported that there was no relationship between masticatory function and nutritional status, but this may be due to the fact that the assessment items were the number of teeth and occluding pairs of teeth, rather than masticatory function, which is the ability to pull back food from the anterior region of the mouth to the molar region and squeeze back processed food from the mouth to the pharynx [ 19 ]. Therefore, based on the results of our study, we believe that masticatory function is related to postoperative nutritional status. Since it is well known that tongue pressure and masticatory function decrease with resection, especially in patients with oral cancer, our results also support the results of previous studies [ 20 , 21 ]. In addition, a cross-sectional study of 909 hospitalized patients showed an association between EAT-10 levels and nutritional status, and the results of this study were similar [ 22 ]. Therefore, malnutrition may occur due to type I postoperative oral dysfunction (transport type). In the nutritional instructions for type I postoperative oral dysfunction, it is especially important to choose a food texture that facilitates the formation of boluses, which can be transported to the pharynx by gravity [ 23 ]. In addition, the use of palatal augmentation prosthesis as a patient specific oral-maxillofacial prosthetic treatment makes it easier to direct the bolus into the esophagus, and rehabilitation with maneuvers on swallowing function is a reinstatement of safe oral intake [ 24 , 25 ]. In contrast, multivariate analysis did not show a significant association between occlusal force and nutritional status, but occlusal force was the only component of Type III postoperative oral dysfunction, suggesting the possibility of nutritional impairment caused by Type III postoperative oral dysfunction. Decreased occlusal force is mainly caused by resection of the masticatory muscles (temporalis, masseter, lateral pterygoid, and medial pterygoid muscles) and loss of occluding pairs of teeth due to maxillary or mandibular resection [ 26 ]. This study is the first to show that maxillary and mandibular deficiencies can reduce occlusal force and affect nutritional status, while also suggesting that oral-maxillofacial prosthetic treatment may be useful. The first-line treatment for patients with maxillary or mandibular defects is patient-specific oral-maxillofacial prosthetic treatment using dentures and dental implants [ 27 ]. However, prosthetic treatment has some limitations, and even with dental implants, it is unlikely that the occlusal force will be restored to what it was before resection [ 28 ]. Decreased occlusal force is mainly associated with decreased intake of vegetables and proteins, suggesting that nutritional guidance should pay more attention to the loss of food diversity than food texture [ 29 ]. In addition, since regular and longitudinal dental visits are important for oral-maxillofacial prosthetic management and care, community collaboration is also important from the perspective of long-term nutritional management following oral cancer treatment [ 30 ]. The results of the trend test suggested that malnutrition caused by the Type 1 and Type 3 postoperative oral dysfunctions described above may be exacerbated in stages. In other words, in clinical practice, we should not only focus on the presence of malnutrition, but also screen and intervene earlier for patients in the pre-malnutrition or intermediate stages of malnutrition using a multidisciplinary team [ 31 ]. The limitation of this study is that the sample size was relatively small. Because of the limited number of items that could be fed into the explanatory variables, only rough confounding adjustments were conducted for tumor site and treatment. However, since postoperative oral dysfunction and dysphagia have been reported to occur in both single and multimodal treatments, it was assumed that an analysis considering more confounding factors would yield results similar to those of this study [ 32 ]. In addition, because many patients in this study had advanced oral cancer, the prevalence of malnutrition due to postoperative oral dysfunction may need to be estimated lower when considering generalizability. However, since the number of severely ill patients is expected to increase in Japan, where the population is super-aging, the generalizability of this study is likely to be high in developed countries with aging populations [ 33 ]. Future studies will need to evaluate whether malnutrition is reversible over time. Conclusion Decreased masticatory function and EAT-10 levels are risk factors for malnutrition. Postoperative oral dysfunction type I (transport type) may be a risk factor for nutritional status in patients treated for oral cancer. Further, nutritional instructions and oral-maxillofacial prosthetic treatment should be adapted to changes in various oral functions. Declarations Acknowledgements This research was funded by the JSPS KAKENHI Grant [grant number 20K18829]. Author contributions R.M., Y.M. and T.K. wrote the main manuscript text. R.M., Y.M. conducted the statistical analyses and prepared the figures and tables. R.M., Y.M., A.K., T.O., S.O., H.T. and T.K. collected the data and performed the study. T.O., S.O., H.T. and T.K. planed and supervised the study. All authors reviewed the manuscript. Competing Interests Statement The authors declare no competing interests. Data availability statement Not applicable. References [1] Cooper JS, Pajak TF, Forastiere AA, Jacobs J, Campbell BH, Saxman SB, et al. 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Validation of masticatory function and related factors in maxillectomy patients based on the concept of "oral hypofunction": A retrospective cross-sectional study. J Prosthodont Res. 2021;65:449-54. [27] Ono T, Kohda H, Hori K, Nokubi T. Masticatory performance in postmaxillectomy patients with edentulous maxillae fitted with obturator prostheses. Int J Prosthodont. 2007;20:145-50. [28] Huang YF, Liu SP, Muo CH, Chang CT. Prosthetic design related to peri-implant bone resorption in microvascular free fibular flap among patients with oral cancer: A retrospective clinical study. J Prosthet Dent. 2020;124:395-9. [29] Inomata C, Ikebe K, Okubo H, Takeshita H, Mihara Y, Hatta K, et al. Dietary Intake Is Associated with Occlusal Force Rather Than Number of Teeth in 80-y-Old Japanese. JDR Clin Trans Res. 2017;2:187-97. [30] Sohn HO, Park EY, Jung YS, Lee EK, Kim EK. Effects of professional oral hygiene care in patients with head-and-neck cancer during radiotherapy: A randomized clinical trial. Indian J Dent Res. 2018;29:700-4. [31] Cremonese G, Bryden G, Bottcher C. A multidisciplinary team approach to preservation of quality of life for patients following oral cancer surgery. ORL Head Neck Nurs. 2000;18:6-11. [32] Huh G, Ahn SH, Suk JG, Lee MH, Kim WS, Kwon SK, et al. Severe late dysphagia after multimodal treatment of stage III/IV laryngeal and hypopharyngeal cancer. Jpn J Clin Oncol. 2020;50:185-92. [33] Aoki T, Ota Y, Sasaki M, Suzuki T, Uchibori M, Nakanishi Y, et al. Quality of life of Japanese elderly oral cancer patients during the perioperative period. Int J Oral Maxillofac Surg. 2021;50:1138-46. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Major revision 21 Apr, 2022 Reviews received at journal 06 Apr, 2022 Reviewers agreed at journal 06 Apr, 2022 Reviewers agreed at journal 05 Apr, 2022 Reviews received at journal 05 Apr, 2022 Reviewers agreed at journal 05 Apr, 2022 Reviewers invited by journal 05 Apr, 2022 Editor assigned by journal 05 Apr, 2022 Editor invited by journal 07 Mar, 2022 Submission checks completed at journal 07 Mar, 2022 First submitted to journal 24 Feb, 2022 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-1392203","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":88815328,"identity":"2e0bfdf8-1daa-4883-a2c9-389c1aa0d3a6","order_by":0,"name":"Reon Morioka","email":"","orcid":"","institution":"Shimane University Faculty of Medicine","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Reon","middleName":"","lastName":"Morioka","suffix":""},{"id":88815329,"identity":"1bc1944e-1ed4-43a7-8142-ff7ed260c69d","order_by":1,"name":"Yuhei Matsuda","email":"","orcid":"","institution":"Shimane University Faculty of Medicine","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Yuhei","middleName":"","lastName":"Matsuda","suffix":""},{"id":88815330,"identity":"4df36710-93a4-4fb8-a694-1a5f692784fb","order_by":2,"name":"Akira Kato","email":"","orcid":"","institution":"Shimane University Faculty of Medicine","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Akira","middleName":"","lastName":"Kato","suffix":""},{"id":88815331,"identity":"f3ebe098-7434-4415-b745-dc5492b5911a","order_by":3,"name":"Tatsuo Okui","email":"","orcid":"","institution":"Shimane University Faculty of Medicine","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Tatsuo","middleName":"","lastName":"Okui","suffix":""},{"id":88815332,"identity":"d14dc6dd-f456-4a8c-bcfa-96d0d025ae6b","order_by":4,"name":"Satoe Okuma","email":"","orcid":"","institution":"Shimane University Faculty of Medicine","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Satoe","middleName":"","lastName":"Okuma","suffix":""},{"id":88815333,"identity":"f1f30704-fbb4-4581-a77c-68aadb09a028","order_by":5,"name":"Hiroto Tatsumi","email":"","orcid":"","institution":"Shimane University Faculty of Medicine","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Hiroto","middleName":"","lastName":"Tatsumi","suffix":""},{"id":88815334,"identity":"df96fce0-5907-485c-8fca-4603470d83ef","order_by":6,"name":"Takahiro Kanno","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABEElEQVRIiWNgGAWjYDACHjBpA8QJDMwMBkgyjA04dEC0pJGu5TBUCzHAnufws8cFFeej+dkTmD8XFGyTN2dvYJNgqLFjYJ6N3Roe3jZz4xlnbufO7HnAJj3D4Lbhzp4DQC3HkhkY5xzAroWfwUyat+127oYbCWzMPAa3GTfcyP8mwcB2gIFxRgIOLezfgFrO5e6/AXQYUIv9hvsPgLb8w6OFtwdky4HcDRIJDNJALYkbbjCwSTC24dFy5kyZNM+Z5NwZZx62gbQkbziTwGyR2JfMg8sv7D3p26R5Kuxy+9uTD3/m+XPbdsPxA4w3PnyzkzPEEWJIADnqgE7iMZxBSAcGkJcgWcsoGAWjYBQMTwAAjqxZGcXvt0MAAAAASUVORK5CYII=","orcid":"","institution":"Shimane University Faculty of Medicine","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Takahiro","middleName":"","lastName":"Kanno","suffix":""}],"badges":[],"createdAt":"2022-02-24 11:14:12","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-1392203/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-1392203/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":19087149,"identity":"ff71dc7a-db69-48b8-b034-5c95cddb90f0","added_by":"auto","created_at":"2022-03-10 18:14:04","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":25355,"visible":true,"origin":"","legend":"\u003cp\u003eSwallowing process model\u003c/p\u003e","description":"","filename":"FIG1.png","url":"https://assets-eu.researchsquare.com/files/rs-1392203/v1/6b15520785aead361a8e25b1.png"},{"id":19087150,"identity":"bbd21098-258f-49c8-97bd-e4877936d96e","added_by":"auto","created_at":"2022-03-10 18:14:04","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":62335,"visible":true,"origin":"","legend":"\u003cp\u003eMultiple group comparisons of MNA-SF scores and oral function measurements. (A): microorganisms; (B) oral dryness; (C) occlusal force; (D) tongue pressure; (E) masticatory function; (F) EAT-10; MNA-SF: Mini Nutritional Assessment-Short Form; EAT-10: Eating Assessment Tool\u003c/p\u003e","description":"","filename":"FIG2.png","url":"https://assets-eu.researchsquare.com/files/rs-1392203/v1/c708f85facac36137f105394.png"},{"id":19087152,"identity":"6f84a0f5-3646-4093-85ad-8cc213331e46","added_by":"auto","created_at":"2022-03-10 18:14:07","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":537074,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-1392203/v1/69b2bdaf-0fa7-4fb7-a1b6-8509bb3fa904.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eRelationship Between Oral Function Measurement and Malnutrition Following Oral Cancer Treatment: A Single-Center Cross-Sectional Study\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe disease-specific survival rates of oral cancer patients have been increased with the development of surgical techniques, molecular targeted drugs, and immune checkpoint inhibitors, as well as the application of radiotherapy, represented by intensity-modulated radiation therapy [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. With an increase in the number of oral cancer patients due to the increased survival rate after treatment and the aging of the population, the number of oral cancer patients living with the sequelae of oral cancer treatment is increasing [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. According to the current National Comprehensive Cancer Network (NCCN) guidelines, resection is often the first-line treatment for oral cancer [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Thus, there is a wide range of sequelae after oral cancer treatment, such as xerostomia, dysphagia, speech disorder, tooth loss, chronic pain, body image concerns, anxiety/depression, trismus, and malnutrition; it was also reported that the quality of life of patients with oral cancer deteriorated after treatment [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. In particular, restriction of food intake is a sequela that can lead to malnutrition. Approximately one-quarter of patients who have undergone oral cancer treatment experience a decrease in food intake [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe swallowing process is remarkably complex, involving six cranial nerves, multiple muscle groups, and cortical and subcortical brain signals that must be precisely coordinated within a few seconds [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. In recent years, swallowing behavior has often been described using process models (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. A four-phase continuous model of swallowing and process models are used to understand dysphagia caused by dementia, stroke, amyotrophic lateral sclerosis, and oral cancer [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. In oral cancer treatment, sudden anatomical structural displacement and lack of motor sequence lead to postoperative impairment of oral function, which impairs Stage I transport, processing, and Stage II transport. Hence, there is a need for more suitable methods to evaluate postoperative dysphagia in oral cancer patients. The Matsuda\u0026ndash;Kanno classification of postoperative oral dysfunction is useful for comprehending different types of swallowing dysfunction, as previously reported [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Briefly, three components were identified using principal component analysis in the Matsuda\u0026ndash;Kanno classification [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Type 1 postoperative oral dysfunction (transport type) includes masticatory function, Eating Assessment Tool (EAT-10), and tongue pressure. It is widely considered a conceptual disorder that affects both Stage I and Stage II transport. Type 2 postoperative oral dysfunction (oral hygiene type) consists of items related to bacterial counts, oral health perception, and oral dryness. Oral dryness as an oral function has been reported to be an accelerator for an increased number of oral microorganisms [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Type 3 postoperative oral dysfunction (occlusal type) consists of occlusal force alone. This component is thought to be an independent component because its elements are very different from those of other components [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Therefore, recent studies have clarified the details of postoperative oral function following evidence-based oral cancer treatment guided by the NCCN guidelines [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eHowever, there are still some problems with nutritional instructions for oral cancer patients. Although there are reports that early intervention by a dietitian may improve the nutritional status of patients with oral cancer, two randomized controlled trials could not confirm the effectiveness of this intervention [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Therefore, we hypothesized that different types of postoperative oral dysfunction require different nutritional guidance and conducted a study to clarify the relationship between various postoperative oral functions and nutritional status.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eData collection\u003c/h2\u003e \u003cp\u003e Participants in this cross-sectional study were enrolled according to the following criteria: (1) patients diagnosed and treated for oral squamous cell carcinoma based on NCCN guidelines by a single surgical team in a single center; (2) patients who visited the Department of Oral and Maxillofacial Surgery/Oral Care Center at Shimane University Hospital (Shimane, Japan); (3) patients aged 20 years or older; and (4) patients who could understand the questions and answer the questionnaire. No exclusion criteria were set [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. All data were collected just before the patient was discharged from the hospital. The study period lasted from September 2019 to December 2021, and data were collected using a sequential sampling method. This study was approved by the Institutional Review Board of the Ethics Committee of the Shimane University Faculty of Medicine (approval number: 4041). Also, all methods were performed in accordance with Declarations of Helsinki. Written informed consent was obtained from each participant prior to participation in the study.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eBackground data\u003c/h2\u003e \u003cp\u003eWe sampled the following variables as background data: sex, age (years), body mass index (BMI, kg/m\u003csup\u003e2\u003c/sup\u003e), drinking habit (regular drinker or not), Brinkman index, Eastern Cooperative Oncology Group performance status, primary tumor site, cancer stage based on the criteria of the Union for International Cancer Control (version 8), treatment methods (surgery/surgery and adjuvant radiotherapy/surgery and adjuvant chemoradiotherapy), presence of neck dissection, presence of reconstructive surgery, and number of teeth.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eOral function measurement\u003c/h2\u003e \u003cp\u003eThe method recommended by the Japanese Society of Gerodontology in its position paper was adopted to measure oral function [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. However, tongue-lip motor function could not be assessed in patients with tongue defects caused by oral cancer treatment; therefore, it was removed from the assessment items.\u003c/p\u003e \u003cp\u003eMicroorganisms\u003c/p\u003e \u003cp\u003eThe number of microorganisms was measured by collecting samples from the center of the tongue dorsum using a bacterial counter (Panasonic Healthcare Co., Ltd., Tokyo, Japan). The number of microorganisms indicated by the bacterial counter and the grade were recorded.\u003c/p\u003e \u003cp\u003eOral dryness\u003c/p\u003e \u003cp\u003e Oral dryness was measured using an oral moisture checker (Mucus, Life Co., Ltd., Saitama, Japan), and the median of three measurements on the dorsum of the tongue was taken as the data. Measurements were taken on the healthy side if there was a reconstructed flap due to a defect in the tongue, and in the middle of the flap if a total resection had been performed.\u003c/p\u003e \u003cp\u003eOcclusal force\u003c/p\u003e \u003cp\u003eThe occlusal force was measured using a pressure-sensitive paper (Dental Prescale Occluzer, GC Corporation, Tokyo, Japan) by clenching for 3 s at the intercuspal position. If the subject had a denture, the occlusal force was measured with the denture in place.\u003c/p\u003e \u003cp\u003eTongue pressure\u003c/p\u003e \u003cp\u003eTongue pressure was measured at the center of the dorsum of the tongue using a JMS tongue pressure measuring instrument (TPM-01, JMS Co., Ltd., Hiroshima, Japan).\u003c/p\u003e \u003cp\u003eMasticatory function\u003c/p\u003e \u003cp\u003eMasticatory function was measured using a masticatory ability testing system (Gluco Sensor GS-II, GC Corporation, Tokyo, Japan).\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e \u003ch2\u003eEAT-10\u003c/h2\u003e \u003cp\u003eSwallowing function was assessed using a 10-question questionnaire measured on a 5-point Likert scale (0\u0026thinsp;=\u0026thinsp;no problem; 4\u0026thinsp;=\u0026thinsp;severe problem) developed by Belafsky in 2008 [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. The EAT-10 has a maximum total score of 40, with higher scores indicating poor swallowing function.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eSwallowing function measurement\u003c/h2\u003e \u003cp\u003eFunctional oral intake scale\u003c/p\u003e \u003cp\u003eThe functional oral intake scale (FOIS) has a maximum total score of 40, with higher scores indicating poor swallowing function [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eMini Nutritional Assessment-Short Form\u003c/h2\u003e \u003cp\u003eNutritional status was assessed using the Mini Nutritional Assessment-Short Form (MNA-SF), which consists of six items with a maximum score of 14 and a minimum score of 0 [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. The MNA-SF scores can also be classified into three groups (normal nutritional status [scores 12\u0026ndash;14], at risk of malnutrition [scores 8\u0026ndash;11], and malnourished [scores 0\u0026ndash;7]).\u003c/p\u003e \u003cp\u003eMatsuda\u0026ndash;Kanno classification\u003c/p\u003e \u003cp\u003eThe Matsuda\u0026ndash;Kanno classification was used as a reference for classifying postoperative oral dysfunctions. The classification can be divided into three types: transport, oral hygiene, and occlusal. In this study, the cut-off values of each oral function measurement were used as references (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMatsuda\u0026ndash;Kanno classification of postoperative oral dysfunction and cut-off values for oral function measurements\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTypes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNames\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDefinition\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReference values for diagnostic criteria\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTransport type\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eA condition in which dysfunction occurs during the oral preparatory and transit phases of swallowing due to treatment-induced damage to the tongue, palate, buccal mucosa, or oral floor.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMasticatory function (cut-off value: 83 mg/dL)\u003c/p\u003e \u003cp\u003eEAT-10 (cut-off value: 12)\u003c/p\u003e \u003cp\u003eTongue pressure (cut-off value: 14 kPa)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eII\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOral hygiene type\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eA condition in which the self-cleaning and antibacterial moisturizing functions of the oral cavity are impaired by treatment.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNumber of microorganisms (cut-off value: 10\u003csup\u003e6.5\u003c/sup\u003e or more)\u003c/p\u003e \u003cp\u003eOral dryness (cut-off value: 27.0)\u003c/p\u003e \u003cp\u003eChief complaint of subjective oral health perception\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIII\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOcclusion type\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eA condition in which occlusion is impaired due to loss of maxilla and mandible or teeth from treatment.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOcclusal force (cut-off value: 230 N)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eEAT-10: Eating Assessment Tool\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eDescriptive analyses were used to calculate the median, interquartile range (IQR), and relative frequency. For group comparisons, we used the chi-square test and Mann\u0026ndash;Whitney U test with Bonferroni correction after the Kruskal\u0026ndash;Wallis test as a multiple comparison method. In addition, a trend test (Jonckheere\u0026ndash;Terpstra test) was performed. Finally, a multiple regression analysis was conducted with the total MNA-SF score as the objective variable. Statistical analyses were performed using SPSS version 26 (SPSS Japan Inc., Tokyo, Japan). We calculated two-tailed P-values for all analyses, and the alpha level of significance was set at P\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003ePatient characteristics\u003c/h2\u003e \u003cp\u003ePatient characteristics are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. This survey included 75 patients who were treated for oral cancer, 52 (69.3%) of whom were male and 23 (30.7%) were female. The median age of the patients was 72.0 years (IQR: 64.0\u0026ndash;78.0 years). In addition, 59 (78.7%) patients had a performance status of 0. The tongue was the most frequent primary tumor site, and 31 (41.3%) patients had early stage cancer. Surgery alone was the most common treatment (40 patients, 53.3%). Neck dissection and reconstruction were performed in 48 (64.0%) and 47 (62.7%) patients, respectively. The median number of teeth was 16.0 (IQR: 3.0\u0026ndash;24.0). The median (IQR) values of oral function measurements were 3.0 (2.0\u0026ndash;5.0), 24.8 (21.3\u0026ndash;26.7), 245.6 (18.0\u0026ndash;443.6), 17.1 (7.5\u0026ndash;23.6), 75.0 (15.0\u0026ndash;150.0), and 15.0 (4.0\u0026ndash;25.0) for microorganisms (grade), oral dryness, occlusal force (N), tongue pressure (kPa), masticatory function (mg/dL), and EAT-10, respectively. The median FOIS score was 5.0 (IQR: 5.0\u0026ndash;6.0), and the median MNA-SF score (malnourished) was 28 (37.3%).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic and clinical characteristics (N\u0026thinsp;=\u0026thinsp;75)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategories\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN (%), median (25\u0026ndash;75 percentile)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e52 (69.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23 (30.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e72.0 (64.0\u0026ndash;78.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBody mass index (kg/m\u0026sup2;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20.4 (18.6\u0026ndash;23.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBrinkman index\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.0 (0.0\u0026ndash;440.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDrinking habit\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRegular drinker\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e34 (45.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSocial drinker\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7 (9.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e34 (45.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of teeth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16.0 (3.0\u0026ndash;24.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSystemic disease (yes)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDiabetes mellitus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17 (22.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e27 (36.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCardiovascular disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8 (10.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCerebrovascular disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5 (6.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLiver disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4 (5.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePulmonary disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8 (10.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eKidney disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5 (6.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOrthopedic disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8 (10.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePsychiatric disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6 (8.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCancer (except oral cancer)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6 (8.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePerformance status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e59 (78.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9 (12.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1 (1.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6 (8.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary tumor site\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTongue\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e31 (41.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUpper gingiva\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16 (21.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLower gingiva\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16 (21.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePalate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3 (4.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOral floor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5 (6.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBuccal mucosa\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3 (4.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLip\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1 (1.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTumor stage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStage I\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17 (22.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStage II\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9 (12.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStage III\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12 (16.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStage IV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e37 (49.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTreatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSurgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e40 (53.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSurgery\u0026thinsp;+\u0026thinsp;Radiotherapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10 (13.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSurgery\u0026thinsp;+\u0026thinsp;Chemoradiotherapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25 (33.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeck dissection (yes)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e48 (64.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReconstruction (yes)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e47 (62.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOral function mesurement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMicroorganisms (grade)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.0 (2.0\u0026ndash;5.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOral dryness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24.8 (21.3\u0026ndash;26.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOcculusal force (N)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e245.6 (18.0\u0026ndash;443.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTongue pressure (kPa)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17.1 (7.5\u0026ndash;23.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMasticatory function (mg/dL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e75.0 (15.0\u0026ndash;150.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEAT-10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15.0 (4.0\u0026ndash;25.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFunctional oral intake scale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6 (8.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4 (5.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8 (10.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22 (29.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25 (33.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10 (13.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMNA-SF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9.0 (7.0\u0026ndash;11.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNormal nutritional status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16 (21.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAt risk of malnutrition\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e31 (41.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMalnourished\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28 (37.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003eMNA-SF: Mini Nutritional Assessment-Short Form\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eMultiple group comparisons of MNA-SF scores and related factors\u003c/h2\u003e \u003cp\u003eMultiple group comparisons of MNA-SF scores and related factors are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. There were significant differences in age (P\u0026thinsp;=\u0026thinsp;0.03), body mass index (P\u0026thinsp;\u0026lt;\u0026thinsp;0.01), number of teeth (P\u0026thinsp;=\u0026thinsp;0.02), performance status (P\u0026thinsp;\u0026lt;\u0026thinsp;0.01), tumor stage (P\u0026thinsp;=\u0026thinsp;0.04), and treatment methods (surgery/surgery and adjuvant radiotherapy/surgery and adjuvant chemoradiotherapy; P\u0026thinsp;\u0026lt;\u0026thinsp;0.01).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eGroup comparisons of MNA-SF and related factors (N\u0026thinsp;=\u0026thinsp;75)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCategories\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003eMNA-SF (N [%], mean [SD], or median [25\u0026ndash;75 percentile])\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNormal nutritional status\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAt risk of malnutrition\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMalnourished\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP-values\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14 (18.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20 (26.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e18 (24.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.21\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2 (2.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e11 (14.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e10 (13.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e70 (63.0\u0026ndash;73.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e71.0 (64.0\u0026ndash;74.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e77.5 (71.0\u0026ndash;86.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.03*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBody mass index (kg/m\u0026sup2;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23.5 (20.2\u0026ndash;24.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e21.1 (19.3\u0026ndash;23.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e19.0 (17.0\u0026ndash;86.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBrinkman index\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e200.0 (0.0\u0026ndash;440.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.0 (0.0\u0026ndash;400.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.0 (0.0\u0026ndash;525.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.31\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of teeth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21.0 (10.5\u0026ndash;26.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20.0 (8.0\u0026ndash;26.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e6.5 (0.0\u0026ndash;21.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.02*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePerformance status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.0 (0.0\u0026ndash;0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.0 (0.0\u0026ndash;0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.0 (0.0\u0026ndash;1.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary tumor site\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTongue\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6 (8.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e13 (17.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e12 (16.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.94\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGingiva\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5 (6.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14 (18.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e11 (14.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.65\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5 (6.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4 (5.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e5 (6.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.31\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTumor stage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.0 (1.0\u0026ndash;4.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.0 (1.0\u0026ndash;4.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4.0 (3.0\u0026ndash;4.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.04*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTreatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSurgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12 (16.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e21 (28.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e7 (9.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSurgery\u0026thinsp;+\u0026thinsp;Radiotherapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1 (1.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1 (1.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e8 (10.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSurgery\u0026thinsp;+\u0026thinsp;Chemoradiotherapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3 (4.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9 (12.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e13 (17.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeck dissection (yes)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10 (13.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e17 (22.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e21 (28.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.27\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReconstruction (yes)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9 (12.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e18 (24.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e20 (26.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.48\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eMNA-SF: Mini Nutritional Assessment-Short Form; SD: standard deviation\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e*P\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eMultiple group comparisons of MNA-SF scores and oral function measurements\u003c/h2\u003e \u003cp\u003eMultiple group comparisons of MNA-SF scores and oral function measurements are shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. There were significant differences in occlusal force, tongue pressure, masticatory function, and EAT-10 levels (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eRelationship between MNA-SF and oral function measurement using multiple regression analysis\u003c/h2\u003e \u003cp\u003eMultiple regression analysis showed a statistically significant association with MNA-SF in terms of masticatory function (β\u0026thinsp;=\u0026thinsp;0.28, P\u0026thinsp;=\u0026thinsp;0.01) and EAT-10 levels (β = -0.32, P\u0026thinsp;=\u0026thinsp;0.01; Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eRelationship between MNA-SF and oral function measurement using multiple regression analysis\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eβ\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eB\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e95% confidence interval\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAdjusted R\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLower\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eUpper\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMicroorganisms (grade)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.27\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOral dryness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.28\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOcculusal force (N)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.30\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTongue pressure (kPa)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.29\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMasticatory function (mg/dL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.01*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.33\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEAT-10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.01*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.34\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eIn the multiple regression analysis, analyses were separated for each oral function, and sex, age, tumor stage, treatment, and primary tumor site were simultaneously forced into the model equation for each analysis to adjust for confounding factors. MNA-SF, Mini Nutritional Assessment-Short Form; β, standardized partial regression coefficient; B, partial regression coefficient.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e*P\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003e The major finding of this study is that multiple oral dysfunctions have an impact on nutritional status. Of these, masticatory function and EAT-10 levels were found to be independent and distinct oral dysfunctions in our previous studies [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. In addition, the EAT-10 swallowing assessment has traditionally been associated with nutritional status in healthy individuals [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Therefore, our hypothesis that \u0026ldquo;different types of postoperative oral dysfunction require different nutritional guidance\u0026rdquo; is likely to be correct, and our results were reasonable.\u003c/p\u003e \u003cp\u003eMasticatory function and EAT-10 constitute type I postoperative oral dysfunction. Arthur et al. reported that there was no relationship between masticatory function and nutritional status, but this may be due to the fact that the assessment items were the number of teeth and occluding pairs of teeth, rather than masticatory function, which is the ability to pull back food from the anterior region of the mouth to the molar region and squeeze back processed food from the mouth to the pharynx [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Therefore, based on the results of our study, we believe that masticatory function is related to postoperative nutritional status. Since it is well known that tongue pressure and masticatory function decrease with resection, especially in patients with oral cancer, our results also support the results of previous studies [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. In addition, a cross-sectional study of 909 hospitalized patients showed an association between EAT-10 levels and nutritional status, and the results of this study were similar [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Therefore, malnutrition may occur due to type I postoperative oral dysfunction (transport type). In the nutritional instructions for type I postoperative oral dysfunction, it is especially important to choose a food texture that facilitates the formation of boluses, which can be transported to the pharynx by gravity [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. In addition, the use of palatal augmentation prosthesis as a patient specific oral-maxillofacial prosthetic treatment makes it easier to direct the bolus into the esophagus, and rehabilitation with maneuvers on swallowing function is a reinstatement of safe oral intake [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn contrast, multivariate analysis did not show a significant association between occlusal force and nutritional status, but occlusal force was the only component of Type III postoperative oral dysfunction, suggesting the possibility of nutritional impairment caused by Type III postoperative oral dysfunction. Decreased occlusal force is mainly caused by resection of the masticatory muscles (temporalis, masseter, lateral pterygoid, and medial pterygoid muscles) and loss of occluding pairs of teeth due to maxillary or mandibular resection [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. This study is the first to show that maxillary and mandibular deficiencies can reduce occlusal force and affect nutritional status, while also suggesting that oral-maxillofacial prosthetic treatment may be useful. The first-line treatment for patients with maxillary or mandibular defects is patient-specific oral-maxillofacial prosthetic treatment using dentures and dental implants [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. However, prosthetic treatment has some limitations, and even with dental implants, it is unlikely that the occlusal force will be restored to what it was before resection [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Decreased occlusal force is mainly associated with decreased intake of vegetables and proteins, suggesting that nutritional guidance should pay more attention to the loss of food diversity than food texture [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. In addition, since regular and longitudinal dental visits are important for oral-maxillofacial prosthetic management and care, community collaboration is also important from the perspective of long-term nutritional management following oral cancer treatment [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe results of the trend test suggested that malnutrition caused by the Type 1 and Type 3 postoperative oral dysfunctions described above may be exacerbated in stages. In other words, in clinical practice, we should not only focus on the presence of malnutrition, but also screen and intervene earlier for patients in the pre-malnutrition or intermediate stages of malnutrition using a multidisciplinary team [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe limitation of this study is that the sample size was relatively small. Because of the limited number of items that could be fed into the explanatory variables, only rough confounding adjustments were conducted for tumor site and treatment. However, since postoperative oral dysfunction and dysphagia have been reported to occur in both single and multimodal treatments, it was assumed that an analysis considering more confounding factors would yield results similar to those of this study [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. In addition, because many patients in this study had advanced oral cancer, the prevalence of malnutrition due to postoperative oral dysfunction may need to be estimated lower when considering generalizability. However, since the number of severely ill patients is expected to increase in Japan, where the population is super-aging, the generalizability of this study is likely to be high in developed countries with aging populations [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Future studies will need to evaluate whether malnutrition is reversible over time.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eDecreased masticatory function and EAT-10 levels are risk factors for malnutrition. Postoperative oral dysfunction type I (transport type) may be a risk factor for nutritional status in patients treated for oral cancer. Further, nutritional instructions and oral-maxillofacial prosthetic treatment should be adapted to changes in various oral functions.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research was funded by the JSPS KAKENHI Grant [grant number 20K18829].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eR.M., Y.M. and T.K. wrote the main manuscript text. R.M., Y.M. conducted the statistical analyses and prepared the figures and tables. R.M., Y.M., A.K., T.O., S.O., H.T. and T.K. collected the data and performed the study. T.O., S.O., H.T. and T.K. planed and supervised the study. All authors reviewed the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests Statement \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003cp\u003e[1] Cooper JS, Pajak TF, Forastiere AA, Jacobs J, Campbell BH, Saxman SB, et al. Postoperative concurrent radiotherapy and chemotherapy for high-risk squamous-cell carcinoma of the head and neck. N Engl J Med. 2004;350:1937-44.\u003c/p\u003e\n\u003cp\u003e[2] Shah JP, Gil Z. Current concepts in management of oral cancer--surgery. Oral Oncol. 2009;45:394-401.\u003c/p\u003e\n\u003cp\u003e[3] Dickson RC, Tappel AL. Effects of selenocystine and selenomethionine on activation ofulfhydryl enzymes. 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Cancer. 2016;122:1185-200.\u003c/p\u003e\n\u003cp\u003e[13] Brown TE, Banks MD, Hughes BGM, Lin CY, Kenny LM, Bauer JD. Randomised controlled trial of early prophylactic feeding vs standard care in patients with head and neck cancer. Br J Cancer. 2017;117:15-24.\u003c/p\u003e\n\u003cp\u003e[14] Minakuchi S, Tsuga K, Ikebe K, Ueda T, Tamura F, Nagao K, et al. Oral hypofunction in the older population: Position paper of the Japanese Society of Gerodontology in 2016. Gerodontology. 2018;35:317-24.\u003c/p\u003e\n\u003cp\u003e[15] Belafsky PC, Mouadeb DA, Rees CJ, Pryor JC, Postma GN, Allen J, et al. Validity and reliability of the Eating Assessment Tool (EAT-10). Ann Otol Rhinol Laryngol. 2008;117:919-24.\u003c/p\u003e\n\u003cp\u003e[16] Ihara Y, Tashimo Y, Nozue S, Iizumi Y, Fukunishi Y, Saito Y, et al. Changes in Oral Function and Quality of Life in Tongue Cancer Patients Based on Resected Area. Asian Pac J Cancer Prev. 2021;22:2549-57.\u003c/p\u003e\n\u003cp\u003e[17] Rubenstein LZ, Harker JO, Salva A, Guigoz Y, Vellas B. Screening for undernutrition in geriatric practice: developing the short-form mini-nutritional assessment (MNA-SF). J Gerontol A Biol Sci Med Sci. 2001;56:M366-72.\u003c/p\u003e\n\u003cp\u003e[18] Chatindiara I, Allen J, Popman A, Patel D, Richter M, Kruger M, et al. Dysphagia risk, low muscle strength and poor cognition predict malnutrition risk in older adults athospital admission. BMC Geriatr. 2018;18:78.\u003c/p\u003e\n\u003cp\u003e[19] Friedlander AH, Tajima T, Kawakami KT, Wang MB, Tomlinson J. The relationship between measures of nutritional status and masticatory function in untreated patients with head and neck cancer. J Oral Maxillofac Surg. 2008;66:85-92.\u003c/p\u003e\n\u003cp\u003e[20] Hasegawa Y, Sugahara K, Fukuoka T, Saito S, Sakuramoto A, Horii N, et al. 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Head Neck. 1993;15:419-24.\u003c/p\u003e\n\u003cp\u003e[25] Aramany MA, Downs JA, Beery QC, Aslan Y. Prosthodontic rehabilitation for glossectomy patients. J Prosthet Dent. 1982;48:78-81.\u003c/p\u003e\n\u003cp\u003e[26] Fujikawa N, Ogino Y, Koga S, Ueno M, Moroi R, Koyano K. Validation of masticatory function and related factors in maxillectomy patients based on the concept of \"oral hypofunction\": A retrospective cross-sectional study. J Prosthodont Res. 2021;65:449-54.\u003c/p\u003e\n\u003cp\u003e[27] Ono T, Kohda H, Hori K, Nokubi T. Masticatory performance in postmaxillectomy patients with edentulous maxillae fitted with obturator prostheses. Int J Prosthodont. 2007;20:145-50.\u003c/p\u003e\n\u003cp\u003e[28] Huang YF, Liu SP, Muo CH, Chang CT. Prosthetic design related to peri-implant bone resorption in microvascular free fibular flap among patients with oral cancer: A retrospective clinical study. J Prosthet Dent. 2020;124:395-9.\u003c/p\u003e\n\u003cp\u003e[29] Inomata C, Ikebe K, Okubo H, Takeshita H, Mihara Y, Hatta K, et al. Dietary Intake Is Associated with Occlusal Force Rather Than Number of Teeth in 80-y-Old Japanese. JDR Clin Trans Res. 2017;2:187-97.\u003c/p\u003e\n\u003cp\u003e[30] Sohn HO, Park EY, Jung YS, Lee EK, Kim EK. Effects of professional oral hygiene care in patients with head-and-neck cancer during radiotherapy: A randomized clinical trial. Indian J Dent Res. 2018;29:700-4.\u003c/p\u003e\n\u003cp\u003e[31] Cremonese G, Bryden G, Bottcher C. A multidisciplinary team approach to preservation of quality of life for patients following oral cancer surgery. ORL Head Neck Nurs. 2000;18:6-11.\u003c/p\u003e\n\u003cp\u003e[32] Huh G, Ahn SH, Suk JG, Lee MH, Kim WS, Kwon SK, et al. Severe late dysphagia after multimodal treatment of stage III/IV laryngeal and hypopharyngeal cancer. Jpn J Clin Oncol. 2020;50:185-92.\u003c/p\u003e\n\u003cp\u003e[33] Aoki T, Ota Y, Sasaki M, Suzuki T, Uchibori M, Nakanishi Y, et al. Quality of life of Japanese elderly oral cancer patients during the perioperative period. Int J Oral Maxillofac Surg. 2021;50:1138-46.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-1392203/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-1392203/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjectives\u003c/h2\u003e \u003cp\u003eOral dysfunction and dysphagia after oral cancer treatment have been linked to a decrease in nutritional status. This study aimed to identify specific oral functions related to nutritional status.\u003c/p\u003e\u003ch2\u003ePatients and Methods\u003c/h2\u003e \u003cp\u003e: We conducted a cross-sectional study from September 2019 to December 2021. We recruited 75 participants (median age: 72.0 years), including 52 (69.3%) males and 23 (30.7%) females, collected background data, and evaluated oral function. The Mini Nutritional Assessment-Short Form (MNA-SF) scores were divided into three groups (normal nutritional status, at risk of malnutrition, and malnourished), and a multi-group comparison was conducted for each oral function measurement (microorganisms, oral dryness, occlusal force, tongue pressure, masticatory function, and Eating Assessment Tool [EAT-10]).\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe primary tumor site was the tongue in 31 patients (41.3%), gingiva in 30 (40.0%), and others in 14 (18.7%). Multiple comparisons revealed significant differences in occlusal force, tongue pressure, masticatory function, and EAT-10 level between each MNA-SF group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Multiple regression analysis showed a statistically significant association with MNA-SF in terms of masticatory function and EAT-10 levels.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eDecreased masticatory function and EAT-10 levels are risk factors for malnutrition. Nutritional instructions and oral-maxillofacial prosthetic treatment should be adapted to changes in oral function.\u003c/p\u003e","manuscriptTitle":"Relationship Between Oral Function Measurement and Malnutrition Following Oral Cancer Treatment: A Single-Center Cross-Sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2022-03-10 18:14:03","doi":"10.21203/rs.3.rs-1392203/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major revision","date":"2022-04-21T16:01:22+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2022-04-07T00:45:36+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"76c72e47-414a-4c73-b447-378fc6e0aae6","date":"2022-04-06T11:35:24+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"3184e6f2-1dc4-4822-80aa-3170328ff693","date":"2022-04-06T00:44:43+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2022-04-05T15:49:03+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"3ed47875-bdef-4ff7-a7a5-67088418daf9","date":"2022-04-05T15:06:04+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2022-04-05T15:04:47+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2022-04-05T13:10:57+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2022-03-07T11:19:40+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2022-03-07T11:16:25+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2022-02-24T11:06:53+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"40ae7d2e-cf8b-48bd-a365-ed47b545abe8","owner":[],"postedDate":"March 10th, 2022","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2022-08-25T05:44:29+00:00","versionOfRecord":[],"versionCreatedAt":"2022-03-10 18:14:03","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-1392203","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-1392203","identity":"rs-1392203","version":["v1"]},"buildId":"WrCJVZZCHTDjtuVLN7oU0","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}