Nutritional characteristics of patients with dry mouth and/or Sjögren disease in a Hungarian cohort

Abstract

Background People with any form of dry mouth may have problems with eating, swallowing, speaking, taste perception, wearing dentures, and maintaining good oral health. Subsequently, it can have a major impact on the quality of life through its effects on the qualitative and quantitative parameters of nutrition. Nevertheless, little is known about the effects of different foods and nutrients on salivation and orofacial sicca symptoms. Despite this, the literature on the relationship between xerostomia (x), hyposalivation (h), Sjögren disease (SD), and nutrition is relatively sparse. Objective The authors aimed to evaluate the dietary habits of middle-aged patients with newly diagnosed dry mouth and/or SD compared with healthy controls. Methods A total of 128 participants (10 men and 118 women; mean age: 53 ± 13 years) enrolled in the study. A 35-question questionnaire containing a “computer-assisted personal interview”-type exploratory survey was used to record body mass index (BMI), possible food allergies, harmful habits, used sources of health-related information, and nutritional habits such as frequency and types of daily meals, for example, fruit, vegetable, meat, vitamin, and trace element consumption. Subjective sicca symptoms (xerostomia, xerophthalmia) were also assessed by guided questions, while the unstimulated whole saliva (UWS) flow rate was determined by the spitting method to confirm hyposalivation. SD was diagnosed based on the 2016 ACR-EULAR diagnostic criteria. Participants were divided into four groups: healthy controls (c), xerostomia (x), hyposalivation (h), and SD. Patients' data were compared with those of healthy controls. Results The mean BMI of the participants did not show a significant difference from the normal BMI, although it was slightly elevated in all four patient groups (c: 24.7; x: 25.4; h: 26.2; SD: 25.2). The smoking percentage was high in the SD group: 49% vs. 18% in the c group ( p = 0.01), while it was 0 in both the x and h groups. The percentage of food allergy and/or intolerance (lactose, milk protein or gluten, floating, and bloating) was increased among all patients compared with healthy controls: 50% of patients with xerostomia and 44% and 68% with those with hyposalivation compared with only 16% of healthy controls ( p < 0.05, p < 0.05, p < 0.00001, respectively). Similarly, liquid consumption was between 1.9 and 2.2 L/day in all groups, and the interviewed participants preferred water ( approximately 78%) and diary milk products (more than 80%). Significantly less patients with xerostomia consumed alcohol (2.6 vs. 18%, p < 0.05) and vegetable milk regularly (2.6 vs. 18%, p < 0.05) compared with healthy controls; alcohol consumption was also low in the h (4.7%) and SD (6.4%) group of patients. There was no significant difference in the intake of different vitamins and trace elements between any patient group and the c group, except that of vitamin D3, which was consumed in a significantly higher frequency by the x group of patients ( p < 0.05). Extra sugar, processed food, snack, extra salt consumption, and grain and wheat types of preference were at similar levels in all the examined groups. It was observed that all four groups favored apple among all fruits, while patients with dry mouth did not prefer sour fruits like berries (hyposalivation p < 0.05) and citrus fruits (x and h; p < 0.05 and p < 0.05) or irritating agents like onions (h; p < 0.05), as these foods might deteriorate both the dryness feeling and the burning mucosal symptoms. Potato was less preferred by the other groups compared with the healthy control group and might cause swallowing problems in patients of the x group ( p < 0.05). Nevertheless, rice and tomato-paprika consumption was increased in the h group ( p < 0.05, p < 0.05). With regard to meat types, poultry (50%–88%), pork (40%–58%), and seafood (33%–50%) were the most popular, but possibly because of its less fat content, the x and SD group of patients