title: Chewing ability in conjunction with food intake and energy status in later life affects survival in Taiwanese with the metabolic syndrome.
abstract: OBJECTIVE
  To examine chewing ability and survival in older adults after 8 years of follow-up and consider any interaction with the metabolic syndrome (MetS).
  
  
  METHODS
  Prospective cohort.
  
  
  METHODS
  The Elderly Nutrition and Health Survey in Taiwan during 1999/00, a nationally representative sample of Taiwanese aged 65 and older.
  
  
  METHODS
  One thousand four hundred ten people (729 men and 681 women).
  
  
  METHODS
  Chewing ability and food intake were ascertained using a questionnaire, supplemented by 24-hour dietary recall. The MetS was defined according to National Cholesterol Education Program Adult Treatment Panel III criteria for Asians. Death according to the National Death Registry by December 31, 2006, was the outcome measure.
  
  
  RESULTS
  During follow-up, 368 subjects died. A significantly higher age- and sex-adjusted hazard ratio (HR=1.44, 95% confidence interval (CI)=1.10-1.78, P=.009) for mortality was found in those who had unsatisfactory chewing ability. Age, sex, and appetite together explain the effect of chewing on mortality. Dietary diversity, body mass index, and health status may also play a role in mediating a possible mortality effect of chewing. Significant interactions between chewing ability and the MetS and mortality were found (P=.04 for five components and .006 for three energy-related components). Jointly, those who had unsatisfactory chewing ability and the MetS were at higher risk of death than those who had satisfactory chewing ability without the MetS (HR=1.65, 95% CI=1.11-2.46 for 5 MetS components; HR=2.58, 95% CI=1.58-4.23 for 3 MetS components).
  
  
  CONCLUSIONS
  Self-reported unsatisfactory chewing ability is associated with greater mortality risk in older adults, and MetS increases the risk of mortality in people with chewing difficulty.
authors.affiliation: School of Public Health, National Defense Medical Center, Taipei, Taiwan, ROC. mmsl@ndmctsgh.edu.tw
authors.forename: Meei-Shyuan
authors.initials: MS
authors.lastname: Lee
authors.forename: Yi-Chen
authors.initials: YC
authors.lastname: Huang
authors.forename: Mark L
authors.initials: ML
authors.lastname: Wahlqvist
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D004435:Eating; D002149:Energy Intake; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D016015:Logistic Models; D008297:Male; D008409:Mastication / Q000502:physiology*; D024821:Metabolic Syndrome / Q000401:mortality* / Q000503:physiopathology; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D012737:Sex Factors; D011795:Surveys and Questionnaires; D016019:Survival Analysis; D013624:Taiwan / Q000453:epidemiology