Advertisement

Dysphagia

, Volume 33, Issue 2, pp 258–265 | Cite as

A Significant Association of Malnutrition with Dysphagia in Acute Patients

  • Tsukasa Saito
  • Keisuke Hayashi
  • Hajime Nakazawa
  • Fumika Yagihashi
  • Leo O. Oikawa
  • Tetsuo Ota
Original Article

Abstract

Dysphagia and malnutrition seem to be associated, but little research in detail has been reported. We aimed to clarify the association between dysphagia and malnutrition by adopting accurate diagnosis and mathematical evaluation of dysphagia using videofluorography and nutritional assessment calculated by a well-established nutritional risk index. We conducted a retrospective analysis of 165 enrolled patients who were admitted to our hospital for acute diseases and underwent videofluorography on suspicion of dysphagia in the year 2016. We diagnosed high-risk dysphagia in patients with 8-point penetration–aspiration scale (PAS) score over 4. We used the geriatric nutritional risk index (GNRI) as a nutritional assessment tool. A GNRI score less than 91.2 corresponds to malnutrition. The median age of 165 enrolled patients was 76.0, and the number of female patients was 53. The mean GNRI was 81.2, and 134 patients (81.2%) had malnutrition. The number of the patients with a diagnosis of high-risk dysphagia was 54 (32.7%). The GNRI of patients with high-risk dysphagia was significantly less than that of patients without (mean value 77.7 ± 10.5 vs. 83.0 ± 10.5, P = 0.003). GNRI < 91.2 was independently and significantly associated with high-risk dysphagia (OR 3.094; CI 1.057–9.058; P = 0.039). Based on the current study, the authors propose evaluating nutritional status to predict dysphagia risk of patients in the acute phase.

Keywords

Malnutrition Deglutition Deglutition disorders Dysphagia GNRI Elderly 

Notes

Acknowledgements

We thank Mayumi Ito, nurse in our department, for her excellent management and assistance in VF.

Compliance with Ethical Standards

Conflict of interest

All authors declared that they have no conflict of interest.

References

  1. 1.
    United Nations, Department of Economic and Social Affairs, Population Division. World population prospects: the 2015 revision, key findings and advance. 2015.Google Scholar
  2. 2.
    Dziewas R, Beck AM, Clave P, et al. Recognizing the importance of dysphagia: stumbling blocks and stepping stones in the twenty-first century. Dyspagia. 2016;. doi: 10.1007/s00455-016-9746-2.Google Scholar
  3. 3.
    Martino R, Foley N, Bhogal S, et al. Dysphagia after stroke: incidence, diagnosis, and pulmonary complications. Stroke. 2005;36:2756–63.CrossRefPubMedGoogle Scholar
  4. 4.
    Pirlich M, Schütz T, Norman K, et al. The German hospital malnutrition study. Clin Nutr. 2006;25:563–72.CrossRefPubMedGoogle Scholar
  5. 5.
    Correia MI, Waitzberg DL. The impact of malnutrition on morbidity, mortality, length of hospital stay and costs evaluated through a multivariate model analysis. Clin Nutr. 2003;22:235–9.CrossRefPubMedGoogle Scholar
  6. 6.
    Carrión S, Cabré S, Monteis R, et al. Oropharyngeal dysphagia is a prevalent risk factor for malnutrition in a cohort of older patients admitted with an acute disease to a general hospital. Clin Nutr. 2015;34:436–42.CrossRefPubMedGoogle Scholar
  7. 7.
    Serra-Prat M, Hinojosa G, López D, et al. Prevalence of oropharyngeal dysphagia and impaired safety and efficacy of swallow in independently living older persons. J Am Geriatr Soc. 2011;59:186–7.CrossRefPubMedGoogle Scholar
  8. 8.
    Nishioka S, Okamoto T, Takayama M, et al. Malnutrition risk predicts recovery of full oral intake among older adult stroke patients undergoing enteral nutrition: secondary analysis of a multicentre survey (the APPLE study). Clin Nutr. 2016;. doi: 10.1016/j.cinu2016.06.028.PubMedGoogle Scholar
  9. 9.
    Kaiser MJ, Bauer JM, Rämsch C, et al. Mini nutritional assessment international group. Frequency of malnutrition in older adults: a multinational perspective using the mini nutritional assessment. J Am Geriatr Soc. 2010;58:578–83.CrossRefGoogle Scholar
  10. 10.
    Horner J, Massey EW. Silent aspiration following stroke. Neurology. 1998;38:317–9.CrossRefGoogle Scholar
  11. 11.
    Smith HA, Lee SH, O’Neill PA, et al. The combination of bedside swallowing assessment and oxygen saturation monitoring of swallowing in acute stroke: a safe and humane screening tool. Age Ageing. 2000;29:495–9.CrossRefPubMedGoogle Scholar
  12. 12.
    Ramsey D, Smithard DG, Kalra L. Early assessment of dysphagia and aspiration risk in acute stroke patients. Stroke. 2003;34:1252–7.CrossRefPubMedGoogle Scholar
  13. 13.
    Takeuchi K, Aida J, Furuta M, et al. Nutritional status and dysphagia risk among community-dwelling frail older adults. J Nutr Health Aging. 2014;18:352–7.CrossRefPubMedGoogle Scholar
  14. 14.
    Kawashima K, Motohashi Y, Fujishima I. Prevalence of dysphagia among community-dwelling elderly individuals as estimated using a questionnaire for dysphagia screening. Dysphagia. 2004;19:266–71.CrossRefPubMedGoogle Scholar
  15. 15.
    Steele CM, Grace-Martin K. Reflections on clinical and statistical use of the penetration-aspiration scale. Dysphagia. 2017;. doi: 10.1007/s00455-017-9809-z.PubMedCentralGoogle Scholar
  16. 16.
    Moon JH, Jung JH, Won YS, et al. Effects of expiratory muscle strength training on swallowing function in acute stroke patients with dysphagia. J Phys Ther Sci. 2017;29:609–12.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Tabor L, Gaziano J, Watts S, et al. Defining swallowing-related quality of life profiles in individuals with amyotrophic lateral sclerosis. Dysphagia. 2016;31:376–82.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Lee JH, Lee KW, Kim SB, et al. The functional dysphagia scale is a useful tool for predicting aspiration pneumonia in patients with Parkinson disease. Ann Rehabil Med. 2016;40:440–6.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Tutor JD, Srinivasan S, Gosa MM, et al. Pulmonary function in infants with swallowing dysfunction. PLoS ONE. 2015;10:e0123125.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Krisciunas GP, Castellano K, McCulloch TM, et al. Impact of compliance on dysphagia rehabilitation in head and neck cancer patients: results from a multi-center clinical trial. Dysphagia. 2017;32:327–36.CrossRefPubMedGoogle Scholar
  21. 21.
    The Veterans Affairs Total Parenteral Nutrition Cooperative Study Group. Perioperative total parenteral nutrition in surgical patients. N Engl J Med. 1991;47:366–81.Google Scholar
  22. 22.
    Buzby GP, Knox LS, Crosby LO, et al. Study protocol: a randomized clinical trial of total parenteral nutrition in malnourished surgical patients. Am J Clin Nutr. 1988;47:366–81.CrossRefPubMedGoogle Scholar
  23. 23.
    Bouillanne O, Morineau G, Dupont C, et al. Geriatric nutritional risk index: a new index for evaluating at-risk elderly medical patients. Am J Clin Nutr. 2005;82:277–83.CrossRefGoogle Scholar
  24. 24.
    Yamada K, Furuya R, Takita T, et al. Simplified nutritional screening tools for patients on maintenance hemodialysis. Am J Clin Nutr. 2008;87:106–13.CrossRefPubMedGoogle Scholar
  25. 25.
    Cereda E, Pedrolli C. The use of the geriatric nutritional risk index (GNRI) as a simplified nutritional screening tool. Am J Clin Nutr. 2008;87:1966–7.CrossRefPubMedGoogle Scholar
  26. 26.
    James WP, Francois PJ. The choice of cut-off point for distinguishing normal body weights from underweight or ‘chronic energy deficiency’ in adults. Eur J Clin Nutr. 1994;48:S179.PubMedGoogle Scholar
  27. 27.
    Kuzuya M, Kanda S, Koike T, et al. Evaluation of mini-nutritional assessment for Japanese frail elderly. Nutrition. 2005;21:498–503.CrossRefPubMedGoogle Scholar
  28. 28.
    Kidd D, Lawson J, Nesbitt R, et al. Aspiration in acute stroke: a clinical study with videofluoroscopy. QJM. 1993;86:825–9.PubMedGoogle Scholar
  29. 29.
    Gates J, Hartnell GG, Gramigna GD. Videofluoroscopy and swallowing studies for neurologic disease: a primer. Radiographics. 2005;26:e22.CrossRefGoogle Scholar
  30. 30.
    Splaingard ML, Hutchins B, Sulton LD, et al. Aspirations in rehabilitation patients: videofluoroscopy vs. bedside clinical assessment. Arch Phys Med Rehabil. 1988;69:637–40.PubMedGoogle Scholar
  31. 31.
    Rosenbek JC, Robbins JA, Roecker EB, et al. A penetration-aspiration scale. Dysphagia. 1996;11:93–8.CrossRefPubMedGoogle Scholar
  32. 32.
    Robbins J, Coyle J, Rosenbek J, et al. Differentiation of normal and abnormal airway protection during swallowing using the penetration-aspiration scale. Dysphagia. 1999;14:228–32.CrossRefPubMedGoogle Scholar
  33. 33.
    Yoshikawa M, Yoshida M, Nagasaki T, et al. Aspects of swallowing in healthy dentate elderly persons older than 80 years. J Gerontol A Biol Sci Med Sci. 2005;60:506–9.CrossRefPubMedGoogle Scholar
  34. 34.
    Veldee MS, Peth LD. Can protein-calorie malnutrition cause dysphagia? Dysphagia. 1992;7:86–101.CrossRefPubMedGoogle Scholar
  35. 35.
    Saito T, Hayashi K, Nakazawa H, et al. Clinical characteristics and lesions responsible for swallowing hesitation after acute cerebral infarction. Dysphagia. 2016;31:567–73.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Ghosh S, Vaid K, Mohan M, et al. Effect of degree and duration of protein-calorie malnutrition and well nourished children. J Neurol Neurosurg Psychiatry. 1979;42:760–3.CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Kumar A, Ghai OP, Singh N. Delayed nerve conduction velocities in children with protein-calorie malnutrition. J Pediatr. 1977;90:149–53.CrossRefPubMedGoogle Scholar
  38. 38.
    Keys A, Brozek J, Henschel A, et al. The biology of human starvation, vol. 1. Minneapolis: University of Minnesota Press; 1950. p. 184–208.Google Scholar
  39. 39.
    Wurtman RJ, Fernstrom JD. Control of brain neurotransmitter synthesis by precursor availability and nutritional state. Biochem Pharmacol. 1976;25:1691–6.CrossRefPubMedGoogle Scholar
  40. 40.
    Kessler JP, Jean A. Inhibitory influence of monoamines and brainstem monoaminergic regions of the medullary swallowing reflex. Neurochi Lett. 1986;65:41–6.CrossRefGoogle Scholar
  41. 41.
    Leslie P, Drinnan MJ, Ford GA, et al. Swallow respiratory patterns and aging: presbyphagia or dysphagia? J Gerontol A Biol Sci Med Sci. 2005;60:391–5.CrossRefPubMedGoogle Scholar
  42. 42.
    Sura L, Madhavan A, Carnaby G, et al. Dysphagia in the elderly: management and nutritional considerations. Clin Interv Aging. 2012;7:287–98.PubMedPubMedCentralGoogle Scholar
  43. 43.
    Ney DM, Weiss JM, Kind AJ, et al. Senescent swallowing: impact, strategies, and interventions. Nutr Clin Pract. 2009;24:395–413.CrossRefPubMedPubMedCentralGoogle Scholar
  44. 44.
    Moreira NC, Krausch-Hofmann S, Matthys C, et al. Risk factors for malnutrition in older adults: a systematic review of the literature based on longitudinal data. Adv Nutr. 2016;16:507–22.CrossRefGoogle Scholar
  45. 45.
    Wysokiński A, Sobów T, Kłoszewska I, Kostka T. Mechanisms of the anorexia of aging-a review. Age. 2015;37:81.CrossRefPubMedCentralGoogle Scholar
  46. 46.
    Takata Y, Ansai T, Soh I, et al. Body mass index and disease-specific mortality in an 80-year-old population at the 12-year follow-up. Arch Gerontol Geriatr. 2013;57:46–53.CrossRefPubMedGoogle Scholar
  47. 47.
    Ballmer PE. Causes and mechanisms of hypoalbuminemia. Clin Nutr. 2001;20:271–3.CrossRefPubMedGoogle Scholar
  48. 48.
    Jones CH, Smye SW, Newstead CG, et al. Extracellular fluid volume determined by bioelectric impedance and serum albumin in CAPD patients. Nephrol Dial Transpl. 1998;13:393–7.CrossRefGoogle Scholar
  49. 49.
    Carrión S, Roca M, Costa A, et al. Nutritional status of older patients with oropharyngeal dysphagia in a chronic versus an acute clinical situation. Clin Nutr. 2016;. doi: 10.1016/j.clnu.2016.07.009.PubMedGoogle Scholar
  50. 50.
    Garrow J. Starvation in hospital. BMJ. 1994;308:934.CrossRefPubMedPubMedCentralGoogle Scholar
  51. 51.
    Gariballa SE, Parker SG, Taub N, et al. Nutritional status of hospitalized acute stroke patients. Br J Nutr. 1998;79:481–7.CrossRefPubMedGoogle Scholar
  52. 52.
    Yoo SH, Kim JS, Kwon SU, et al. Undernutrition as a predictor of poor clinical outcomes in acute ischemic stroke patients. Arch Neurol. 2008;65:39–43.PubMedGoogle Scholar
  53. 53.
    Gyan E, Raynard B, Durand JP, et al. NutriCancer2012 Investigator Group. Malnutrition in patients with cancer. JPEN J Parenter Enteral Nutr. 2017;1:148607116688881. doi: 10.1177/0148607116688881.Google Scholar
  54. 54.
    Saitoh M, Dos Santos MR, Ebner N, et al. Nutritional status and its effects on muscle wasting in patients with chronic heart failure: insights from studies investigating co-morbidities aggravating heart failure. Wien Klin Wochenschr. 2016;128:497–504.CrossRefPubMedGoogle Scholar
  55. 55.
    Collins PF, Eila M, Kurukulaaratchy RJ, et al. The influence of deprivation on malnutrition risk in outpatients with chronic obstructive pulmonary disease (COPD). Clin Nutr. 2016;. doi: 10.1016/j.clnu.2016.11.005.Google Scholar
  56. 56.
    Gonzalez Lindh M, Blom Johansson M, Jennische M, et al. Prevalence of swallowing dysfunction screened in Swedish cohort of COPD patients. Int J Obstruct Pulmon Dis. 2017;12:331–7.CrossRefGoogle Scholar
  57. 57.
    Pikus L, Levine MS, Yang YX, et al. Videofluoroscopic studies of swallowing dysfunction and the relative risk of pneumonia. Am J Roentgenol. 2003;180:1613–6.CrossRefGoogle Scholar
  58. 58.
    Ribeiro PW, Cola PC, Gatto AR, et al. Relationship between dysphagia, national institutes of health stroke scale score, and predictors of pneumonia after ischemic stroke. J Stroke Cerebrovasc Dis. 2015;24:2088–94.CrossRefPubMedGoogle Scholar
  59. 59.
    Nii M, Maeda K, Wakabahashi H, et al. Nutritional improvement and energy intake are associated with functional recovery in patients after cerebrovascular disorders. J Stroke Cerebrovasc Dis. 2016;25:57–62.CrossRefPubMedGoogle Scholar
  60. 60.
    Davies M. Nutritional screening and assessment in cancer-associated malnutrition. Eur J Oncol Nurs. 2005;9:S64–73.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  1. 1.Department of Physical Medicine and RehabilitationAsahikawa Medical University HospitalAsahikawaJapan
  2. 2.Department of Internal Medicine, Cardiovascular, Respiratory and Neurology DivisionAsahikawa Medical UniversityAsahikawaJapan

Personalised recommendations