Prevalence of skeletal muscle mass loss and its association with swallowing function after cardiovascular surgery

Temporal recovery and prognostic factors for dysphagia following cardiovascular surgery: Retrospective analysis and development of predictive score

OBJECTIVE

Dysphagia is a common complication associated with cardiovascular surgery (CVS). This study sought to better understand recovery timelines, identify risk factors, and create a prognostic model for oral intake restoration.

METHODS

This retrospective study included 134 patients who had CVS between April 2022 and March 2024. We assessed swallowing ability through fiberoptic endoscopic evaluation of swallowing (FEES). We randomly divided the patients' data into a training dataset and a test dataset in a ratio of 70/30 and Kaplan-Meier analyses and Cox regression were used to assess predictors of total oral intake. We also created a scoring system using the estimated regression coefficients.

RESULTS

Most patients with CVS achieved total oral intake in 7-11 days after extubation. Over 168 h of intubation, the presence of penetration or aspiration, a poor FEES score (score > 6), and perioperative complications were significant risk factors for delayed total oral intake. The predicting score was calculated by adding the scores for each individual factor, including FEES score, penetration/aspiration, and preoperative complications. Scores ranged 0-8, categorizing patients into 0-2, 3-5, and 6-8 groups, clearly demonstrating that the higher the predicting score, the longer the time to total oral intake in both the training and the test dataset.

CONCLUSIONS

All risk factors for unsuccessful or delayed total oral intake were intubation for more than a week, poor swallowing ability, and the presence of perioperative complications. The scoring system accurately predicts the restoration of oral intake following CVS.

Nutritional Aspects of Wound Care

Malnutrition is a collective term that includes both undernutrition and malnutrition. Malnutrition presents with and without inflammation, is reported in underweight, normal weight, and overweight individuals, and is associated with undesirable alterations in body composition, and diminished functional status. Older adults commonly experience dwindling nutritional status as evidenced by insidious weight loss, insufficient dietary intake, loss of muscle mass, quality, and strength, declining functional status, and other physical and emotional decline indicators. Sustained pressure, acute trauma, malnutrition, and inflammatory-driven chronic conditions increase the risk for skin integrity issues.

Impact of the perioperative assessment of deglutition on postoperative respiratory complications in elderly patients undergoing gastrectomy for gastric cancer

PURPOSE

To investigate the association between perioperative deglutition screening and postoperative respiratory complications (PRCs) in elderly patients undergoing gastrectomy for gastric cancer.

METHODS

We analyzed data from 86 patients with gastric cancer (aged ≥ 70 years) who underwent gastrectomy between October, 2016 and November, 2018. Videofluoroscopic swallowing examinations (VFSEs) were performed before and after surgery. We examined the association of these results with postoperative respiratory complications, as well as the relationships between demographic, operative, and swallowing function assessment data.

RESULTS

PRCs were identified in 16 patients. The results of pre- and postoperative VFSE showed abnormalities in 28 and 32 patients, respectively. Multivariate analysis revealed that abnormalities in the postoperative VFSEs were strongly associated with the development of PRCs (P = 0.002). The findings of this analysis suggests that ventilatory impairment, a Charlson comorbidity index score ≥ 3, and an open surgical approach are independent risk factors for PRCs.

CONCLUSION

This is the first study to demonstrate the efficacy of perioperative assessment of swallowing function using VFSE for predicting PRCs in elderly patients undergoing gastrectomy for gastric cancer.

Development of predictive score for postoperative dysphagia after emergency abdominal surgery in patients of advanced age

Aim

Postoperative dysphagia after emergency abdominal surgery (EAS) in patients of advanced age has become problematic, and appropriate dysphagia management is needed. This study was performed to identify predictive factors of dysphagia after EAS and to explore the usefulness of swallowing screening tools (SSTs).

Methods

This retrospective study included 267 patients of advanced age who underwent EAS from 2012 to 2022. They were assigned to a dysphagia group and non-dysphagia group using the Food Intake Level Scale (FILS) (dysphagia was defined as a FILS level of <7 on postoperative day 10). From 2018, original SSTs including a modified water swallowing test were performed by nurses.

Results

The incidence of postoperative dysphagia was 22.8% (61/267). Patients were significantly older in the dysphagia than non-dysphagia group. The proportions of patients who had poor nutrition, cerebrovascular disorder, Parkinson's disease, dementia, nursing-care service, high intramuscular adipose tissue content (IMAC), and postoperative ventilator management were much higher in the dysphagia than non-dysphagia group. Using logistic regression analysis, high IMAC, postoperative ventilator management, cerebrovascular disorder, and dementia were correlated with postoperative dysphagia and were assigned 10, 4, 3, and 3 points, respectively, according to each odds ratio. The optimal cut-off value was 7 according to a receiver operating characteristics curve. Using 1:1 propensity score matching for high-risk patients, the incidence of postoperative dysphagia was reduced by SSTs.

Conclusions

The new prediction score obtained from this study can identify older patients at high risk for dysphagia after EAS, and SSTs may improve these patients' short-term outcomes.

Swallowing biomechanics in tracheostomised critically ill patients compared to age- and gender-matched healthy controls

Objective

The mechanistic effects of a tracheostomy on swallowing are unclear. Pharyngeal high-resolution manometry with impedance (P-HRM-I) is a novel swallow assessment tool providing quantifiable metrics. This study aimed to characterise swallowing biomechanics in tracheostomised critically ill (non-neurological) patients.

Design

Cohort study.

Setting

Australian tertiary hospital intensive care unit.

Participants

Tracheostomised adults, planned for decannulation.

Main outcome measures

Swallowing assessment using P-HRM-I, compared to healthy age- and gender-matched controls.

Results

In this tracheostomised cohort (n = 10), the Swallow Risk Index, a global measure of swallow function, was significantly elevated (p < 0.001). At the upper oesophageal sphincter (UOS), hypopharyngeal intrabolus pressure and UOS integrated relaxation pressure were significantly elevated (control 0.65 mmHg [-1.02, 2.33] v tracheostomy 13.7 mmHg [10.4, 16.9], P < 0.001; control -4.28 mmHg [-5.87, 2.69] v tracheostomy 12.2 mmHg [8.83, 15.6], P < 0.001, respectively). Furthermore, UOS opening extent and relaxation time were reduced (control 4.83 mS [4.60, 5.07] v tracheostomy 4.33 mS [3.97, 4.69], P = 0.002; control 0.52 s [0.49, 0.55] v tracheostomy 0.41 s [0.37, 0.45], P < 0.001, respectively). Total pharyngeal contractility (PhCI) measuring pharyngeal pressure generation was significantly elevated (control 199.5 mmHg cm.s [177.4, 221.6] v tracheostomy 326.5 mmHg cm.s [253.3, 399.7]; P = 0.001).

Conclusion

In a critically ill tracheostomised cohort, UOS dysfunction was the prevalent biomechanical feature, with elevated pharyngeal pressures. Pharyngeal weakness is not contributing to dysphagia in this cohort. Instead, elevated pharyngeal pressures may represent a compensatory mechanism to overcome the UOS dysfunction. Further studies to extend these findings may inform the development of timely and targeted rehabilitation.

Dental Prosthetic Rehabilitation Interventions in Elderly Patients Hospitalized in the Nursing Homes of the Lombardy Region: A Retrospective Study

Background: The difficulty of frail, non-self-sufficient or non-ambulatory collaborating elderly residents in nursing homes to eat due to a lack of teeth or the absence of a dental prosthesis leads to an increasingly evident increase in the patients’ systemic pathological state, particularly in older patients who take a lot of medications. Total or partial edentulousness that is not filled with dental prostheses or that is filled with inadequate prostheses, associated with socioeconomic factors, depression, impaired motor functions, heart disease and a large number of chronic diseases including excessive use of drugs, often affects elderlies’ feeding. Aim: In this study, prosthetic rehabilitation was performed on some frail elderly residents in 10 nursing homes in the Lombardy district, and, subsequently, meal behavior and social activity were examined in two information questionnaires through compilation. Methods: The research was conducted on only 67 patients, 26 men and 41 women, aged between 75 and 99, who were guests in 10 health facilities (nursing homes) in the Lombard district; only 8 residents did not undergo prosthetic rehabilitation, as they did not cooperate. All the patients who were visited underwent oral prosthetic rehabilitation, and, subsequently, some aspects such as nutrition and socialization were assessed with other residents through the aid of two information dossiers. Results: the results showed that all the residents, despite difficulties in chewing with the new prosthesis, were fed and did not refuse more consistent foods; in addition, there was an improvement in social activity among the residents. Only 19.3% of men and 22% of women continued to eat little; there was an improvement in the participation in social activities among the residents, with a percentage of 73% of men and 88% of women; in particular, during meals 35 residents conversed with the other residents. Discussion: The dental problems of elderly people residing in social welfare homes are increasingly evident when other systemic pathologies are present. It would be desirable to introduce telemedicine in residences for the elderly for the monitoring of dental problems. Conclusions: From the information obtained and from the evaluation of the change in the elderly, it can be concluded that it would be desirable to include specific dental protocols to create a network, including a telematic one, to monitor and perform more dental checks in nursing homes.

Impact of dysphagia and its severity on long-term survival and swallowing function outcomes in patients with idiopathic inflammatory myopathies other than inclusion body myositis

OBJECTIVE

To investigate the impact of dysphagia on long-term survival and swallowing function outcomes in patients with idiopathic inflammatory myopathy other than inclusion body myositis.

METHODS

We retrospectively evaluated consecutive patients with idiopathic inflammatory myopathy other than inclusion body myositis to investigate the impact of dysphagia and its severity assessed using the Food Intake LEVEL Scale on survival and swallowing function outcomes. Time-to-event analyses were used, including Kaplan-Meier curves with log-rank (trend) test, cumulative incidence with Gray's test, and Cox proportional hazards models.

RESULTS

Of the 254 patients, 26 were dysphagic, including eight severe (Food Intake LEVEL Scale [FILS] score 2, 3) and six most severe (FILS score 1) cases; 210 were non-dysphagic, and 18 were indeterminate cases. During the 5 years after myositis diagnosis, 15 (57.7%) dysphagic and 31 (14.8%) non-dysphagic patients died, and dysphagic patients had significantly shorter survival. However, multivariate analysis showed that shorter survival was significantly associated with baseline age-adjusted Charlson Comorbidity Index (hazard ratio [HR] 1.57, 95% confidence interval [CI] 1.36-1.82]), but not with dysphagia (HR 1.46, 95% CI 0.69-3.10). Dysphagia severity was significantly associated with delayed recovery of dysphagia. In 20 non-severe or severe dysphagic cases, 19 restored swallowing function within 1 year. The most severe cases had a significantly higher cumulative probability of death before recovery from dysphagia than severe cases.

CONCLUSION

The poor survival of dysphagic myositis patients was largely confounded by advanced age and comorbid malignancies. However, patients with the most severe dysphagia had a significantly worse swallowing function and survival prognosis than those with milder dysphagia.

Sarcopenic Dysphagia: A Narrative Review from Diagnosis to Intervention

Sarcopenia, defined as a decline in muscle mass and function related to aging, affects both limb and swallowing-related muscles. Sarcopenic dysphagia is characterized by decreased swallowing function; therefore, early detection of subclinical dysphagia and subsequent intervention appear to be crucial in the elderly. Numerous tools have been employed to measure the function, strength, and mass of swallowing-related muscles in sarcopenic elderly. The swallowing function can be evaluated by questionnaires like Eating Assessment Tool, Functional Oral Intake Scale, and Food Intake Level Scale, and tests such as the modified water swallowing test and videofluoroscopic swallowing study. Surface electromyography and high-resolution manometry can be applied for quantifying swallowing-related muscle strength. Modalities such as ultrasonography and magnetic resonance imaging are capable of estimating the swallowing muscle mass. In patients with sarcopenic dysphagia, a thorough assessment should be given followed by an integrated intervention combining swallowing muscle strengthening, nutrition support, food texture modification, physical, and occupational therapies. This article aimed to comprehensively summarize the diagnostic criteria/tools as well as their associations/performance in sarcopenic dysphagia. The intervention strategy will also be narrated in this review.

Factors Affecting the Swallowing Dysfunction Following Oral Cancer Surgery

OBJECTIVE

To investigate the factors affecting the postoperative swallowing dysfunction in patients who underwent oral cancer surgery.

METHODS

Retrospective review of clinical records of 70 patients (50 males and 20 females) who underwent oral cancer surgeries from July 2007 to April 2015 were enrolled. Multiple regression analysis was performed using the Food Intake LEVEL Scale (FILS) at discharge as the objective variable and age, tumor size, resection of the tongue base, suprahyoid muscle resection, segmental mandibulectomy, neck dissection and radiation therapy as the explanatory variables in 70 patients. In addition, multiple regression analysis was performed between objective variables, which include maximum hyoid bone movement, laryngeal elevation delay time, pharyngeal constriction ratio (PCR), residue in the vallecular and pear-shaped depression (pyriform sinuses), and Penetration-Aspiration Scale score and one of the main factors representing the characteristics of each case as the explanatory variables, and age was treated as an adjustment factor in 23 patients.

RESULTS

The FILS shows significant negative correlation by age and resection of the tongue base. In videofluoroscopic swallowing study, the maximum movement, PCR and residue in the vallecular are significantly correlated with factors demonstrating the characteristic for each case.

CONCLUSION

It was suggested that in elderly patients, the presence of more than half of the tongue base resection, suprahyoid muscle resection and neck dissection cause severe dysphagia after surgery.

Association of preoperative sarcopenia with postoperative dysphagia in patients with thoracic esophageal cancer

BACKGROUND

The purpose of the current study was to clarify the relationship between clinical features of dysphagia after esophagectomy and preoperative sarcopenia.

METHODS

A total of 187 cases were included in the current study. The psoas cross-sectional area on pre-treatment computed tomography was measured in thoracic esophageal cancer patients who underwent curative resection. The psoas muscle index (PMI) cut-off levels for sarcopenia were 6.36 cm2/m2 for men and 3.92 cm2/m2 for women. Swallowing function was evaluated using videofluoroscopic swallowing study (VFSS) and fiberoptic endoscopic evaluation of swallowing (FEES) at postoperative days 7-15, and classified according to the food intake level scale (FILS). Perioperative swallowing rehabilitation was performed in all cases.

RESULTS

In the 187 included patients, the median PMI was 5.42 cm2/m2 for men and 3.43 cm2/m2 for women, and 133 cases (71%) met the sarcopenia criteria. The FILS <4 (no oral intake) was 15% in the non-sarcopenia group, and 38% in the sarcopenia group (P = 0.003). There was no significant difference in the incidence of postoperative complications, including pneumonia and re-admission due to pneumonia, between the two groups. Preoperative sarcopenia and recurrent laryngeal nerve palsy were be independent risk factors for postoperative dysphagia.

CONCLUSIONS

Sarcopenic patients with esophageal cancer develop postoperative dysphagia more often than non-sarcopenic patients. Prehabilitation and nutritional support for patients with preoperative sarcopenia could play an important role to mitigate postoperative dysphagia.

Association between Body Composition and Dysphagia in Patients with Amyotrophic Lateral Sclerosis

Background: The influence of changes in body composition on swallowing in patients with Amyotrophic Lateral Sclerosis (ALS) is unknown. Understanding the interrelation between body compartments and dysphagia may establish specific treatments related to both nutritional aspects as to myofunctional ones designed to delay swallowing loss. Aim: The aim of the study was to evaluate the relationship between body composition and dysphagia during the course of the disease. Methods: The protocol of this study included assessments carried out quarterly for one year and included: analysis of body composition by multi-frequency segmental bioimpedance, nutritional diagnosis, maximum strength test of the tongue and lips, analysis of swallowing using the Functional Oral Intake Score (FOIS) and Swallowing Rating Scale of the American Speech-Language-Hearing Association (ASHA), speech intelligibility and analysis of disease severity. To measure the degree of relationship between quantitative variables, Spearman’s correlation was used. Results: Thirty-four patients were evaluated, 28 Spinal Group and 6 Bulbar Group. The results did not show any significant differences in the analysis of body composition between the groups. Positive associations were found between body compartments and swallowing analysis. The phase angle showed a strong correlation between the FOIS scales (r = 0.74, p < 0.01), ASHA (r = 0.77, p < 0.01) and tongue (r = 0.66, p < 0.01). Conclusions: Changes in body compartments were related to swallowing functionality and speech intelligibility in ALS patients, emphasizing the importance of analyzing body compartments for decision making by the interdisciplinary team. Although these preliminary data were collected in a small sample size, they serve to motivate future studies in this area.

Intramuscular adipose tissue of the quadriceps is more strongly related to recovery of swallowing ability than is muscle mass in older inpatients: A prospective study

OBJECTIVES

This study aimed to examine whether intramuscular adipose tissue of the quadriceps at admission is related to the recovery of swallowing ability during a hospital stay in older inpatients.

METHODS

This prospective study included 344 inpatients ages ≥ 65 y. Those who had stroke that was the obvious cause of dysphagia were excluded. Recovery of swallowing ability was assessed using Food Intake Level Scale (FILS) score at discharge and FILS change. Ultrasound images were acquired at admission. Intramuscular adipose tissue and muscle mass of the quadriceps were assessed based on echo intensity and muscle thickness, respectively. Multiple regression analysis was performed to examine whether quadriceps echo intensity is independently associated with FILS score at discharge and FILS change. The independent variables were quadriceps echo intensity and thickness, subcutaneous fat thickness of the thigh, Barthel Index score at admission, age, sex, number of medications, C-reactive protein, updated Charlson Comorbidity Index, FILS score at admission, Geriatric Nutritional Risk Index, days from disease onset, length of hospital stay, and units of rehabilitation therapy.

RESULTS

Quadriceps echo intensity was independently and significantly associated with FILS score at discharge (β = -0.15, P < 0.01) and FILS change (β = -0.19, P < 0.01). Quadriceps thickness was not independently and significantly associated with FILS score at discharge or FILS change.

CONCLUSIONS

The present study revealed that intramuscular adipose tissue of the quadriceps in older inpatients is more strongly related to recovery of swallowing ability than is muscle mass.

Relationship Between Early Postoperative Change in Total Psoas Muscle Area and Long-term Prognosis in Esophagectomy for Patients with Esophageal Cancer

PURPOSE

Postoperative sarcopenia following esophagectomy for esophageal cancer has become a severe problem due to the increasing number of elderly patients undergoing surgery. This study aimed to clarify the relationship between early postoperative skeletal muscle change and cancer prognosis, and propose effective interventions to prevent sarcopenia.

METHODS

This study retrospectively analyzed 152 patients who underwent esophagectomy for esophageal cancer. Total psoas muscle area (TPA) was measured before surgery as baseline and on postoperative day 7 (± 2). The effect of early postoperative skeletal muscle loss on 5-year survival was investigated. Moreover, 5-year survival in patients with postoperative complications and a high inflammatory status, which were previously reported as poor prognostic factors of esophageal cancer, was also investigated.

RESULTS

Among the 152 patients, 52 (34.2%) showed a decrease in TPA, while 100 (65.8%) maintained their TPA. The TPA decreasing group exhibited poor 5-year overall survival (OS) (p = 0.003) and 5-year recurrence-free survival (RFS) (p < 0.001). The TPA decreasing group also showed a poor 5-year OS in patients who developed severe postoperative complications (p = 0.015). Multivariate analyses showed that decreased TPA was found to be independently associated with OS (p = 0.017) as well as RFS (p = 0.002).

CONCLUSIONS

Our findings suggested a relationship between decreased TPA within 1 week after esophagectomy and long-term prognosis among patients with esophageal cancer. If TPA can be maintained, the prognosis was better even in cases with serious complications.

Digastric muscle mass and intensity in older patients with sarcopenic dysphagia by ultrasonography

AIM

The aim of this study was to investigate digastric muscle mass and intensity between no sarcopenic dysphagia and sarcopenic dysphagia.

METHODS

Patients aged ≥65 years were enrolled. According to the diagnostic algorithm for sarcopenic dysphagia, the patients were divided into two groups, no sarcopenic dysphagia and sarcopenic dysphagia. Handgrip strength, gait speed, skeletal muscle mass, tongue pressure, Mini Nutritional Assessment-Short Form and Food Intake LEVEL Scale were investigated. Digastric muscle mass and intensity were examined by ultrasonography. Univariate and multivariate analyses were performed to analyze two groups. Multivariate logistic regression analysis was performed to determine independent factors for the presence of sarcopenic dysphagia. To estimate the accuracy of diagnosing sarcopenic dysphagia, a receiver operating characteristic curve analysis was performed for digastric muscle mass and intensity.

RESULTS

Forty-five patients (mean ± SD, 84.3 ± 7.8 years, 22 men, 23 women) including 19 no sarcopenic dysphagia and 26 sarcopenic dysphagia were examined. In sarcopenic dysphagia, lower BMI, Food Intake LEVEL Scale, Mini Nutritional Assessment-Short Form and smaller muscle mass and greater muscle intensity were found compared with no sarcopenic dysphagia. In multivariate logistic regression analysis, digastric muscle mass and intensity were identified as independent factors for sarcopenic dysphagia. The cut-off value of muscle mass was 75.1 mm² (area under curve: 0.731, sensitivity: 0.692, specificity: 0.737) and muscle intensity was 27.8 (area under curve: 0.823, sensitivity: 0.923, specificity: 0.632).

CONCLUSIONS

Digastric muscle mass was smaller and muscle intensity was greater in sarcopenic dysphagia than no sarcopenic dysphagia. Ultrasonography of digastric muscle, as well as the tongue and geniohyoid muscle, is useful. Geriatr Gerontol Int 2021; 21: 14-19.

Cachexia, muscle wasting, and frailty in cardiovascular disease

The last several years have seen increasing interest in understanding cachexia, muscle wasting, and physical frailty across the broad spectrum of patients with cardiovascular illnesses. This interest originally started in the field of heart failure, but has recently been extended to other areas such as atrial fibrillation, coronary artery disease, peripheral artery disease as well as to patients after cardiac surgery or transcatheter aortic valve implantation. Tissue wasting and frailty are prevalent among many of the affected patients. The ageing process itself and concomitant cardiovascular illness decrease lean mass while fat mass is relatively preserved, making elderly patients particularly prone to develop wasting syndromes and frailty. The aim of this review is to provide an overview of the available knowledge of body wasting and physical frailty in patients with cardiovascular illness, particularly focussing on patients with heart failure in whom most of the available data have been gathered. In addition, mechanisms of wasting and possible therapeutic targets are discussed.

Translating Dysphagia Evidence into Practice While Avoiding Pitfalls: Assessing Bias Risk in Tracheostomy Literature

Critically ill patients who require a tracheostomy often have dysphagia. Widespread practice guidelines have yet to be developed regarding the acute assessment and management of dysphagia in patients with tracheostomy. In order for clinicians to base their practice on the best available evidence, they must first assess the applicable literature and determine its quality. To inform guideline development, our objective was to assess literature quality concerning swallowing following tracheostomy in acute stages of critical illness in adults. Our systematic literature search (published previously) included eight databases, nine gray literature repositories and citation chasing. Using inclusion criteria determined a priori, two reviewers, blinded to each other, conducted an eligibility review of identified citations. Patients with chronic tracheostomy and etiologies including head and/or neck cancer diagnoses were excluded. Four teams of two reviewers each, blinded to each other, assessed quality of included studies using a modified Cochrane Risk of Bias tool (RoB). Disagreements were resolved by consensus. Data were summarized descriptively according to study design and RoB domain. Of 6,396 identified citations, 74 studies met our inclusion criteria. Of those, 71 were observational and three were randomized controlled trials. Across all studies, the majority (> 75%) had low bias risk with: participant blinding, outcome reporting, and operationally defined outcomes. Areas requiring improvement included assessor and study personnel blinding. Prior to translating the literature into practice guidelines, we recommend attention to study quality limitations and its potential impact on study outcomes. For future work, we suggest an iterative approach to knowledge translation.

Using GLIM criteria, cutoff value for low BMI in Asian populations discriminates high or low muscle mass: A cross-sectional study

OBJECTIVES

The aim of this study was to examine whether differences in muscle mass and intramuscular adipose tissue are present between patients with a moderately and severely low body mass index (BMI) as discriminated by the cutoff value for a low BMI among patients ≥70 y of age in Asian populations according to the Global Leadership Initiative on Malnutrition (GLIM) criteria.

METHODS

This cross-sectional study included 345 inpatients ≥70 y of age. The participants were placed into one of the following three groups: severely low BMI (<17.8 kg/m²; n = 96), moderately low BMI (≥17.8 to <20 kg/m²; n = 81), and normal BMI (≥20 kg/m²; n = 168). Ultrasound images were obtained with B-mode ultrasound imaging. Muscle mass and intramuscular adipose tissue of the quadriceps were assessed based on the muscle thickness and echo intensity, respectively. Analysis of covariance was used to examine the differences in the quadriceps thickness and echo intensity among the three groups.

RESULTS

The quadriceps thickness and echo intensity in the severely low, moderately low, and normal BMI groups were 0.9 ± 0.3, 1.1 ± 0.4, and 1.4 ± 0.5 cm and 93.3 ± 20.8, 91.3 ± 19.3, 80.1 ± 21.6, respectively. The quadriceps thickness in the severely low BMI group was statistically significantly lower than that in the moderately low BMI (P < 0.001) and normal BMI (P < 0.001) groups, and the quadriceps thickness in the moderately low BMI group was also statistically significantly lower than that in the normal BMI group (P < 0.001). The quadriceps echo intensity showed no significant differences among the three groups.

CONCLUSIONS

The cutoff value for a low BMI discriminates high or low muscle mass. Results of this study supported the validity of 17.8 kg/m² as the cutoff value for a low BMI with which to grade the severity of malnutrition in Asian populations ≥70 y of age according to the GLIM criteria from the perspective of muscle mass.

Sex differences in postsurgical skeletal muscle depletion after donation of living-donor liver transplantation, although minimal, should not be ignored

Background

Donor safety is the top priority in living-donor liver transplantation. Splenic hypertrophy and platelet count decrease after donor surgery are reported to correlate with the extent of hepatectomy, but other aftereffects of donor surgeries are unclear. In this study, we evaluated the surgical effects of donor hepatectomy on skeletal muscle depletion and their potential sex differences.

Methods

Among a total of 450 consecutive donor hepatectomies performed from April 2001 through March 2017, 277 donors who completed both preoperative and postoperative (60–119 days postsurgery) evaluation by computed tomography were the subjects of this study. Donors aged 45 years or older were considered elderly donors. Postoperative skeletal muscle depletion was assessed on the basis of the cross-sectional area of the psoas major muscle. Postoperative changes in the spleen volume and platelet count ratios were also analysed to evaluate the effects of major hepatectomy.

Results

The decrease in the postoperative skeletal muscle mass in the overall donor population was slight (99.4 ± 6.3%). Of the 277 donors, 59 (21.3%) exhibited skeletal muscle depletion (i.e., < 95% of the preoperative value). Multivariate analysis revealed that elderly donor (OR:2.30, 95% C.I.: 1.27–4.24) and female donor (OR: 1.94, 95% C.I. 1.04–3.59) were independent risk factors for postoperative skeletal muscle depletion. Stratification of the subjects into four groups by age and sex revealed that the elderly female donor group had significantly less skeletal muscle mass postoperatively compared with the preoperative values (95.6 ± 6.8%), while the other three groups showed no significant decrease. Due to their smaller physical characteristics, right liver donation was significantly more prevalent in the female groups than in the male groups (112/144, 77.8% vs 65/133, 48.9%; p < 0.001). The estimated liver resection rate correlated significantly with the splenic hypertrophy ratio (r = 0.528, p < 0.001) and the extent of the platelet count decrease (r = − 0.314, p < 0.001), but donor age and sex did not affect these parameters.

Conclusion

Elderly female donors have a higher risk of postoperative skeletal muscle depletion. Additionally, female donors are more likely to donate a right liver graft, whose potential subclinical risks include postoperative splenic enlargement and a platelet count decrease.

Investigating Swallowing and Tracheostomy Following Critical Illness: A Scoping Review

OBJECTIVES

Tracheostomy and dysphagia often coexist during critical illness; however, given the patient's medical complexity, understanding the evidence to optimize swallowing assessment and intervention is challenging. The objective of this scoping review is to describe and explore the literature surrounding swallowing and tracheostomy in the acute care setting.

DATA SOURCES

Eight electronic databases were searched from inception to May 2017 inclusive, using a search strategy designed by an information scientist. We conducted manual searching of 10 journals, nine gray literature repositories, and forward and backward citation chasing.

STUDY SELECTION

Two blinded reviewers determined eligibility according to inclusion criteria: English-language studies reporting on swallowing or dysphagia in adults (≥ 17 yr old) who had undergone tracheostomy placement while in acute care. Patients with head and/or neck cancer diagnoses were excluded.

DATA EXTRACTION

We extracted data using a form designed a priori and conducted descriptive analyses.

DATA SYNTHESIS

We identified 6,396 citations, of which 725 articles were reviewed and 85 (N) met inclusion criteria. We stratified studies according to content domains with some featuring in multiple categories: dysphagia frequency (n = 38), swallowing physiology (n = 27), risk factors (n = 31), interventions (n = 21), and assessment comparisons (n = 12) and by patient etiology. Sample sizes (with tracheostomy) ranged from 10 to 3,320, and dysphagia frequency ranged from 11% to 93% in studies with consecutive sampling. Study design, sampling method, assessment methods, and interpretation approach varied significantly across studies.

CONCLUSIONS

The evidence base surrounding this subject is diverse, complicated by heterogeneous patient selection methods, design, and reporting. We suggest ways the evidence base may be developed.

Poor Oral Health as a Determinant of Malnutrition and Sarcopenia

Aging is accompanied by profound changes in many physiological functions, leading to a decreased ability to cope with stressors. Many changes are subtle, but can negatively affect nutrient intake, leading to overt malnutrition. Poor oral health may affect food selection and nutrient intake, leading to malnutrition and, consequently, to frailty and sarcopenia. On the other hand, it has been highlighted that sarcopenia is a whole-body process also affecting muscles dedicated to chewing and swallowing. Hence, muscle decline of these muscle groups may also have a negative impact on nutrient intake, increasing the risk for malnutrition. The interplay between oral diseases and malnutrition with frailty and sarcopenia may be explained through biological and environmental factors that are linked to the common burden of inflammation and oxidative stress. The presence of oral problems, alone or in combination with sarcopenia, may thus represent the biological substratum of the disabling cascade experienced by many frail individuals. A multimodal and multidisciplinary approach, including personalized dietary counselling and oral health care, may thus be helpful to better manage the complexity of older people. Furthermore, preventive strategies applied throughout the lifetime could help to preserve both oral and muscle function later in life. Here, we provide an overview on the relevance of poor oral health as a determinant of malnutrition and sarcopenia.

Associations between tongue strength and skeletal muscle mass under dysphagia rehabilitation for geriatric out patients

PURPOSE

The purpose of this study was to examine how skeletal muscle mass influences the effectiveness of dysphagia rehabilitation.

METHODS

The cross-sectional study and the prospective cohort study were conducted in a clinic, specialized in rehabilitation of patients with dysphagia, located in Tokyo, Japan. Skeletal muscle mass measurement by bioelectrical impedance analysis and tongue strength measurement were performed on 178 outpatients with dysphagia. In addition, the Barthel Index, Mini Nutritional Assessment-Short Form, and Functional Oral Intake Scale values were measured. Dysphagia rehabilitation was performed, and 88 of the patients who were available for follow-up one year later were included in a follow-up study. In the cross-sectional study, the associations between tongue strength and other factors were examined. In the follow-up study, factors associated with rehabilitation effectiveness, shown by tongue strength, were examined.

RESULTS

Tongue strength and skeletal muscle mass were correlated, and both decreased as eating and swallowing function level decreased. After one year of dysphagia rehabilitation, tongue strength and skeletal muscle mass increased. The factors associated with the amount of increase in tongue strength were initial tongue strength and skeletal muscle mass.

CONCLUSIONS

For patients with dysphagia, maintenance of skeletal muscle mass was associated with improvement of tongue strength in rehabilitation. This indicates that prevention of sarcopenia in dysphagia patients contributes to the effect of rehabilitation.