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Wakabayashi H, Kakehi S, Mizuno S, Kinoshita T, Toga S, Ohtsu M, Nishioka S, Momosaki R. Prevalence and prognosis of cachexia according to the Asian Working Group for Cachexia criteria in sarcopenic dysphagia: A retrospective cohort study. Nutrition 2024; 122:112385. [PMID: 38428221 DOI: 10.1016/j.nut.2024.112385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 01/22/2024] [Accepted: 01/31/2024] [Indexed: 03/03/2024]
Abstract
OBJECTIVE The aim to examine the prevalence and prognosis of cachexia according to the Asian Working Group for Cachexia (AWGC) criteria in patients with sarcopenic dysphagia. METHODS A retrospective cohort study was conducted with 271 patients diagnosed with sarcopenic dysphagia out of 467 patients enrolled in the Japanese sarcopenic dysphagia database. Cachexia was diagnosed by the AWGC criteria. The AWGC criteria includes chronic diseases, either or both weight loss (2% or more over 3-6 mo) or low BMI (<21 kg/m2), and at least one of the following: anorexia, decreased grip strength (<28 kg in men and <18 kg in women), or elevated C-reactive protein levels (>0.5 mg/dL). Outcomes were death, swallowing function as assessed by the Food Intake LEVEL Scale (FILS), and activities of daily living as assessed by the Barthel Index (BI) at follow-up. RESULTS The mean age was 84 (±8) y; 152 (56%) were female, and 97 (36%) had cachexia. In univariate analysis, death was significantly more common in the cachexia group (15% versus 2%, P ≤ 0.001). Logistic regression analysis showed that cachexia was independently associated with death (odds ratio: 3.557, 95% confidence interval: 1.010, 12.529). No significant differences were found in the presence or absence of cachexia in the FILS (7 versus 8, P = 0.849) and BI (55 versus 52.5, P = 0.892). CONCLUSIONS Cachexia was found in 36% of patients with sarcopenic dysphagia, and death was significantly higher in cachexia.
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Affiliation(s)
- Hidetaka Wakabayashi
- Department of Rehabilitation Medicine, Tokyo Women's Medical University Hospital, Tokyo, Japan.
| | - Shingo Kakehi
- Department of Rehabilitation Medicine, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Satoko Mizuno
- Department of Rehabilitation Medicine, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Tomoko Kinoshita
- Department of Rehabilitation Medicine, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Sayaka Toga
- Department of Rehabilitation Medicine, Makita Rehabilitation Hospital, Tokyo, Japan
| | - Masahiro Ohtsu
- Department of Orthopedic Surgery, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Shinta Nishioka
- Department of Clinical Nutrition and Food Service, Nagasaki Rehabilitation Hospital, Nagasaki, Japan
| | - Ryo Momosaki
- Department of Rehabilitation Medicine, Mie University Graduate School of Medicine, Mie, Japan
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Miyazaki S, Tamaki A, Wakabayashi H, Arai H. Definition, diagnosis, and treatment of respiratory sarcopenia. Curr Opin Clin Nutr Metab Care 2024; 27:210-218. [PMID: 38126204 DOI: 10.1097/mco.0000000000001003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
PURPOSE OF REVIEW Skeletal muscle weakness and wasting also occurs in the respiratory muscles, called respiratory sarcopenia. Respiratory sarcopenia may lead to worse clinical indicators and outcomes. We present a novel definition and diagnostic criteria for respiratory sarcopenia, summarize recent reports on the association between respiratory sarcopenia, physical and nutritional status, and clinical outcomes, and provide suggestions for the prevention and treatment of respiratory sarcopenia. RECENT FINDINGS Recently, a novel definition and diagnostic criteria for respiratory sarcopenia have been prepared. Respiratory sarcopenia is defined as a condition in which there is both low respiratory muscle strength and low respiratory muscle mass. Respiratory muscle strength, respiratory muscle mass, and appendicular skeletal muscle mass are used to diagnose respiratory sarcopenia. Currently, it is challenging to definitively diagnose respiratory sarcopenia due to the difficulty in accurately determining low respiratory muscle mass. Decreased respiratory muscle strength and respiratory muscle mass are associated with lower physical and nutritional status and poorer clinical outcomes. Exercise interventions, especially respiratory muscle training, nutritional interventions, and their combinations may effectively treat respiratory sarcopenia. Preventive interventions for respiratory sarcopenia are unclear. SUMMARY The novel definition and diagnostic criteria will contribute to promoting the assessment and intervention of respiratory sarcopenia.
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Affiliation(s)
| | - Akira Tamaki
- Department of Physical Therapy, School of Rehabilitation, Hyogo Medical University, Kobe
| | - Hidetaka Wakabayashi
- Department of Rehabilitation Medicine, Tokyo Women's Medical University Hospital, Tokyo
| | - Hidenori Arai
- National Center for Geriatrics and Gerontology, Obu, Japan
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Shiraishi A, Yoshimura Y, Wakabayashi H, Nagano F, Matsumoto A, Shimazu S, Kido Y, Bise T, Kuzuhara A, Hori K, Hamada T, Yoneda K, Maekawa K. Impaired oral status is associated with sarcopenic obesity in post-stroke patients. Gerodontology 2024. [PMID: 38644049 DOI: 10.1111/ger.12756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2024] [Indexed: 04/23/2024]
Abstract
PURPOSE Oral problems and muscle health are indeed significant concerns in ageing populations. However, there is limited evidence concerning the association between these issues. The study's focus was to investigate the association between oral problems and sarcopenic obesity, wherein sarcopenia and obesity coexist concurrently, in post-stroke patients. METHODS This retrospective, observational, cross-sectional study included patients hospitalised for post-stroke rehabilitation. Oral problems were assessed using the Revised Oral Assessment Guide (ROAG). Sarcopenic obesity was diagnosed according to the European Society of Clinical Nutrition and Metabolism/European Association for the Study of Obesity criteria. Multiple linear regression analysis was used to examine the association between the ROAG and sarcopenic obesity after adjusting for confounding factors. RESULTS A total of 760 patients were included, with a mean (SD) age of 71 (9) years, of whom 408 (54.7%) were male. The median (interquartile range, 25th and 75th percentiles) ROAG was 11 [9, 13]. Sarcopenic obesity was diagnosed in 16 (3.9%) men, 18 (5.1%) women, and 34 (4.5%) patients overall. Multivariate linear analysis showed that ROAG was significantly and positively associated with sarcopenic obesity (β = .091, P = .023), followed by obesity alone (β = .084, P = .044), and sarcopenia alone (β = .081, P = .037). CONCLUSION Oral problems were associated with sarcopenic obesity in post-stroke. Oral assessment and intervention may have a positive impact on ADL and QOL in post-stroke patients with sarcopenic obesity.
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Affiliation(s)
- Ai Shiraishi
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto, Japan
| | - Yoshihiro Yoshimura
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto, Japan
| | - Hidetaka Wakabayashi
- Department of Rehabilitation Medicine, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Fumihiko Nagano
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto, Japan
| | - Ayaka Matsumoto
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto, Japan
| | - Sayuri Shimazu
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto, Japan
| | - Yoshifumi Kido
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto, Japan
| | - Takahiro Bise
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto, Japan
| | - Aomi Kuzuhara
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto, Japan
| | - Kota Hori
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto, Japan
| | - Takenori Hamada
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto, Japan
| | - Kouki Yoneda
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto, Japan
| | - Kenichiro Maekawa
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto, Japan
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Mori T, Wakabayashi H, Fujishima I, Narabu R, Shimizu A, Oshima F, Itoda M, Ogawa S, Ohno T, Yamada M, Kunieda K, Shigematsu T, Ogawa N, Nishioka S, Fukuma K, Ishikawa Y, Saito Y. Cutoff value of the geniohyoid muscle mass to identify sarcopenic dysphagia by ultrasonography. Eur Geriatr Med 2024:10.1007/s41999-024-00971-6. [PMID: 38587613 DOI: 10.1007/s41999-024-00971-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 03/10/2024] [Indexed: 04/09/2024]
Abstract
PURPOSE Determining the strength and area of the swallowing muscles is important in patients with sarcopenic dysphagia. Although the normative data on the strength of the swallowing muscles have been reported, those of the area of the geniohyoid muscle are poorly investigated. We investigated the cross-sectional area of the geniohyoid muscle in Japanese subjects without dysphagia using ultrasonography to determine the normative and cut-off values. METHODS 142 subjects without dysphagia were included. The older group (age ≥ 65 years) included 36 (women 27/men 9) subjects, and the younger group (age ≤ 39 years) included 106 (women 54/men 52) subjects. The cross-sectional area of the geniohyoid muscle was measured by ultrasound. The mean of the younger group-2 standard deviation (SD) was calculated and used as a cut-off value for low swallowing muscle mass. RESULTS The mean (SD) of the area of the geniohyoid muscle of each group was as follows: older women group 167.2 (32.6) mm2, older men group 193.2 (49.5) mm2, younger women group 247.3 (37.4) mm2, younger men group 313.1 (59.2) mm2. The mean 2SD of the geniohyoid muscle area in the younger women group was 172.5 mm2 and in the younger men group 194.7 mm2. CONCLUSION We found that the cut-off value of the ultrasonographic cross-sectional area of the geniohyoid muscle was 172.5 mm2 for women and 194.7 mm2 for men. These values could be used as cut-off values for the mass of the geniohyoid muscle to identify patients with sarcopenic dysphagia.
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Affiliation(s)
- Takashi Mori
- Department of Oral and Maxillofacial Surgery, Southern Tohoku General Hospital, Yatsuyamada 7-115, Koriyama, Fukushima, Japan.
| | - Hidetaka Wakabayashi
- Department of Rehabilitation Medicine, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Ichiro Fujishima
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, Shizuoka, Japan
| | - Risa Narabu
- Fukushima Medical Device Development Support Centre, Fukushima, Japan
| | - Akio Shimizu
- Department of Food and Health Science, Faculty of Health and Human Development, The University of Nagano, Nagano, Japan
| | - Fumiko Oshima
- Department of Rehabilitation, Japanese Red Cross Society Suwa Hospital, Nagano, Japan
| | - Masataka Itoda
- Department of Oral Rehabilitation, Osaka Dental University Hospital, Osaka, Japan
| | - Sumito Ogawa
- Department of Geriatric Medicine, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Tomohisa Ohno
- Department of Dentistry, Hamamatsu City Rehabilitation Hospital, Shizuoka, Japan
| | - Minoru Yamada
- Faculty of Human Sciences, University of Tsukuba, Tokyo, Japan
| | - Kenjiro Kunieda
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, Shizuoka, Japan
- Department of Neurology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Takashi Shigematsu
- Department of Rehabilitation Medicine, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | | | - Shinta Nishioka
- Department of Clinical Nutrition and Food Service, Nagasaki Rehabilitation Hospital, Nagasaki, Japan
| | - Kazuki Fukuma
- Department of Neurology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Yukari Ishikawa
- Department of Oral and Maxillofacial Surgery, Southern Tohoku General Hospital, Yatsuyamada 7-115, Koriyama, Fukushima, Japan
| | - Yuto Saito
- Department of Oral and Maxillofacial Surgery, Southern Tohoku General Hospital, Yatsuyamada 7-115, Koriyama, Fukushima, Japan
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Wakabayashi H, Kinoshita S, Isowa T, Sakai K, Tohara H, Momosaki R. Impact of Motivation for Eating Habits, Appetite and Food Satisfaction, and Food Consciousness on Food Intake and Weight Loss in Older Nursing Home Patients. Ann Geriatr Med Res 2024; 28:110-115. [PMID: 38246748 PMCID: PMC10982441 DOI: 10.4235/agmr.23.0185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/18/2023] [Accepted: 01/13/2024] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND This study analyzed data from the Long-term care Information system For Evidence (LIFE) database to examine the effects of motivation to eat, appetite and food satisfaction, and food consciousness on food intake and weight loss. METHODS Of the 748 nursing home residents enrolled in the LIFE database, 336 met the eligibility criteria for this cross-sectional study. Motivation to eat, appetite and food satisfaction, and food consciousness were rated on five-point Likert scales (e.g., good, fair, normal, not so good, and not good). We applied Spearman rank correlation coefficient and multiple regression analyses to analyze the relationships between these three items, daily energy and protein intake, and body weight loss over 6 months. RESULTS The mean participant age was 87.4±8.1 years and 259 (77%) were female. The required levels of care included-level 1, 1 (0%); level 2, 4 (1%); level 3, 107 (32%); level 4, 135 (40%); and level 5, 89 (27%). The mean daily energy intake was 28.2±7.8 kcal/kg. The mean daily protein intake was 1.1±0.3 g/kg. The mean weight loss over six months was 1.2±0.7 kg. We observed strong positive correlations among motivation to eat, appetite and food satisfaction, and food consciousness (r>0.8). These three items were significantly associated with higher daily energy intake but not with daily protein intake. Only appetite and food satisfaction were significantly associated with lower weight loss over six months. CONCLUSION The observed associations of appetite and food satisfaction suggest that these factors may be more important to assess than motivation to eat or food consciousness among older adult residents of long-term care facilities.
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Affiliation(s)
- Hidetaka Wakabayashi
- Department of Rehabilitation Medicine, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Shoji Kinoshita
- Department of Rehabilitation Medicine, Jikei University School of Medicine, Tokyo, Japan
| | - Tokiko Isowa
- Department of Nursing, Graduate School of Medicine, Mie University, Mie, Japan
| | - Kotomi Sakai
- Department of Research, Heisei Medical Welfare Group Research Institute, Tokyo, Japan
| | - Haruka Tohara
- Department of Dysphagia Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ryo Momosaki
- Department of Rehabilitation Medicine, Graduate School of Medicine, Mie University, Mie, Japan
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Wakabayashi H. Triad of rehabilitation, nutrition, and oral management for sarcopenic dysphagia in older people. Geriatr Gerontol Int 2024; 24 Suppl 1:397-399. [PMID: 37577770 DOI: 10.1111/ggi.14651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 07/22/2023] [Accepted: 07/27/2023] [Indexed: 08/15/2023]
Affiliation(s)
- Hidetaka Wakabayashi
- Department of Rehabilitation Medicine, Tokyo Women's Medical University Hospital, Tokyo, Japan
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Togashi S, Ohinata H, Noguchi T, Wakabayashi H, Nakamichi M, Shimizu A, Nishioka S, Momosaki R. Polypharmacy, Potentially Inappropriate Medications, and Dysphagia in Older Inpatients: A Multi-Center Cohort Study. Ann Geriatr Med Res 2024; 28:86-94. [PMID: 38229436 PMCID: PMC10982443 DOI: 10.4235/agmr.23.0203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/05/2024] [Accepted: 01/10/2024] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND Although the relationship between medication status, symptomatology, and outcomes has been evaluated, data on the prevalence of polypharmacy and potentially inappropriate medications (PIMs) and the association of polypharmacy and PIMs with swallowing function during follow-up are limited among hospitalized patients aged ≥65 years with dysphagia. METHODS In this 19-center cohort study, we registered 467 inpatients aged ≥65 years and evaluated those with the Food Intake LEVEL Scale (FILS) scores ≤8 between November 2019 and March 2021. Polypharmacy was defined as prescribing ≥5 medications and PIMs were identified based on the 2023 Updated Beers Criteria. We applied a generalized linear regression model to examine the association of polypharmacy and PIMs with FILS score at discharge. RESULTS We analyzed 399 participants (median age, 83.0 years; males, 49.8%). The median follow-up was 51.0 days (interquartile range, 22.0-84.0 days). Polypharmacy and PIMs were present in 67.7% of and 56.1% of patients, respectively. After adjusting for covariates, neither polypharmacy (β = 0.05; 95% confidence interval [CI], -0.04-0.13, p=0.30) nor non-steroidal anti-inflammatory medications (β = 0.09; 95% CI, -0.02-0.19; p=0.10) were significantly associated with FILS score at discharge. CONCLUSION The results of this study indicated a high proportion of polypharmacy and PIMs among inpatients aged ≥65 years with dysphagia. Although these prescribed conditions were not significantly associated with swallowing function at discharge, our findings suggest the importance of regularly reviewing medications to ensure the appropriateness of prescriptions when managing older inpatients.
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Affiliation(s)
- Shintaro Togashi
- Center for Outcomes Research and Economic Evaluation for Health, National Institute of Public Health, Wako‐shi, Japan
- Department of Nursing Care, Sendai Kosei Hospital, Sendai, Japan
| | | | - Taiji Noguchi
- Department of Social Science, Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, Obu, Japan
- Japan Society for the Promotion of Science, Chiyoda, Japan
| | - Hidetaka Wakabayashi
- Department of Rehabilitation Medicine, Tokyo Women's Medical University Hospital, Shinjuku, Japan
| | | | - Akio Shimizu
- Department of Food and Health, Faculty of Health and Human Development, The University of Nagano, Nagano, Japan
| | - Shinta Nishioka
- Department of Clinical Nutrition and Food Service, Nagasaki Rehabilitation Hospital, Nagasaki, Japan
| | - Ryo Momosaki
- Department of Rehabilitation Medicine, Mie University Graduate School of Medicine, Tsu, Japan
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Naito T, Wakabayashi H, Aso S, Konishi M, Saitoh M, Baracos VE, Coats AJ, Anker SD, Sherman L, Klompenhouwer T, Shirotani N, Inui A, Arai H. The barriers to interprofessional care for cancer cachexia among Japanese healthcare providers: A nationwide survey. J Cachexia Sarcopenia Muscle 2024; 15:387-400. [PMID: 38018293 PMCID: PMC10834325 DOI: 10.1002/jcsm.13384] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 09/13/2023] [Accepted: 10/22/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Cancer cachexia is a severe complication of advanced malignancy, with few therapeutic options. To promote interprofessional care for cancer cachexia, healthcare providers' needs should be addressed in detail. This pre-planned subgroup analysis of the Global Educational Needs Evaluation: a systemic interprofessional study in cancer cachexia (GENESIS-CC) survey aimed to identify barriers to interprofessional care of cancer cachexia in Japan. METHODS A nationwide survey was electronically conducted for healthcare providers in oncological or general healthcare facilities from January to March 2021 in Japan. The Japanese Regional Advisory Board developed a barrier scoring system with 33 from the 58 original survey items to quantify six domains of barriers: (1) lack of confidence, (2) lack of knowledge, (3) barriers in personal practice, (4) barriers in perception, (5) barriers in team practice and (6) barriers in education. The largest possible barrier score was set at 100 points. We compared the scores by profession. RESULTS A total of 1227 valid responses were obtained from 302 (24.6%) physicians, 252 (20.5%) pharmacists, 236 (19.2%) nurses, 218 (17.8%) dietitians, 193 (15.7%) rehabilitation therapists and 26 (2.0%) other professionals. Overall, 460 (37.5%) were not very or at all confident about cancer cachexia care, 791 (84.1%) agreed or strongly agreed that care was influenced by reimbursement availability and 774 (81.9%) did not have cancer cachexia as a mandatory curriculum. The largest mean barrier score (± standard deviation) was 63.7 ± 31.3 for education, followed by 55.6 ± 21.8 for team practice, 43.7 ± 32.5 for knowledge, 42.8 ± 17.7 for perception and 36.5 ± 16.7 for personal practice. There were statistically significant interprofessional differences in all domains (P < 0.05), especially for pharmacists and nurses with the highest or second highest scores in most domains. CONCLUSIONS There is a need to improve the educational system and team practices of cancer cachexia for most Japanese healthcare providers, especially pharmacists and nurses. Our study suggests the need to reform the mandatory educational curriculum and reimbursement system on cancer cachexia to promote interprofessional care for cancer cachexia in Japan.
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Affiliation(s)
- Tateaki Naito
- Division of Thoracic OncologyShizuoka Cancer Center1007, Shimonagakubo, Nagaizumi‐cho, Sunto‐gunShizuoka411‐8777Japan
| | - Hidetaka Wakabayashi
- Department of Rehabilitation MedicineTokyo Women's Medical University HospitalTokyoJapan
| | - Sakiko Aso
- Division of NursingShizuoka Cancer CenterShizuokaJapan
| | - Masaaki Konishi
- Department of CardiologyYokohama City University School of MedicineYokohamaJapan
| | - Masakazu Saitoh
- Department of Physical Therapy, Faculty of Health ScienceJuntendo UniversityTokyoJapan
| | - Vickie E. Baracos
- Division of Palliative Care Medicine, Department of OncologyUniversity of AlbertaEdmontonABCanada
| | - Andrew J. Coats
- Scientific Director Heart Research InstituteSydneyNSWAustralia
| | - Stefan D. Anker
- Division of Cardiology and Metabolism, Department of Cardiology and Berlin‐Brandenburg Centre for Regenerative Therapies (BCRT), DZHK (German Centre for Cardiovascular Research), Partner Site BerlinCharité‐Universitätsmedizin Berlin (CVK)BerlinGermany
| | | | | | | | - Akio Inui
- Pharmacological Department of Herbal MedicineKagoshima University Graduate School of Medical and Dental SciencesKagoshimaJapan
| | - Hidenori Arai
- National Center for Geriatrics and GerontologyObuJapan
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Wakabayashi H, Mori T, Nishioka S, Maeda K, Yoshimura Y, Iida Y, Shiraishi A, Fujiwara D. Psychological aspects of rehabilitation nutrition: A position paper by the Japanese Association of Rehabilitation Nutrition (secondary publication). J Gen Fam Med 2024; 25:1-9. [PMID: 38240004 PMCID: PMC10792333 DOI: 10.1002/jgf2.668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 11/26/2023] [Indexed: 01/22/2024] Open
Abstract
Psychological aspects of rehabilitation nutrition affect physical, cognitive, and social rehabilitation nutrition. When depression is recognized, not only pharmacotherapy and psychotherapy, but also non-pharmacological therapies such as exercise, nutrition, psychosocial, and other interventions can be expected to improve depression. Therefore, accurate diagnosis and intervention without overlooking depression is important. Psychological aspects of preventive rehabilitation nutrition is also important because depression can be partially prevented by appropriate exercise and nutritional management. Even in the absence of psychological negatives, increasing more psychological positives from a positive psychology perspective can be useful for both patients and healthcare professionals. Positive rehabilitation nutrition interventions can increase more psychological positives, such as well-being, through cognitive-behavioral therapy and mindfulness on their own, as well as through interventions on environmental factors. Consequently, physical, cognitive, and social positives are also expected to be enhanced.
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Affiliation(s)
- Hidetaka Wakabayashi
- Department of Rehabilitation MedicineTokyo Women's Medical University HospitalTokyoJapan
| | - Takashi Mori
- Department of Oral and Maxillofacial SurgerySouthern Tohoku General HospitalKoriyamaJapan
| | - Shinta Nishioka
- Department of Clinical Nutrition and Food ServiceNagasaki Rehabilitation HospitalNagasakiJapan
| | - Keisuke Maeda
- Nutrition Therapy Support CenterAichi Medical University HospitalNagoyaJapan
| | - Yoshihiro Yoshimura
- Center for Sarcopenia and Malnutrition ResearchKumamoto Rehabilitation HospitalKumamotoJapan
| | - Yuki Iida
- Department of Physical TherapyToyohashi SOZO University School of Health SciencesToyohashiJapan
| | - Ai Shiraishi
- Center for Sarcopenia and Malnutrition ResearchKumamoto Rehabilitation HospitalKumamotoJapan
| | - Dai Fujiwara
- Department of Rehabilitation MedicineSaka General HospitalShiogamaJapan
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10
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Yoshimura Y, Wakabayashi H, Nagano F, Matsumoto A, Shimazu S, Shiraishi A, Kido Y, Bise T, Hori K, Yoneda K. Reply to the Letter to the Editor - "Phase angle is associated with sarcopenic obesity in post-stroke patients". Clin Nutr 2024; 43:305-306. [PMID: 37993394 DOI: 10.1016/j.clnu.2023.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 11/14/2023] [Indexed: 11/24/2023]
Affiliation(s)
- Yoshihiro Yoshimura
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto, Japan.
| | - Hidetaka Wakabayashi
- Department of Rehabilitation Medicine, Tokyo Women's Medical University Hospital, Japan.
| | - Fumihiko Nagano
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto, Japan.
| | - Ayaka Matsumoto
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto, Japan.
| | - Sayuri Shimazu
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto, Japan.
| | - Ai Shiraishi
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto, Japan.
| | - Yoshifumi Kido
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto, Japan.
| | - Takahiro Bise
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto, Japan.
| | - Kota Hori
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto, Japan.
| | - Koki Yoneda
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto, Japan.
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Murata H, Tashiro S, Sakamoto H, Ishida R, Kuwabara M, Matsuda K, Shiokawa Y, Hirano T, Momozaki R, Maeda K, Wakabayashi H, Yamada S. Impact of rehabilitation dose on body mass index change in older acute patients with stroke: a retrospective observational study. Front Nutr 2023; 10:1270276. [PMID: 38115884 PMCID: PMC10728649 DOI: 10.3389/fnut.2023.1270276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 11/21/2023] [Indexed: 12/21/2023] Open
Abstract
Background It is established that a low body mass index (BMI) correlates with a diminished home discharge rate and a decline in activities of daily living (ADL) capacity among elderly stroke patients. Nevertheless, there exists a paucity of knowledge regarding strategies to mitigate BMI reduction during the acute phase. This investigation seeks to elucidate the impact of rehabilitation dose, as determined by both physical and occupational therapy, on BMI alterations, positing that a heightened rehabilitation dose could thwart BMI decline. Methods This retrospective, observational study was conducted in the stroke unit of a university hospital. Enrollees comprised individuals aged ≥65 years, hospitalized for stroke, and subsequently relocated to rehabilitation facilities between January 2019 and November 2020. The percentage change in BMI (%ΔBMI) was calculated based on BMI values at admission and discharge. Multivariate multiple regression analysis was employed to ascertain the influence of rehabilitation dose on %ΔBMI. Results A total of 187 patients were included in the analysis, of whom 94% experienced a reduction in BMI during acute hospitalization. Following adjustment for sociodemographic and clinical factors, multivariable analyzes revealed a positive association between rehabilitation dose and %ΔBMI (β = 0.338, p < 0.001). Conclusion The findings of this study suggest that, in the context of acute stroke treatment, an augmented rehabilitation dose is associated with a diminished decrease in BMI.
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Affiliation(s)
- Hiroyasu Murata
- Department of Rehabilitation Medicine, Kyorin University Hospital, Mitaka, Japan
| | - Syoichi Tashiro
- Department of Rehabilitation Medicine, Kyorin University School of Medicine, Mitaka, Japan
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Hayato Sakamoto
- Department of Rehabilitation Medicine, Kyorin University Hospital, Mitaka, Japan
| | - Rika Ishida
- Department of Rehabilitation Medicine, Kyorin University Hospital, Mitaka, Japan
| | - Mayuko Kuwabara
- Department of Rehabilitation Medicine, Kyorin University Hospital, Mitaka, Japan
| | - Kyohei Matsuda
- Department of Rehabilitation Medicine, Kyorin University School of Medicine, Mitaka, Japan
| | | | - Teruyuki Hirano
- Department of Stroke and Cerebrovascular Medicine, Kyorin University, Mitaka, Japan
| | - Ryo Momozaki
- Department of Rehabilitation Medicine, Mie University Graduate School of Medicine, Tsu, Japan
| | - Keisuke Maeda
- Department of Geriatric Medicine, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Hidetaka Wakabayashi
- Department of Rehabilitation Medicine, Tokyo Women’s Medical University Hospital, Shinjuku, Japan
| | - Shin Yamada
- Department of Rehabilitation Medicine, Kyorin University School of Medicine, Mitaka, Japan
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12
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Wakabayashi H, Kakehi S, Kishima M, Itoda M, Nishioka S, Momosaki R. Impact of registered dietitian and dental hygienist involvement on functional outcomes in patients with dysphagia: triad of rehabilitation, nutrition, and oral management. Eur Geriatr Med 2023; 14:1301-1306. [PMID: 37442874 DOI: 10.1007/s41999-023-00833-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 07/04/2023] [Indexed: 07/15/2023]
Abstract
PURPOSE To investigate whether the involvement of both registered dietitians and dental hygienists results in greater improvement in swallowing function and activities of daily living (ADL) in patients with dysphagia undergoing rehabilitation. METHODS Of 467 patients enrolled in the Japanese Sarcopenic Dysphagia database, 433 met the study eligibility criteria in a retrospective cohort study. Patients were divided into two groups based on whether or not they received intervention by both registered dietitians and dental hygienists. Outcomes were changes in the Food Intake Level Scale (FILS) and the Barthel Index (BI) at initial and follow-up assessments. Multiple regression analyses adjusted for age, sex, sarcopenia, dwelling, Charlson comorbidity index, malnutrition diagnosed by the Global Leadership Initiative on Malnutrition, and initial FILS or BI were conducted to examine the relationship between the involvement of both registered dietitians and dental hygienists. RESULTS The mean age was 80.5 and ± 10.7 years, and 222 were female. Both registered dietitians and dental hygienists were involved in 242 (57%) patients. Median and interquartile range changes in FILS and BI were 1 (0, 2) and 15 (0, 32.5), respectively. In multiple regression analyses, the change in the FILS was significantly higher in the involvement of both registered dietitians and dental hygienists (standardized coefficient = 0.075, P = 0.033), however, the change in the BI was not significantly different between the groups. CONCLUSION The involvement of both registered dietitians and dental hygienists improved swallowing function, but not ADL. Triad of rehabilitation, nutrition, and oral management may be useful for patients with dysphagia.
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Affiliation(s)
- Hidetaka Wakabayashi
- Department of Rehabilitation Medicine, Tokyo Women's Medical University Hospital, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-0054, Japan.
| | - Shingo Kakehi
- Department of Rehabilitation Medicine, Tokyo Women's Medical University Hospital, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-0054, Japan
| | - Masako Kishima
- Department of Dentistry, Wakakusa-Tatsuma Rehabilitation Hospital, Osaka, Japan
- Department of Oral Rehabilitation, Osaka Dental University Hospital, Osaka, Japan
| | - Masataka Itoda
- Department of Oral Rehabilitation, Osaka Dental University Hospital, Osaka, Japan
| | - Shinta Nishioka
- Department of Clinical Nutrition and Food Service, Nagasaki Rehabilitation Hospital, Nagasaki, Japan
| | - Ryo Momosaki
- Department of Rehabilitation Medicine, Mie University Graduate School of Medicine, Tsu, Japan
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13
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Shimizu A, Ohno T, Fujishima I, Kayashita J, Momosaki R, Nishioka S, Wakabayashi H. Impact of Poor Oral Health Status on Swallowing Function Improvement in Older Dysphagic Patients. Cureus 2023; 15:e51249. [PMID: 38288242 PMCID: PMC10823192 DOI: 10.7759/cureus.51249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2023] [Indexed: 01/31/2024] Open
Abstract
Background This study aimed to explore the relationship between poor oral health status and improvement in swallowing function in older patients with dysphagia across various clinical settings, including acute and post-acute care environments. Methods This retrospective cohort study encompassed patients aged 65 years and older with dysphagia. Oral health status was assessed using the oral health assessment tool (OHAT) or the revised oral assessment guide (ROAG). In this study, an OHAT score of ≥3 or an ROAG score of ≥13 indicated poor oral health status. The primary outcome measured was the change in the food intake level scale (FILS) score, which reflects swallowing function, during the observation period. The association between changes in FILS score and poor oral health status was analyzed using a multivariable linear regression model. Results The study included 361 older patients with dysphagia (mean age 82.7 ± 7.7 years; 47.3% male), of whom 82.5% had poor oral health. A negative association was found between poor oral health status and improvement in FILS score at the endpoint (partial regression coefficient: -0.523, 95% confidence interval: -0.99 to -0.06, P=0.026). Conclusions Our findings underscore the negative impact of poor oral health status on the improvement of swallowing function and emphasize the importance of oral health interventions for older patients. Further study on oral health interventions' effects on improving swallowing function in older patients with dysphagia is warranted.
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Affiliation(s)
- Akio Shimizu
- Department of Food and Health Science, Faculty of Health and Human Development, The University of Nagano, Nagano, JPN
| | - Tomohisa Ohno
- Department of Dentistry, Hamamatsu City Rehabilitation Hospital, Hamamatsu, JPN
| | - Ichiro Fujishima
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, Hamamatsu, JPN
| | - Jun Kayashita
- Department of Health Sciences, Faculty of Human Culture and Science, Prefectural University of Hiroshima, Hiroshima, JPN
| | - Ryo Momosaki
- Department of Rehabilitation Medicine, Mie University Graduate School of Medicine, Tsu, JPN
| | - Shinta Nishioka
- Department of Clinical Nutrition and Food Service, Nagasaki Rehabilitation Hospital, Nagasaki, JPN
| | - Hidetaka Wakabayashi
- Department of Rehabilitation Medicine, Tokyo Women's Medical University Hospital, Shinjuku-ku, JPN
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14
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Sato Y, Yoshimura Y, Abe T, Nagano F, Matsumoto A, Wakabayashi H. Change in phase angle is associated with improvement in activities of daily living and muscle function in patients with acute stroke. Eur Geriatr Med 2023; 14:1333-1341. [PMID: 37603189 DOI: 10.1007/s41999-023-00853-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 08/01/2023] [Indexed: 08/22/2023]
Abstract
PURPOSE The phase angle (PhA) is a simple index that reflects nutritional status and muscle quality. This study aimed to investigate the association between PhA changes and activities of daily living (ADL), muscle strength, and muscle mass in patients with acute stroke. METHODS This retrospective, observational, cross-sectional study included patients hospitalized for acute stroke. The primary outcome was functional independence measure (FIM) of motor gain. The secondary outcomes were changes in handgrip strength and skeletal muscle mass index (SMI) during hospitalization. Multivariate analysis was used to examine whether PhA changes were associated with outcomes, after adjusting for potential confounders. RESULTS Hundred and sixty one subjects (mean age 74.6 years, 92 men) were included in the study. Multivariate analysis showed that PhA change was significantly and positively correlated with the gain in FIM motor scores, both for men (β = 0.634, p < 0.001) and women (β = 0.660, p < 0.001). Furthermore, there were significant associations between PhA change and changes in handgrip strength for men (β = 0.222, p = 0.030) and women (β = 0.491, p < 0.001), as well as SMI for men (β = 0.556, p < 0.001) and women (β = 0.290, p = 0.025). CONCLUSIONS An increased phase angle was positively associated with ADL, muscle strength, and muscle mass at discharge in patients with acute stroke.
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Affiliation(s)
- Yoichi Sato
- Department of Rehabilitation, Uonuma Kikan Hospital, Niigata, Japan
| | - Yoshihiro Yoshimura
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, 760 Magate, Kikuyo-Machi, Kikuchi-Gun, Kumamoto, 869-1106, Japan.
| | - Takafumi Abe
- Department of Rehabilitation, Uonuma Kikan Hospital, Niigata, Japan
| | - Fumihiko Nagano
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, 760 Magate, Kikuyo-Machi, Kikuchi-Gun, Kumamoto, 869-1106, Japan
| | - Ayaka Matsumoto
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, 760 Magate, Kikuyo-Machi, Kikuchi-Gun, Kumamoto, 869-1106, Japan
| | - Hidetaka Wakabayashi
- Department of Rehabilitation Medicine, Tokyo Women's Medical University Hospital, Tokyo, Japan
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15
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Takahashi K, Wakabayashi H, Maeda K, Nagai T, Momosaki R. Impact of body mass index on outcomes of inpatients with vertebral compression fractures in Japan: A retrospective cohort study. Geriatr Gerontol Int 2023; 23:788-794. [PMID: 37735145 DOI: 10.1111/ggi.14676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 08/24/2023] [Accepted: 09/04/2023] [Indexed: 09/23/2023]
Abstract
AIM The present study examined the relationship between body mass index and the ability to perform the activities of daily living in patients with vertebral compression fractures. METHODS A retrospective cohort analysis of patients aged >65 years hospitalized with a vertebral compression fracture was carried out using a nationwide database in Japan. Body mass index was categorized as underweight (<18.5 kg/m2 ), normal weight (18.5-22.9 kg/m2 ), overweight (23.0-27.4 kg/m2 ) and obese (≥27.5 kg/m2 ) according to the World Health Organization criteria for the Asia-Pacific region. The primary outcome was Barthel Index gain, namely, the change in the Barthel Index score at discharge from that at admission. Secondary outcomes were the length of hospital stay and readmission within 30 days of discharge. RESULTS Among 41 423 participants, 24.5% were classified as underweight, excluding those with missing body mass index data. The underweight group had a significantly lower Barthel Index gain than the normal, overweight and obese groups (median 20 vs 25 vs 30 vs 30, respectively, P < 0.001). The underweight group also had longer hospital stays and higher 30-day readmission rates than the other groups. A multivariable analysis showed that being underweight was independently associated with a Barthel Index gain -3.63 points (95% confidence interval -4.58 to -2.68) lower than normal weight. Furthermore, being underweight was an independent variable affecting the length of hospital stay and readmission within 30 days (P < 0.001). CONCLUSIONS In patients with vertebral compression fractures, being underweight leads to lower Barthel Index scores, longer hospital stays and increased readmissions within 30 days of discharge. Geriatr Gerontol Int 2023; 23: 788-794.
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Affiliation(s)
- Kohei Takahashi
- Tamura Surgical Hospital Department of Rehabilitation, Tamura Surgical Hospital, Kawasaki-shi, Japan
| | - Hidetaka Wakabayashi
- Department of Rehabilitation Medicine, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Keisuke Maeda
- Nutrition Therapy Support Center, Aichi Medical University Hospital, Nagakute, Japan
- Department of Geriatric Medicine, Hospital, National Center for Geriatrics and Gerontology, Morioka, Japan
| | - Takako Nagai
- Department of Rehabilitation Medicine, Nihon University Hospital, Tokyo, Japan
| | - Ryo Momosaki
- Department of Rehabilitation Medicine, Mie University Graduate School of Medicine, Tsu, Japan
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Kakehi S, Isono E, Wakabayashi H, Shioya M, Ninomiya J, Aoyama Y, Murai R, Sato Y, Takemura R, Mori A, Masumura K, Suzuki B. Sarcopenic Dysphagia and Simplified Rehabilitation Nutrition Care Process: An Update. Ann Rehabil Med 2023; 47:337-347. [PMID: 37907225 PMCID: PMC10620494 DOI: 10.5535/arm.23101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/15/2023] [Accepted: 09/18/2023] [Indexed: 11/02/2023] Open
Abstract
Sarcopenic dysphagia is characterized by weakness of swallowing-related muscles associated with whole-body sarcopenia. As the number of patients with sarcopenia increases with the aging of the world, the number of patients with sarcopenic dysphagia is also increasing. The prevalence of sarcopenic dysphagia is high in the institutionalized older people and in patients hospitalized for pneumonia with dysphagia in acute care hospitals. Prevention, early detection and intervention of sarcopenic dysphagia with rehabilitation nutrition are essential. The diagnosis of sarcopenic dysphagia is based on skeletal and swallowing muscle strength and muscle mass. A reliable and validated diagnostic algorithm for sarcopenic dysphagia is used. Sarcopenic dysphagia is associated with malnutrition, which leads to mortality and Activities of Daily Living (ADL) decline. The rehabilitation nutrition approach improves swallowing function, nutrition status, and ADL. A combination of aggressive nutrition therapy to improve nutrition status, dysphagia rehabilitation, physical therapy, and other interventions can be effective for sarcopenic dysphagia. The rehabilitation nutrition care process is used to assess and problem solve the patient's pathology, sarcopenia, and nutrition status. The simplified rehabilitation nutrition care process consists of a nutrition cycle and a rehabilitation cycle, each with five steps: assessment, diagnosis, goal setting, intervention, and monitoring. Nutrition professionals and teams implement the nutrition cycle. Rehabilitation professionals and teams implement the rehabilitation cycle. Both cycles should be done simultaneously. The nutrition diagnosis of undernutrition, overnutrition/obesity, sarcopenia, and goal setting of rehabilitation and body weight are implemented collaboratively.
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Affiliation(s)
- Shingo Kakehi
- Department of Rehabilitation Medicine, Tokyo Women’s Medical University Hospital, Tokyo, Japan
| | - Eri Isono
- Department of Rehabilitation Medicine, Tokyo Women’s Medical University Hospital, Tokyo, Japan
| | - Hidetaka Wakabayashi
- Department of Rehabilitation Medicine, Tokyo Women’s Medical University Hospital, Tokyo, Japan
| | - Moeka Shioya
- Department of Rehabilitation Medicine, Tokyo Women’s Medical University Hospital, Tokyo, Japan
| | - Junki Ninomiya
- Department of Rehabilitation Medicine, Tokyo Women’s Medical University Hospital, Tokyo, Japan
| | - Yohei Aoyama
- Department of Rehabilitation Medicine, Tokyo Women’s Medical University Hospital, Tokyo, Japan
| | - Ryoko Murai
- Department of Rehabilitation Medicine, Tokyo Women’s Medical University Hospital, Tokyo, Japan
| | - Yuka Sato
- Department of Rehabilitation Medicine, Tokyo Women’s Medical University Hospital, Tokyo, Japan
| | - Ryohei Takemura
- Department of Rehabilitation Medicine, Tokyo Women’s Medical University Hospital, Tokyo, Japan
| | - Amami Mori
- Department of Rehabilitation Medicine, Tokyo Women’s Medical University Hospital, Tokyo, Japan
| | - Kei Masumura
- Department of Rehabilitation Medicine, Tokyo Women’s Medical University Hospital, Tokyo, Japan
| | - Bunta Suzuki
- Department of Rehabilitation Medicine, Tokyo Women’s Medical University Hospital, Tokyo, Japan
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17
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Kokura Y, Nishioka S, Maeda K, Wakabayashi H. Ultrasound utilized by registered dietitians for body composition measurement, nutritional assessment, and nutritional management. Clin Nutr ESPEN 2023; 57:173-180. [PMID: 37739653 DOI: 10.1016/j.clnesp.2023.06.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 06/09/2023] [Accepted: 06/23/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND AND AIMS Ultrasound has been used primarily as a tool for body composition measurement in the field of clinical nutrition. Although many recent reports have demonstrated that ultrasound could be a useful tool for nutritional assessment, it is not well incorporated into registered dietitians' (RDs) practice. The aim of this review was to summarize the usefulness of ultrasound in assessing body composition and nutritional status and in nutritional management by RDs. METHODS Studies on ultrasonography, nutritionists, body composition, nutritional assessment, and diet therapy was searched using the MEDLINE databases. RESULTS After reviewing the articles, we categorized them into the following topics; 1) principles of muscle measurement using the ultrasound, types of muscle that can be measured, 2) indices of muscle and muscle mass and quality as assessed using ultrasound and its relationship to nutritional indicator, 3) diagnosis of the Global Leadership Initiative on Malnutrition (GLIM) criteria malnutrition using ultrasound, 4) practical nutritional management using ultrasound and 5) education and issues for ultrasound implementation. Ultrasound can evaluate low body mass index, unintentional loss of body weight, low skeletal muscle mass index, decreased food intake/assimilation, and disease burden/inflammation, all which are essential items of the phenotypic and etiologic criteria of the GLIM. CONCLUSION Ultrasound may be useful for RDs to perform body composition measurement, nutritional assessment, and nutritional management. It will be important to identify the cutoff values for ultrasound-based measurements of muscle mass. In order for RDs to perform a body composition measurement, nutritional assessment, and nutritional management using ultrasound, educational issues need to be addressed.
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Affiliation(s)
- Yoji Kokura
- Department of Nutritional Management, Keiju Hatogaoka Integrated Facility for Medical and Long-term Care, Anamizu, Japan.
| | - Shinta Nishioka
- Department of Clinical Nutrition and Food Services, Nagasaki Rehabilitation Hospital, Nagasaki, Japan
| | - Keisuke Maeda
- Nutrition Therapy Support Center, Aichi Medical University Hospita, Nagakute, Japan; Department of Geriatric Medicine, Hospital, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Hidetaka Wakabayashi
- Department of Rehabilitation Medicine, Tokyo Women's Medical University Hospital, Tokyo, Japan
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18
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Yoshimura Y, Wakabayashi H, Nagano F, Matsumoto A, Shimazu S, Shiraishi A, Kido Y, Bise T, Hori K, Yoneda K. Phase angle is associated with sarcopenic obesity in post-stroke patients. Clin Nutr 2023; 42:2051-2057. [PMID: 37677910 DOI: 10.1016/j.clnu.2023.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 08/15/2023] [Accepted: 08/27/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND & AIMS Evidence is limited concerning the association between bioimpedance analysis-derived phase angle and sarcopenic obesity. This study examined this association in patients who underwent convalescent rehabilitation after stroke. METHODS This cross-sectional study included hospitalized patients with post-acute stroke. The phase angle was measured using a multifrequency bioimpedance analysis. Sarcopenic obesity was diagnosed according to the European Society of Clinical Nutrition and Metabolism/European Association for the Study of Obesity criteria. A multiple linear regression analysis was used to examine the association between the phase angle and sarcopenic obesity after adjusting for confounding factors. A receiver operating characteristic curve was used to calculate the optimal phase angle cutoff value for predicting sarcopenic obesity. RESULTS A total of 760 patients (median age 71 years; 352 women) were analyzed. The median (interquartile range, 25th and 75th percentiles) phase angle was 4.45° (4.10°, 4.88°). Sarcopenic obesity was diagnosed in 16 (3.9%) men, 18 (5.1%) women, and 34 (4.5%) patients overall. The multiple linear regression analysis showed that sarcopenic obesity (β = -0.185, p = 0.017) and sarcopenia (β = -0.121, p = 0.012) were significantly and negatively associated with the phase angle. Obesity was not significantly associated with the phase angle (β = -0.078, p = 0.094). The optimal cutoff value of the phase angle for diagnosing sarcopenic obesity was 4.29° (sensitivity 0.65, specificity 0.80, area under the curve [AUC] 0.79, 95% CI 0.77-0.87, p < 0.001) in men and 3.84° (sensitivity 0.67, specificity 0.84, AUC 0.81, 95% CI 0.79-0.86, p < 0.001) in women. CONCLUSION The phase angle was associated with sarcopenic obesity, and the cutoff values of the phase angle that could predict sarcopenic obesity were 4.29° for men and 3.84° for women. This simple and practical phase angle-based prediction of sarcopenic obesity can be useful in clinical practice.
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Affiliation(s)
- Yoshihiro Yoshimura
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto, Japan.
| | - Hidetaka Wakabayashi
- Department of Rehabilitation Medicine, Tokyo Women's Medical University Hospital, Japan.
| | - Fumihiko Nagano
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto, Japan.
| | - Ayaka Matsumoto
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto, Japan.
| | - Sayuri Shimazu
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto, Japan.
| | - Ai Shiraishi
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto, Japan.
| | - Yoshifumi Kido
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto, Japan.
| | - Takahiro Bise
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto, Japan.
| | - Kota Hori
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto, Japan.
| | - Koki Yoneda
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto, Japan.
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19
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Arai H, Maeda K, Wakabayashi H, Naito T, Konishi M, Assantachai P, Auyeung WT, Chalermsri C, Chen W, Chew J, Chou M, Hsu C, Hum A, Hwang IG, Kaido T, Kang L, Kamaruzzaman SB, Kim M, Lee JSW, Lee W, Liang C, Lim WS, Lim J, Lim YP, Lo RS, Ong T, Pan W, Peng L, Pramyothin P, Razalli NH, Saitoh M, Shahar S, Shi HP, Tung H, Uezono Y, von Haehling S, Won CW, Woo J, Chen L. Diagnosis and outcomes of cachexia in Asia: Working Consensus Report from the Asian Working Group for Cachexia. J Cachexia Sarcopenia Muscle 2023; 14:1949-1958. [PMID: 37667992 PMCID: PMC10570088 DOI: 10.1002/jcsm.13323] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 07/05/2023] [Accepted: 08/02/2023] [Indexed: 09/06/2023] Open
Abstract
Chronic diseases often lead to metabolic disorders, causing anabolic resistance and increased energy consumption, which result in cachexia. Cachexia, in turn, can lead to major clinical consequences such as impaired quality of life, shortened life expectancy, and increased healthcare expenditure. Existing international diagnostic criteria for cachexia employ thresholds derived from Western populations, which may not apply to Asians due to differing body compositions. To address this issue, the Asian Working Group for Cachexia (AWGC) was initiated. The AWGC comprises experts in cachexia research and clinical practice from various Asian countries and aims to develop a consensus on diagnostic criteria and significant clinical outcomes for cachexia in Asia. The AWGC, composed of experts in cachexia research and clinical practice from several Asian countries, undertook three-round Delphi surveys and five meetings to reach a consensus. Discussions were held on etiological diseases, essential diagnostic items for cachexia, including subjective and objective symptoms and biomarkers, and significant clinical outcomes. The consensus highlighted the importance of multiple diagnostic factors for cachexia, including chronic diseases, either or both weight loss or low body mass index, and at least one of the following: anorexia, decreased grip strength (<28 kg in men and <18 kg in women), or elevated C-reactive protein levels (>5 mg/L [0.5 mg/dL]). The AWGC proposed a significant weight change of 2% or more over a 3-6 month period and suggested a tentative cut-off value of 21 kg/m2 for low body mass index in diagnosing cachexia. Critical clinical outcomes were determined to be mortality, quality of life as assessed by tools such as EQ-5D or the Functional Assessment of Anorexia/Cachexia Therapy, and functional status as measured by the Clinical Frailty Scale or Barthel Index, with significant emphasis on patient-reported outcomes. The AWGC consensus offers a comprehensive definition and user-friendly diagnostic criteria for cachexia, tailored specifically for Asian populations. This consensus is set to stimulate future research and enhance the multidisciplinary approach to managing cachexia. With plans to develop further guidelines for the optimal treatment, prevention, and care of cachexia in Asians, the AWGC criteria are expected to drive research across chronic co-morbidities and cancer in Asia, leading to future refinement of diagnostic criteria.
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Affiliation(s)
- Hidenori Arai
- National Center for Geriatrics and GerontologyObuJapan
| | - Keisuke Maeda
- Nutrition Therapy Support CenterAichi Medical University HospitalNagakuteJapan
- Department of Geriatric MedicineNational Center for Geriatrics and GerontologyObuJapan
| | - Hidetaka Wakabayashi
- Department of Rehabilitation MedicineTokyo Women's Medical University HospitalTokyoJapan
| | - Tateaki Naito
- Division of Thoracic OncologyShizuoka Cancer CenterShizuokaJapan
| | - Masaaki Konishi
- Department of CardiologyYokohama City University School of MedicineYokohamaJapan
| | | | - Wai Tung Auyeung
- Jockey Club Institute of AgeingThe Chinese University of Hong KongShatinHong KongChina
| | - Chalobol Chalermsri
- Department of Preventive and Social Medicine, Division of Geriatric Medicine, Faculty of Medicine Siriraj HospitalMahidol UniversityBangkokThailand
- Department of Women's and Children's HealthUppsala UniversityUppsalaSweden
| | - Wei Chen
- Department of Clinical Nutrition, Department of Health MedicinePeking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Justin Chew
- Department of Geriatric MedicineTan Tock Seng HospitalSingapore
- Institute of Geriatrics and Active AgeingTan Tock Seng HospitalSingapore
| | - Ming‐Yueh Chou
- Center for Geriatrics and GerontologyKaohsiung Veterans General HospitalKaohsiung CityTaiwan
| | - Chih‐Cheng Hsu
- National Center for Geriatrics and Welfare ResearchMiaoli CountyTaiwan
| | - Allyn Hum
- Department of Geriatrics and Palliative CareTan Tock Seng HospitalSingapore
| | - In Gyu Hwang
- Department of Internal MedicineChung‐Ang University Hospital, Chung‐Ang University College of MedicineSeoulRepublic of Korea
| | - Toshimi Kaido
- Department of Gastroenterological and General SurgerySt. Luke's International HospitalTokyoJapan
| | - Lin Kang
- Department of Geriatric MedicinePeking Union Medical College HospitalBeijingChina
| | | | - Miji Kim
- Department of Biomedical Science and Technology, College of Medicine, East‐West Medical Research InstituteKyung Hee UniversitySeoulRepublic of Korea
| | - Jenny Shun Wah Lee
- Institute of AgingThe Chinese University of Hong Kong, Department of Medicine, Alice Ho Miu Ling Nethersole HospitalTai PoHong Kong
| | - Wei‐Ju Lee
- Aging and Health Research CenterNational Yang Ming Chiao Tung UniversityTaipei CityTaiwan
| | - Chih‐Kuang Liang
- Center for Geriatrics and GerontologyKaohsiung Veterans General HospitalKaohsiung CityTaiwan
- Center for Healthy Longevity and Aging SciencesNational Yang Ming Chiao Tung UniversityTaipei CityTaiwan
| | - Wee Shiong Lim
- Department of Geriatric Medicine, Institute of Geriatric MedicineTan Tock Seng HospitalSingapore
- Lee Kong Chian School of MedicineNanyang Technological UniversitySingapore
| | - Jae‐Young Lim
- Department of Rehabilitation MedicineSeoul National University College of Medicine, Seoul National University Bundang HospitalSeongnamRepublic of Korea
| | - Yen Peng Lim
- Department of Nutrition and DieteticsTan Tock Seng HospitalSingapore
| | - Raymond See‐Kit Lo
- Department of Medicine and TherapeuticsChinese University of Hong Kong, Shatin HospitalMa On ShanHong Kong
| | - Terence Ong
- Department of Medicine, Faculty of MedicineUniversity MalayaKuala LumpurMalaysia
| | - Wen‐Harn Pan
- Institute of Biomedical SciencesAcademia Sinica, TaiwanTaipei CityTaiwan
| | - Li‐Ning Peng
- Aging and Health Research CenterNational Yang Ming Chiao Tung UniversityTaipei CityTaiwan
| | - Pornpoj Pramyothin
- Division of Nutrition, Department of Medicine, Faculty of Medicine Siriraj HospitalMahidol UniversityBangkokThailand
| | - Nurul Huda Razalli
- Centre for Healthy Aging and Wellness (H‐CARE), Faculty of Health SciencesUniversiti Kebangsaan Malaysia, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul AzizKuala LumpurMalaysia
| | - Masakazu Saitoh
- Department of Physical Therapy, Faculty of Health ScienceJuntendo UniversityTokyoJapan
| | - Suzana Shahar
- Center for Healthy Aging and Wellness, Faculty Health SciencesUniversiti Kebangsaan MalaysiaKuala LumpurMalaysia
| | - Han Ping Shi
- Department of Gastrointestinal Surgery, Department of Clinical Nutrition, Beijing Shijitan HospitalCapital Medical University of ChinaBeijingChina
| | - Heng‐Hsin Tung
- National Yang Ming Chiao Tung UniversityTaipei CityTaiwan
| | - Yasuhito Uezono
- Department of Pain Control ResearchThe Jikei University School of MedicineTokyoJapan
| | - Stephan von Haehling
- Department of Cardiology and PneumologyUniversity of Goettingen Medical Center, Georg‐August‐University GoettingenGoettingenGermany
- German Center for Cardiovascular Research (DZHK), partner site GöttingenGöttingenGermany
| | - Chang Won Won
- Department of Family MedicineCollege of Medicine, Kyung Hee UniversitySeoulRepublic of Korea
| | - Jean Woo
- Department of Medicine & TherapeuticsThe Chinese University of Hong Kong, Prince of Wales HospitalHong Kong SARChina
| | - Liang‐Kung Chen
- Center for Healthy Longevity and Aging SciencesNational Yang Ming Chiao Tung UniversityTaipei CityTaiwan
- Center for Geriatrics and GerontologyTaipei Veterans General Hospital; Taipei Municipal Gan‐Dau HospitalTaipei CityTaiwan
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20
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Rezaei S, de Oliveira LC, Ghanavati M, Shadnoush M, Akbari ME, Akbari A, Hadizadeh M, Ardehali SH, Wakabayashi H, Elhelali A, Rahmani J. The effect of anamorelin (ONO-7643) on cachexia in cancer patients: Systematic review and meta-analysis of randomized controlled trials. J Oncol Pharm Pract 2023; 29:1725-1735. [PMID: 37525932 DOI: 10.1177/10781552231189864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
BACKGROUND Cachexia is associated with increased morbidity and mortality rates in patients with cancer. This meta-analysis aims to explore the effect of anamorelin on cancer cachexia markers. METHODS We searched MEDLINE/PubMed, SCOPUS, and WOS from their inception until 5 June 2022. A systematic search was conducted according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines. We included trials investigating the effect of anamorelin on body weight, lean body mass, fat mass, insulin-like growth factor 1 (IGF-1), handgrip, quality of life insulin-like growth factor-binding protein 3 (IGFBP-3), and in patients with cancer. A random-effects model was run to pooled results. RESULTS Five articles providing 1331 participants were analyzed in this study. Pooled analysis revealed a significant increase in body weight (weighted mean difference (WMD): 1.56 kg, 95% confidence interval (CI): 1.20, 1.92; I2= 0%), lean body mass (WMD: 1.36 kg, 95% CI: 0.85, 1.86; I2= 53.1%), fat mass (WMD: 1.02 kg, 95% CI: 0.51, 1.53; I2= 60.7%), IGF-1 (WMD: 51.16 ng/mL, 95% CI: 41.42, 60.90, I2= 0%), and IGFBP-3 (WMD: 0.43 μg/mL, 95% CI: 0.17, 0.68, I2= 98.6%). Results showed no significant increase in appetite when analysis run on all studies without considering different doses 0.29 (95% CI: -0.30, 0.89, I2= 73.8%), however, there was a significant increase in appetite without heterogeneity and inconsistency 0.59 (95% CI: 0.32, 0.86; I2= 0%) in the 100 mg/day group compared to anamorelin non-user. CONCLUSIONS Patients with cancer who receive anamorelin as a treatment for cachexia showed a significant increase in body weight, lean body mass, fat mass, IGF-1, and IGFBP-3.
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Affiliation(s)
- Shahla Rezaei
- Nutrition Research Center, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Matin Ghanavati
- National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahdi Shadnoush
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition Science and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Atieh Akbari
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Hadizadeh
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Hossein Ardehali
- Department of Anesthesiology and Critical Care, Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hidetaka Wakabayashi
- Department of Rehabilitation Medicine, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Ala Elhelali
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University, Baltimore, MD, USA
| | - Jamal Rahmani
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Abstract
PURPOSE OF REVIEW Anamorelin was approved for production and marketing in Japan on 22 January 2021 for cancer cachexia in non-small-cell lung cancer, gastric cancer, pancreatic cancer, and colorectal cancer. The authors describe the updates of anamorelin for cancer cachexia in Japan. RECENT FINDINGS Recent evidence showed that anamorelin improved lean body mass, body weight, and appetite in patients with cancer cachexia in clinical practice. Anamorelin does not increase body weight in the severe-weight-loss group in cachectic patients with pancreatic cancer. Several case reports showed that anamorelin can cause cardiac adverse drug reactions. Among the cardiac adverse reactions, fatal arrhythmias should be monitored carefully even if it is the first dose. Anamorelin combined with nutrition, physical activity, and exercise may be more useful than anamorelin alone for treating cancer cachexia. An interim analysis from post-marketing all-case surveillance was performed; however, details have not yet been published. When anamorelin cannot be used for cancer cachexia, Kampo medicines can be considered as an option. SUMMARY Anamorelin has changed the clinical practice of cancer cachexia in Japan. The authors hope that anamorelin is available for other disease-related cachexia along with appropriate multidisciplinary interventions.
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Affiliation(s)
- Hidetaka Wakabayashi
- Department of Rehabilitation Medicine, Tokyo Women's Medical University Hospital, Tokyo
| | - Hidenori Arai
- National Center for Geriatrics and Gerontology, Aichi
| | - Akio Inui
- Pharmacological Department of Herbal Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
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22
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Fukuma K, Kamada M, Yamamoto K, Yokota C, Abe S, Nakazawa S, Tanaka T, Chichikawa T, Nakaoku Y, Nishimura K, Koga M, Takaya S, Sugimoto K, Nishioka S, Wakabayashi H, Fujishima I, Ihara M. Pre-existing sarcopenia and swallowing outcomes in acute stroke patients. Clin Nutr 2023; 42:1454-1461. [PMID: 37451157 DOI: 10.1016/j.clnu.2023.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 06/04/2023] [Accepted: 06/08/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND & AIMS This study aimed to investigate the associations of pre-existing sarcopenia with swallowing function, oral intake level, and aspiration pneumonia in patients with acute stroke. METHODS This observational study included patients (≥60 years of age) with acute ischemic stroke or intracerebral hemorrhage within 7 days of onset who were screened for sarcopenia, malnutrition, and swallowing difficulties in a stroke-care unit within 48 h of admission. Sarcopenia was defined by the Asian Working Group on Sarcopenia 2019 as having a low calf circumference, handgrip strength, and appendicular muscle mass index. The primary outcome was impaired oral intake (functional oral intake scale <5 points) at 3, 7, and 14 days after admission, and the secondary outcome was aspiration pneumonia during hospitalization. RESULTS We enrolled 350 patients (median age of 77 years; 63% males) who underwent the aforementioned screening. Sarcopenia was diagnosed in 34% of patients, and malnutrition was found in 66% of patients with sarcopenia. When compared with the comparison group (defined as patients with either or both normal calf circumference and handgrip strength), the sarcopenia group had significantly lower tongue pressure and a higher prevalence of dysphagia. Sarcopenia was associated with functional oral intake scale <5 at 7 days (adjusted odds ratio [OR], 4.72; 95% confidence interval [CI], 1.91-11.71); p = 0.002) and 14 days (adjusted OR, 3.93; 95% CI, 1.47-10.53; p = 0.006) and with aspiration pneumonia during hospitalization (adjusted OR, 6.12; 95% CI, 1.63-22.94; p = 0.007). CONCLUSION Acute stroke patients with sarcopenia may have weakness of the swallowing-related muscles which may lead to impaired oral intake and aspiration pneumonia.
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Affiliation(s)
- Kazuki Fukuma
- Department of Neurology, National Cerebral and Cardiovascular Center, Osaka, Japan.
| | - Masatoshi Kamada
- Department of Stroke Rehabilitation, National Cerebral and Cardiovascular, Osaka, Japan
| | - Kazuya Yamamoto
- Department of Stroke Rehabilitation, National Cerebral and Cardiovascular, Osaka, Japan
| | - Chiaki Yokota
- Department of Stroke Rehabilitation, National Cerebral and Cardiovascular, Osaka, Japan
| | - Soichiro Abe
- Department of Neurology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Shinsaku Nakazawa
- Department of Neurology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Tomotaka Tanaka
- Department of Neurology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Takuro Chichikawa
- Department of Clinical Nutrition, National Cerebral and Cardiovascular, Osaka, Japan
| | - Yuriko Nakaoku
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Kunihiro Nishimura
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Masatoshi Koga
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Shigetoshi Takaya
- Department of Neurology and Rehabilitation Medicine, Senri Rehabilitation Hospital, Osaka, Japan
| | - Ken Sugimoto
- Department of General and Geriatric Medicine, Kawasaki Medical School General Medical Center, Okayama, Japan
| | - Shinta Nishioka
- Department of Clinical Nutrition and Food Service, Nagasaki Rehabilitation Hospital, Nagasaki, Japan
| | - Hidetaka Wakabayashi
- Department of Rehabilitation Medicine, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Ichiro Fujishima
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, Shizuoka, Japan
| | - Masafumi Ihara
- Department of Neurology, National Cerebral and Cardiovascular Center, Osaka, Japan.
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23
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Maki H, Wakabayashi H, Maeda K, Nakamichi M, Kubota K, Momosaki R. Impact of the Comorbidity Polypharmacy Score on Clinical Outcome in Patients with Hip Fracture undergoing surgery Using Real-World Data. Ann Clin Epidemiol 2023; 5:88-94. [PMID: 38504727 PMCID: PMC10944981 DOI: 10.37737/ace.23012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 06/01/2023] [Indexed: 03/21/2024]
Abstract
BACKGROUND The Comorbidity Polypharmacy Score (CPS) is calculated by the number of drugs carried plus the number of comorbidities on admission and divided into three categories (minor, 0-7; moderate, 8-14; and severe, 15+). This study investigates whether CPS can predict the clinical outcomes in older patients with hip fractures undergoing surgery. METHODS This retrospective longitudinal study used a multicenter hospital-based database containing the Diagnosis Procedure Combination. Consecutive patients with hip fractures (ICD-10 codes S720 and S721) who were aged ≥65 years between April 2014 and August 2020 were included. We evaluated the predictive association between the CPS and Barthel Index (BI) efficiency. The primary outcome was defined as the BI efficiency, and the secondary outcome was the length of hospital stay. RESULTS We enrolled 11,564 patients, and 80.5% of them were female. The mean age was 83.9 ± 6.5 years. The BI efficiency was the lowest in the CPS severe group with a median [interquartile range] of 0.67 [0.10, 1.43]. The length of hospital stay was the highest in the CPS severe group, with a median of 35 [21, 58]. Additionally, multiple linear regression analysis revealed that the CPS was independently associated with the BI efficiency (β = -0.100, 95% CI: -0.040, -0.029; P < 0.001) and the length of hospital stay (β = 0.047, 95% CI: 0.199, 0.366; P < 0.001). CONCLUSIONS An increased CPS score is associated with low BI efficiency and longer length of hospital stay in patients with hip fractures.
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Affiliation(s)
- Hiroki Maki
- Department of Pharmacy, Kofu Municipal Hospital
| | - Hidetaka Wakabayashi
- Department of Rehabilitation Medicine, Tokyo Women’s Medical University Hospital
| | - Keisuke Maeda
- Department of Geriatric Medicine, Hospital, National Center for Geriatrics and Gerontology
| | | | - Kazumi Kubota
- Department of Healthcare Information Management, The University of Tokyo Hospital
| | - Ryo Momosaki
- Department of Rehabilitation Medicine, Mie University Graduate School of Medicine
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Wakabayashi H. Hospital-associated sarcopenia, acute sarcopenia, and iatrogenic sarcopenia: Prevention of sarcopenia during hospitalization. J Gen Fam Med 2023; 24:146-147. [PMID: 37261047 PMCID: PMC10227739 DOI: 10.1002/jgf2.625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 04/14/2023] [Indexed: 06/02/2023] Open
Abstract
Sarcopenia can be classified as age-, activity-, nutrition-, and disease-related. Hospital-associated sarcopenia, acute sarcopenia, and iatrogenic sarcopenia are activity-, nutrition-, and disease-related, not age-related. There is considerable overlap between hospital-associated sarcopenia and acute sarcopenia; however, they are distinct concepts. Some causes of hospital-associated sarcopenia and acute sarcopenia are iatrogenic.
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Affiliation(s)
- Hidetaka Wakabayashi
- Department of Rehabilitation MedicineTokyo Women's Medical University HospitalShinjuku‐kuTokyoJapan
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25
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Shimizu A, Maki H, Ohno T, Nomoto A, Fujishima I, Kayashita J, Momosaki R, Nishioka S, Wakabayashi H. Association of poor oral health status and faecal incontinence in patients with dysphagia: A cross-sectional analysis from the Sarcopenic Dysphagia Database. J Oral Rehabil 2023; 50:286-292. [PMID: 36609695 DOI: 10.1111/joor.13413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 10/08/2022] [Accepted: 01/02/2023] [Indexed: 01/09/2023]
Abstract
BACKGROUND Poor oral health status may alter oral and gut microbiota. Previous studies have shown that poor oral health can exacerbate gut inflammation. Therefore, poor oral health status may be related to faecal incontinence via changes in the gut. OBJECTIVE To investigate the association between poor oral health status and faecal incontinence in inpatients with dysphagia. METHODS This multicentre cross-sectional study included 423 patients (mean age 79.8 ± 11.5 years, 48.2% female) with dysphagia. Oral health status was assessed at each facility using the Oral Health Assessment Tool (OHAT) or the Revised Oral Assessment Guide (ROAG). Poor oral health status was defined as an OHAT score of ≥3 or a ROAG score of ≥13. A multivariate logistic model was used to analyse the association between poor oral health status and faecal incontinence. RESULTS A total of 351 (83.0%) patients had poor oral health and 97 (22.7%) had faecal incontinence. Patients with poor oral health status had a higher proportion of faecal incontinence than those with normal oral health status (25.4% vs. 11.1%, p = .009). A multivariate logistic model revealed an association between faecal incontinence and poor oral health status (adjusted odds ratio = 2.501, 95% confidence interval = 1.065-5.873, p = .035). CONCLUSIONS Poor oral health status assessed by OHAT or ROAG in inpatients with dysphagia may adversely affect faecal incontinence. Further studies are needed to determine the causal relationship between poor oral health status and faecal incontinence.
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Affiliation(s)
- Akio Shimizu
- Department of Health Science, Faculty of Health and Human Development, The University of Nagano, Nagano, Japan
| | - Hiroki Maki
- Department of Pharmacy, Kofu Municipal Hospital, Kofu, Yamanashi, Japan
| | - Tomohisa Ohno
- Department of Dentistry, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Japan
| | - Akiko Nomoto
- Department of Dentistry, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Japan
| | - Ichiro Fujishima
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Japan
| | - Jun Kayashita
- Department of Health Sciences, Faculty of Human Culture and Science, Prefectural University of Hiroshima, Hiroshima, Japan
| | - Ryo Momosaki
- Department of Rehabilitation Medicine, Mie University Graduate School of Medicine, Tsu, Japan
| | - Shinta Nishioka
- Department of Clinical Nutrition and Food Service, Nagasaki Rehabilitation Hospital, Nagasaki, Japan
| | - Hidetaka Wakabayashi
- Department of Rehabilitation Medicine, Tokyo Women's Medical University, Tokyo, Japan
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26
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Yoshimura Y, Wakabayashi H, Nagano F, Matsumoto A, Shimazu S, Shiraishi A, Kido Y, Bise T. Prevalence And Association With Outcomes Of The Espen And Easo-Defined Diagnostic Criteria For Sarcopenic Obesity In Patients Undergoing Rehabilitation After Stroke. Clin Nutr ESPEN 2023. [DOI: 10.1016/j.clnesp.2022.09.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
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27
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Kido Y, Yoshimura Y, Wakabayashi H, Nagano F, Matsumoto A, Bise T, Shimazu S, Shiraishi A. Improvement in sarcopenia is positively associated with recovery of independence in urination and defecation in patients undergoing rehabilitation after a stroke. Nutrition 2023; 107:111944. [PMID: 36634435 DOI: 10.1016/j.nut.2022.111944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 11/13/2022] [Accepted: 12/08/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVES This study aimed to examine the association between improvement in sarcopenia and the recovery of urinary and defecatory independence in patients undergoing convalescent rehabilitation. METHODS A retrospective cohort study was conducted of 849 older inpatients after a stroke. Of these, patients with sarcopenia and dependent voiding movements were targeted. Sarcopenia was assessed according to the Asian Working Group for Sarcopenia 2019, and diagnosed using handgrip strength (HGS) and skeletal muscle-mass index. Outcomes were sphincter control items of the Functional Independence Measure (FIM) at the time of discharge: urinary (FIM-Bladder) and defecation (FIM-Bowel). A score of six or higher was considered independent. A logistic regression analysis was used to determine whether sarcopenia improvement was associated with outcomes. RESULTS Of the patients recruited, 151 were diagnosed with sarcopenia at baseline, of whom patients dependent in urination (109 patients) and defecation (102 patients) were included in the analysis. The multivariate analysis showed that improvement in sarcopenia (odds ratio [OR]: 3.28; 95% confidence interval [CI],1.01-10.70; P = 0.048) and HGS (OR: 6.25; 95% CI, 1.45-26.90; P = 0.014) were independently associated with FIM-Bladder at the time of discharge. Improvement in HGS (OR: 4.33; 95% CI, 0.99-18.90; P = 0.048) was independently associated with FIM-Bowel at the time of discharge CONCLUSIONS: Improvement in sarcopenia and muscle strength during hospitalization may have a positive effect on urinary independence in stroke patients undergoing convalescent rehabilitation, and improvement in muscle strength may have a positive effect on defecation independence. Multidisciplinary sarcopenia treatment should be implemented in addition to conventional rehabilitation for these patients.
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Affiliation(s)
- Yoshifumi Kido
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto, Japan
| | - Yoshihiro Yoshimura
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto, Japan.
| | - Hidetaka Wakabayashi
- Department of Rehabilitation Medicine, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Fumihiko Nagano
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto, Japan
| | - Ayaka Matsumoto
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto, Japan
| | - Takahiro Bise
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto, Japan
| | - Sayuri Shimazu
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto, Japan
| | - Ai Shiraishi
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto, Japan
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28
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Nagai T, Wakabayashi H, Nishioka S, Momosaki R. Importance of early assessment and multioccupational interventions in sarcopenic dysphagia and aspiration pneumonia. Geriatr Gerontol Int 2023; 23:153-154. [PMID: 36560884 DOI: 10.1111/ggi.14527] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Takako Nagai
- Department of Rehabilitation Medicine, Nihon University Hospital, Tokyo, Japan
| | - Hidetaka Wakabayashi
- Department of Rehabilitation Medicine, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Shinta Nishioka
- Department of Clinical Nutrition and Food Services, Nagasaki Rehabilitation Hospital, Nagasaki, Japan
| | - Ryo Momosaki
- Department of Rehabilitation Medicine, Mie University Graduate School of Medicine, Tsu, Japan
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29
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Nishioka S, Wakabayashi H. Interaction between malnutrition and physical disability in older adults: is there a malnutrition-disability cycle? Nutr Rev 2023; 81:191-205. [PMID: 35831980 DOI: 10.1093/nutrit/nuac047] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Malnutrition and physical disability are urgent issues in super-aging societies and the 2 phenomena are closely linked in older adults. Both conditions have common underlying causes, including physiological changes due to aging and burdens imposed by disease or injury. Accordingly, a concept of the malnutrition-disability cycle was generated and a comprehensive literature search was performed. There was insufficient evidence to prove an interrelationship between malnutrition and physical disabilities, because of the study design and poor quality, among other factors. However, some evidence exists for the interaction between low body mass index and swallowing disorders, and the effects of some malnutrition and disability components. This review provides the rationale for this interaction, the concept of a malnutrition-disability cycle is proposed, and the available evidence is critically appraise.
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Affiliation(s)
- Shinta Nishioka
- is with the Department of Clinical Nutrition and Food Services, Nagasaki Rehabilitation Hospital, Nagasaki City, Nagasaki, Japan
| | - Hidetaka Wakabayashi
- is with the Department of Rehabilitation Medicine, Tokyo Women's Medical University Hospital, Tokyo, Japan
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30
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Sato S, Miyazaki S, Tamaki A, Yoshimura Y, Arai H, Fujiwara D, Katsura H, Kawagoshi A, Kozu R, Maeda K, Ogawa S, Ueki J, Wakabayashi H. Respiratory sarcopenia: A position paper by four professional organizations. Geriatr Gerontol Int 2023; 23:5-15. [PMID: 36479799 DOI: 10.1111/ggi.14519] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/16/2022] [Accepted: 11/20/2022] [Indexed: 12/13/2022]
Abstract
We defined respiratory sarcopenia as a coexistence of respiratory muscle weakness and decreased respiratory muscle mass. Although respiratory muscle function is indispensable for life support, its evaluation has not been included in the regular assessment of respiratory function or adequately evaluated in clinical practice. Considering this situation, we prepared a position paper outlining basic knowledge, diagnostic and assessment methods, mechanisms, involvement in respiratory diseases, intervention and treatment methods, and future perspectives on respiratory sarcopenia, and summarized the current consensus on respiratory sarcopenia. Respiratory sarcopenia is diagnosed when respiratory muscle weakness and decreased respiratory muscle mass are observed. If respiratory muscle mass is difficult to measure, we can use appendicular skeletal muscle mass as a surrogate. Probable respiratory sarcopenia is defined when respiratory muscle weakness and decreased appendicular skeletal muscle mass are observed. If only respiratory muscle strength is decreased without a decrease in respiratory function, the patient is diagnosed with possible respiratory sarcopenia. Respiratory muscle strength is assessed using maximum inspiratory pressure and maximum expiratory pressure. Ultrasonography and computed tomography are commonly used to assess respiratory muscle mass; however, there are insufficient data to propose the cutoff values for defining decreased respiratory muscle mass. It was jointly prepared by the representative authors and authorized by the Japanese Society for Respiratory Care and Rehabilitation, Japanese Association on Sarcopenia and Frailty, Japanese Society of Respiratory Physical Therapy and Japanese Association of Rehabilitation Nutrition. Geriatr Gerontol Int 2023; 23: 5-15.
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Affiliation(s)
- Susumu Sato
- Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | | | - Akira Tamaki
- Department of Physical Therapy, School of Rehabilitation, Hyogo Medical University, Kobe, Japan
| | - Yoshihiro Yoshimura
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto, Japan
| | - Hidenori Arai
- National Center for Geriatrics and Gerontology, Obu, Japan
| | - Dai Fujiwara
- Department of Rehabilitation Medicine, Saka General Hospital, Miyagi, Japan
| | - Hideki Katsura
- Department of Respiratory Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | | | - Ryo Kozu
- Department of Physical Therapy Science, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Keisuke Maeda
- Department of Geriatric Medicine, Hospital, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Sumito Ogawa
- Department of Geriatric Medicine, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Jun Ueki
- Clinical Research Unit of Respiratory Pathophysiology, Graduate School of Health Care and Nursing, Juntendo University, Chiba, Japan
| | - Hidetaka Wakabayashi
- Department of Rehabilitation Medicine, Tokyo Women's Medical University Hospital, Tokyo, Japan
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Nagai T, Wakabayashi H, Nishioka S, Momosaki R. Association between board-certified physiatrist involvement and functional outcomes in sarcopenic dysphagia patients: a retrospective cohort study of the Japanese Sarcopenic Dysphagia Database. J Rural Med 2023; 18:21-27. [PMID: 36700126 PMCID: PMC9832312 DOI: 10.2185/jrm.2022-026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 10/07/2022] [Indexed: 01/06/2023] Open
Abstract
Objective: Dysphagia rehabilitation is an important area in geriatric nutrition due to the commonality of sarcopenic dysphagia in older adults. However, there have been no reports on the efficacy of treatment by board-certified physiatrists (BCP) in patients with sarcopenic dysphagia. This study therefore aimed to investigate whether intervention by board-certified physiatrists affects the functional prognosis of patients with sarcopenic dysphagia. Materials and Methods: Of 467 patients enrolled in the Japanese Sarcopenic Dysphagia database between November 2019 and March 2021, 433 met the study eligibility criteria. The patients were divided into two groups based on whether or not they received intervention by a BCP. The clinical characteristics and outcomes of the two groups were compared. Statistical analyses were performed by inverse probability weighting (IPW). Results: BCPs were involved in the management of 57.0% of patients with sarcopenic dysphagia. These patients had a significantly higher increase in the Barthel index both before and after IPW correction than those not managed by a BCP (P=0.001 and P=0.016, respectively). However, sarcopenic dysphagia significantly improved in the non-BCP group before IPW correction (P<0.001), although there was no significant difference after IPW correction (P=0.301). Conclusion: BCP management was significantly associated with higher activities of daily living (ADL), but not with an improvement in sarcopenic dysphagia. To provide and manage effective rehabilitation, it is necessary to familiarize patients with the management and training of sarcopenic dysphagia rehabilitation for BCP in order to cope in regions with few rehabilitation units.
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Affiliation(s)
- Takako Nagai
- Department of Rehabilitation Medicine, Nihon University
Hospital, Japan
| | - Hidetaka Wakabayashi
- Department of Rehabilitation Medicine, Tokyo Women’s Medical
University Hospital, Japan
| | - Shinta Nishioka
- Department of Clinical Nutrition and Food Services, Nagasaki
Rehabilitation Hospital, Japan
| | - Ryo Momosaki
- Department of Rehabilitation Medicine, Mie University
Graduate School of Medicine, Japan
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Kishimoto H, Wakabayashi H, Nishioka S, Momosaki R. Discriminative Evaluation of Sarcopenic Dysphagia Using Handgrip Strength or Calf Circumference in Patients with Dysphagia Using the Area under the Receiver Operating Characteristic Curve. J Clin Med 2022; 12:jcm12010118. [PMID: 36614919 PMCID: PMC9821689 DOI: 10.3390/jcm12010118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/21/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022] Open
Abstract
This multicenter cross-sectional study aimed to evaluate the discriminative ability of sarcopenic dysphagia (SD) using handgrip strength (HGS) or calf circumference (CC) in patients with dysphagia. Patients aged 20 years or older who were registered in a database at acute, rehabilitation, long-term care hospitals and home health care facilities were included. Logistic regression analysis was performed using SD as the outcome and HGS, CC, and other confounding factors as covariates, separately by sex. Algorithm-based SD diagnosis and HGS or CC were used as the reference and index tests, respectively. Their accuracy was evaluated using the area under the receiver operating characteristic curve (AUC), and cutoff values were calculated. Of the 460 patients, 285 (126 males) were diagnosed with SD. Logistic regression analysis showed that HGS (odds ratio [OR], 0.909; 95% confidence interval [CI], 0.873−0.947) in males and CC (OR, 0.767; 95% CI, 0.668−0.880) in females were independently associated with SD. The AUC for HGS in males was 0.735 (p < 0.001) and CC in females was 0.681 (p < 0.001). The cutoff values were 19.7 kg for HGS in males (sensitivity, 0.75; specificity, 0.63) and 29.5 cm for CC in females (sensitivity, 0.86; specificity, 0.48). HGS in males and CC in females provided statistically significant information to discriminate SD from dysphagia.
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Affiliation(s)
- Hiroshi Kishimoto
- Department of Rehabilitation Medicine, Ibaraki Prefectural University of Health Sciences Hospital, Ibaraki 300-0331, Japan
- Correspondence:
| | - Hidetaka Wakabayashi
- Department of Rehabilitation Medicine, Tokyo Women’s Medical University Hospital, Shinjuku-ku, Tokyo 162-0054, Japan
| | - Shinta Nishioka
- Department of Clinical Nutrition and Food Service, Nagasaki Rehabilitation Hospital, Nagasaki 850-0854, Japan
| | - Ryo Momosaki
- Department of Rehabilitation Medicine, Mie University Graduate School of Medicine, Tsu 514-8507, Japan
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Sakai A, Wakabayashi H. Comment on "Association between protein intake and changes in renal function among Japanese community-dwelling older people: The SONIC study". Geriatr Gerontol Int 2022; 22:1058-1059. [PMID: 36321251 DOI: 10.1111/ggi.14505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 10/17/2022] [Indexed: 12/12/2022]
Affiliation(s)
| | - Hidetaka Wakabayashi
- Department of Rehabilitation Medicine, Tokyo Women's Medical University, Tokyo, Japan
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Nishioka S, Nakahara S, Takasaki M, Shiohama N, Kokura Y, Suzuki T, Yokoi-Yoshimura Y, Nii M, Maeda K, Wakabayashi H. The concept of aggressive nutrition therapy and clinical indication: A position paper. Clin Nutr ESPEN 2022; 52:322-330. [PMID: 36513472 DOI: 10.1016/j.clnesp.2022.09.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/01/2022] [Accepted: 09/12/2022] [Indexed: 01/28/2023]
Abstract
Aggressive nutrition therapy is a nutritional management method that sets energy intake requirements by adding the amount of energy accumulated to energy consumption. It is used to treat patients with undernutrition and sarcopenia. However, evidence for aggressive nutrition therapy is insufficient, and validation through high-quality clinical research is essential. Therefore, this paper aimed to clarify the concept of aggressive nutrition therapy, present indications and contraindications; and describe the effects, limitations, and the need to individualize aggressive nutrition therapy for different pathological conditions. Aggressive nutrition therapy should be accompanied by the etiology of undernutrition, sarcopenia, and nutritional metabolism in various states. In addition to calculating nutritional requirements, the nutritional management methods of oral intake, tube feeding, and parenteral nutrition should be appropriately selected. A nutrition plan with the amount of energy accumulated should also be a vital issue. This position paper was authored by the Registered Dietitian Subcommittee of the Japanese Association of Rehabilitation Nutrition and was approved by the Japanese Association of Rehabilitation Nutrition.
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Affiliation(s)
- Shinta Nishioka
- Department of Clinical Nutrition and Food Services, Nagasaki Rehabilitation Hospital, 4-11 Ginyamachi, Nagasaki City, Nagasaki, 850-0854, Japan.
| | - Saori Nakahara
- Department of Nutrition, Suzuka General Hospital, 1275-53 Yamanohana, Yasuzuka-cho, Suzuka, Mie, 513-8630, Japan
| | - Miyuki Takasaki
- Department of Nutrition, Tokatsu-clinic Hospital, 865-2 Hinokuchi, Matsudo, Chiba, 271-0067, Japan
| | - Nahoko Shiohama
- Department of Nutrition, Saiseikai Kyoto Hospital, 101 Shimokaiinji-Shimouchida, Nagaokakyo, Kyoto, 617-8617, Japan
| | - Yoji Kokura
- Department of Nutritional Management, Keiju Hatogaoka Integrated Facility for Medical and Long-term Care, 15-39 Mugigaura, Anamizumachi, Hosugun, Ishikawa, 927-0023, Japan
| | - Tatsuro Suzuki
- Department of Nutrition, Wakamatsu Hospital of University of Occupational and Environmental Health, 1-17-1 Hamamachi, Wakamatsu-ku, Kitakyushu, Fukuoka, 808-0024, Japan
| | - Yuri Yokoi-Yoshimura
- Nutrition Support Section, Nakajima Pharmacy, 7-2-6 Nishi-Nanajo-Minami, Obihiro, Hokkaido, 080-0017, Japan
| | - Maria Nii
- Department of Nutrition and Food Service, Sakurakai Hospital, 5-2610-1 Handa, Osaka-Sayama, Osaka, 589-0011, Japan
| | - Keisuke Maeda
- Department of Geriatric Medicine, National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu City, Aichi, 474-8511, Japan
| | - Hidetaka Wakabayashi
- Department of Rehabilitation Medicine, Tokyo Women's Medical University Graduate School of Medicine, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
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Tomohara-Ichishima H, Wakabayashi H, Maeda K, Nishioka S, Momosaki R. Reply to Dr. Yamada. Respir Med Res 2022; 82:100942. [DOI: 10.1016/j.resmer.2022.100942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 06/09/2022] [Indexed: 11/17/2022]
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Yoshimura Y, Wakabayashi H, Nagano F, Matsumoto A, Shimazu S, Shiraishi A, Kido Y, Bise T. The Applicability of the ESPEN and EASO-Defined Diagnostic Criteria for Sarcopenic Obesity in Japanese Patients after Stroke: Prevalence and Association with Outcomes. Nutrients 2022; 14:nu14194205. [PMID: 36235857 PMCID: PMC9570818 DOI: 10.3390/nu14194205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 10/06/2022] [Accepted: 10/07/2022] [Indexed: 11/14/2022] Open
Abstract
Sarcopenic obesity is of growing research and clinical interest; however, validated diagnostic criteria are lacking. We therefore aimed to examine the prevalence of sarcopenic obesity as diagnosed by the criteria recently proposed by the European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Association for the Study of Obesity (EASO), and its association with outcomes among patients after stroke. This study was based on a cohort of 760 Japanese patients after stroke admitted to a post-acute rehabilitation hospital. Sarcopenic obesity was diagnosed at admission according to the ESPEN and EASO criteria using reference values specific to Asians. Outcomes included the motor domain of the functional independence measure (FIM-motor) and the food intake level scale (FILS) at discharge. Multivariate linear regression models were used to assess the associations between sarcopenic obesity and outcomes. Among 760 patients (median age, 73 years; 352 women and 408 men), sarcopenic obesity was diagnosed in 34 patients (4.5%; 5.4% of women and 4.1% of men). In multivariate analyses, sarcopenic obesity was independently and negatively associated with FIM-motor (β = −0.048, p = 0.031) and FILS at discharge (β = −0.095, p = 0.046) in women. In contrast, in men, sarcopenic obesity showed an independent negative association with FIM-motor at discharge (β = −0.117, p < 0.001) but no statistically significant association with FILS at discharge (β = −0.004, p = 0.323). In conclusion, the prevalence of sarcopenic obesity diagnosed by the ESPEN and EASO-defined criteria was as low as 4.5% among Japanese patients after stroke. Furthermore, sarcopenic obesity was negatively associated with improvements in activities of daily living and dysphagia.
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Affiliation(s)
- Yoshihiro Yoshimura
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto 869-1106, Japan
- Correspondence: ; Tel.: +81-96-232-3111
| | - Hidetaka Wakabayashi
- Department of Rehabilitation Medicine, Tokyo Women’s Medical University Hospital, Tokyo 162-8666, Japan
| | - Fumihiko Nagano
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto 869-1106, Japan
| | - Ayaka Matsumoto
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto 869-1106, Japan
| | - Sayuri Shimazu
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto 869-1106, Japan
| | - Ai Shiraishi
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto 869-1106, Japan
| | - Yoshifumi Kido
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto 869-1106, Japan
| | - Takahiro Bise
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto 869-1106, Japan
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Nagai T, Wakabayashi H, Nishioka S, Momosaki R. Functional prognosis in patients with sarcopenic dysphagia: An observational cohort study from the Japanese sarcopenic dysphagia database. Geriatr Gerontol Int 2022; 22:839-845. [PMID: 36054468 DOI: 10.1111/ggi.14466] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 07/16/2022] [Accepted: 08/02/2022] [Indexed: 01/22/2023]
Abstract
AIM In sarcopenic dysphagia, confirmation of recovery of the swallowing function and activity of daily living is insufficient. The aim of this study was to examine differences in the recovery of the swallowing function and activities of daily living between sarcopenic dysphagia patients and non-sarcopenic dysphagia patients. METHODS The registry data of the Japanese Sarcopenic Dysphagia Database were used for the analysis; 440 patients met the eligibility criteria of the study. Dysphagia was evaluated according to the Food Intake Level Scale and a five-step diagnostic algorithm for the disorder. Patients were divided into two groups according to the presence or absence of sarcopenic dysphagia. RESULTS Sarcopenic dysphagia was found in 268 cases (60.9%). The rate of improvement in the Food Intake Level Scale was 47.4% in sarcopenic dysphagia patients and 62.2% in non-sarcopenic dysphagia patients. The rate of improvement in the Food Intake Level Scale was lower in the sarcopenic dysphagia patients (P = 0.008). A multiple regression analysis showed that the presence of sarcopenic dysphagia had a significant influence on changes in the Food Intake Level Scale and Barthel Index (β = -0.191, 95% confidence interval, -1.484 to -0.530, P < 0.001, β = 0.112, 95% confidence interval, 0.587 to 10.450, P = 0.028). CONCLUSION Improvement in the swallowing function was poor in patients with sarcopenic dysphagia. Sarcopenic dysphagia should be examined to improve swallowing function. Geriatr Gerontol Int 2022; 22: 839-845.
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Affiliation(s)
- Takako Nagai
- Department of Rehabilitation Medicine, Nihon University Hospital, Tokyo, Japan
| | - Hidetaka Wakabayashi
- Department of Rehabilitation Medicine, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Shinta Nishioka
- Department of Clinical Nutrition and Food Services, Nagasaki Rehabilitation Hospital, Nagasaki, Japan
| | - Ryo Momosaki
- Department of Rehabilitation Medicine, Mie University Graduate School of Medicine, Tsu, Japan
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Affiliation(s)
- Hidetaka Wakabayashi
- Department of Rehabilitation Medicine Tokyo Women's Medical University Hospital Tokyo Japan
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Kose E, Yoshimura Y, Wakabayashi H, Matsumoto A. Use of antipsychotics is negatively associated with muscle strength in older adults with sarcopenia after stroke. J Stroke Cerebrovasc Dis 2022; 31:106587. [PMID: 35793581 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 05/20/2022] [Accepted: 05/29/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE The use of antipsychotics has been shown to affect activities of daily living during rehabilitation but reports regarding their effects on older patients with sarcopenia are insufficient. We aimed to examine the effect of the use of antipsychotics on muscle strength and muscle mass in older patients with sarcopenia undergoing convalescent rehabilitation after stroke. METHODS This retrospective cohort study was conducted at a rehabilitation hospital between 2015 and 2020. The study outcomes included skeletal muscle mass index and hand grip strength at discharge. Multivariate analyses were used to determine whether the use of antipsychotics at admission and at 4 weeks after admission were independently associated with the study outcomes, after adjusting for potential confounders. RESULTS Of the 619 stroke patients admitted, 196 (mean age 81 years; 44.4% men) had sarcopenia at admission and were included in the final analysis. The median hand grip strength and median skeletal muscle mass index values were 12.5 (5.9-17.9) kg and 5.1 (4.5-6.0) kg/m2, respectively. In the multivariate analyses, the use of antipsychotics at 4 weeks post-admission was independently associated with hand grip strength at discharge (β = -0.125, p = 0.008), which was not the case when used at admission. Furthermore, the use of antipsychotics at admission and at 4 weeks after admission were not significantly associated with the skeletal muscle mass index at discharge. CONCLUSIONS The use of antipsychotics in older patients with sarcopenia after stroke was negatively associated with handgrip strength at discharge.
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Affiliation(s)
- Eiji Kose
- Department of Pharmacy, Teikyo University School of Medicine University Hospital, Tokyo, Japan
| | - Yoshihiro Yoshimura
- Department of Rehabilitation Medicine, Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, 760 Magate, Kikuyo-Town, Kikuchi-County, Kumamoto 869-1106, Japan.
| | - Hidetaka Wakabayashi
- Department of Rehabilitation Medicine, Tokyo Women's Medical University Hospital, Japan
| | - Ayaka Matsumoto
- Department of Pharmacy, Kumamoto Rehabilitation Hospital, Kumamoto, Japan
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Kimura M, Naganuma A, Ogawa Y, Inagawa M, Nishioka S, Momosaki R, Wakabayashi H. Calf circumference and stroke are independent predictors for an improvement in the food intake level scale in the Japanese sarcopenic dysphagia database. Eur Geriatr Med 2022; 13:1211-1220. [PMID: 35612760 DOI: 10.1007/s41999-022-00651-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 04/15/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to use the food intake level scale (FILS) to clarify whether calf circumference (CC) and stroke contribute to an improvement of inpatient dysphagia. METHODS We used the Japanese sarcopenic dysphagia database (n = 467) to analyze FILS data recorded at admission and after follow-up in 322 cases. A multivariate analysis was performed to determine whether CC and stroke improved the FILS by two points or more. RESULTS The patient characteristics were as follows: 177 (55%) men; median age, 81 years; median body mass index, 20.3 kg/m2; median CC, 28.2 cm; presence of sarcopenic dysphagia, 183 (56.8%); history of stroke, 103 (32%); median FILS on admission (interquartile range (IQR)), 6 (2-7); and median FILS at the end of the observation (IQR), 7 (7-8). Comparison of FILS at admission and discharge showed that 137 patients had an improvement in the scale of two points or more, whereas 185 patients had no improvement. Multivariate logistic regression analysis showed the factors that were associated independently with an improvement in dysphagia were: age < 80 years (odds ratio (OR) 2.20, 95% confidence interval (CI) 1.36-3.54, p = 0.001); CC ≥ 29.4 cm (OR 2.19, 95% CI 1.33-3.61, p = 0.002); sex (OR 1.67, 95% CI 1.03-2.71, p = 0.037); and stroke (OR 1.85, 95% CI 1.09-3.16, p = 0.023). CONCLUSIONS Our results suggest that a CC ≥ 29.4 cm and history of stroke contributed to an improvement of inpatient dysphagia at discharge. The contribution of the easy-to-measure CC to predict an improvement in swallowing function may be very useful in daily clinical practice.
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Affiliation(s)
- Masanori Kimura
- Nutrition Support Team, National Hospital Organization Takasaki General Medical Center, Takasaki, Gunma, Japan
- Department of Oral and Maxillofacial Surgery, National Hospital Organization Takasaki General Medical Center, Takasaki, Gunma, Japan
| | - Atsushi Naganuma
- Nutrition Support Team, National Hospital Organization Takasaki General Medical Center, Takasaki, Gunma, Japan.
- Department of Gastroenterology, National Hospital Organization Takasaki General Medical Center, 36 Takamatsu-cho, Takasaki, Gunma, 370-0829, Japan.
| | - Yusuke Ogawa
- Nutrition Support Team, National Hospital Organization Takasaki General Medical Center, Takasaki, Gunma, Japan
| | - Motoaki Inagawa
- Nutrition Support Team, National Hospital Organization Takasaki General Medical Center, Takasaki, Gunma, Japan
- Department of Oral and Maxillofacial Surgery, National Hospital Organization Takasaki General Medical Center, Takasaki, Gunma, Japan
| | - Shinta Nishioka
- Department of Clinical Nutrition and Food Services, Nagasaki Rehabilitation Hospital, Nagasaki, Japan
| | - Ryo Momosaki
- Department of Rehabilitation Medicine, Mie University Graduate School of Medicine, Mie, Japan
| | - Hidetaka Wakabayashi
- Department of Rehabilitation Medicine, Tokyo Women's Medical University Hospital, Tokyo, Japan
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Tomohara-Ichishima H, Wakabayashi H, Maeda K, Nishioka S, Momosaki R. Relationship of body mass index on activities of daily living in hospitalized patients with chronic obstructive pulmonary disease. Respir Med Res 2022; 81:100899. [PMID: 35523042 DOI: 10.1016/j.resmer.2022.100899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 02/07/2022] [Accepted: 02/21/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Weight loss and low lean body mass in patients with chronic obstructive pulmonary disease (COPD) are associated with increased mortality; however, the association between body mass index (BMI) and physical ability remains undetermined. We aimed to investigate the effect of BMI on activities of daily living (ADL) in hospitalized patients with COPD. METHODS We used the Japan Medical Data Center's hospital-based database to extract data on hospitalized patients aged ≥ 20 years admitted for COPD between April 2014 and December 2018. The primary outcome was the presence or absence of deterioration in the Barthel Index score for ADLs at discharge compared with that at admission. Secondary outcomes were the length of hospital stay, readmission within 30 days, and the number of drugs administered on admission. RESULTS We identified 6529 patients with COPD from the Diagnosis Procedure Combination database, of which 3476 were analyzed (excluded: n = 5, ages < 20 years; n = 3048, missing entries). Barthel Index scores tended to decline in patients with BMI < 18.5 kg/m2 (odds ratio, OR: 2.030, p < 0.001) and Hugh-Jones grade 4 (OR: 1.79, p = 0.05) and grade 5 (OR: 2.15, p = 0.01), but not in the obese group (p = 0.598). The low-weight group had a significantly longer hospital stay (p < 0.001) at 14 (8-25) days with greater readmissions within 30 days (6.3%, p < 0.001). CONCLUSION Low BMI is associated with lower Barthel Index scores, longer hospital stays, requiring readmissions within 30 days of discharge.
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Affiliation(s)
- Hitomi Tomohara-Ichishima
- Department of Clinical Nutrition and Food Service, Saiseikai Otaru Hospital, 10-1 Thikkou, Otaru, Hokkaido 047-0008, Japan.
| | - Hidetaka Wakabayashi
- Department of Rehabilitation Medicine, Tokyo Women's Medical University Hospital, Japan
| | - Keisuke Maeda
- Department of Geriatric Medicine, National Center for Geriatrics and Gerontology, Japan
| | - Shinta Nishioka
- Department of Clinical Nutrition and Food Service, Nagasaki Rehabilitation Hospital, Japan
| | - Ryo Momosaki
- Department of Rehabilitation Medicine, Mie University Graduate School of Medicine, Japan
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Wakabayashi H, Kishima M, Itoda M, Fujishima I, Kunieda K, Ohno T, Shigematsu T, Oshima F, Mori T, Ogawa N, Nishioka S, Momosaki R, Yamada M, Ogawa S. Prevalence of Hoarseness and Its Association with Severity of Dysphagia in Patients with Sarcopenic Dysphagia. J Nutr Health Aging 2022; 26:266-271. [PMID: 35297470 PMCID: PMC8883003 DOI: 10.1007/s12603-022-1754-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 02/15/2022] [Indexed: 10/29/2022]
Abstract
OBJECTIVES To investigate the prevalence of hoarseness and its association with the severity of dysphagia in patients with sarcopenic dysphagia. DESIGN Cross-sectional study using the Japanese sarcopenic dysphagia database. SETTING 19 hospitals including 9 acute care hospitals, 8 rehabilitation hospitals, 2 long-term care hospitals, and 1 home visit rehabilitation team. PARTICIPANTS 287 patients with sarcopenic dysphagia, aged 20 years and older. MEASUREMENTS Sarcopenic dysphagia was diagnosed using a reliable and validated diagnostic algorithm for the condition. The presence and characteristics of hoarseness classified as breathy, rough, asthenic, and strained were assessed. The prevalence of hoarseness and the relationship between hoarseness and Food Intake LEVEL Scale (FILS) were examined. Order logistic regression analysis adjusted for age, sex, naso-gastric tube, and handgrip strength was used to examine the relationship between hoarseness and FILS at baseline and at follow-up. RESULTS The mean age was 83 ± 10 years. Seventy-four (26%) patients had hoarseness, while 32 (11%), 20 (7%), 22 (8%), and 0 (0%) patients had breathy, rough, asthenic, and strained hoarseness, respectively. Median FILS at the initial evaluation was 7 (interquartile range, 5-8). Hoarseness (β=0.747, 95% confidence intervals= 0.229, 1.265, p=0.005), age, sex, naso-gastric tube, and handgrip strength were associated independently with baseline FILS, while hoarseness (β=0.213, 95% confidence intervals= -0.324, 0.750, p=0.438) was not associated independently with the FILS at follow-up. CONCLUSIONS Hoarseness was associated with the severity of dysphagia at baseline, however not a prognostic factor for sarcopenic dysphagia. Resistance training of swallowing and respiratory muscles and voice training as part of rehabilitation nutrition might be useful for treating sarcopenic dysphagia.
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Affiliation(s)
- H Wakabayashi
- Hidetaka Wakabayashi, MD, PhD, Department of Rehabilitation Medicine, Tokyo Women's Medical University Hospital, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, Japan. Code; 162-0054, Tel: +81-3-3353-8111, Fax: +81-3-5269-7639, E-mail:
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Wakabayashi H, Maeda K, Momosaki R, Kokura Y, Yoshimura Y, Fujiwara D, Kosaka S, Suzuki N. Diagnostic reasoning in rehabilitation nutrition: Position paper by the Japanese Association of Rehabilitation Nutrition (secondary publication). J Gen Fam Med 2022; 23:205-216. [PMID: 35800646 PMCID: PMC9249927 DOI: 10.1002/jgf2.549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 04/12/2022] [Indexed: 11/16/2022] Open
Abstract
Diagnostic reasoning is the thought process used to arrive at a diagnosis based on symptoms, examination findings, and laboratory values. Diagnosis is categorized as nonanalytic reasoning (intuition) and analytic reasoning (analysis). Rehabilitation nutrition involves the diagnosis of nutritional disorders, sarcopenia, and excess or deficient nutrient intake. There is usually only one correct answer for the presence or absence of these. On the other hand, there may be no single correct answer for the causes of anorexia, weight loss, or sarcopenia, and analytical reasoning is required. In this case, diagnostic reasoning involves hypotheses. Simply using nutritional supplements without performing diagnostic reasoning about these causes is like prescribing antipyretic analgesics to a patient with a headache without diagnosing the cause of the headache. To maximize function and quality of life in rehabilitation nutrition, it is necessary to suspect the common causes of anorexia, weight loss, and sarcopenia in all cases.
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Affiliation(s)
- Hidetaka Wakabayashi
- Department of Rehabilitation Medicine Tokyo Women's Medical University Hospital Tokyo Japan
| | - Keisuke Maeda
- Department of Geriatric Medicine National Center for Geriatrics and Gerontology Obu Japan
| | - Ryo Momosaki
- Department of Rehabilitation Medicine Mie University Graduate School of Medicine Mie Japan
| | - Yoji Kokura
- Department of Nutritional Management Keiju Hatogaoka Integrated Facility for Medical and Long‐term Care Nanao Japan
| | - Yoshihiro Yoshimura
- Center for Sarcopenia and Malnutrition Research Kumamoto Rehabilitation Hospital Kumamoto Japan
| | - Dai Fujiwara
- Department of Rehabilitation Medicine Saka General Hospital Shiogama Japan
| | - Shintaro Kosaka
- Department of Internal Medicine Nerima Hikarigaoka Hospital Tokyo Japan
| | - Norio Suzuki
- Division of Cardiology, Department of Internal Medicine St. Marianna University School of Medicine Kawasaki Japan
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Inoue T, Takeuchi I, Iida Y, Takahashi K, Nagano F, Miyazaki S, Shirado K, Yoshimura Y, Momosaki R, Maeda K, Wakabayashi H. Disease-specific Nutritional Physical Therapy: A Position Paper by the Japanese Association of Rehabilitation Nutrition (Secondary Publication). JMA J 2022; 5:252-262. [PMID: 35611233 PMCID: PMC9090541 DOI: 10.31662/jmaj.2021-0202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 02/04/2022] [Indexed: 11/09/2022] Open
Abstract
Nutritional disorders diminish the effectiveness of physical therapy. The pathogenesis of nutritional disorders, such as sarcopenia, frailty, and cachexia, differs from disease to disease. Disease-specific nutrition can maximize the function, activity, participation, and quality of life for patients undergoing physical therapy, a practice known as nutritional physical therapy. Understanding and practicing disease-specific nutritional physical therapy is essential to meet patients' diverse needs and goals with any disease. Thus, the physical therapist division of the Japanese Association of Rehabilitation Nutrition, with advice from the Japanese Society of Nutrition and Swallowing Physical Therapy, developed this review. It discusses the impact of disease-specific nutritional physical therapy on sarcopenia and frailty in community-dwelling older adults, obesity and metabolic syndrome, critical illness, musculoskeletal diseases, stroke, respiratory diseases, cardiovascular diseases, diabetes, renal disease, cancer, and sports.
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Affiliation(s)
- Tatsuro Inoue
- Department of Physical Therapy, Niigata University of Health and Welfare, Niigata, Japan
| | - Izumi Takeuchi
- Department of Rehabilitation, Suizenji Tohya Hospital, Kumamoto, Japan
| | - Yuki Iida
- Department of Physical Therapy, Toyohashi SOZO University School of Health Sciences, Aichi, Japan
| | - Kohei Takahashi
- Department of Rehabilitation, Tamura Surgical Hospital, Kanagawa, Japan
| | - Fumihiko Nagano
- Department of Rehabilitation, Kumamoto Rehabilitation Hospital, Kumamoto, Japan
| | | | - Kengo Shirado
- Department of Rehabilitation, Iizuka Hospital, Fukuoka, Japan
| | - Yoshihiro Yoshimura
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto, Japan
| | - Ryo Momosaki
- Department of Rehabilitation Medicine, Mie University Graduate School of Medicine, Mie, Japan
| | - Keisuke Maeda
- Department of Geriatric Medicine, Hospital, National Center for Geriatrics and Gerontology, Aichi, Japan
| | - Hidetaka Wakabayashi
- Department of Rehabilitation Medicine, Tokyo Women's Medical University Graduate School of Medicine, Tokyo, Japan
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Yoshimura Y, Wakabayashi H, Nagano F, Bise T, Shimazu S, Shiraishi A, Kido Y, Matsumoto A. Chair-Stand Exercise Improves Sarcopenia in Rehabilitation Patients after Stroke. Nutrients 2022; 14:nu14030461. [PMID: 35276820 PMCID: PMC8840470 DOI: 10.3390/nu14030461] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 01/13/2022] [Accepted: 01/19/2022] [Indexed: 11/21/2022] Open
Abstract
Currently, there is a lack of evidence to show that exercise therapy improves sarcopenia in older patients in clinical practice. We therefore conducted a retrospective cohort study to clarify the effects of chair-stand exercise on improving sarcopenia among patients diagnosed with sarcopenia undergoing convalescent rehabilitation after stroke. According to the latest Asian criteria, sarcopenia was diagnosed when both skeletal muscle mass index (SMI) and handgrip strength (HGS) were low. Patients were asked to perform a repeated chair-stand exercise as whole-body resistance training, in addition to the rehabilitation program. Outcomes included sarcopenia rates, SMI, HGS, and physical function at hospital discharge. Multivariate analyses were used to examine whether the frequency of daily chair-stand exercise was independently associated with the outcomes after adjustment for potential confounders. After enrollment, 302 patients with sarcopenia (mean age: 78.6 years; 46.4% male) were analyzed. Overall, sarcopenia prevalence decreased by 21.9%, from 100% at admission to 78.1% at discharge. Multivariate analyses showed that the frequency of the exercise was significantly associated with the presence of sarcopenia (odds ratio: 0.986, p = 0.010), SMI (β = 0.181, p < 0.001), and HGS (β = 0.101, p = 0.032) at discharge, respectively. The chair-standing exercise was effective in improving sarcopenia in these patients.
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Affiliation(s)
- Yoshihiro Yoshimura
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto 869-1106, Japan; (F.N.); (T.B.); (S.S.); (A.S.); (Y.K.); (A.M.)
- Correspondence: ; Tel.: +81-96-232-3111
| | - Hidetaka Wakabayashi
- Department of Rehabilitation Medicine, Tokyo Women’s Medical University Hospital, Tokyo 162-8666, Japan;
| | - Fumihiko Nagano
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto 869-1106, Japan; (F.N.); (T.B.); (S.S.); (A.S.); (Y.K.); (A.M.)
| | - Takahiro Bise
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto 869-1106, Japan; (F.N.); (T.B.); (S.S.); (A.S.); (Y.K.); (A.M.)
| | - Sayuri Shimazu
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto 869-1106, Japan; (F.N.); (T.B.); (S.S.); (A.S.); (Y.K.); (A.M.)
| | - Ai Shiraishi
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto 869-1106, Japan; (F.N.); (T.B.); (S.S.); (A.S.); (Y.K.); (A.M.)
| | - Yoshifumi Kido
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto 869-1106, Japan; (F.N.); (T.B.); (S.S.); (A.S.); (Y.K.); (A.M.)
| | - Ayaka Matsumoto
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto 869-1106, Japan; (F.N.); (T.B.); (S.S.); (A.S.); (Y.K.); (A.M.)
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Matsumoto A, Yoshimura Y, Wakabayashi H, Kose E, Nagano F, Bise T, Kido Y, Shimazu S, Shiraishi A. Deprescribing Leads to Improved Energy Intake among Hospitalized Older Sarcopenic Adults with Polypharmacy after Stroke. Nutrients 2022; 14:nu14030443. [PMID: 35276802 PMCID: PMC8838977 DOI: 10.3390/nu14030443] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 01/14/2022] [Accepted: 01/16/2022] [Indexed: 12/15/2022] Open
Abstract
Evidence is scarce regarding the polypharmacy in patients with sarcopenia. The aim of this study was to investigate the effect of deprescribing for polypharmacy on the improvement of nutritional intake and sarcopenia in older patients with sarcopenia. A retrospective cohort study was conducted with hospitalized older patients with sarcopenia undergoing rehabilitation after stroke. Study outcomes included energy intake, protein intake, handgrip strength (HG) and skeletal muscle mass index (SMI) at hospital discharge. To consider the effects of deprescribing for polypharmacy, we used multivariate analyses to examine whether the change in the number of medications during hospitalization was associated with outcomes. Of 361 patients after enrollment, 91 (mean age 81.0 years, 48.4% male) presented with sarcopenia and polypharmacy and were eligible for analysis. The change in the number of medications was independently associated with energy intake (β = −0.237, p = 0.009) and protein intake (β = −0.242, p = 0.047) at discharge, and was not statistically significantly associated with HG (β = −0.018, p = 0.768) and SMI (β = 0.083, p = 0.265) at discharge, respectively. Deprescribing was associated with improved nutritional intake in older sarcopenic patients with polypharmacy undergoing stroke rehabilitation.
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Affiliation(s)
- Ayaka Matsumoto
- Department of Pharmacy, Kumamoto Rehabilitation Hospital, Kumamoto 869-1106, Japan;
| | - Yoshihiro Yoshimura
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto 869-1106, Japan
- Correspondence: ; Tel.: +81-96-232-3111
| | - Hidetaka Wakabayashi
- Department of Rehabilitation Medicine, Tokyo Women’s Medical University Hospital, Tokyo 162-8666, Japan;
| | - Eiji Kose
- Department of Pharmacy, Teikyo University School of Medicine University Hospital, Tokyo 173-8606, Japan;
| | - Fumihiko Nagano
- Department of Rehabilitation, Kumamoto Rehabilitation Hospital, Kumamoto 869-1106, Japan; (F.N.); (T.B.); (Y.K.)
| | - Takahiro Bise
- Department of Rehabilitation, Kumamoto Rehabilitation Hospital, Kumamoto 869-1106, Japan; (F.N.); (T.B.); (Y.K.)
| | - Yoshifumi Kido
- Department of Rehabilitation, Kumamoto Rehabilitation Hospital, Kumamoto 869-1106, Japan; (F.N.); (T.B.); (Y.K.)
| | - Sayuri Shimazu
- Department of Nutritional Management, Kumamoto Rehabilitation Hospital, Kumamoto 869-1106, Japan;
| | - Ai Shiraishi
- Department of Dental Office, Kumamoto Rehabilitation Hospital, Kumamoto 869-1106, Japan;
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Abstract
PURPOSE OF REVIEW We describe the recent advances in rehabilitation nutrition, which is especially important for disabled or frail older individuals. RECENT FINDINGS Recent evidence pertaining to rehabilitation nutrition conducted in rehabilitation wards and acute care hospitals has been accumulating. The combination of rehabilitation nutrition and rehabilitation pharmacotherapy is important for eliciting higher functions. The 2020 update of the clinical practice guidelines for rehabilitation nutrition provides a weak recommendation for enhanced nutritional care for patients with cerebrovascular disease, hip fracture, cancer, or acute illness who are undergoing rehabilitation. Rehabilitation nutritional care process and the International Classification of Functioning, Disability and Health-Dietetics are used to implement high-quality rehabilitation nutrition. Aggressive nutrition therapy incorporates the daily energy expenditure plus daily energy accumulation to increase body weight and muscle mass. Preventing and treating sarcopenic dysphagia should include iatrogenic sarcopenia prevention and aggressive nutrition therapy. The diagnosis criteria for respiratory sarcopenia and sarcopenic respiratory disability have been established. SUMMARY The International Association of Rehabilitation Nutrition and Total Nutrition Therapy Rehabilitation program may contribute to international expansion of rehabilitation nutrition. Improving evidence-practice gaps in rehabilitation nutrition and increasing national health insurance coverage of aggressive nutrition therapy and rehabilitation nutrition teams are warranted.
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Affiliation(s)
- Satoko Mizuno
- Department of Rehabilitation Medicine, Tokyo Women's Medical University Hospital, Tokyo, Japan
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Inoue T, Iida Y, Takahashi K, Shirado K, Nagano F, Miyazaki S, Takeuchi I, Yoshimura Y, Momosaki R, Maeda K, Wakabayashi H. Nutrition and Physical Therapy: A Position Paper by the Physical Therapist Section of the Japanese Association of Rehabilitation Nutrition (Secondary Publication). JMA J 2022; 5:243-251. [PMID: 35611222 PMCID: PMC9090552 DOI: 10.31662/jmaj.2021-0201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 01/17/2022] [Indexed: 11/09/2022] Open
Abstract
Several patients undergoing physical therapy have nutritional problems. Knowledge of nutrition is necessary for addressing nutritional problems, such as malnutrition, sarcopenia, frailty, and cachexia. However, the relationship between physical therapy and nutrition is not fully understood. Physical therapy plays an important role in nutritional management, and evaluations, such as muscle strength and muscle mass evaluations, play an important role in nutritional screening and diagnosis. Exercise, as the core of physical therapy, is essential for nutritional interventions. Several recent studies have suggested that a combination of nutrition and physical therapy interventions can maximize the function, activity, participation, and quality of life of patients. The combination of nutrition and physical therapy interventions is key to addressing the needs of modern and diverse populations. This position paper was developed by the Physical Therapist Section of the Japanese Association of Rehabilitation Nutrition in consultation with the Japanese Society of Nutrition and Swallowing Physical Therapy.
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Affiliation(s)
- Tatsuro Inoue
- Department of Physical Therapy, Niigata University of Health and Welfare, Niigata, Japan
| | - Yuki Iida
- Department of Physical Therapy, Toyohashi SOZO University School of Health Sciences, Aichi, Japan
| | - Kohei Takahashi
- Department of Rehabilitation, Tamura Surgical Hospital, Kanagawa, Japan
| | - Kengo Shirado
- Department of Rehabilitation, Iizuka Hospital, Fukuoka, Japan
| | - Fumihiko Nagano
- Department of Rehabilitation, Kumamoto Rehabilitation Hospital, Kumamoto, Japan
| | | | - Izumi Takeuchi
- Department of Rehabilitation, Suizenji Tohya Hospital, Kumamoto, Japan
| | - Yoshihiro Yoshimura
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto, Japan
| | - Ryo Momosaki
- Department of Rehabilitation Medicine, Mie University Graduate School of Medicine, Mie, Japan
| | - Keisuke Maeda
- Department of Geriatric Medicine, Hospital, National Center for Geriatrics and Gerontology, Aichi, Japan
| | - Hidetaka Wakabayashi
- Department of Rehabilitation Medicine, Tokyo Women's Medical University Graduate School of Medicine, Tokyo, Japan
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Bise T, Yoshimura Y, Wakabayashi H, Nagano F, Kido Y, Shimazu S, Shiraishi A, Matsumoto A. Association between BIA-derived Phase Angle and Sarcopenia and Improvement in Activities of Daily Living and Dysphagia in Patients undergoing Post-Stroke Rehabilitation. J Nutr Health Aging 2022; 26:590-597. [PMID: 35718868 DOI: 10.1007/s12603-022-1803-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVES To investigate the predictive value of the BIA-derived phase angle with respect to the functional prognosis and baseline sarcopenia in patients undergoing post-stroke rehabilitation. DESIGN Retrospective cohort study. SETTING AND PARTICIPANTS Overall, 577 Japanese patients admitted to a post-acute care hospital from 2016 to 2020 were recruited. MEASUREMENTS Body composition analysis, which included BIA-derived phase angle and skeletal muscle mass, was performed using bioelectrical impedance analysis (BIA). Study outcomes included physical function assessed using the Functional Independence Measure (FIM-motor) and the level of dysphagia assessed using the Food Intake LEVEL Scale (FILS). Sarcopenia was defined as the loss of skeletal muscle mass and decreased muscle strength. Receiver operating characteristic curves were used to calculate the optimal cutoff value of BIA-derived phase angle to diagnose sarcopenia. Multivariate analyses were used to determine whether the BIA-derived phase angle at admission was associated with outcomes at discharge and baseline sarcopenia. RESULTS After enrollment, 499 patients (mean age: 74.0 ± 13.1 years; 52.0% men) were examined. The median FIM-motor and FILS scores at admission were 47 (20-69) and 8 (7-10), respectively. Sarcopenia was observed in 43.2% of patients. After adjusting for potential confounders, BIA-derived phase angle was positively associated with FIM-motor scores at discharge (β = 0.134, P < 0.001), FIM-motor score gain (β = 2.504, P < 0.001), and FILS scores at discharge (β = 0.120, P = 0.039). BIA-derived phase angle was negatively associated with the sarcopenia diagnosis at baseline (odds ratio = -0.409, P < 0.001); its cutoff value was 4.76° (sensitivity 0.800, specificity 0.790, P < 0.001) for sarcopenia diagnosis in men and 4.11° (sensitivity 0.735, specificity 0.829, P < 0.001) in women. CONCLUSION BIA-derived phase angle was positively associated with the recovery of physical function and dysphagia level and negatively associated with baseline sarcopenia in patients undergoing post-stroke rehabilitation. The BIA-derived phase angle cutoff for sarcopenia diagnosis was 4.76° for men and 4.11° for women.
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Affiliation(s)
- T Bise
- Yoshihiro Yoshimura, Kumamoto Rehabilitation Hospital, Kikuchi, Kumamoto, Japan,
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Mori T, Wakabayashi H, Kishima M, Itoda M, Fujishima I, Kunieda K, Ohno T, Shigematsu T, Oshima F, Ogawa N, Nishioka S, Momosaki R, Shimizu A, Saito Y, Yamada M, Ogawa S. Association between Inflammation and Functional Outcome in Patients with Sarcopenic Dysphagia. J Nutr Health Aging 2022; 26:400-406. [PMID: 35450997 DOI: 10.1007/s12603-022-1769-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES This study aimed to investigate whether inflammation affects the outcome of swallowing ability to improve treatment for sarcopenic dysphagia. DESIGN A retrospective observational cohort study was performed using data from the Japanese sarcopenic dysphagia database. SETTING The database was constructed using data from 19 hospitals and one home visiting rehabilitation team. PARTICIPANTS Patients with sarcopenic dysphagia with measurements of C-reactive protein (CRP) and serum albumin (Alb) were included. MEASUREMENTS Patients were assigned to two groups using CRP, Alb, and the Japanese modified Glasgow Prognostic Score (mGPS). The Food Intake LEVEL Scale (FILS) was measured at the times of admission and follow-up (FILS follow-up) to assess swallowing function. RESULTS A total of 197 patients were included. Mean or median values of each parameter were as follows: age: 83.8±8.7, Alb: 3.2 ± 0.6 g/dL, CRP: 8.0 [3.0, 29.0] mg/L, mGPS: 1 [1-2], FILS: 7 [6-8], FILS follow-up: 8 [7-8], and duration of follow-up: 57.0 [27.0, 85.0] days. The FILS score at follow-up was significantly lower in the high CRP group (≥ 5.0 mg/L) than in the low CRP group (< 5.0 mg/L) (p = 0.01). Further, the FILS score at follow-up was significantly lower in the high mGPS group (class; 2) than in the low mGPS group (class; 0 and 1) (p = 0.03). In the multiple linear regression analyses without FILS at baseline, CRP and mGPS were independent risk factors for FILS follow-up. When FILS at baseline was entered, CRP and mGPS were not an independent risk factors for FILS follow-up. CONCLUSIONS Inflammation could modify the outcome of the patients with sarcopenic dysphagia. Inflammation may be an important risk factor in evaluating patients with sarcopenic dysphagia.
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Affiliation(s)
- T Mori
- Hidetaka Wakabayashi, MD, PhD, Department of Rehabilitation Medicine, Tokyo Women's Medical University Hospital, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, Japan. Code; 162-0054, Tel: +81-3-3353-8111, Fax: +81-3-5269-7639, E-mail:
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