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Hernandez SG, Feldman S, Perez-Abalo M. Malnutrition, Dysphagia, Sarcopenia and Weakness in the Older Population: A Retrospective Review to Enlighten Future Directions for Health System Best Practices. Dysphagia 2024; 39:514-521. [PMID: 38078983 DOI: 10.1007/s00455-023-10636-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 10/24/2023] [Indexed: 05/26/2024]
Abstract
The older population is growing exponentially causing greater demands on healthcare. Malnutrition, dysphagia, sarcopenia and weakness are highly prevalent diseases in the older population. Previous research (Byun et al. in BMC Geriatr 19(356):1-7, 2019; Fujishima et al. in Geriatr Gerontol Int 19:91-97, 2019; Hernandez et al. in Nutr Hosp 32(4):1830-1836, 2015; Nagano et al. in J Nutr Health Aging 23(3):256-265.5, 2019; Nishioka et al. in Clin Nutr 36(4):1089-1096, 2017; Robinson et al. in Clin Nutr 37(4):1121-1132, 2018, https://doi.org/10.1016/j.clnu.2017.08.016 ) has shown that these disorders are frequently associated, in many cases, preventable using screenings and intervention. This study utilized the National Hospital Discharge Survey of 2008 from the National Center of Health Statistics as secondary data to examine the associations amongst these four variables as well as possible correlations with age, days of care in the acute care hospital setting and frequency of rehabilitative and nutritional interventions received by these patients. Out of 165,630 cases, a sample size of 59,029 cases ages 65 and above were filtered by the researchers for desired diagnoses and procedure codes. After this, all neurological diagnoses were filtered and excluded by the researchers, resulting in 2458 cases. Using the Chi square test of independence, findings revealed significant associations between the variables of malnutrition and dysphagia (χ2 (1) = 1882.618, p = 0.001), dysphagia and weakness (χ2 (1) = 21.069, p = 0.001) and malnutrition weakness (χ2 (1) = 88.434, p = 0.001). The point biserial correlation coefficient was calculated to examine possible associations between these four conditions and age as well as days of care. A significant negative correlation was found between malnutrition and age (rpb (2456) = - 0.043, p = 0.05). In addition, days of care were significantly correlated with malnutrition (r(2456) = 0.138, p = 0.001) and inversely significantly correlated with dysphagia (r(2456) = - 110, p = 0.001), weakness (r(2456) = - 0.060, p = 0.001) and sarcopenia (r(2456) = - 0.041, p = 0.05). Lastly, the study found a large disparity between cases that received rehabilitative and nutritional intervention and those that didn't.
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Affiliation(s)
- Samantha G Hernandez
- Human Services, Albizu University, 2173 NW 99th Ave., Doral, FL, 33172, USA.
- , Miami, USA.
| | | | - Maria Perez-Abalo
- Human Services, Albizu University, 2173 NW 99th Ave., Doral, FL, 33172, USA
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Huang ST, Wang TG, Peng MC, Chen WM, Jao AT, Tang FT, Hsieh YT, Ho CS, Yeh SM. Predictors for Failed Removal of Nasogastric Tube in Patients With Brain Insult. Ann Rehabil Med 2024; 48:220-227. [PMID: 38830633 PMCID: PMC11217763 DOI: 10.5535/arm.230011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 03/25/2024] [Accepted: 05/02/2024] [Indexed: 06/05/2024] Open
Abstract
OBJECTIVE To construct a prognostic model for unsuccessful removal of nasogastric tube (NGT) was the aim of our study. METHODS This study examined patients with swallowing disorders receiving NGT feeding due to stroke or traumatic brain injury in a regional hospital. Clinical data was collected, such as age, sex, body mass index (BMI), level of activities of daily living (ADLs) dependence. Additionally, gather information regarding the enhancement in Functional Oral Intake Scale (FOIS) levels and the increase in food types according to the International Dysphagia Diet Standardization Initiative (IDDSI) after one month of swallowing training. A stepwise logistic regression analysis model was employed to predict NGT removal failure using these parameters. RESULTS Out of 203 patients, 53 patients (26.1%) had experienced a failed removal of NGT after six months of follow-up. The strongest predictors for failed removal were age over 60 years, underweight BMI, total dependence in ADLs, and ischemic stroke. The admission prediction model categorized patients into high, moderate, and low-risk groups for removal failure. The failure rate of NGT removal was high not only in the high-risk group but also in the moderate-risk groups when there was no improvement in FOIS levels and IDDSI food types. CONCLUSION Our predictive model categorizes patients with brain insults into risk groups for swallowing disorders, enabling advanced interventions such as percutaneous endoscopic gastrostomy for high-risk patients struggling with NGT removal, while follow-up assessments using FOIS and IDDSI aid in guiding rehabilitation decisions for those at moderate risk.
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Affiliation(s)
- Shih-Ting Huang
- Department of Physical Medicine and Rehabilitation, Lotung Poh-Ai Hospital, Lo-Hsu Foundation, Yilan County, Taiwan (R.O.C.)
| | - Tyng-Guey Wang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, School of Medicine, National Taiwan University, Taipei City, Taiwan (R.O.C.)
| | - Mei-Chih Peng
- Department of Physical Medicine and Rehabilitation, Lotung Poh-Ai Hospital, Lo-Hsu Foundation, Yilan County, Taiwan (R.O.C.)
| | - Wan-Ming Chen
- Big Data Center, Lotung Poh-Ai Hospital, Lo-Hsu Foundation, Yilan County, Taiwan (R.O.C.)
| | - An-Tzu Jao
- Big Data Center, Lotung Poh-Ai Hospital, Lo-Hsu Foundation, Yilan County, Taiwan (R.O.C.)
| | - Fuk Tan Tang
- Department of Physical Medicine and Rehabilitation, Lotung Poh-Ai Hospital, Lo-Hsu Foundation, Yilan County, Taiwan (R.O.C.)
| | - Yu-Ting Hsieh
- Department of Physical Medicine and Rehabilitation, Lotung Poh-Ai Hospital, Lo-Hsu Foundation, Yilan County, Taiwan (R.O.C.)
| | - Chun Sheng Ho
- Department of Physical Medicine and Rehabilitation, Lotung Poh-Ai Hospital, Lo-Hsu Foundation, Yilan County, Taiwan (R.O.C.)
| | - Shu-Ming Yeh
- Department of Physical Medicine and Rehabilitation, Lotung Poh-Ai Hospital, Lo-Hsu Foundation, Yilan County, Taiwan (R.O.C.)
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Ikenaga Y, Fudeya M, Kusunoki T, Yamaguchi H. Factors Contributing to Complete Oral Intake in Dysphagic Stroke Patients with Enteral Feeding Tubes in Convalescent Rehabilitation Wards. Prog Rehabil Med 2023; 8:20230011. [PMID: 37006382 PMCID: PMC10061229 DOI: 10.2490/prm.20230011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 03/01/2023] [Indexed: 04/03/2023] Open
Abstract
Objectives: This study investigated the factors contributing to complete oral intake (COI) in dysphagic stroke patients with enteral feeding tubes in the local clinical setting. Methods: Data of patients with percutaneous endoscopic gastrostomy (PEG) or nasogastric tube (NGT) feeding on admission to convalescent rehabilitation wards (CRWs) were extracted from the Kaga Regional Cooperation Clinical Pathway for Stroke database for multiple centers including 19 acute care hospitals and 11 hospitals with CRWs. Patients were divided into two groups based on their status regarding COI or incomplete oral intake (ICOI) at discharge. Logistic regression analysis with forced-entry variables was used to identify factors contributing to COI. Results: On discharge from CRWs, COI and ICOI were observed in 140 and 207 cases, respectively. The COI group was younger, had a higher rate of initial stroke, higher Functional Oral Intake Scale (FOIS) scores, higher Functional Independence Measure (FIM) motor and cognitive scores, higher Body Mass Index (BMI), lower rate of patients with PEG, and shorter stays in acute care wards. Logistic regression analysis with forced entry revealed that younger age; initial stroke; higher FOIS score, FIM cognitive score, and BMI; and shorter stay in the acute care ward contributed to COI. Conclusions: The primary factors contributing to COI in dysphagic stroke patients with enteral feeding tubes were younger age, initial stroke, higher swallowing and cognitive function, good nutritional status, and shorter stay in the acute care ward.
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Affiliation(s)
- Yasunori Ikenaga
- Department of Rehabilitation Medicine, Yawata Medical Center, Komatsu, Japan
- Council of Kaga Local Stroke Network, Nonoichi, Ishikawa, Japan
| | - Masami Fudeya
- Council of Kaga Local Stroke Network, Nonoichi, Ishikawa, Japan
| | | | - Hiromi Yamaguchi
- Department of Rehabilitation Medicine, Yawata Medical Center, Komatsu, Japan
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4
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Effects of Undernutrition on Swallowing Function and Activities of Daily Living in Hospitalized Patients: Data from the Japanese Sarcopenic Dysphagia Database. Nutrients 2023; 15:nu15051291. [PMID: 36904290 PMCID: PMC10005210 DOI: 10.3390/nu15051291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 02/27/2023] [Accepted: 03/03/2023] [Indexed: 03/08/2023] Open
Abstract
This retrospective cohort study examined the effects of undernutrition on swallowing function and activities of daily living in hospitalized patients. Data from the Japanese Sarcopenic Dysphagia Database were used, and hospitalized patients aged ≥20 years with dysphagia were included in the analysis. Participants were assigned to the undernutrition or normal nutritional status group based on the Global Leadership Initiative on Malnutrition criteria. The primary outcome was the Food Intake Level Scale change, and the secondary outcome was the Barthel Index change. Among 440 residents, 281 (64%) were classified under the undernutrition group. The undernutrition group had a significantly higher Food Intake Level Scale score at baseline and Food Intake Level Scale change (p = 0.001) than the normal nutritional status group. Undernutrition was independently associated with the Food Intake Level Scale change (B = -0.633, 95% confidence interval = -1.099 to -0.167) and the Barthel Index change (B = -8.414, 95% confidence interval = -13.089 to -3.739). This was defined as the period from the date of admission to the hospital until discharge or 3 months later. Overall, our findings indicate that undernutrition is associated with reduced improvement in swallowing function and the ability to perform activities of daily living.
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Yokota J, Takahashi R, Endo R, Chiba T, Sasaki K, Matsushima K. Physical performance and maximum tongue pressure associated with oral intake independence: a retrospective study on hospitalized patients with heart failure. Sci Rep 2022; 12:18549. [PMID: 36329193 PMCID: PMC9633604 DOI: 10.1038/s41598-022-21968-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 10/06/2022] [Indexed: 11/06/2022] Open
Abstract
Dysphagia in patients with heart failure leads to poorer outcomes during hospitalization and after discharge. Therefore, addressing dysphagia is critical for improving patient prognosis. This retrospective observational study aimed to evaluate associations between improvements in swallowing dysfunction at the time of hospital discharge and the physical function, cognitive function, nutritional status, and maximum tongue pressure (MTP). Overall, 111 patients who underwent cardiac rehabilitation and were deemed to have oral intake impairment were included. The exclusion criteria comprised the following: pre-admission diagnosis of dysphagia, in-hospital death, and missing data. Patients were categorized based on whether they did (n = 65) or did not (n = 46) exhibit improvements in oral intake impairment, which were determined from the functional oral intake scale (FOIS) score at discharge. Associations between potential explanatory variables and the FOIS score at discharge were assessed using a linear regression model. After adjusting for covariates, such as age, sex, heart failure severity, short physical performance battery score, Mini-Mental State Examination score, transthyretin level, and provision of swallowing therapy, the FOIS score at discharge was significantly associated with the MTP (P = 0.024, confidence interval: 0.006-0.046). In conclusion, the MTP was independently associated with improvements in FOIS in patients with heart failure.
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Affiliation(s)
- Junichi Yokota
- grid.257016.70000 0001 0673 6172Division of Comprehensive Rehabilitation Sciences, Hirosaki University Graduate School of Health Sciences, 66-1, Hon-cho, Hirosaki, Aomori, 036-8564 Japan ,grid.415495.80000 0004 1772 6692Department of Clinical Research, National Hospital Organization Sendai Medical Center, Sendai, Japan
| | - Ren Takahashi
- grid.415495.80000 0004 1772 6692Department of Rehabilitation, National Hospital Organization Sendai Medical Center, Sendai, Japan
| | - Ryunosuke Endo
- grid.257016.70000 0001 0673 6172Division of Comprehensive Rehabilitation Sciences, Hirosaki University Graduate School of Health Sciences, 66-1, Hon-cho, Hirosaki, Aomori, 036-8564 Japan
| | - Takaaki Chiba
- grid.415495.80000 0004 1772 6692Department of Rehabilitation, National Hospital Organization Sendai Medical Center, Sendai, Japan
| | - Kosuke Sasaki
- grid.415495.80000 0004 1772 6692Department of Rehabilitation, National Hospital Organization Sendai Medical Center, Sendai, Japan
| | - Keisuke Matsushima
- grid.415495.80000 0004 1772 6692Department of Rehabilitation, National Hospital Organization Sendai Medical Center, Sendai, Japan
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Kose E, Hirai T, Seki T, Okudaira M, Yasuno N. Anticholinergic Load Is Associated with Swallowing Dysfunction in Convalescent Older Patients after a Stroke. Nutrients 2022; 14:nu14102121. [PMID: 35631262 PMCID: PMC9143519 DOI: 10.3390/nu14102121] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 05/14/2022] [Accepted: 05/17/2022] [Indexed: 02/05/2023] Open
Abstract
This study aimed to establish whether anticholinergic load affects the swallowing function of geriatric stroke patients in convalescent stages, as no proven association between the anticholinergic load-based Anticholinergic Risk Scale and the swallowing dysfunction in Japanese patients was known. A retrospective cohort study was conducted on hospitalized older patients undergoing rehabilitation after stroke. The study outcomes included evaluating the patients at hospital discharge using the Functional Oral Intake Scale. To evaluate the effects of an increased anticholinergic load, we used a multivariate analysis to examine whether the change in the Anticholinergic Risk Scale during hospitalization was associated with the outcome. Of 542 enrolled patients, 345 (63.7%) presented with cerebral infarction, 148 (27.3%) with intracerebral hemorrhage, and 49 (9%) with subarachnoid hemorrhage. The change in the Anticholinergic Risk Scale was independently associated with the Functional Oral Intake Scale (β = −0.118, p = 0.0164) at discharge. Among anticholinergics, the use of chlorpromazine, hydroxyzine, haloperidol, metoclopramide, risperidone, etc., increased significantly from admission to discharge. An increased anticholinergic load was associated with swallowing dysfunction in older patients undergoing stroke rehabilitation.
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Affiliation(s)
- Eiji Kose
- Department of Pharmacy, Teikyo University School of Medicine University Hospital, Tokyo 173-8606, Japan;
- Correspondence: ; Tel.: +81-3-3964-1211
| | - Toshiyuki Hirai
- Department of Pharmacy, Hitachinaka General Hospital, Ibaraki 312-0057, Japan; (T.H.); (T.S.)
| | - Toshiichi Seki
- Department of Pharmacy, Hitachinaka General Hospital, Ibaraki 312-0057, Japan; (T.H.); (T.S.)
| | - Michiyo Okudaira
- Laboratory of Hospital Pharmacy, School of Pharmacy, Teikyo University, Tokyo 173-8606, Japan;
| | - Nobuhiro Yasuno
- Department of Pharmacy, Teikyo University School of Medicine University Hospital, Tokyo 173-8606, Japan;
- Laboratory of Hospital Pharmacy, School of Pharmacy, Teikyo University, Tokyo 173-8606, Japan;
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7
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de Sire A, Ferrillo M, Lippi L, Agostini F, de Sire R, Ferrara PE, Raguso G, Riso S, Roccuzzo A, Ronconi G, Invernizzi M, Migliario M. Sarcopenic Dysphagia, Malnutrition, and Oral Frailty in Elderly: A Comprehensive Review. Nutrients 2022; 14:nu14050982. [PMID: 35267957 PMCID: PMC8912303 DOI: 10.3390/nu14050982] [Citation(s) in RCA: 63] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 02/23/2022] [Accepted: 02/24/2022] [Indexed: 02/04/2023] Open
Abstract
Frailty is a highly prevalent condition in the elderly that has been increasingly considered as a crucial public health issue, due to the strict correlation with a higher risk of fragility fractures, hospitalization, and mortality. Among the age-related diseases, sarcopenia and dysphagia are two common pathological conditions in frail older people and could coexist leading to dehydration and malnutrition in these subjects. “Sarcopenic dysphagia” is a complex condition characterized by deglutition impairment due to the loss of mass and strength of swallowing muscles and might be also related to poor oral health status. Moreover, the aging process is strictly related to poor oral health status due to direct impairment of the immune system and wound healing and physical and cognitive impairment might indirectly influence older people’s ability to carry out adequate oral hygiene. Therefore, poor oral health might affect nutrient intake, leading to malnutrition and, consequently, to frailty. In this scenario, sarcopenia, dysphagia, and oral health are closely linked sharing common pathophysiological pathways, disabling sequelae, and frailty. Thus, the aim of the present comprehensive review is to describe the correlation among sarcopenic dysphagia, malnutrition, and oral frailty, characterizing their phenotypically overlapping features, to propose a comprehensive and effective management of elderly frail subjects.
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Affiliation(s)
- Alessandro de Sire
- Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
- Correspondence: (A.d.S.); (M.F.)
| | - Martina Ferrillo
- Department of Health Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
- Correspondence: (A.d.S.); (M.F.)
| | - Lorenzo Lippi
- Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, 28100 Novara, Italy; (L.L.); (M.I.)
| | - Francesco Agostini
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, 00185 Rome, Italy;
| | - Roberto de Sire
- Department of Clinical Medicine and Surgery, University Federico II of Naples, 80126 Naples, Italy;
| | - Paola Emilia Ferrara
- University Polyclinic Foundation Agostino Gemelli IRCSS, Catholic University of Sacred Heart, 00168 Rome, Italy; (P.E.F.); (G.R.)
| | - Giuseppe Raguso
- Department of Otolaryngology-Head and Neck Surgery, University of Verona, 37129 Verona, Italy;
| | - Sergio Riso
- Dietetic and Clinical Nutrition Unit, Maggiore della Carità Hospital, 28100 Novara, Italy;
| | - Andrea Roccuzzo
- Department of Periodontology, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010 Bern, Switzerland;
- Department of Oral and Maxillofacial Surgery, Copenhagen University Hospital (Rigshospitalet), 2100 Copenhagen, Denmark
| | - Gianpaolo Ronconi
- University Polyclinic Foundation Agostino Gemelli IRCSS, Catholic University of Sacred Heart, 00168 Rome, Italy; (P.E.F.); (G.R.)
| | - Marco Invernizzi
- Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, 28100 Novara, Italy; (L.L.); (M.I.)
- Translational Medicine, Dipartimento Attività Integrate Ricerca e Innovazione (DAIRI), Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| | - Mario Migliario
- Dental Clinic, Department of Translational Medicine, University of Eastern Piedmont, 28100 Novara, Italy;
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Fantini M, Crosetti E, Affaniti R, Sprio AE, Bertotto I, Succo G. Preoperative prognostic factors for functional and clinical outcomes after open partial horizontal laryngectomies. Head Neck 2021; 43:3459-3467. [PMID: 34405480 DOI: 10.1002/hed.26845] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 06/19/2021] [Accepted: 08/05/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND In minority of cases, the clinical recovery of the neolarynx after open partial horizontal laryngectomies (OPHLs) can be challenging, possibly affecting the final functional outcome. METHODS One hundred and twenty-three patients who underwent OPHLs were selected. A series of clinical preoperative independent variables were considered. All patients were monitored for the following dependent outcome variables: sequelae; need for percutaneous endoscopic gastrostomy positioning; days before tracheal cannula removal and nasogastric tube removal; and length of hospital stay. Univariate and multivariate logistic regression analyses were performed to identify significant associations between preoperative clinical variables and outcomes variables. RESULTS Multivariate analysis confirmed age, cT classification, body mass index, and smoking habits as significant prognostic factors for worse functional and clinical recovery outcomes. CONCLUSIONS Knowing what variables are significantly associated with worse clinical and functional outcomes can guide clinicians in defining the best surgical choice not only from an oncological perspective, but also for a better postoperative recovery.
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Affiliation(s)
- Marco Fantini
- Head and Neck Oncology Unit, Candiolo Cancer Institute, FPO IRCCS, Candiolo (TO), Italy
| | - Erika Crosetti
- Head and Neck Oncology Unit, Candiolo Cancer Institute, FPO IRCCS, Candiolo (TO), Italy
| | - Riccardo Affaniti
- Head and Neck Oncology Unit, Candiolo Cancer Institute, FPO IRCCS, Candiolo (TO), Italy
| | - Andrea Elio Sprio
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy.,Department of Research, ASOMI College of Sciences, Marsa, Malta
| | - Ilaria Bertotto
- Radiology Unit, Candiolo Cancer Institute, FPO IRCCS, Candiolo, Italy
| | - Giovanni Succo
- Head and Neck Oncology Unit, Candiolo Cancer Institute, FPO IRCCS, Candiolo (TO), Italy.,Oncology Department, University of Turin, Orbassano (TO), Italy
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9
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Diagnosis and Treatment of Sarcopenic Dysphagia: A Scoping Review. Dysphagia 2021; 36:523-531. [PMID: 33620563 DOI: 10.1007/s00455-021-10266-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 02/07/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Sarcopenic dysphagia is a swallowing disorder due to sarcopenia involving the whole-body skeletal muscles and swallowing muscles. This scoping review aimed to explore the currently known information on the diagnosis and treatment of sarcopenic dysphagia and to clarify the types of research required to develop the field. METHODS We searched the PubMed, MEDLINE, CINAHL, and Cochrane databases from their inception to October 2020, using the search terms "(sarcopenia or sarcopenic or myopenia or dynapenia) and (dysphagia or swallowing or deglutition) and (diagnosis or treatment)". Articles reporting diagnosis method and treatment of sarcopenic dysphagia were included. RESULTS Twenty-one and eight articles reported on the diagnostic and treatment method, respectively. A diagnostic algorithm for sarcopenic dysphagia was most frequently used (n = 10). Other diagnostic methods included consensus diagnostic criteria for sarcopenic dysphagia (n = 4), sarcopenia and dysphagia without other causes of dysphagia (n = 4), and both sarcopenia and dysphagia (n = 3). The medical treatments for patients with sarcopenic dysphagia were described in single-patient case reports (n = 8) only. There were six articles reporting on a combination of rehabilitation and nutritional support. These reports showed the importance of interdisciplinary rehabilitation nutrition for improving patients' nutritional status and sarcopenia. CONCLUSIONS A reliable and validated diagnostic algorithm was the most widely used diagnostic method for sarcopenic dysphagia. Only case reports have been published for the medical treatment of patients with sarcopenic dysphagia. Interdisciplinary rehabilitation nutrition may be useful for treating patients with sarcopenic dysphagia.
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Håglin L, Edström M, Bäckman L, Forsgren L. Low level of phosphate in male patients reporting swallowing disturbances in early Parkinson's disease. CLINICAL NUTRITION EXPERIMENTAL 2020. [DOI: 10.1016/j.yclnex.2019.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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11
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Wada Y, Izumi H, Shimizu T, Takeda Y. A More Oxidized Plasma Albumin Redox State and Lower Plasma HDL Particle Number Reflect Low-Protein Diet Ingestion in Adult Rats. J Nutr 2020; 150:256-266. [PMID: 31552421 DOI: 10.1093/jn/nxz223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 08/09/2019] [Accepted: 08/22/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Plasma albumin (ALB) redox state reflects protein nutritional status, but how it differs from other protein nutrition biomarkers remains to be fully elucidated. OBJECTIVE This study aimed to delineate the characteristics of plasma ALB redox state as a protein nutrition biomarker. METHODS Adult male Wistar rats were maintained on an AIN-93 M [14% casein, control (CT)] diet or an AIN-93 M-based 5% casein [low protein (LP)] diet ad libitum for 4 wk. Plasma samples were repeatedly obtained from the same rats at weeks 0-4, ALB redox state was determined by HPLC, and the concentrations of conventional protein nutrition biomarkers, ALB and transthyretin (TTR), were compared between the groups by Student t test. Body mass, relative muscle masses, plasma proteome, and plasma lipids at week 4 were also compared. RESULTS Plasma ALB redox state shifted to a more oxidized state in the LP diet group compared with the CT diet group at weeks 1-4. The LP diet group also showed significantly lower plasma ALB concentrations at weeks 1 and 2 (13% and 11% lower, respectively) and significantly lower TTR concentration at week 1 (21% lower) compared with the CT diet group, but these concentrations did not differ significantly at weeks 3 and 4. After 4 wk, body mass and relative soleus and gastrocnemius muscle masses did not differ, but the relative plantaris muscle mass tended to be 4% lower (1.75 compared with 1.68 g/kg body mass) in the LP diet group compared with the CT group (P = 0.06). The LP diet group also had a significantly lower HDL particle number than the CT group (30% lower). CONCLUSIONS A more oxidized plasma ALB redox state and lower plasma HDL particle number reflect LP diet ingestion in adult rats, which did not exhibit changes of plasma ALB and TTR concentrations.
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Affiliation(s)
- Yasuaki Wada
- Wellness & Nutrition Science Institute, Morinaga Milk Industry Co., Ltd., Zama, Kanagawa, Japan.,Center for Food and Medical Innovation Promotion, Institute for the Promotion of Business-Regional Collaboration of Hokkaido University, Sapporo, Hokkaido, Japan
| | - Hirohisa Izumi
- Wellness & Nutrition Science Institute, Morinaga Milk Industry Co., Ltd., Zama, Kanagawa, Japan.,Center for Food and Medical Innovation Promotion, Institute for the Promotion of Business-Regional Collaboration of Hokkaido University, Sapporo, Hokkaido, Japan
| | - Takashi Shimizu
- Wellness & Nutrition Science Institute, Morinaga Milk Industry Co., Ltd., Zama, Kanagawa, Japan
| | - Yasuhiro Takeda
- Wellness & Nutrition Science Institute, Morinaga Milk Industry Co., Ltd., Zama, Kanagawa, Japan
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12
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Byun SE, Kwon KB, Kim SH, Lim SJ. The prevalence, risk factors and prognostic implications of dysphagia in elderly patients undergoing hip fracture surgery in Korea. BMC Geriatr 2019; 19:356. [PMID: 31852457 PMCID: PMC6921569 DOI: 10.1186/s12877-019-1382-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 12/11/2019] [Indexed: 02/08/2023] Open
Abstract
Background Dysphagia is prevalent in geriatric patients, such as elderly hip fracture patients, and is associated with a poor prognosis. This study investigated (1) the prevalence of dysphagia based on clinical screening and a video-fluoroscopic swallowing study (VFSS), (2) the risk factors of dysphagia, and (3) the prognostic implications of dysphagia in elderly patients (≥ 65 years) undergoing hip fracture surgery. Methods In this retrospective study, data from 393 female and 153 male patients ≥65 years of age who underwent surgery for a hip fracture between 2015 and 2018 were analysed. Patients who were considered at high risk of dysphagia after screening underwent a VFSS. To identify risk factors of dysphagia, demographic factors, the American Society of Anesthesiologists classification, past medical history, known risk factors of dysphagia, and factors associated with surgery were analysed using a binary logistic regression model. Odds ratios (ORs) of dysphagia for having poor prognosis including postoperative pneumonia, intensive care unit (ICU) admission, and death within 6 months after surgery were obtained by logistic regression. The association of postoperative pneumonia with poor prognosis was also analysed. Results Dysphagia was seen in 5.3% of hip fracture patients. In multivariate regression analysis, a serum albumin level < 3.5 g/dL was identified as a risk factor for dysphagia (OR [95%CI] = 3.13 [1.40, 7.01]). Dysphagia was identified as a risk factor for postoperative pneumonia in regression analysis after adjustment (OR [95%CI] = 3.12 [1.05, 9.27]). Postoperative pneumonia was significantly associated with ICU admission (OR [95% CI] = 4.56 [1.85, 11.28]) and death within 6 months after surgery (OR [95% CI] = 2.56 [1.03, 6.33]). Conclusions Dysphagia in elderly hip fracture surgery patients was associated with postoperative pneumonia, a risk factor for poor outcomes including ICU admission and death within 6 months after surgery. A serum albumin level < 3.5 g/dL was identified as a risk factor for dysphagia. Therefore, diagnostic testing should be performed to detect dysphagia, especially in patients with a low serum albumin level. Finally, particular care should be taken to prevent postoperative complications in patients with dysphagia.
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Affiliation(s)
- Seong-Eun Byun
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Kyeu Back Kwon
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Sang Ho Kim
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Seung-Jae Lim
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
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Comment on “Sarcopenia is an Independent Risk Factor for Dysphagia in Community-Dwelling Older Adults”. Dysphagia 2019; 34:718-719. [DOI: 10.1007/s00455-019-09981-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 01/18/2019] [Indexed: 10/27/2022]
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Özsürekci C, Arslan SS, Demir N, Çalışkan H, Şengül Ayçiçek G, Kılınç HE, Yaşaroğlu ÖF, Kızılarslanoğlu C, Tuna Doğrul R, Balcı C, Sümer F, Karaduman A, Yavuz BB, Cankurtaran M, Halil MG. Timing of Dysphagia Screening in Alzheimer's Dementia. JPEN J Parenter Enteral Nutr 2019; 44:516-524. [PMID: 31172554 DOI: 10.1002/jpen.1664] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 04/18/2019] [Indexed: 11/06/2022]
Abstract
BACKGROUND Dysphagia is an important and frequent symptom in Alzheimer's dementia (AD). We hypothesized that dysphagia could be seen in the early stages of AD and sarcopenia presence rather than the severity of the AD affecting dysphagia. The main aim of this study was to investigate swallowing functions in AD patients according to stages. The second aim was to investigate the correlation between sarcopenia and dysphagia in AD. METHODS This study involved 76 probable AD patients. For all participants, diagnosis of sarcopenia was based on definitions from the revised version of European Working Group on Sarcopenia in Older People at 2018. Dysphagia symptom severity was evaluated by the Turkish version of the Eating Assessment Tool, a videofluoroscopic swallowing study (VFSS) was performed for instrumental evaluation of swallowing. The patients were divided into 3 groups according to the clinical dementia rating (CDR) scale as CDR 1 (mild dementia), CDR 2 (moderate dementia), and CDR 3 (severe dementia). Swallowing evaluation parameters were analyzed between these groups. RESULTS Mean age was 78.9 ± 6.4 years, and 56.4% were female. Twenty-six patients had mild dementia, 31 patients had moderate dementia, 19 patients had severe dementia (CDR 3). We found that sarcopenia rates were similar between AD stages according to CDR in our study population and dysphagia could be seen in every stage of AD. In a multivariate analysis, polypharmacy and sarcopenia were found to be independently associated factors for dysphagia, irrespective of stage of AD (OR: 6.1, CI: 1.57-23.9, P = 0.009; OR: 4.9, CI: 1.24-19.6, P = 0.023, respectively). CONCLUSION Aspirations may be subtle so that AD patients and caregivers may not be aware of swallowing difficulties. Therefore, all AD patients, especially those who have polypharmacy and/or sarcopenia (probable-sarcopenia-severe sarcopenia), should be screened for dysphagia in every stage.
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Affiliation(s)
- Cemile Özsürekci
- Internal Medicine Department, Division of Geriatrics, Hacettepe University Medical Faculty, Ankara, Turkey
| | - Selen Serel Arslan
- Department of Physiotherapy and Rehabilitation, Division of Swallowing Disorders, Hacettepe University Medical Science Faculty, Ankara, Turkey
| | - Numan Demir
- Department of Physiotherapy and Rehabilitation, Division of Swallowing Disorders, Hacettepe University Medical Science Faculty, Ankara, Turkey
| | - Hatice Çalışkan
- Internal Medicine Department, Division of Geriatrics, Hacettepe University Medical Faculty, Ankara, Turkey
| | - Gözde Şengül Ayçiçek
- Internal Medicine Department, Division of Geriatrics, Hacettepe University Medical Faculty, Ankara, Turkey
| | - Hasan Erkan Kılınç
- Department of Physiotherapy and Rehabilitation, Division of Swallowing Disorders, Hacettepe University Medical Science Faculty, Ankara, Turkey
| | - Ömer Faruk Yaşaroğlu
- Department of Physiotherapy and Rehabilitation, Division of Swallowing Disorders, Hacettepe University Medical Science Faculty, Ankara, Turkey
| | - Cemal Kızılarslanoğlu
- Internal Medicine Department, Division of Geriatrics, Gazi University Medical Faculty, Ankara, Turkey
| | - Rana Tuna Doğrul
- Internal Medicine Department, Division of Geriatrics, Hacettepe University Medical Faculty, Ankara, Turkey
| | - Cafer Balcı
- Internal Medicine Department, Division of Geriatrics, Hacettepe University Medical Faculty, Ankara, Turkey
| | - Fatih Sümer
- Internal Medicine Department, Division of Geriatrics, Hacettepe University Medical Faculty, Ankara, Turkey
| | - Ayşe Karaduman
- Department of Physiotherapy and Rehabilitation, Division of Swallowing Disorders, Hacettepe University Medical Science Faculty, Ankara, Turkey
| | - Burcu Balam Yavuz
- Internal Medicine Department, Division of Geriatrics, Hacettepe University Medical Faculty, Ankara, Turkey
| | - Mustafa Cankurtaran
- Internal Medicine Department, Division of Geriatrics, Hacettepe University Medical Faculty, Ankara, Turkey
| | - Meltem Gülhan Halil
- Internal Medicine Department, Division of Geriatrics, Hacettepe University Medical Faculty, Ankara, Turkey
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Fujishima I, Fujiu-Kurachi M, Arai H, Hyodo M, Kagaya H, Maeda K, Mori T, Nishioka S, Oshima F, Ogawa S, Ueda K, Umezaki T, Wakabayashi H, Yamawaki M, Yoshimura Y. Sarcopenia and dysphagia: Position paper by four professional organizations. Geriatr Gerontol Int 2019; 19:91-97. [DOI: 10.1111/ggi.13591] [Citation(s) in RCA: 175] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 11/15/2018] [Accepted: 11/21/2018] [Indexed: 02/06/2023]
Affiliation(s)
- Ichiro Fujishima
- Department of Rehabilitation Medicine; Hamamatsu City Rehabilitation Hospital; Hamamatsu Japan
| | - Masako Fujiu-Kurachi
- Department of Speech and Hearing Sciences; International University of Health and Welfare; Narita Japan
| | - Hidenori Arai
- National Center for Geriatrics and Gerontology; Obu Japan
| | - Masamitsu Hyodo
- Department of Otolaryngology; Kochi Medical School; Kochi Japan
| | - Hitoshi Kagaya
- Department of Rehabilitation Medicine I, School of Medicine; Fujita Health University; Toyoake Japan
| | - Keisuke Maeda
- Palliative Care Center; Aichi Medical University; Nagakute Japan
| | - Takashi Mori
- Department of Oral and Maxillofacial Surgery; Southern Tohoku General Hospital; Koriyama Japan
| | - Shinta Nishioka
- Department of Clinical Nutrition and Food Services; Nagasaki Rehabilitation Hospital; Nagasaki Japan
| | - Fumiko Oshima
- Department of Rehabilitation; Japanese Red Cross Society Suwa Hospital; Suwa Japan
| | - Sumito Ogawa
- Department of Geriatric Medicine, Graduate School of Medicine; The University of Tokyo; Tokyo Japan
| | - Koichiro Ueda
- Department of Dysphagia Rehabilitation; Nihon University School of Dentistry; Tokyo Japan
| | - Toshiro Umezaki
- Department of Speech and Hearing Sciences; International University of Health and Welfare, and the Voice and Swallowing Center, Fukuoka Sanno Hospital; Fukuoka Japan
| | - Hidetaka Wakabayashi
- Department of Rehabilitation Medicine; Yokohama City University Medical Center; Yokohama Japan
| | - Masanaga Yamawaki
- Department of General Medicine; Kyoto Prefectural University of Medicine; Kyoto Japan
| | - Yoshihiro Yoshimura
- Department of Rehabilitation Medicine; Kumamoto Rehabilitation Hospital; Kumamoto Japan
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Wada Y, Komatsu Y, Izumi H, Shimizu T, Takeda Y, Kuwahata M. Increased Ratio of Non-mercaptalbumin-1 Among Total Plasma Albumin Demonstrates Potential Protein Undernutrition in Adult Rats. Front Nutr 2018; 5:64. [PMID: 30090810 PMCID: PMC6068262 DOI: 10.3389/fnut.2018.00064] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 06/29/2018] [Indexed: 12/25/2022] Open
Abstract
The redox state of plasma albumin shifts in response to dietary protein intake in growing rats, and the shift is more sensitive than that of plasma albumin level, a classical marker of protein nutritional status. While it has been suggested that plasma albumin redox state could be useful as a novel marker of protein nutritional status, the above animal model is highly sensitive to dietary protein intake and the observation may not be extrapolated widely to humans. This study aimed to investigate whether albumin redox state also reflects protein nutritional status in adult rats, which have a lower dietary protein requirement and are less responsive to protein intake. Male adult rats were placed on AIN-93M diet (14% casein), or AIN-93M-based low protein diets (10 or 5% casein) ad libitum for 24 weeks. Whereas there was no significant difference in body weight between the groups at the end of the experimental period, the 5% casein diet group had the smallest gastrocnemius muscle weight among the groups, which was significantly lower than that of the 10% casein diet group. Plasma albumin level was also lower in the 5% casein diet group compared with the other groups, but the differences were limited and inconsistent during the experimental period. Among the albumin redox isoforms such as mercaptalbumin, non-mercaptalbumin-1, and non-mercaptalbumin-2, the ratio of non-mercaptalbumin-1 among total albumin was significantly higher in the 5% casein diet group, and the increase remained constant throughout the experimental period. Increased non-mercaptalbumin-1 ratio would thus demonstrate the presence of potential protein undernutrition in adult rats, as manifested only by a decreased gain in a specific type of skeletal muscle; non-mercaptalbumin-1 among total albumin ratio could be useful as a robust marker of protein nutritional status, contributing to prevention of protein undernutrition-related diseases such as frailty and sarcopenia.
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Affiliation(s)
- Yasuaki Wada
- Wellness & Nutrition Science Institute, Morinaga Milk Industry Co., Ltd., Zama, Japan
| | - Yosuke Komatsu
- Wellness & Nutrition Science Institute, Morinaga Milk Industry Co., Ltd., Zama, Japan
| | - Hirohisa Izumi
- Wellness & Nutrition Science Institute, Morinaga Milk Industry Co., Ltd., Zama, Japan
| | - Takashi Shimizu
- Wellness & Nutrition Science Institute, Morinaga Milk Industry Co., Ltd., Zama, Japan
| | - Yasuhiro Takeda
- Wellness & Nutrition Science Institute, Morinaga Milk Industry Co., Ltd., Zama, Japan
| | - Masashi Kuwahata
- Department of Nutrition Science, Graduate School of Life and Environmental Sciences, Kyoto Prefectural University, Kyoto, Japan
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Zhao WT, Yang M, Wu HM, Yang L, Zhang XM, Huang Y. Systematic Review and Meta-Analysis of the Association between Sarcopenia and Dysphagia. J Nutr Health Aging 2018; 22:1003-1009. [PMID: 30272106 DOI: 10.1007/s12603-018-1055-z] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 03/29/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Sarcopenia, an age-related decrease in muscle mass and function, is associated with several potential adverse health outcomes. Its association with another age-related syndrome, dysphagia remains unclear. This systematic review and meta-analysis aims to explore the association between sarcopenia and dysphagia. METHODS PubMed, Embase, Scopus and CINAHL were searched for cross-sectional, case-control and cohort studies that investigated the association between sarcopenia and dysphagia. First author, publication year, study type, sample size, inclusion and exclusion criteria, participant demographics, definition and measurement for evaluation of sarcopenia and dysphagia, main outcomes were retrieved. The association between sarcopenia and dysphagia were expressed by odds ratio (OR) and 95% confidence interval (CI). RESULTS 9 studies are eligible in the systematic review, and 5 cross-sectional studies comprising 913 participants which showed dichotomous classification of sarcopenia and dysphagia were included in the meta-analysis. The crude odds ratios (ORs) were extracted from 5 studies, and 4 of them also provide adjusted ORs. The crude ORs between sarcopenia and dysphagia is 6.17 (95% CI, 3.81- 10.00), after adjusting for some confounders, such as age, sex, Barthel Index score, nutritional status, sarcopenia is also have an association with dysphagia (adjusted ORs, 4.06; 95% CI, 2.27-7.29). The subgroup analysis showed that there was no significant difference between different sarcopenia diagnostic criteria, assessment tools of skeletal muscle mass and dysphagia. CONCLUSION Sarcopenia was positively associated with dysphagia. Prevention and screening of dysphagia is essential among sarcopenic old patients. The causal relationship requires more prospective cohort study for confirmation.
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Affiliation(s)
- W-T Zhao
- Xue-mei Zhang, BS, is Professor,The Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, National Clinical Research Center of Geriatrics, West China Hopital, Sichuan University, Chengdu, China. No.37 Guoxue Alley, Wuhou District, Chengdu City, Sichuan Province, PR China. E-mail address: . Telephone number: 18980601339
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A Significant Association of Malnutrition with Dysphagia in Acute Patients. Dysphagia 2017; 33:258-265. [DOI: 10.1007/s00455-017-9855-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 10/04/2017] [Indexed: 02/07/2023]
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Nishioka S, Okamoto T, Takayama M, Urushihara M, Watanabe M, Kiriya Y, Shintani K, Nakagomi H, Kageyama N. Malnutrition risk predicts recovery of full oral intake among older adult stroke patients undergoing enteral nutrition: Secondary analysis of a multicentre survey (the APPLE study). Clin Nutr 2017; 36:1089-1096. [DOI: 10.1016/j.clnu.2016.06.028] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 05/17/2016] [Accepted: 06/29/2016] [Indexed: 10/21/2022]
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Ikenaga Y, Nakayama S, Taniguchi H, Ohori I, Komatsu N, Nishimura H, Katsuki Y. Factors Predicting Recovery of Oral Intake in Stroke Survivors with Dysphagia in a Convalescent Rehabilitation Ward. J Stroke Cerebrovasc Dis 2017; 26:1013-1019. [PMID: 28108097 DOI: 10.1016/j.jstrokecerebrovasdis.2016.12.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 12/03/2016] [Accepted: 12/08/2016] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Percutaneous endoscopic gastrostomy may be performed in dysphagic stroke patients. However, some patients regain complete oral intake without gastrostomy. This study aimed to investigate the predictive factors of intake, thereby determining gastrostomy indications. METHOD Stroke survivors admitted to our convalescent rehabilitation ward who underwent gastrostomy or nasogastric tube placement from 2009 to 2015 were divided into 2 groups based on intake status at discharge. Demographic data and Functional Independence Measure (FIM), Dysphagia Severity Scale (DSS), National Institutes of Health Stroke Scale, and Glasgow Coma Scale (GCS) scores on admission were compared between groups. We evaluated the factors predicting intake using a stepwise logistic regression analysis. RESULTS Thirty-four patients recovered intake, whereas 38 achieved incomplete intake. Mean age was lower, mean body mass index (BMI) was higher, and mean time from stroke onset to admission was shorter in the complete intake group. The complete intake group had less impairment in terms of GCS, FIM, and DSS scores. In the stepwise logistic regression analysis, BMI, FIM-cognitive score, and DSS score were significant independent factors predicting intake. The formula of BMI × .26 + FIM cognitive score × .19 + DSS score × 1.60 predicted recovery of complete intake with a sensitivity of 88.2% and a specificity of 84.2%. CONCLUSIONS Stroke survivors with dysphagia with a high BMI and FIM-cognitive and DSS scores tended to recover oral intake.
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Affiliation(s)
- Yasunori Ikenaga
- Department of Rehabilitation Medicine, Yawata Medical Center, Komatsu City, Japan.
| | - Sayaka Nakayama
- Department of Rehabilitation Medicine, Yawata Medical Center, Komatsu City, Japan
| | - Hiroki Taniguchi
- Department of Rehabilitation Medicine, Yawata Medical Center, Komatsu City, Japan
| | - Isao Ohori
- Department of Rehabilitation Medicine, Yawata Medical Center, Komatsu City, Japan
| | - Nahoko Komatsu
- Department of Rehabilitation Medicine, Yawata Medical Center, Komatsu City, Japan
| | - Hitoshi Nishimura
- Department of Rehabilitation Medicine, Yawata Medical Center, Komatsu City, Japan
| | - Yasuo Katsuki
- Department of Rehabilitation Medicine, Yawata Medical Center, Komatsu City, Japan
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Santos CM, Cassiani RA, Dantas RO. VIDEOFLUOROSCOPIC EVALUATION OF SWALLOWS IN ANOREXIA NERVOSA. ARQUIVOS DE GASTROENTEROLOGIA 2016; 53:136-40. [PMID: 27438416 DOI: 10.1590/s0004-28032016000300003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 05/13/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND There are some studies in the literature about the feeding behavior and masticatory process in patients with feeding disorders; however, it is not very well known if there are alterations in oral-pharyngeal swallowing dynamics in subjects with anorexia nervosa. OBJECTIVE To evaluate the oral and pharyngeal bolus transit in patients with anorexia nervosa. METHODS The study was conducted with 8 individuals clinically diagnosed and in treatment for restricting-type anorexia nervosa (seven women and one man), and 14 healthy individuals with no digestive or neurological symptoms (10 women, 4 men). Swallows were evaluated by videofluoroscopy with three swallows of 5 mL liquid bolus and three swallows of 5 mL paste bolus consistency, given in a random sequence. The participants were asked after each swallow about the sensation of the bolus passage. RESULTS In the analysis of oral-pharyngeal transit duration, the mean duration of pharyngeal transit with paste bolus in patients with anorexia was shorter than in healthy volunteers (P=0.02). In the duration of movement of the hyoid bone, longer movement was observed in anorexia than in healthy volunteers with liquid bolus (P=0.01). With liquid bolus, five (62.5%) patients and one (7.1%) control had sensation of the bolus passage (P<0.05). CONCLUSION There seems to be no important alterations of swallowing in subjects with anorexia nervosa, although the results suggest that pharyngeal transit has shorter duration than that seen in healthy volunteers and the hyoid movement duration is longer in patients than in healthy volunteers. Fast pharyngeal transit may be the cause of bolus transit perception in patients with anorexia nervosa.
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Affiliation(s)
- Carla Manfredi Santos
- Fonoaudiologia, Centro de Reabilitação, Hospital do Estado, Ribeirão Preto, SP, Brasil
| | | | - Roberto Oliveira Dantas
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
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Brody R. Nutrition Issues in Dysphagia: Identification, Management, and the Role of the Dietitian. Nutr Clin Pract 2016. [DOI: 10.1177/0884533699014005s10] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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Yokota J, Ogawa Y, Yamanaka S, Takahashi Y, Fujita H, Yamaguchi N, Onoue N, Ishizuka T, Shinozaki T, Kohzuki M. Cognitive Dysfunction and Malnutrition Are Independent Predictor of Dysphagia in Patients with Acute Exacerbation of Congestive Heart Failure. PLoS One 2016; 11:e0167326. [PMID: 27898735 PMCID: PMC5215957 DOI: 10.1371/journal.pone.0167326] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 11/13/2016] [Indexed: 02/06/2023] Open
Abstract
Early detection and intervention for dysphagia is important in patients with congestive heart failure (CHF). However, previous studies have focused on how many patients with dysphagia develop CHF. Studies focusing on the comorbidity of dysphagia in patients with CHF are rare. Additionally, risk factors for dysphagia in patients with CHF are unclear. Thus, the aim of this study was to clarify risk factors for dysphagia in patients with acute exacerbation of CHF. A total of 105 patients, who were admitted with acute exacerbation of CHF, were enrolled. Clinical interviews, blood chemistry analysis, electrocardiography, echocardiography, Mini-Mental State Examination (MMSE), exercise tolerance tests, phonatory function tests, and evaluation of activities of daily living (ADL) and nutrition were conducted on admission. After attending physicians permitted the drinking of water, swallowing screening tests were performed. Patients were divided into a dysphagia group (DG) or a non-dysphagia group (non-DG) based on Functional Oral Intake Scale level. Among the 105 patients, 38 had dysphagia. A greater number of patients had history of aspiration pneumonia and dementia, and there was a higher age, N-terminal pro-B-type natriuretic peptide level in the DG compared with the non-DG. MMSE scores, exercise tolerance, phonatory function, status of ADL, nutrition, albumin, and transthyretin were lower in the DG compared with the non-DG. In multivariate analysis, after adjusting for age and sex, MMSE, BI score, and transthyretin was independently associated with dysphagia. Comorbidity of dysphagia was 36.1% in patients with acute exacerbation of CHF, and cognitive dysfunction and malnutrition may be an independent predictor of dysphagia.
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Affiliation(s)
- Junichi Yokota
- Department of Internal Medicine and Rehabilitation Science, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Rehabilitation, Sendai Medical Center, Sendai, Japan
| | - Yoshiko Ogawa
- Department of Sport and Medical Sciences, Faculty of Medical Technology, Teikyo University, Tokyo, Japan
| | | | | | - Hiroshi Fujita
- Department of Cardiology, Sendai Medical Center, Sendai, Japan
| | | | - Noriko Onoue
- Department of Cardiology, Sendai Medical Center, Sendai, Japan
| | | | | | - Masahiro Kohzuki
- Department of Internal Medicine and Rehabilitation Science, Tohoku University Graduate School of Medicine, Sendai, Japan
- * E-mail:
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Kobayashi Y, Somoto Y, Mitsuyama E, Tanaka A, Yuda N, Nakada H, Yamada A, Yamauchi K, Abe F, Nagasawa T. Supplementation of protein-free diet with whey protein hydrolysates prevents skeletal muscle mass loss in rats. JOURNAL OF NUTRITION & INTERMEDIARY METABOLISM 2016. [DOI: 10.1016/j.jnim.2016.03.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Wakabayashi H, Matsushima M. Dysphagia Assessed by the 10-Item Eating Assessment Tool Is Associated with Nutritional Status and Activities of Daily Living in Elderly Individuals Requiring Long-Term Care. J Nutr Health Aging 2016; 20:22-7. [PMID: 26728929 DOI: 10.1007/s12603-016-0671-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES The 10-item Eating Assessment Tool (EAT-10) is a self-administered questionnaire for dysphagia screening, with each item scored from 0 to 4. We assessed the associations among the EAT-10 score, nutritional status and activities of daily living (ADL) in elderly individuals requiring long-term care. DESIGN Cross-sectional study. SETTING Geriatric health services facilities, acute hospitals, and the community. PARTICIPANTS Elderly individuals ≥65 years of age with dysphagia or possible dysphagia (N=237). MEASUREMENTS The EAT-10, the Mini Nutritional Assessment Short Form (MNA-SF) and the Barthel Index. RESULTS There were 90 males and 147 females. Mean age was 82 ± 8 years. Eighty-nine were in geriatric health services facilities, 28 were in acute hospitals, and 120 were community-dwelling. The median Barthel Index score was 55 (interquartile range: 25, 80). The median EAT-10 score was 1 (interquartile range: 0, 9), and 101 respondents a score > 3, indicating the presence of dysphagia. The MNA-SF revealed that 81 were malnourished, 117 were at risk of malnutrition, and 39 had a normal nutritional status. The Barthel Index score and MNA-SF score were significantly lower in those with an EAT-10 score between 3 and 40, compared to those with an EAT-10 score between 0 and 2. The EAT-10 has an independent effect on the Barthel Index and the MNA-SF by adjusting for covariates such as age, gender, and setting in multiple regression analysis. CONCLUSIONS Dysphagia assessed by the EAT-10 is associated with nutritional status and ADL in elderly individuals requiring long-term care.
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Affiliation(s)
- H Wakabayashi
- Hidetaka Wakabayashi, Department of Rehabilitation Medicine, Yokohama City University Medical Center, 4-57 Urafune-chou, Minami ward, Yokohama City, Japan 232-0024, E-mail: , Tel: +81-45-261-5656; Fax: +81-45-253-9955
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Wakabayashi H, Matsushima M, Uwano R, Watanabe N, Oritsu H, Shimizu Y. Skeletal muscle mass is associated with severe dysphagia in cancer patients. J Cachexia Sarcopenia Muscle 2015; 6:351-7. [PMID: 26673551 PMCID: PMC4670744 DOI: 10.1002/jcsm.12052] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 04/28/2015] [Accepted: 05/04/2015] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The purpose of this study was to assess the association between skeletal muscle mass, activities of daily living (ADLs) and severe dysphagia in cancer patients. METHODS A nested case-control study was performed in 111 consecutive cancer patients with dysphagia who were prescribed speech therapy. Skeletal muscle mass comprising the cross-sectional area of the left and right psoas muscles was assessed via abdominal computed tomography at the third lumbar vertebral level. ADLs were evaluated by the Barthel Index. The severity of dysphagia was assessed by the Food Intake Level Scale and was characterized by non-oral feeding or oral food intake at discharge. Univariate and logistic regression analyses were applied to examine the associations between dysphagia, skeletal muscle index (SMI) and ADLs. RESULTS There were 86 men and 25 women (mean age, 70 years). The mean SMI was 5.68 ± 1.74 cm(2)/m(2) in men and 4.43 ± 1.21 cm(2)/m(2) in women. The median Barthel Index score was 20. Thirty-three patients were on non-oral feeding at discharge. The mean SMI did not differ significantly between non-oral feeding and oral food intake groups in t-test. The median Barthel Index score was lower in the non-oral feeding group in Mann-Whitney U test. Logistic regression analysis of the severity of dysphagia adjusted for age, sex, SMI, Barthel Index score, serum albumin, cancer type and stage, and vocal cord paralysis showed that SMI was associated independently with oral food intake at discharge. Barthel Index score showed a tendency to be associated with oral food intake. CONCLUSIONS Skeletal muscle mass is associated with severe dysphagia in cancer patients. ADLs show a tendency to be associated with severe dysphagia in cancer patients.
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Affiliation(s)
- Hidetaka Wakabayashi
- Department of Rehabilitation Medicine, Yokohama City University Medical Center 4-57 Urafune-chou, Minami ward, Yokohama, 232-0024, Japan ; Division of Clinical Epidemiology, Jikei University School of Medicine 3-25-8 Nishi-shinbashi, Minato ward, Tokyo, 105-0003, Japan
| | - Masato Matsushima
- Division of Clinical Epidemiology, Jikei University School of Medicine 3-25-8 Nishi-shinbashi, Minato ward, Tokyo, 105-0003, Japan
| | - Rimiko Uwano
- Department of Rehabilitation Medicine, Yokohama City University Medical Center 4-57 Urafune-chou, Minami ward, Yokohama, 232-0024, Japan
| | - Naoko Watanabe
- Department of Rehabilitation Medicine, Yokohama City University Medical Center 4-57 Urafune-chou, Minami ward, Yokohama, 232-0024, Japan
| | - Hideyuki Oritsu
- Department of Rehabilitation Medicine, Yokohama City University Medical Center 4-57 Urafune-chou, Minami ward, Yokohama, 232-0024, Japan
| | - Yoshitaka Shimizu
- Department of Rehabilitation Medicine, Yokohama City University Medical Center 4-57 Urafune-chou, Minami ward, Yokohama, 232-0024, Japan
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Wakabayashi H, Sakuma K. Rehabilitation nutrition for sarcopenia with disability: a combination of both rehabilitation and nutrition care management. J Cachexia Sarcopenia Muscle 2014; 5:269-77. [PMID: 25223471 PMCID: PMC4248414 DOI: 10.1007/s13539-014-0162-x] [Citation(s) in RCA: 244] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 09/01/2014] [Indexed: 11/25/2022] Open
Abstract
Malnutrition and sarcopenia often occur in rehabilitation settings. The prevalence of malnutrition and sarcopenia in older patients undergoing rehabilitation is 49-67 % and 40-46.5 %, respectively. Malnutrition and sarcopenia are associated with poorer rehabilitation outcome and physical function. Therefore, a combination of both rehabilitation and nutrition care management may improve outcome in disabled elderly with malnutrition and sarcopenia. The concept of rehabilitation nutrition as a combination of both rehabilitation and nutrition care management and the International Classification of Functioning, Disability and Health guidelines are used to evaluate nutrition status and to maximize functionality in the elderly and other people with disability. Assessment of the multifactorial causes of primary and secondary sarcopenia is important because rehabilitation nutrition for sarcopenia differs depending on its etiology. Treatment of age-related sarcopenia should include resistance training and dietary supplements of amino acids. Therapy for activity-related sarcopenia includes reduced bed rest time and early mobilization and physical activity. Treatment for disease-related sarcopenia requires therapies for advanced organ failure, inflammatory disease, malignancy, or endocrine disease, while therapy for nutrition-related sarcopenia involves appropriate nutrition management to increase muscle mass. Because primary and secondary sarcopenia often coexist in people with disability, the concept of rehabilitation nutrition is useful for their treatment. Stroke, hip fracture, and hospital-associated deconditioning are major causes of disability, and inpatients of rehabilitation facilities often have malnutrition and sarcopenia. We review the concept of rehabilitation nutrition, the rehabilitation nutrition options for stroke, hip fracture, hospital-associated deconditioning, sarcopenic dysphagia, and then evaluate the amount of research interest in rehabilitation nutrition.
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Affiliation(s)
- Hidetaka Wakabayashi
- Department of Rehabilitation Medicine, Yokohama City University Medical Center, 4-57 Urafune-chou, Minami ward, Yokohama city, Japan, 232-0024,
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Maeda K, Akagi J. Decreased Tongue Pressure is Associated with Sarcopenia and Sarcopenic Dysphagia in the Elderly. Dysphagia 2014; 30:80-7. [DOI: 10.1007/s00455-014-9577-y] [Citation(s) in RCA: 162] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Accepted: 09/16/2014] [Indexed: 11/28/2022]
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Ettinger L, Keller HH, Duizer LM. Characterizing commercial pureed foods: sensory, nutritional, and textural analysis. J Nutr Gerontol Geriatr 2014; 33:179-97. [PMID: 25105714 DOI: 10.1080/21551197.2014.927304] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Dysphagia (swallowing impairment) is a common consequence of stroke and degenerative diseases such as Parkinson's and Alzheimer's. Limited research is available on pureed foods, specifically the qualities of commercial products. Because research has linked pureed foods, specifically in-house pureed products, to malnutrition due to inferior sensory and nutritional qualities, commercial purees also need to be investigated. Proprietary research on sensory attributes of commercial foods is available; however direct comparisons of commercial pureed foods have never been reported. Descriptive sensory analysis as well as nutritional and texture analysis of commercially pureed prepared products was performed using a trained descriptive analysis panel. The pureed foods tested included four brands of carrots, of turkey, and two of bread. Each commercial puree was analyzed for fat (Soxhlet), protein (Dumas), carbohydrate (proximate analysis), fiber (total fiber), and sodium content (Quantab titrator strips). The purees were also texturally compared with a line spread test and a back extrusion test. Differences were found in the purees for sensory attributes as well as nutritional and textural properties. Findings suggest that implementation of standards is required to reduce variability between products, specifically regarding the textural components of the products. This would ensure all commercial products available in Canada meet standards established as being considered safe for swallowing.
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Affiliation(s)
- Laurel Ettinger
- a Department of Food Science , University of Guelph , Guelph , Ontario , Canada
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Holmes SRM, Gudridge TA, Gaudiani JL, Mehler PS. Dysphagia in severe anorexia nervosa and potential therapeutic intervention: a case series. Ann Otol Rhinol Laryngol 2012; 121:449-56. [PMID: 22844864 DOI: 10.1177/000348941212100705] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES In severe anorexia nervosa, there are a litany of medical complications that affect virtually every body system, and severe weakness is a typical characteristic. To our knowledge, aspiration risk, dysphagia recognition, and dysphagia management and intervention have not been well described in the literature in regard to severe anorexia nervosa. The purpose of this case series is to increase awareness among clinicians of possible oropharyngeal dysphagia symptoms that may present in patients with severe anorexia nervosa. METHODS We describe the cases of 3 patients with severe anorexia nervosa who presented with symptoms of dysphagia. The speech-language pathology team administered dysphagia therapy to the 3 patients utilizing neuromuscular electrical stimulation (NMES) in conjunction with swallowing therapy tasks that included strengthening exercises and compensatory strategies. RESULTS After the course of dysphagia treatment intervention, the 3 patients were able to tolerate an oral diet with improved swallowing function and no ongoing aspiration. CONCLUSIONS The use of NMES in conjunction with traditional swallowing exercises in the treatment of dysphagia in patients with anorexia nervosa may reduce the need for enteral feeding and prolonged hospitalization. In regard to dysphagia intervention and management within this population and across other populations, rigorous randomized controlled studies are necessary for determining the efficacy of NMES and traditional swallowing therapy implementation.
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Affiliation(s)
- Samantha R M Holmes
- ACUTE Center for Eating Disorders, Denver Health Medical Center, Denver, Colorado, USA
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Holmes SRM, Gudridge TA, Gaudiani JL, Mehler PS. Dysphagia in severe anorexia nervosa: a case report. Int J Eat Disord 2012; 45:463-6. [PMID: 22253066 DOI: 10.1002/eat.20971] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/31/2011] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The purpose of this case report is to increase awareness among clinicians that oropharyngeal dysphagia occurs in patients with severe anorexia nervosa, placing them at risk for aspiration and impeding nutritional rehabilitation. METHOD We describe a patient with severe anorexia nervosa who manifested symptoms of dysphagia, with resultant aspiration pneumonia, at the time of her admission for medical stabilization. RESULTS The speech pathology team administered dysphagia therapy, using neuromuscular electrical stimulation (NMES) in conjunction with swallowing therapy. Following the course of dysphagia treatment intervention, the patient was able to tolerate an oral diet with improved swallowing function and no ongoing aspiration. DISCUSSION Patients with severe anorexia nervosa should be screened for possible dysphagia. NMES in the treatment of dysphagia in patients with anorexia nervosa may reduce the need for enteral feeds and prolonged hospitalization.
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Keller H, Chambers L, Niezgoda H, Duizer L. Issues associated with the use of modified texture foods. J Nutr Health Aging 2012; 16:195-200. [PMID: 22456772 DOI: 10.1007/s12603-011-0160-z] [Citation(s) in RCA: 90] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Use of modified texture foods (MTF) is common in the geriatric population. There is a potential for increased prevalence of use of MTF due in part to longer survival of persons with dementia, those who have suffered from a stroke, as well as other degenerative diseases that affect chewing and swallowing. Unfortunately, little clinical, nutritional and sensory research has been conducted on MTF to inform practice. This review highlights issues identified in the literature to date that influence nutritional and sensory quality and acceptability of these foods. Use of MTF is highly associated with undernutrition, however causality is difficult to demonstrate due to confounding factors such as the requirement for feeding assistance. Knowledge gaps and considerations that need to be taken into account when conducting research are identified.
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Affiliation(s)
- H Keller
- University of Guelph, Guelph, ONT, Canada.
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Malandraki GA, McCullough G, He X, McWeeny E, Perlman AL. Teledynamic evaluation of oropharyngeal swallowing. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2011; 54:1497-505. [PMID: 22052284 PMCID: PMC4165336 DOI: 10.1044/1092-4388(2011/10-0284)] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
PURPOSE The objective of the present investigation was to test the feasibility and clinical utility of a real-time Internet-based protocol for remote, telefluoroscopic evaluation of oropharyngeal swallowing. METHOD In this prospective cohort study, the authors evaluated 32 patients with a primary diagnosis of stroke or head/neck cancer. All patients participated in 2 separate fluoroscopic swallowing evaluations--one traditional on site and one telefluoroscopic off site--through the use of a telemedicine system. Agreement between sites was tested for 3 categories of variables: (a) overall severity of swallowing difficulty, (b) presence and extent of laryngeal penetration and aspiration as rated by the 8-point Penetration-Aspiration scale, and (c) treatment recommendations. RESULTS Results showed overall good agreement in subjective severity ratings (κ = 0.636) and in Penetration-Aspiration scale ratings (mean absolute difference = 1.1 points) between the onsite and offsite clinicians. Agreement in treatment recommendations was moderate to high, ranging from 69.3% to 100%. CONCLUSIONS The present study supports the feasibility and clinical utility of a telemedicine system for evaluating oropharyngeal swallowing. Given the difficulty and expertise needed to complete such evaluations, this study offers promising clinical avenues for patients in rural, remote, and underserved communities and countries where expert swallowing specialists are not available.
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Affiliation(s)
- GA Malandraki
- Department of Biobehavioral Sciences, Program of Speech and Language Pathology, Teachers College, Columbia University, New York
- Department of Speech and Hearing Science, University of Illinois, Urbana-Champaign
- Corresponding Author Address and Contact Information: Adrienne L Perlman, PhD, University of Illinois at Urbana-Champaign, Department of Speech and Hearing Science, 901 South Sixth St., Champaign, IL 61820,
| | - G McCullough
- Department of Speech Language Pathology, University of Central Arkansas, Conway
| | - X He
- Department of Statistics, University of Illinois, Urbana-Champaign
| | - E McWeeny
- Department of Audiology and Speech Pathology, University of Arkansas at Little Rock and University of Arkansas for Medical Sciences
| | - AL Perlman
- Department of Speech and Hearing Science, University of Illinois, Urbana-Champaign
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Taylor KA, Barr SI. Provision of Small, Frequent Meals Does Not Improve Energy Intake of Elderly Residents with Dysphagia Who Live in an Extended-Care Facility. ACTA ACUST UNITED AC 2006; 106:1115-8. [PMID: 16815130 DOI: 10.1016/j.jada.2006.04.014] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Malnutrition and dehydration are potential consequences of dysphagia, a common swallowing disorder among elderly individuals. Providing smaller, more frequent meals has been suggested (but not demonstrated) to improve energy intake among this group. Accordingly, this study was designed to assess whether the same energy content in five vs three daily meals would improve energy intake. Thirty-seven residents of an extended-care facility, aged older than 65 years, previously evaluated for dysphagia, and receiving a texture-modified diet, agreed to participate in a crossover study with random assignment to three or five meals during an initial 4-day study period, followed by the opposite meal pattern in a second period. Six were excluded from analysis, as their medical condition deteriorated before or during the study. Food and fluids consumed by participants during each study period were weighed before and after each meal. Average energy intakes were similar between the three- and five-meal patterns (1,325+/-207 kcal/day vs 1,342+/-177 kcal/day, respectively; P=0.565); fluid intake was higher with five meals (698+/-156 mL/day) vs three (612+/-176 mL/day; P=0.003). Because offering five daily feedings did not improve energy intakes when compared with three, dietitians caring for this vulnerable group might need to consider other nutrition intervention strategies.
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Wright L, Cotter D, Hickson M, Frost G. Comparison of energy and protein intakes of older people consuming a texture modified diet with a normal hospital diet. J Hum Nutr Diet 2005; 18:213-9. [PMID: 15882384 DOI: 10.1111/j.1365-277x.2005.00605.x] [Citation(s) in RCA: 152] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND There are very few studies looking at the energy and protein requirements of patients requiring texture modified diets. Dysphagia is the main indication for people to be recommended texture-modified diets. Older people post-stroke are the key group in the hospital setting who consume this type of diet. The diets can be of several consistencies ranging from pureed to soft textures. OBJECTIVE To compare the 24-hour dietary intake of older people consuming a texture modified diet in a clinical setting to older people consuming a normal hospital diet. METHOD Weighed food intakes and food record charts were used to quantify the patients' intakes, which were compared to their individual requirements. RESULTS The oral intake of 55 patients was measured. Twenty-five of the patients surveyed were eating a normal diet and acted as controls for 30 patients who were prescribed a texture-modified diet. The results showed that the texture-modified group had significantly lower intakes of energy (3877 versus 6115 kJ, P < 0.0001) and protein (40 versus 60 g, P < 0.003) compared to consumption of the normal diet. The energy and protein deficit from estimated requirements was significantly greater in the texture-modified group (2549 versus 357 kJ, P < 0.0001; 6 versus 22 g, P = 0.013; respectively). CONCLUSION These statistically significant results indicate that older people on texture-modified diets have a lower intake of energy and protein than those consuming a normal hospital diet and it is likely that other nutrients will be inadequate. All patients on texture-modified diets should be assessed by the dietitian for nutritional support. Evidence based strategies for improving overall nutrient intake should be identified.
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Affiliation(s)
- L Wright
- Department of Nutrition and Dietetics, Hammersmith Hospitals NHS Trust, Charing Cross Hospital, London, UK.
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Lee JSW, Tse SLS, Tsze SCY, Kwok T. PROTEIN MALNUTRITION IS ADVERSELY ASSOCIATED WITH SWALLOWING RECOVERY IN TUBE-FED OLDER PEOPLE. J Am Geriatr Soc 2004; 52:1588-9. [PMID: 15341578 DOI: 10.1111/j.1532-5415.2004.52430_9.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Asensio A, Ramos A, Núñez S. Factores pronósticos de mortalidad relacionados con el estado nutricional en ancianos hospitalizados. Med Clin (Barc) 2004; 123:370-3. [PMID: 15482700 DOI: 10.1016/s0025-7753(04)74521-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVE The proportion of elderly patients hospitalized in acute care wards has progressively increased. Patients with a decreased functional status are prone to have malnutrition which negatively affects their prognosis and increases mortality. However, it is unclear whether functional and nutritional status are independent risk factors of mortality. PATIENTS AND METHOD We investigated the relation between functional status (Katz index) and nutritional parameters and the incidence of mortality in a prospective, observational study of a cohort of elderly patients who were admitted to an internal medicine ward. Prevalence of malnutrition upon admission and cumulative incidence rate of in-hospital mortality were computed. Also, potential nutritional and functional prognostic factors for in-hospital mortality were identified by multiple logistic regression. RESULTS The prevalence of malnutrition in 105 patients included in the cohort was 57.1% (95 percent confidence interval, 47.1% to 66.8%). The incidence of in-hospital mortality was 14.3% (95 percent confidence interval, 8.2% to 22.5%). After adjustment, independent prognostic factors for in-hospital mortality were: a high level of functional dependence (F and G categories of Katz index, OR 6.1; 95 percent confidence interval, 1.4 to 26.3), diminished levels of serum transferrin (each decrement of 1g/L, OR 8.3; 95 percent confidence interval, 3.4 to 20.0) and lymphocyte cell counts (each decrement of 0.5 x 10(9) cells/L, OR 2.3; 95 percent confidence interval, 1.5 to 3.5). CONCLUSIONS The prevalence of malnutrition and the incidence of mortality are very high in the hospitalized elderly. In our cohort, decreased serum transferrin and lymphocyte cell count, and an increased level of functional status were associated with an increased risk of in-hospital mortality. Given the high prevalence of geriatric patients in acute care hospitals, strategies to promote an adequate nutrition may reduce the risk of death.
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Affiliation(s)
- Angel Asensio
- Servicio de Medicina Preventiva, Hospital Universitario Puerta de Hierro, Madrid, España.
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Affiliation(s)
- Paula Leslie
- School of Surgical and Reproductive Sciences, University of Newcastle, Newcastle upon Tyne NE2 4HH.
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Smithard DG, O'Neill PA, Parks C, Morris J. Complications and outcome after acute stroke. Does dysphagia matter? Stroke 1996; 27:1200-4. [PMID: 8685928 DOI: 10.1161/01.str.27.7.1200] [Citation(s) in RCA: 427] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND PURPOSE The published data on the relationship between dysphagia and both outcome and complications after acute stroke have been inconclusive. We examined the relationship between these, using bedside assessment and videofluoroscopic examination. METHODS We prospectively studied 121 consecutive patients admitted with acute stroke. A standardized bedside assessment was performed by a physician. We performed videofluoroscopy blinded to this assessment within 3 days of stroke onset and within a median time of 24 hours of the bedside evaluations. The presence of aspiration was recorded. Mortality, functional outcome, lengthy of stay, place of discharge, occurrence of chest infection, nutritional status, and hydration were the main outcome measures. RESULTS Patients with an abnormal swallow (dysphagia) on bedside assessment had a higher risk of chest infection (P=.05) and a poor nutritional state (P=.001). The presence of dysphagia was associated with an increased risk of death (P=.001), disability (P=.02), length of hospital stay (P<.001), and institutional care (P<.05). When other factors were taken into account, dysphagia remained as an independent predictor of outcome only with regard to mortality. The use of videofluoroscopy in detecting aspiration did not add to the value of bedside assessment. CONCLUSIONS Bedside assessment of swallowing is of use in identifying patients at risk of developing complications. The value of routine screening with videofluoroscopy to detect aspiration is questioned.
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Affiliation(s)
- D G Smithard
- University Department of Geriatric Medicine, South Manchester University Hospitals Trust, UK
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Abstract
OBJECTIVE To determine the appropriateness of dietary levels of residents with suspected feeding and/or swallowing disorders. DESIGN Chart review, evaluation, intervention, observation. SETTING Two skilled nursing facilities, one in Washington, one in Florida. SUBJECTS Two hundred twelve residents, mean age 72.9, suspected of having feeding and/or swallowing disorders. MEASUREMENTS After documentation of dietary level, each resident on a mechanically modified diet was given an evaluation by a speech/language pathologist specific to their feeding and swallowing skills. Changes in the dietary level were made, and the residents were followed for 30 days to evaluate their response. RESULTS Thirty-one percent of the residents in the two facilities were prescribed a mechanically altered diet. Ninety-one percent were at dietary levels below that which they could tolerate safely; four percent were at dietary levels higher than they could tolerate; five percent were considered to be at the appropriate diet level. CONCLUSIONS Many nursing home residents may be inappropriately placed or maintained on mechanically altered diets. Regular reevaluation of their dietary level is necessary because most may be able to eat safely at higher levels. Active participation by speech/language pathologists knowledgeable in the assessment of oropharyngeal dysphagia is helpful in this process.
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Affiliation(s)
- M E Groher
- James A. Haley VA Hospital, Tampa, Florida, USA
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Letters to the Editor. Med Chir Trans 1993. [DOI: 10.1177/014107689308601124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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