Search

Objectives: According to the recently proposed diagnostic criteria for sarcopenic dysphagia, sarcopenic dysphagia can be classified as probable or possible based on tongue pressure. However, it is unclear whether patients with probable and possible sarcopenic dysphagia have different characteristics. Therefore, this study aimed to investigate whether patients with possible and probable sarcopenic dysphagia have different clinical characteristics. Design: A cross-sectional study. Setting: A rehabilitation hospital. PARTICIPANTS: In total, 129 patients aged ≥65 years with sarcopenic dysphagia were included. Methods: A tongue pressure of <20 kPa was indicative of probable sarcopenic dysphagia, and a tongue pressure of ≥20 kPa was indicative of possible sarcopenic dysphagia. Kuchi-Kara Taberu (KT) index scores were compared between the probable or possible sarcopenic dysphagia groups. Results: According to the tongue pressure, 76 and 53 patients were classified into the probable and possible sarcopenic dysphagia groups, respectively. In multiple linear regression analysis, the presence of probable sarcopenic dysphagia was independently associated with the total KT index score (standardized coefficient: −0.313, regression coefficient: −4.500, 95% confidence interval [CI], −6.920 to −2.080, P < 0.001). The presence of probable sarcopenic dysphagia was independently associated with some subitems of the KT index (willingness to eat, cognitive function while eating, oral preparatory and propulsive phase, severity of pharyngeal dysphagia, eating behavior, and daily living activities). Conclusions: Patients with probable sarcopenic dysphagia were characterized by poor overall eating-related conditions, especially poor swallowing ability, ability to perform activities of daily living, and nutritional status. [ABSTRACT FROM AUTHOR]

Background: Malnutrition may worsen clinical outcomes in stroke patients. Few malnutrition screening tools have been validated in the rehabilitation setting. The present study aimed to assess the concurrent and predictive validity of two malnutrition screening tools. Methods: We retrospectively collected scores for the Mini Nutritional Assessment Short‐Form (MNA‐SF) and the Geriatric Nutritional Risk Index (GNRI) in consecutive stroke patients aged ≥65 years in a rehabilitation hospital. Concurrent validity was confirmed against the European Society for Clinical Nutrition and Metabolism diagnostic criteria for malnutrition (ESPEN‐DCM). Malnutrition risk within the ESPEN‐DCM process was assessed using the Malnutrition Universal Screening Tool. Cut‐off values with maximum Youden index, and with sensitivity (Se) >90% and specificity (Sp) >50%, were defined as appropriate for identification and screening of malnutrition, respectively. The Functional Independence Measure and discharge destination were used to explore predictive validity. Results: Overall, 420 patients were analysed. Of these, we included 125 patients in the malnutrition group and 295 in the non‐malnutrition group based on the ESPEN‐DCM. Cut‐off values for the identification and screening of malnutrition were 5 (Se: 0.78; Sp: 0.85) and 7 (Se: 0.96; Sp: 0.57) for the MNA‐SF; 92 (Se: 0.74; Sp: 0.84) and 98 (Se: 0.93; Sp: 0.50) for the GNRI, respectively. The GNRI predicted discharge to acute care hospital, whereas the MNA‐SF did not predict all outcome measures. Conclusions: The MNA‐SF and the GNRI have a fair concurrent validity in stroke patients, although lower cut‐off values than currently used were required for the MNA‐SF. The GNRI exhibits good predictive validity for discharge destination. [ABSTRACT FROM AUTHOR]

A new method for the synthesis of tartary buckwheat protein (TBP) and its effect on the cholesterol metabolism in rats and mice fed cholesterol-enriched diet are studied. The analysis reveals that TBP can be used as a potential source of functional food ingredients.

This study was conducted to investigate the effects of a buckwheat protein product (BWP) on plasma cholesterol, gallbladder bile composition and fecal steroid excretion in hamsters fed diets with 5 g/kg cholesterol. Diets also contained 200 g/kg of casein, soy protein isolate (SPI) or BWP as protein sources. After 2 wk, plasma and liver concentrations of cholesterol in the hamsters fed BWP were significantly lower than those in the hamsters fed casein and SPI. The molar proportion of cholesterol in gallbladder bile was significantly lower in the BWP group than in the other groups, whereas that of bile acids was slightly higher in the BWP group (P

Background: Simple, noninvasive, and repeatable screening methods are essential for assessing swallowing disorders. We focused on patients with acute stroke and aimed to assess the characteristics of swallowing screening tests, including the modified Mann Assessment of Swallowing Ability score, tongue pressure, and repetitive saliva swallowing test (RSST), compared with detailed videofluoroscopic swallowing study (VFSS) findings to contribute as a helpful resource for their comprehensive and complementary use., Methods and Results: We enrolled first-ever patients with acute stroke conducting simultaneous assessments, including VFSS, modified Mann Assessment of Swallowing Ability score, tongue pressure measurement, and RSST. VFSS assessed aspiration, laryngeal penetration, oral cavity residue, vallecular residue, pharyngeal residue, and swallowing reflex delay. Screening tests were compared with VFSS findings, and multiple logistic analysis determined variable importance. Cutoff values for each abnormal VFSS finding were assessed using receiver operating characteristic analyses. We evaluated 346 patients (70.5±12.6 years of age, 143 women). The modified Mann Assessment of Swallowing Ability score was significantly associated with all findings except aspiration. Tongue pressure was significantly associated with oral cavity and pharyngeal residue. The RSST was significantly associated with all findings except oral cavity residue. Receiver operating characteristic analyses revealed that the minimum cutoff value for all VFSS abnormal findings was RSST ≤2., Conclusions: The modified Mann Assessment of Swallowing Ability is useful for broadly detecting swallowing disorders but may miss mild issues and aspiration. The RSST, with a score of ≤2, is valuable for indicating abnormal VFSS findings. Tongue pressure, especially in oral and pharyngeal residues, is useful. Combining these tests might enhance accuracy of the swallowing evaluation.

Purpose: This study investigated the factors associated with oral frailty among community-dwelling older adults. In particular, we compared the factors between individuals in the young-old and old-old groups and clarified the differences between the two groups., Methods: We measured the basic attributes, body composition, grip strength, gait function, oral function, cognitive function, and daily living function using the Kihon checklist in older people living independently in T City, Aichi Prefecture. The risk of oral frailty was assessed using the Oral Frailty Screening and Evaluation Form (OFI-8), and the measurement results were compared between two groups: those with and those without risk. To identify the factors associated with oral frailty, we performed a multivariate analysis with the risk of oral frailty as the dependent variable and a univariate analysis separately for the young-old and old-old groups., Results: The mean age of the 100 subjects was 76.6±4.6 years old. Forty-four subjects were at risk of oral frailty, and 55 subjects were not at risk. The high-risk group had significantly higher rates of polypharmacy, depression, and a slow walking speed than the no-risk group. The risk factors associated with oral frailty were living alone, polypharmacy, and depression. The risk factors for oral frailty were a poor ambulatory function in the young-old and a poor ambulatory function, decline in the cognitive function, and depression in the old-old., Conclusions: The results of this study suggest that the risk factors for oral frailty differ between older individuals in the young-old and old-old groups and that age-appropriate support is necessary to prevent oral frailty in older people.

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., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Shimizu et al.)

Fluid thickening is a valid therapeutic strategy for patients with oropharyngeal dysphagia (OD). The main aim of this study was to determine the therapeutic effect of the xanthan-gum-based thickener Tsururinko Quickly (TQ, Morinaga Milk Co., Tokyo, Japan) in older patients with severe OD. A total of 85 patients (83.32 ± 6.75 y) with OD and a penetration-aspiration score (PAS) of n ≥ 3 were studied by videofluoroscopy while swallowing duplicate 10 mL boluses at <50 mPa·s, 100, 200, 400, 800, and 1600 mPa·s, to assess the safety and efficacy of swallowing and the biomechanics of a swallowing response at each viscosity level. At <50 mPa·s, only 16.25% patients swallowed safely, 45% had penetrations (PAS 3-5), and 38.75% had aspirations (PAS 6-8). Fluid thickening with TQ greatly increased the prevalence of patients with safe swallowing from 62.90% at 100 mPa·s to 95.24% at 1600 mPa·s in a shear-viscosity-dependent manner. The penetrations and aspirations were significantly reduced to 3.60% and 1.19%, respectively, at 1600 mPa·s. The threshold viscosity was 100 mPa·s and the increasing viscosity above 800 mPa·s did not further improve the therapeutic effect significantly. Increasing the shear viscosity significantly reduced the time to laryngeal vestibule closure (-16.70%), increased the time to upper oesophageal sphincter opening (+26.88%), and reduced the pharyngeal bolus velocity (-31.62%) without affecting the pharyngeal residue. TQ has a strong shear-viscosity-dependent effect on the safety of swallowing in older patients with severe OD without increasing the pharyngeal residue. The therapeutic range for TQ is 100-800 mPa·s, with 200 and 800 mPa·s being the optimal doses to cover the needs of older patients with OD.

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., (© 2023 John Wiley & Sons Ltd.)

Competing Interests: Conflict of Interest: The authors declare that there are no conflicts of interest.

In 2022, the European Society for Clinical Nutrition and Metabolism (ESPEN) and European Association for the Study of Obesity (EASO) working group proposed uniform diagnostic criteria for sarcopenic obesity. However, no study has adapted these criteria to an Asian population or examined sarcopenic obesity prevalence diagnosed using these criteria or its association with functional outcomes. This retrospective cohort study investigated sarcopenic obesity prevalence diagnosed based on the ESPEN and EASO criteria, and its association with functional outcomes in 1080 older Japanese patients (mean age 79.5 years, 43.5 % male) undergoing rehabilitation. Based on the mentioned criteria, sarcopenic obesity is defined as a BMI ≥ 25 kg/m 2 , increased percent body fat (PBF), reduced skeletal muscle mass (SMM), and low handgrip strength. Sarcopenic obesity prevalence was investigated using various ESPEN- and EASO-proposed definitions of increased PBF and reduced SMM. Functional outcomes were evaluated based on whether patients improved in the minimal clinically important difference (MCID) of the Functional Independence Measure (FIM). The prevalence was 4.3-5.3 %. Sarcopenic obesity was not independently related to FIM MCID achievement. Sarcopenic obesity prevalence-based on the ESPEN and EASO criteria-in older Japanese patients undergoing rehabilitation was low and was not associated with poor functional outcomes., Competing Interests: Conflict of Interests The authors have no conflicts., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Increasing shear viscosity (ShV) in thickening products (TP) is a valid therapeutic strategy for oropharyngeal dysphagia (OD). However, salivary amylase in the oral phase and shear rate in the pharyngeal phase of swallowing can change the viscosity of TPs when swallowed. This study aims to design and validate a rheological protocol to reproduce the oral and pharyngeal factors that affect the therapeutic effect of TPs and report the viscosity measurements in a standardized scientific and precise manner. We measured (a) the variability of the ShV measurements across several laboratories; (b) the in vitro and ex vivo properties of TPs and (c) the impact of the X-ray contrast Omnipaque, temperature and resting time on the rheological properties of TPs. A common protocol was applied in four international laboratories to assess five ShV values (100, 200, 400, 800 and 1600 mPa·s) for the xanthan-gum TP Tsururinko Quickly (TQ). The protocol included the dose (g/100 mL water), stirring procedure and standing time before measurement. Each value was characterized at the shear rate of 50 and 300 s -1 pre- and post-oral incubation in eight volunteers. The effect of temperature, standing time and Omnipaque was assessed. The main results of the study were: (a) The mean intra-laboratory variability on the ShV at all levels was very low: 0.85%. The mean inter-laboratory variability was higher: 9.3%; (b) The shear thinning of TQ at 300 s -1 was 75-80%. Increasing the temperature or standing time did not affect the ShV, and oral amylase caused a small decrease; (c) Omnipaque slightly decreased the dose of TP and hardly affected the amylase resistance or shear thinning. This study showed that different laboratories can obtain very accurate and similar ShV measurements using this protocol which uses scientific, universal SI units (mPa·s). Our protocol accurately reproduces oral and pharyngeal factors affecting the therapeutic effect of TPs. The addition of X-ray contrast did not produce significant changes.

Background/objectives: Texture-modified diets (TMDs) may affect nutritional status and sarcopenia in patients after stroke. This study aimed to investigate the association of food texture levels consumed by patients after stroke with the prevalence of malnutrition and sarcopenia., Subjects/methods: This was a two-center cross-sectional study. A total of 443 patients aged ≥65 years undergoing post-stroke rehabilitation and with oral intake in rehabilitation wards in Shizuoka prefecture and Okinawa prefecture, Japan, were included in the analysis. Food textures were categorized according to the International Dysphagia Diet Standardization Initiative (IDDSI) framework. Malnutrition was diagnosed according to the Global Leadership Initiative on Malnutrition and sarcopenia was assess by the European Working Group on Sarcopenia in Older People 2 criteria. The Cochran-Armitage trend test was used to examine the prevalence of malnutrition and sarcopenia by consumption of lower food texture levels., Results: Malnutrition and sarcopenia were diagnosed in 245 (55.3%) and 275 (62.1%) participants, respectively. Consumption of lower food texture levels was associated with a higher prevalence of malnutrition and severe malnutrition (P &lt; 0.001 for both). In addition, consumption of lower food texture levels was associated with a higher prevalence of probable sarcopenia and sarcopenia (P &lt; 0.001 for both). On multivariate analysis, significant associations were observed between IDDSI levels 5 (P &lt; 0.001) and 4 (P = 0.009) and malnutrition, and between IDDSI levels 6 (P = 0.015), 5 (P = 0.033), and 4 (P = 0.015) and sarcopenia., Conclusions: In patients with stroke, consumption of lower food texture levels categorized by the IDDSI framework was associated with a higher prevalence of malnutrition and sarcopenia., (© 2022. The Author(s), under exclusive licence to Springer Nature Limited.)

Background: The effect of sarcopenia on the recovery of swallowing function, and the interaction among sarcopenia, nutrition care, and rehabilitation therapy are inconclusive., Methods: This multicenter cohort study was conducted between November 2018 and October 2020 in convalescent rehabilitation hospitals in Japan and included post-stroke patients aged ≥65 years with dysphagia. All participants were assigned to sarcopenia and non-sarcopenia groups. The primary outcome was the achievement of ≥2 Food Intake Level Scale [FILS] gain, and the secondary outcomes included Functional Independence Measure (FIM) gain and efficiency. Considering the effect modification of energy intake and rehabilitation duration, logistic regression analyses were performed., Results: Overall, 153 participants with (median age, 82 years; 57.5% women) and 40 without (median age 75 years; 35.0% women) sarcopenia were included. The non-sarcopenia group had more patients who achieved an FILS gain of ≥2 (75.0%) than the sarcopenia group (51.0%). Sarcopenia was independently associated with a poor FILS gain (odds ratio:0.34, 95% confidence intervals: 0.13-0.86) but not associated with FIM gain or efficiency. This association was not affected by the rehabilitation duration or energy intake., Conclusions: In conclusion, sarcopenia was negatively associated with the recovery of swallowing function in stroke patients without interaction by energy intake and rehabilitation duration.

This position paper prepared by the Japanese Working Group on Integrated Nutrition for Dysphagic People (JWIND) aims to summarize the need for nutritional management in adult patients with dysphagia, the issues that nutrition professionals should address, and the promising approaches as well as to propose a vision for the future of nutritional care for adult patients with dysphagia. JWIND is a joint certification system recognized by the Japan Dietetic Association and the Japanese Society of Dysphagia Rehabilitation; its members are mostly experts known as "Certified Specialist of Registered Dietitian for Dysphagia Rehabilitation." Malnutrition and dysphagia are associated with each other. Therefore, malnutrition detection and intervention are essential for patients with dysphagia. However, evidence on the usefulness nutritional assessment and intervention to ensure appropriate nutritional care remains insufficient. Here, we present current knowledge of the relationship between primary diseases causing dysphagia and malnutrition, the indicators used for nutritional assessment, and nutritional interventions such as texture-modified diet (TMD) quality improvement, oral nutritional supplementation, and comprehensive intervention. We also discuss the current status and issues in nutritional care for adult patients with dysphagia. Furthermore, we have proposed measures that nutrition professionals should consider based on 3 perspectives: nutritional assessment, TMD, and nutritional intervention. Individualized and specialized nutritional management by registered dietitians (RDs) through appropriate assessment of the nutritional status of adult patients with dysphagia is needed. To maintain and improve swallowing function and nutritional status, RDs should intervene from the state of risk or early dysphagia onset, providing individualized care per their expertise as part of a multidisciplinary team. However, systematic clinical practice and research regarding the association of nutrition with dysphagia are currently insufficient. Therefore, further clinical practice and evidence building, including the verification of the efficacy on nutritional support through intervention research, are needed., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)

Viscosity measurement using a cone-and-plate rheometer is considered to provide an objective and reliable evaluation of thickening agents for dysphagia management. Here, we showed its measurement uncertainty in the context of an inter-laboratory study. Eight test samples (i.e., four viscosity standard liquids, one xanthan gum reagent powder, and three commercial thickening agent powders) were distributed to 10 laboratories in a blinded manner. According to the same standard operating procedure, each laboratory dissolved the xanthan gum or thickening agents at four concentrations (0.5-4.0 g/100 g) and then measured their viscosity (35-803 mPa∙s). As for the viscosity of the standard liquids, the grand means were 98-100% of the certified values, and the relative standard deviations for repeatability (RSD r ) and reproducibility (RSD R ) were ca. 1% and ca. 5%, respectively, suggesting good accuracy in the measurement process. On the other hand, as for the viscosity of the thickening agents, RSD r and RSD R were ca. 2-6% and ca. 5-8%, respectively; however, heterogeneity in the preparation process comprising a manual dissolving step may increase these to near 60%. Furthermore, RSD r and RSD R of estimated additive concentrations to achieve targeted viscosities (50-500 mPa∙s) based on concentration-viscosity curves were ca. 1-3% and ca. 3-5%, respectively, with a few exceptions. These findings suggest that a strictly standardized procedure provides reliable data on the viscosity measurements for thickening agents., (© 2022 Wiley Periodicals LLC.)

Aims: This study investigated the usefulness of frailty for predicting adverse events in patients with vertebral compression fractures (VCFs) during hospitalization using data obtained from the Japanese health insurance system., Methods: This retrospective cohort study of patients with VCFs aged ≥65 years was conducted using a nationwide database in Japan. We examined the relationships between frailty risk, classified using the Hospital Frailty Risk Score (HFRS), in-hospital mortality, and complications such as pressure ulcers and pneumonia. Multivariate logistic regression analysis was used to estimate the association between the HFRS and the outcomes of patients with VCFs., Results: In this study, the data of 30 980 in-patients with VCFs were analyzed. Of these patients, 76.8%, 21.3%, and 1.9% had low, intermediate, and high risks of frailty, respectively. The higher the risk of frailty, the higher the rate of in-hospital mortality and the occurrence of all complications (P < 0.001 for trend). An intermediate risk of frailty was independently associated with in-hospital mortality (odds ratio [OR], 1.421; P < 0.001), whereas a high risk of frailty did not show statistical significance (OR, 1.385; P = 0.150). Each frailty risk was independently associated with the occurrence of all complications during hospitalization., Conclusions: The HFRS, which can assess the risk of frailty based on routinely collected medical records, was predictive of adverse events in older patients with VCFs based on a nationwide database in Japan. Future studies need to assess approaches to preventing adverse events in frail VCF patients. Geriatr Gerontol Int 2022; 22: 233-239., (© 2022 Japan Geriatrics Society.)

Background: Frailty may predict adverse events in patients with hip fractures. This study aimed to investigate the association between frailty and adverse events in patients with hip fractures after surgery using information from Japanese health insurance., Methods: This retrospective cohort study included patients with hip fractures aged ≥ 65 years using a nationwide database in Japan. We examined the relationship of the frailty risk, which was defined using the Hospital Frailty Risk Score (HFRS), with in-hospital mortality, complications such as delirium and pneumonia, and functional outcomes. We used descriptive analysis, logistic regression, and linear regression analysis to estimate the association between the HFRS and outcomes in patients with hip fracture., Results: We analysed data from 36,192 patients with hip fractures after surgery (mean age: 83.6 ± 6.7 years, female: 79.5%). The proportions of low, intermediate, and high risk of frailty were 68.4%, 28.1%, and 3.5%, respectively. The frailty risk was independently associated with in-hospital mortality (intermediate risk: odds ratio [OR] 1.385, P < 0.001; high risk: OR 1.572; P < 0.001) and the occurrence of complications. Furthermore, each frailty risk was negatively associated with the Barthel Index score at discharge (intermediate risk: coefficient -11.919, P < 0.001; high risk: coefficient -18.044; P < 0.001)., Conclusions: The HFRS could predict adverse events, including in-hospital mortality, in Japanese older patients with hip fractures. This finding supports the validity of using the HFRS in clinical practice for patients with hip fractures., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Objective: In many cases, swallowing function is impaired after the onset of stroke and gradually improves. However, delayed dysphagia has been reported in some post-stroke patients. Recently, several studies have reported that low muscle strength and decreased muscle mass cause dysphagia. This study aimed to investigate whether these conditions are associated with delayed dysphagia after stroke., Design: A multicenter prospective observational cohort study., Setting and Participants: Participants included 165 patients with post-stroke dysphagia (mean age 79.1 ± 8.0 years, 53.3% women) admitted to rehabilitation wards for post-stroke rehabilitation., Methods: Swallowing function was assessed using the Functional Oral Intake Scale. Delayed dysphagia was defined as dysphagia that occurred more than 7 days after stroke onset. We used logistic regression to examine the independent association between low muscle strength and decreased muscle mass and delayed dysphagia development. Furthermore, we examined the relationship between improvement in dysphagia and delayed dysphagia., Results: Delayed dysphagia was observed in 18 (10.9%) patients. The combination of severely low muscle strength and decreased muscle mass was independently associated with the development of delayed dysphagia (adjusted odds ratio: 4.423, 95% confidence interval: 1.400-13.974, P = .011). Delayed dysphagia had an adverse effect on the improvement of dysphagia during in-hospital rehabilitation (adjusted odds ratio: 0.278, 95% confidence interval: 0.078-0.986, P = .047)., Conclusions and Implications: The development of delayed dysphagia was influenced by a combination of severely low muscle strength and decreased muscle mass. Furthermore, delayed dysphagia adversely affects the improvement of dysphagia in patients with stroke and needs to be identified early. Identifying delayed dysphagia using the methods proposed in this study and incorporating early intervention may prevent or delay dependency conditions in this population., (Copyright © 2021 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)

Background: Malnutrition is associated with worse outcome in rehabilitation patients; however, appropriate malnutrition screening tools for this population have not been investigated. We examined the predictive validity of specific cut-off values of the Mini Nutritional Assessment Short-Form version 2 (MNA-SFv2) for Japanese rehabilitation patients., Methods: This retrospective cohort study analyzed adult patients (≥ 20 years) in the Japan Rehabilitation Nutrition Database who were in convalescent rehabilitation wards after stroke or hip fracture. Patients were classified into three categories based on MNA-SFv2 original (0-7, 8-11 and 12-14 points, respectively) or modified (0-5, 6-7 and 8-14 points, respectively) cut-off values: malnutrition, at risk of malnutrition or well-nourished. Functional independence measure (FIM) and home discharge were compared between the categories., Results: Overall, 489 patients were analyzed. Based on the MNA-SFv2 original and modified cut-off values, 64.4% and 36.0% were malnourished, 32.3% and 28.4% were at risk of malnutrition, and 3.3% and 35.6% were well-nourished, respectively. Malnutrition defined by both cut-off values was significantly associated with the FIM at admission, whereas only those defined by modified cut-off values predicted the FIM at discharge (B, -7.1; 95% confidence interval = -12.3 to -1.9). Neither original, nor modified cut-off values predicted discharge to home and long-term care facilities., Conclusions: An MNA-SFv2 score of 0-5 points may be useful to identify Japanese patients with poor outcomes in a rehabilitation setting., (© 2021 The British Dietetic Association Ltd.)

Objectives: This study aimed to evaluate the effect of low tongue pressure on the improvement of swallowing function in people with sarcopenic dysphagia and ongoing dysphagia or physical rehabilitation. In addition, we investigated whether sarcopenic dysphagia at admission was associated with severity of malnutrition., Methods: This was a prospective cohort study of 146 people with sarcopenic dysphagia (mean age 84.6 ± 7.4 y; 68.4% women, 31.6% men) in a postacute rehabilitation hospital. Sarcopenic dysphagia was defined as the presence of both sarcopenia and dysphagia but not neurogenic dysphagia, such as dysphagia due to stroke. Low tongue pressure was classified as "probable" and normal tongue pressure as "possible" sarcopenic dysphagia. Swallowing function was assessed using the Food Intake Level Scale. Malnutrition was diagnosed using the Global Leadership Initiative on Malnutrition criteria. Study outcomes included the amount of change in Food Intake Level Scale score during the rehabilitation period and the association between probable sarcopenic dysphagia and the severity of malnutrition on admission. Statistical significance was set at P < 0.05., Results: There were 83 participants (58.6%) with probable sarcopenic dysphagia. The severity of malnutrition (moderate malnutrition: adjusted odds ratio, 3.388; P = 0.042) and severe malnutrition (adjusted odds ratio, 3.663; P = 0.015) was a contributing factor to probable sarcopenic dysphagia. Probable sarcopenic dysphagia (regression coefficient, -0.384; P = 0.017) was negatively associated with the amount of change in Food Intake Level Scale score., Conclusions: Probable sarcopenic dysphagia with low tongue pressure was associated with poorer improvement in swallowing function and severe malnutrition during postacute rehabilitation. Patients with probable sarcopenic dysphagia may require aggressive nutritional therapy., Competing Interests: Conflict of Interest The authors declare that they have no conflict of interest., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Objective: This study aimed to clarify the association between texture-modified diets and poor appetite in older adults, as it is not fully understood., Design: Cross-sectional study., Setting and Participants: We included 208 inpatients who were aged ≥65 years (mean age 78.9 ± 7.6 years, 57.7% female) and admitted to a rehabilitation unit with stroke, musculoskeletal disease, or hospital-associated deconditioning covered by the Japanese insurance system, between January 2019 and January 2020., Methods: Participants were divided into 2 groups according to their food texture level: International Dysphagia Diet Standardization Initiative (IDDSI) levels 3 to 5 for the texture-modified diet group and levels 6 and 7 for the normal diet group. Appetite was assessed using the Simplified Nutritional Appetite Questionnaire for the Japanese elderly, and a score ≤14 was defined as poor appetite. The relationship between IDDSI levels and poor appetite was analyzed using the Cochrane-Armitage trend test. Logistic regression analysis was used to investigate the relationship between the consumption of texture-modified diets and poor appetite. Statistical significance was set at P < .05., Results: The numbers of participants on modified diets according to the IDDSI framework were as follows: 4, 11, 41, 76, and 76 in levels 3, 4, 5, 6, and 7, respectively. In total, 152 and 56 patients were classified into the regular diet group and texture-modified diet group, respectively. A significantly higher prevalence of poor appetite was observed with the consumption of texture-modified diets (P < .001 for trend). Logistic regression analysis showed that poor appetite was independently associated with the consumption of texture-modified diets (odds ratio 3.443, P = .011)., Conclusions and Implications: These findings indicate that the consumption of texture-modified diets is associated with poor appetite. Further studies are required to verify whether a multimodal approach involving improvement in the appearance, taste, flavor, and nutrients of the food can improve poor appetite., (Copyright © 2021 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)

This cross-sectional study aimed to examine the accuracy of the Simplified Nutritional Appetite Questionnaire (SNAQ) and the SNAQ for Japanese Elderly (SNAQ-JE) for the Global Leadership Initiative on Malnutrition (GLIM)-defined malnutrition and sarcopenia screening in older persons. We included 380 inpatients aged ≥65 years (mean age, 79.3 ± 7.9; 60.0% women) and admitted to rehabilitation units. Undernutrition and sarcopenia were diagnosed based on GLIM criteria and the Asian Working Group for Sarcopenia, respectively, using bioimpedance analysis. Poor appetite was defined as an SNAQ score of <14 points and an SNAQ-JE score of ≤14 points. The sensitivity, specificity, and accuracy of these tools for detecting poor appetite for GLIM-defined malnutrition and sarcopenia were assessed. The rates of GLIM-defined malnutrition and sarcopenia were 56.8% and 59.2%, respectively. The number of patients with poor appetite was 94 (24.7%) for the SNAQ and 234 (61.6%) for the SNAQ-JE. The sensitivity and specificity of the SNAQ measured against GLIM-defined malnutrition were 32.9% and 73.1%, respectively, and against sarcopenia were 29.8% and 70.2%, respectively. The sensitivity and specificity of the SNAQ-JE measured against GLIM-defined malnutrition were 82.6% and 51.0%, respectively, and against sarcopenia were 86.0% and 53.7%, respectively. The SNAQ-JE showed fair accuracy for GLIM-defined malnutrition and sarcopenia in older patients admitted to rehabilitation units.

Background: This study aimed to investigate the predictive validity of the previously reported body mass index (BMI) cutoff values of the Global Leadership Initiative on Malnutrition (GLIM) criteria for patients with pneumonia in Asians, using a nationwide registry database., Methods: The study included 26,098 (2282 patients aged <70 years and 23,784 patients aged ≥70 years) patients with pneumonia aged ≥65 years who were enrolled in the Japan Medical Data Center database between April 2014 and December 2018. Malnutrition was diagnosed using the GLIM criteria, and the severity of malnutrition was diagnosed by using a BMI cutoff value of <17.0 and <17.8 for patients aged <70 and ≥70 years, respectively. Multivariate analysis was performed to determine whether the severity of malnutrition based on BMI was associated with poor clinical outcomes, such as 30-day in-hospital mortality, length of hospital stay (LOS), and 30-day readmission., Results: A total of 14.7% and 24.1% of patients aged <70 and ≥70 years, respectively, experienced severe malnutrition. Severe malnutrition was independently associated with 30-day in-hospital mortality (hazard ratio [HR], 1.19; 95% CI, 1.05-1.34), prolonged LOS (coefficient, 5.13; 95% CI, 4.31-5.94), and 30-day readmission (HR, 2.28; 95% CI, 1.89-2.75) in patients aged ≥70 years; however, only prolonged LOS was independently associated with patients aged <70 years (coefficient, 3.27; 95% CI, -0.24-6.78)., Conclusion: The BMI cutoff values might be valid for patients with pneumonia aged ≥70 years in Asians. Further investigation is required to validate the cutoff value for older adults aged <70 years., (© 2020 American Society for Parenteral and Enteral Nutrition.)

Background and Purpose: We aimed to assess stroke lesions, which play a key role in determining swallowing dysfunction, and findings of videofluoroscopy (VF), which provides the most accurate instrumental assessment for evaluating swallowing function, in patients with acute stroke., Methods: We enrolled 342 patients with first-time acute stroke (age 70.4 ± 12.6 years, 142 female). Patients with dementia and altered mental status due to severe stroke were excluded. All patients underwent cranial magnetic resonance imaging to identify the location of stroke lesion, VF, and tongue pressure measurement., Results: Aspiration was detected in 45 (13.2%) patients. Multivariate analysis identified parietal lobe lesion and the National Institutes of Health Stroke Scale (NIHSS) score as independent significant factors for aspiration (odds ratio 6.33, 95% confidence interval [CI] 2.25-17.84, p < 0.001; odds ratio 1.12, 95% CI 1.03-1.20, p = 0.004, respectively). Swallowing reflex delay was detected in 58 (17.0%) patients. Multivariate analysis identified habitual drinking, basal ganglia lesion, and the NIHSS score as independent significant factors for swallowing reflex delay (odds ratio 0.51, 95% CI 0.26-0.99, p = 0.047; odds ratio 1.91, 95% CI 1.09-3.67, p = 0.041; odds ratio 1.12, 95% CI 1.05-1.20, p < 0.001, respectively). Additionally, oral cavity and pharyngeal residues were independently associated with tongue pressure., Conclusion: Parietal lobe lesions are associated with aspiration and basal ganglia lesions with swallowing reflex delay.

Objectives: Sarcopenic dysphagia is partly characterized by a decline in the strength of the swallowing muscles. However, its associated characteristics and symptoms are unclear. The aim of this study was to clarify the characteristics and symptoms of swallowing ability associated with low tongue muscle strength, which is one of the swallowing muscles in older adults., Methods: This was a cross-sectional study of 197 older patients admitted to the hospital for orthopedic conditions. We measured the maximum tongue pressure (MTP) against the palate. Swallowing-related characteristics were assessed with the Mann assessment of swallowing ability. Sarcopenia was diagnosed using the 2019 Asian Working Group for Sarcopenia., Results: The mean age of patients was 81.3 ± 7.6 y, and 80.2% of patients were women. Forty-two patients (21.3%) showed low MTP, defined as <20 kPa. Approximately 50% of participants had sarcopenia. Patients in the low MTP group had a significantly higher incidence of sarcopenia compared with the normal MTP group (71.4% vs. 48.4%; P = .008). After adjusting for potential confounders in the multivariate analyses, low MTP was found to be independently associated with abnormalities in tongue coordination (odds ratio [OR]: 5.251; 95% confidence interval [CI], 2.336-11.807; P < .001), oral transit (OR: 5.248; 95% CI, 1.424-19.345; P = .013), cough reflex (OR: 2.709; 95% CI, 1.280-5.733; P = .009), and voluntary cough (OR: 7.786; 95% CI, 3.329-18.208; P < .001)., Conclusions: Patients with low tongue strength are characterized by abnormal oral and cough-related characteristics., (Copyright © 2020 Elsevier Inc. All rights reserved.)

This study assessed whether a high provided energy of ≥30 kcal/ideal body weight (IBW)/day (kg) for patients with sarcopenic dysphagia effectively improved swallowing ability and the activities of daily living (ADLs). Among 110 patients with sarcopenic dysphagia (mean age, 84.9 ± 7.4 years) who were admitted to a post-acute hospital, swallowing ability and the ADLs were assessed using the Food Intake LEVEL Scale (FILS) and the Functional Independence Measure (FIM), respectively. The primary outcome was the FILS at discharge, while the secondary outcome was the achievement of the FIM with a minimal clinically important difference (MCID) at discharge. We created a homogeneous probability model without statistically significant differences using the inverse probability of treatment weighting (IPTW) method with and without a mean provided energy of ≥30 kcal/IBW/day (kg) for a period of 1 week of hospitalization and compared the outcomes between groups. A mean provided energy of ≥30 kcal/IBW/day (kg) was achieved in 62.7% of patients. In the IPTW model, the FILS and the rates of achieved MCID of the FIM at discharge were significantly higher in the mean provided energy of ≥30 kcal/IBW/day (kg) group ( p = 0.004 and p < 0.001, respectively). A high provided energy for patients with sarcopenic dysphagia may improve swallowing ability and produce clinically meaningful functional outcomes.

Aim: The recently proposed Global Leadership Initiative on Malnutrition (GLIM) criteria may accurately reflect the nutritional status of older adults because they use information such as reduced muscle mass and chronic and acute disease to diagnose malnutrition. This study aimed to determine the prevalence and characteristics of malnutrition in older adults assessed by the GLIM and the European Society for Clinical Nutrition and Metabolism (ESPEN) diagnostic criteria for malnutrition (DCM) in post-acute geriatric care., Methods: This cross-sectional study included older patients admitted to rehabilitation care units. Malnutrition was evaluated using GLIM-DCM and ESPEN-DCM using a two-step process (initial screening and subsequent steps). The prevalence and differences observed between GLIM-DCM and ESPEN-DCM were reported, and the determinants of each criterion were identified., Results: This study included 335 older patients (mean ± SD, age 80.0 ± 7.5 years; 54.0% women). The prevalence of older patients diagnosed with GLIM-DCM and ESPEN-DCM was 66.9% and 59.1%, respectively, and the agreement between ESPEN-DCM and GLIM-DCM was 80.9%. The results of multivariate analyses showed that all items of the phenotypic and etiologic criteria were independent determinants for GLIM-DCM, whereas disease burden/inflammation (P = 0.996), included in the etiologic criteria of GLIM-DCM, were not determinants of ESPEN-DCM., Conclusion: This study reported the prevalence of malnutrition according to GLIM-DCM and the differences in the characteristics of patients diagnosed with malnutrition based on GLIM-DCM and those diagnosed based on ESPEN-DCM in geriatric rehabilitation care units. Further studies are required to investigate the prevalence of malnutrition in different care settings. Geriatr Gerontol Int 2020; 20: 1221-1227., (© 2020 Japan Geriatrics Society.)

Background and Purpose: Dysphagia in the acute phase of stroke contributes significantly to poor outcomes and is associated with the development of aspiration pneumonia and malnutrition. Therefore, an accurate evaluation of swallowing is necessary before initiating oral food intake. The modified water swallow test (MWST) and the repetitive saliva swallow test (RSST) are commonly used as bedside screening methods for swallowing dysfunction, but it is unclear whether other factors contribute to dysphagia and consequent aspiration. The purpose of this study was to identify characteristics that might be overlooked in screening tests., Methods: Participants were prospectively selected from patients hospitalized for stroke at the Suiseikai Kajikawa Hospital between August 1, 2016 and June 30, 2018. Inclusion criteria were conscious and stable medical condition, and patients who were diagnosed with dementia were excluded. A videofluoroscopic (VF) swallowing study was carried out on all patients who met the inclusion/exclusion criteria and who passed both the MWST and the RSST., Results: Aspiration was observed in 16 of 172 patients (9.3%) when swallowing 3 ml of water. These aspirated patients showed significantly delayed swallowing reflex on VF., Conclusions: Swallowing evaluation using a combination of the MWST and the RSST is reasonably effective. However, patients who show a delayed swallowing reflex might be overlooked by this screening procedure., Competing Interests: Declaration of Competing Interest H. Maruyama obtained speaker fees from Eisai, Pfizer, Takeda Pharmaceutical, Otsuka Pharmaceutical, Nihon Pharmaceutical, Teijin Pharma, Fuji Film, Boehringer Ingelheim, Sumitomo Dainippon Pharma, Nihon Medi-Physics, Bayer, MSD, Daiichi Sankyo, Kyowa Hakko Kirin, Sanofi, Novartis, Kowa Pharmaceutical, Astellas Pharma, Japan Blood Products Organization, Mitsubishi Tanabe Pharma, Ono pharmaceutical, Biogen, and Bristol-Myers Squibb, and research support from Eisai, Pfizer, Takeda Pharmaceutical, Otsuka Pharmaceutical, Nihon Pharmaceutical, Shionogi, Teijin Pharma, Fuji Film, Boehringer Ingelheim, Sumitomo Dainippon Pharma, Nihon Medi-Physics, Bayer, MSD, Daiichi Sankyo, Kyowa Hakko Kirin, Sanofi, Novartis, Kowa Pharmaceutical, Astellas Pharma, Tsumura, Japan Blood Products Organization, Mitsubishi Tanabe Pharma, Mylan., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Texture-modified diets (TMD) is often used in clinical practices for the treatment and prevention of pneumonia. However, it is unclear how stages of TMD affect the swallowing ability and nutritional status in patients with pneumonia. This study aimed to investigate the relationship between the various stages of TMD and swallowing ability and nutritional status in older inpatients with pneumonia. In this retrospective cohort study, data for patients aged ≥ 65 years with pneumonia were obtained from the Japan Rehabilitation Nutrition Database. We performed coarsened exact matching with Mini Nutritional Assessment Short Form (MNA-SF) on admission. Ultimately, 218 patients (mean age 82.9 ± 9.8 years) were included and divided into two groups based on the stages of TMD in the facility: multiple TMD (M-TMD) group (stages of TMD ≥ 6) and control group (stages of TMD < 6). The main outcome was the rate of improvement in the Food Intake Level Scale (FILS) and the maintenance or improvement in the MNA-SF score. We used the within-hospital correction with generalized estimation equations that are commonly used to analyze clustered data while correcting for confounding factors by clustering. Multivariate multiple logistic analysis showed that M-TMD was independently associated with FILS improvement rate and the maintenance or improvement in the MNA-SF score (odds ratio [OR] 3.252; 95% confidence interval [CI] 1.602-6.601; p = 0.001 and OR 1.873; 95% CI 1.054-3.330; p = 0.032, respectively). M-TMD in the facility was associated with the maintenance or improvement in swallowing ability and the nutritional status of patients with pneumonia.

Objective: To evaluate the effects of body mass index (BMI) on recovery of activities of daily living (ADL) in older Asian patients with femoral fracture registered in a nationwide inpatient database in Japan., Methods: We retrospectively analyzed data of patients aged ≥65 years with acute femoral fracture between April 2014 and November 2017 in the Diagnosis Procedure Combination database. Patients were classified into the following categories based on BMI (kg/m 2 ): underweight (<18.5); normal weight (18.5-22.9); overweight (23-27.4); obese (≥27.5); and missing data. Demographic data included age, sex, type of fracture, comorbidities, and Barthel Index (BI). The primary outcome was BI at discharge and secondary outcomes were the overall complication rate and discharge to home., Results: In total, data for 13,348 patients were extracted from the database, of whom 80.3 % were female. At discharge, underweight patients had lower BI than overweight or obese patients. In multivariable analysis, underweight and missing BMI data were associated with lower BI at discharge (partial regression coefficients -2.324 and -5.763, respectively). In contrast, overweight and obese were correlated with higher BI (3.080 and 5.732, respectively). Underweight was independently associated with a higher overall complication rate (odds ratio 1.195) and a lower rate of discharge to home (odds ratio 0.865)., Conclusions: Underweight was associated with poorer performance in ADL, higher risk of complications, and lower rate of discharge to home in older Asian patients with femoral fracture. Overweight and obese had positive effects on ADL., Competing Interests: Declaration of Competing Interest This study was granted from the Japan Society for the Promotion of Science (grant number: 18K10690)., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Objective: This study aimed to elucidate the association between occlusal support and nutritional improvement and recovery of activities of daily living (ADLs) among elderly patients recovering from hip fracture., Background: Many patients with hip fracture are malnourished, and malnutrition is associated with poor functional outcomes. Poor oral status is one reason for malnutrition because loss of occlusal support leads to masticatory disorders and can cause nutrient deficiencies., Methods: We evaluated 202 elderly patients aged 65 years and older (mean age, 84.9 ± 7.9 years). We assessed nutritional status using the Mini Nutritional Assessment-Short Form and ADLs using functional independence measure (FIM) scores. Occlusal support was recorded in accordance with the Eichner Index. We categorised participants into two groups according to the presence or absence of occlusal support, and statistical analyses were performed to investigate the differences between the groups., Results: One group contained 152 participants (mean age, 85.5 ± 7.4 years) with occlusal support, and the other group contained 50 participants (mean age, 83.0 ± 8.9 years) without occlusal support. The group with occlusal support had greater gain of FIM and higher FIM efficiency than did the other group. Multivariate analyses showed that occlusal support was independently associated with nutritional improvement [odds ratio (OR) = 4.00, 95% confidence intervals (CI) = 1.90-8.43] and motor FIM efficiency (R 2  = .338, P < .001)., Conclusions: Our findings suggest that occlusal support is associated with nutritional improvement and the recovery of ADLs in patients recovering from hip fracture., (© 2019 Gerodontology Association and John Wiley & Sons Ltd.)

The Vietnamese older adult population has increased rapidly on an annual basis and dysphagia has become a common issue. The nutritional status of older adults in general and of dysphagic older adults in particular has not received adequate attention. The automatic solution for cases of serious choking/aspiration is still a prescription for tube feeding. In developed countries, oral intake is a priority alternative for dysphagia and has positive consequences. This study aimed to investigate the nutritional status of and feeding practices for dysphagic older adult inpatients in some Vietnamese hospitals. The study was designed as a cross-sectional study and was conducted in three large hospitals in northern Vietnam. The data for 1007 older inpatients (58.3% were females, mean age was 75.5±7.3 y) about their dysphagic status, nutritional status and feeding practices were collected by dietitians. About 29% of the older adult inpatients suffered from malnutrition and 54% had a risk of malnutrition. Half of the dysphagia group had malnutrition and 42% were at risk of malnutrition. About 78% of the dysphagic older adults had oral intake of soft foods/regular foods and the remainder had tube feeding. Almost all dysphagic patients had reduced food intake over the prior 3 mo. The rate of pneumonia was quite high among dysphagic patients. The nutritional status of Vietnamese older adult inpatients in general and of dysphagic older adults specifically was poor. Oral intake of a texture-modified diet should be a method with priority over tube feeding or soft foods/regular foods for dysphagic patients.

Objective: This study aimed to clarify the association between malnutrition and improvement of swallowing ability during rehabilitation of stroke patients., Design: This was a retrospective cohort study., Setting and Participants: One hundred eighty-eight older adults with oropharyngeal dysphagia after stroke who were admitted to a rehabilitation hospital., Methods: The International Dysphagia Diet Standardization Initiative Functional Diet Scale (IDDSI-FDS) was used to assess swallowing ability. The Global Leadership Initiative on Malnutrition (GLIM) definition was used to diagnose malnutrition. The primary outcome was IDDSI-FDS score at discharge., Results: The mean age of the patients was 78.9 ± 7.7 years, and 36.7% were women. A total of 122 (64.8%) patients were diagnosed with malnutrition. Compared with those without malnutrition, malnourished patients had more severe dysphagia on admission. After adjusting for confounders, malnutrition was an independent contributor to the IDDSI-FDS scores at discharge (standardized coefficient: -0.165, P = .011)., Conclusion and Implications: In patients with oropharyngeal dysphagia after stroke, malnutrition at admission inversely affected their swallowing ability at discharge. Dysphagia rehabilitation, including early nutritional intervention, may be effective in the recovery of swallowing ability., (Copyright © 2019 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)

Aim: Texture-modified diets (TMD) have significantly lower energy and protein content than normal diets. Therefore, TMD can cause malnutrition and loss of muscle mass. However, few studies have reported the relationship between TMD and decreased skeletal muscle mass. The aim of the present study was to clarify the association between TMD and decreased skeletal muscle mass., Methods: We reviewed data of 188 older adult patients who were admitted to a rehabilitation hospital. TMD were defined based on the Japanese Dysphagia Diet Criteria 2013 proposed by the Japanese Society of Dysphagia Rehabilitation. The Mini Nutritional Assessment-Short Form was used to assess nutritional status; dual-energy X-ray absorptiometry was used to measure the skeletal muscle mass index, and the cut-off values for decreased skeletal muscle mass index were based on the Asian Working Group for Sarcopenia; the Functional Independence Measure was used to evaluate activities of daily living., Results: The patients' mean age was 80.6 ± 7.5 years, and 62% were women. A total of 22 patients (11.7%) consumed TMD. A total of 104 patients (55.3%) had decreased skeletal muscle mass, and approximately 90% of them consumed TMD. Decreased skeletal muscle mass index (odds ratio 7.199, 95% confidence interval 1.489-34.805, P ≤ 0.01) and Functional Independence Measure scores (odds ratio 0.972, 95% confidence interval 0.952-0.992, P ≤ 0.01) were independently related to TMD in the multivariate analysis., Conclusions: The TMD group was associated with decreased skeletal muscle mass. Future, prospective studies are necessary to investigate causality. Geriatr Gerontol Int 2018; 18: 698-704., (© 2017 Japan Geriatrics Society.)

In Japan, the viscosity of thickened liquids is different among hospitals and nursing homes. In order to standardize viscosity of thickened liquids, the dysphagia diet committee of the Japanese Society of Dysphagia Rehabilitation developed the Japanese Dysphagia Diet 2013 (JDD2013). To decide on a definition of thickened liquids, the committee reviewed categories from other countries. Especially, the criteria of the USA and Australia were used as references. The definition had three levels: mildly thick, moderately thick, and extremely thick. Then a sensory evaluation by health care workers was carried out to decide the viscosity range of each level, and a draft document was made. After collecting public comments, follow-up experiments using thickened water with thickeners using xanthan gum were performed, and the JDD2013 (Thickened Liquid) was determined. The JDD2013 (Thickened Liquid) evaluated the drinking properties, visual properties, and viscosity values of each level. The shear rate of 50 s -1 was adopted to measure the viscosity with a cone and plate type viscometer to duplicate the measurement criteria used by the USA. We also set the values of the JDD2013 with the Line Spread Test to promote the use of guidelines in clinical practice. We believe the JDD2013 standards help hospitals and other settings that care for people with dysphagia to use the same thickness level and the same labels. In the future, the JDD2013 levels will be compared with new international guidelines to help with international understanding of the JDD2013 levels.

Rationale: Swallowing during inspiration and swallowing immediately followed by inspiration increase the chances of aspiration and may cause disease exacerbation. However, the mechanisms by which such breathing-swallowing discoordination occurs are not well-understood. Objectives : We hypothesized that breathing-swallowing discoordination occurs when the timing of the swallow in the respiratory cycle is inappropriate. To test this hypothesis, we monitored respiration and swallowing activity in healthy subjects and in patients with dysphagia using a non-invasive swallowing monitoring system. Measurements and Main Results: The parameters measured included the timing of swallow in the respiratory cycle, swallowing latency (interval between the onset of respiratory pause and the onset of swallow), pause duration (duration of respiratory pause for swallowing), and the breathing-swallowing coordination pattern. We classified swallows that closely follow inspiration (I) as I-SW, whereas those that precede I as SW-I pattern. Patients with dysphagia had prolonged swallowing latency and pause duration, and tended to have I-SW or SW-I patterns reflecting breathing-swallows discoordination. Conclusions: We conclude that swallows at inappropriate timing in the respiratory cycle cause breathing-swallowing discoordination, and the prolongation of swallowing latency leads to delayed timing of the swallow, and results in an increase in the SW-I pattern in patients with dysphagia.