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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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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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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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Matsumoto N, Inuma H, Wakabayashi H, Kakehi S. Comment on high protein intake after subarachnoid hemorrhage improves oral intake and temporal muscle volume. Clin Nutr 2021; 40:4861-4862. [PMID: 34358829 DOI: 10.1016/j.clnu.2021.07.010] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 07/04/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Noaki Matsumoto
- Department of Rehabilitation Medicine, Tokyo Women's Medical University, Japan
| | - Hayato Inuma
- Department of Rehabilitation Medicine, Tokyo Women's Medical University, Japan
| | | | - Shingo Kakehi
- Department of Rehabilitation Medicine, Tokyo Women's Medical University, Japan.
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Kakehi S, Wakabayashi H, Inuma H, Inose T, Shioya M, Aoyama Y, Hara T, Uchimura K, Tomita K, Okamoto M, Yoshida M, Yokota S, Suzuki H. Rehabilitation Nutrition and Exercise Therapy for Sarcopenia. World J Mens Health 2021; 40:1-10. [PMID: 33831974 PMCID: PMC8761238 DOI: 10.5534/wjmh.200190] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [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: 11/27/2020] [Revised: 01/22/2021] [Accepted: 01/22/2021] [Indexed: 11/22/2022] Open
Abstract
Sarcopenia is an age-related loss of skeletal muscle associated with adverse outcomes such as falls, fractures, disability, and increased mortality in older people and hospitalized patients. About half of older male nursing home residents have sarcopenia. The diagnostic criteria by the European Working Group on Sarcopenia in Older People (EWGSOP) and the Asian Working Group for Sarcopenia (AWGS) have led to increased interest in sarcopenia. Exercise and nutritional management are crucial for the prevention and treatment of sarcopenia. Nutritional therapy for sarcopenia that includes 20 g of whey protein and 800 IU of vitamin D twice a day improves lower limb strength. Exercise therapy for sarcopenia, such as resistance training and 6 months of home exercises, improves muscle strength and physical function. Combination therapy that includes both nutritional and exercise therapy improves gait speed and knee extension strength more than either exercise alone or nutrition therapy alone. Excessive bedrest and mismanagement of nutrition in medical facilities can lead to iatrogenic sarcopenia. Iatrogenic sarcopenia is sarcopenia caused by the activities of health care workers in health care facilities. Appropriate nutritional management and exercise programs through rehabilitation nutrition are important for prevention and treatment of iatrogenic sarcopenia. Nutritional and exercise therapy should be started very early after admission and adjusted to the level of inflammation and disease status. Repeated assessment, diagnosis, goal setting, interventions, and monitoring using the rehabilitation nutrition care process is important to maximize treatment effectiveness and improve patients' functional recovery and quality of life.
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Affiliation(s)
- Shingo Kakehi
- Department of Rehabilitation Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Hidetaka Wakabayashi
- Department of Rehabilitation Medicine, Tokyo Women's Medical University, Tokyo, Japan.
| | - Hayato Inuma
- Department of Rehabilitation Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Tomomi Inose
- Department of Rehabilitation Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Moeka Shioya
- Department of Rehabilitation Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Yohei Aoyama
- Department of Rehabilitation Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Taiki Hara
- Department of Rehabilitation Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Kosuke Uchimura
- Department of Rehabilitation Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Kazusa Tomita
- Department of Rehabilitation Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Mizuki Okamoto
- Department of Rehabilitation Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Masato Yoshida
- Department of Rehabilitation Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Shohei Yokota
- Department of Rehabilitation Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Hayato Suzuki
- Department of Rehabilitation Medicine, Tokyo Women's Medical University, Tokyo, Japan
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