Skip to main content

Advertisement

SpringerLink
Log in

A Significant Association of Malnutrition with Dysphagia in Acute Patients

  • Original Article
  • Published:
Dysphagia Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. United Nations, Department of Economic and Social Affairs, Population Division. World population prospects: the 2015 revision, key findings and advance. 2015.

  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. Martino R, Foley N, Bhogal S, et al. Dysphagia after stroke: incidence, diagnosis, and pulmonary complications. Stroke. 2005;36:2756–63.

    Article  PubMed  Google Scholar 

  4. Pirlich M, Schütz T, Norman K, et al. The German hospital malnutrition study. Clin Nutr. 2006;25:563–72.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    Article  Google Scholar 

  10. Horner J, Massey EW. Silent aspiration following stroke. Neurology. 1998;38:317–9.

    Article  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  12. Ramsey D, Smithard DG, Kalra L. Early assessment of dysphagia and aspiration risk in acute stroke patients. Stroke. 2003;34:1252–7.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    PubMed Central  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Tutor JD, Srinivasan S, Gosa MM, et al. Pulmonary function in infants with swallowing dysfunction. PLoS ONE. 2015;10:e0123125.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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. 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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  27. Kuzuya M, Kanda S, Koike T, et al. Evaluation of mini-nutritional assessment for Japanese frail elderly. Nutrition. 2005;21:498–503.

    Article  PubMed  Google Scholar 

  28. Kidd D, Lawson J, Nesbitt R, et al. Aspiration in acute stroke: a clinical study with videofluoroscopy. QJM. 1993;86:825–9.

    CAS  PubMed  Google Scholar 

  29. Gates J, Hartnell GG, Gramigna GD. Videofluoroscopy and swallowing studies for neurologic disease: a primer. Radiographics. 2005;26:e22.

    Article  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  31. Rosenbek JC, Robbins JA, Roecker EB, et al. A penetration-aspiration scale. Dysphagia. 1996;11:93–8.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  34. Veldee MS, Peth LD. Can protein-calorie malnutrition cause dysphagia? Dysphagia. 1992;7:86–101.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Kumar A, Ghai OP, Singh N. Delayed nerve conduction velocities in children with protein-calorie malnutrition. J Pediatr. 1977;90:149–53.

    Article  CAS  PubMed  Google Scholar 

  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. Wurtman RJ, Fernstrom JD. Control of brain neurotransmitter synthesis by precursor availability and nutritional state. Biochem Pharmacol. 1976;25:1691–6.

    Article  CAS  PubMed  Google Scholar 

  40. Kessler JP, Jean A. Inhibitory influence of monoamines and brainstem monoaminergic regions of the medullary swallowing reflex. Neurochi Lett. 1986;65:41–6.

    Article  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  42. Sura L, Madhavan A, Carnaby G, et al. Dysphagia in the elderly: management and nutritional considerations. Clin Interv Aging. 2012;7:287–98.

    PubMed  PubMed Central  Google Scholar 

  43. Ney DM, Weiss JM, Kind AJ, et al. Senescent swallowing: impact, strategies, and interventions. Nutr Clin Pract. 2009;24:395–413.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    Article  Google Scholar 

  45. Wysokiński A, Sobów T, Kłoszewska I, Kostka T. Mechanisms of the anorexia of aging-a review. Age. 2015;37:81.

    Article  PubMed Central  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  47. Ballmer PE. Causes and mechanisms of hypoalbuminemia. Clin Nutr. 2001;20:271–3.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    PubMed  Google Scholar 

  50. Garrow J. Starvation in hospital. BMJ. 1994;308:934.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  51. Gariballa SE, Parker SG, Taub N, et al. Nutritional status of hospitalized acute stroke patients. Br J Nutr. 1998;79:481–7.

    Article  CAS  PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  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. 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.

    Article  CAS  PubMed  Google Scholar 

  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. 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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  60. Davies M. Nutritional screening and assessment in cancer-associated malnutrition. Eur J Oncol Nurs. 2005;9:S64–73.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

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

Author information

Authors and Affiliations

  1. Department of Physical Medicine and Rehabilitation, Asahikawa Medical University Hospital, Midorigaoka Higashi 2-1-1-1, Asahikawa, Hokkaido, 078-8510, Japan

    Tsukasa Saito, Keisuke Hayashi, Hajime Nakazawa, Fumika Yagihashi, Leo O. Oikawa & Tetsuo Ota

  2. Department of Internal Medicine, Cardiovascular, Respiratory and Neurology Division, Asahikawa Medical University, Asahikawa, Japan

    Tsukasa Saito

Authors
  1. Tsukasa Saito
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Keisuke Hayashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hajime Nakazawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Fumika Yagihashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Leo O. Oikawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Tetsuo Ota
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tsukasa Saito.

Ethics declarations

Conflict of interest

All authors declared that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Saito, T., Hayashi, K., Nakazawa, H. et al. A Significant Association of Malnutrition with Dysphagia in Acute Patients. Dysphagia 33, 258–265 (2018). https://doi.org/10.1007/s00455-017-9855-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00455-017-9855-6

Keywords

Search

Navigation