Skip to main content
SpringerLink
Log in

Malnutrition and cachexia may affect death but not functional improvement in patients with sarcopenic dysphagia

  • Research Paper
  • Published:
European Geriatric Medicine Aims and scope Submit manuscript

Key summary points

AbstractSection Aim

To investigate whether two factors, malnutrition and cachexia, affect swallowing function, activities of daily living, and death in sarcopenic dysphagia.

AbstractSection Findings

Four percent of patients with sarcopenic dysphagia were found to have cachexia according to the Asian Working Group for Cachexia criteria. No significant difference in changes in the Food Intake Level Scale and Barthel Index between the malnutrition and cachexia group and the other groups, however death increased significantly.

AbstractSection Message

Assessment of both cachexia and malnutrition is important in sarcopenic dysphagia.

Abstract

Purpose

To investigate whether two factors, malnutrition and cachexia, affect swallowing function, activities of daily living (ADL), and death in sarcopenic dysphagia.

Methods

Of 467 patients enrolled in the Japanese Sarcopenic Dysphagia Database, 271 met the study eligibility criteria in a retrospective cohort study. Patients were divided into four groups based on whether they had cachexia according to the Asian Working Group for Cachexia (AWGC) criteria and malnutrition according to the Global Leadership Initiative on Malnutrition (GLIM) criteria. Multivariate analyses were performed to investigate the differences in changes in the Food Intake LEVEL Scale (FILS) and Barthel Index (BI) and death after follow-up between the malnutrition and cachexia group and the other groups.

Results

The mean age was 83.7 ± 8.3 years, 119 (44%) were men and 152 (56%) were women. The median FILS at baseline was 7 and the median BI was 25. A total of 120 (44%) had malnutrition only, 54 (20%) had neither cachexia nor malnutrition, 12 (4%) had cachexia only, and 85 (31%) had both cachexia and malnutrition. Multivariate analyses showed no significant difference between the change in BI (P = 0.688) and the change in FILS (P = 0.928) between the malnutrition and cachexia group and the other groups; however, death increased significantly (P = 0.010).

Conclusion

Some patients diagnosed with cachexia were not malnourished, although many patients with cachexia were malnourished. While patients with both cachexia and malnutrition did not show significant improvement in ADL and swallowing function compared with patients without both conditions, the number of deaths increased significantly.

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. Wakabayashi H, Kishima M, Itoda M, Fujishima I, Kunieda K, Ohno T et al (2021) Diagnosis and treatment of sarcopenic dysphagia: a scoping review. Dysphagia 36:523–531. https://doi.org/10.1007/s00455-021-10266-8

    Article  PubMed  Google Scholar 

  2. Fujishima I, Fujiu-Kurachi M, Arai H, Hyodo M, Kagaya H, Maeda K et al (2019) Sarcopenia and dysphagia: position paper by four professional organizations. Geriatr Gerontol Int 19:91–97. https://doi.org/10.1111/ggi.13591

    Article  PubMed  Google Scholar 

  3. Bauer J, Morley JE, Schols AMWJ, Ferrucci L, Cruz-Jentoft AJ, Dent E et al (2019) Sarcopenia: a time for action. An SCWD position paper. J Cachexia Sarcopenia Muscle 10:956–961. https://doi.org/10.1002/jcsm.12483

    Article  PubMed  PubMed Central  Google Scholar 

  4. Abu-Ghanem S, Graf A, Govind J (2022) Diagnosis of sarcopenic dysphagia in the elderly: critical review and future perspectives. Dysphagia 37:1093–1102. https://doi.org/10.1007/s00455-021-10371-8

    Article  PubMed  Google Scholar 

  5. Nagai T, Wakabayashi H, Nishioka S, Momosaki R (2022) Functional prognosis in patients with sarcopenic dysphagia: An observational cohort study from the Japanese sarcopenic dysphagia database. Geriatr Gerontol Int 22:839–845. https://doi.org/10.1111/ggi.14466

    Article  PubMed  Google Scholar 

  6. Taguchi K, Wakabayashi H, Fujimoto M, Obayashi S, Yamamoto M, Nishioka S et al (2022) Association between Malnutrition severity and swallowing function in convalescent rehabilitation wards: a multi-center cohort study in malnourished patients with sarcopenic dysphagia. J Nutr Health Aging 26:469–476. https://doi.org/10.1007/s12603-022-1782-z

    Article  CAS  PubMed  Google Scholar 

  7. Matsuo H, Sakuma K (2022) Pathophysiology of cachexia and characteristics of dysphagia in chronic diseases. Asia Pac J Oncol Nurs 22(9):100120. https://doi.org/10.1016/j.apjon.2022.100120

    Article  Google Scholar 

  8. Wakabayashi H (2023) Hospital-associated sarcopenia, acute sarcopenia, and iatrogenic sarcopenia: prevention of sarcopenia during hospitalization. J Gen Fam Med 24:146–147. https://doi.org/10.1002/jgf2.625

    Article  PubMed  PubMed Central  Google Scholar 

  9. Sato Y, Yoshimura Y, Abe T, Nagano F, Matsumoto A (2023) Hospital-associated sarcopenia and the preventive effect of high energy intake along with intensive rehabilitation in patients with acute stroke. Nutrition 116:112181. https://doi.org/10.1016/j.nut.2023.112181

    Article  PubMed  Google Scholar 

  10. Maeda K, Ishida Y, Nonogaki T, Shimizu A, Yamanaka Y et al (2019) Development and predictors of sarcopenic dysphagia during hospitalization of older adults. Nutrients 12:70. https://doi.org/10.3390/nu12010070

    Article  PubMed  PubMed Central  Google Scholar 

  11. Mukundan M, Kashyap K, Dhar M, Muralidharan A, Agarwal D, Saxena Y (2022) Nutritional and functional status as a predictor of short-term mortality in hospitalized elderly patients in a tertiary care hospital. Cureus 24(14):e22576. https://doi.org/10.7759/cureus.22576

    Article  Google Scholar 

  12. Zopf Y, Schink K, Reljic D, Herrmann HJ, Dieterich W, Kiesswetter E et al (2020) Assessing cachexia in older patients: different definitions - But which one is the most practical for clinical routine? Arch Gerontol Geriatr 86:103943. https://doi.org/10.1016/j.archger.2019.103943

    Article  PubMed  Google Scholar 

  13. Arai H, Maeda K, Wakabayashi H, Naito T, Konishi M, Assantachai P et al (2023) Diagnosis and outcomes of cachexia in Asia: working consensus report from the asian working group for cachexia. J Cachexia Sarcopenia Muscle 14:1949–1958. https://doi.org/10.1002/jcsm.13323

    Article  PubMed  PubMed Central  Google Scholar 

  14. Beaudart C, Sanchez-Rodriguez D, Locquet M, Reginster JY, Lengelé L, Bruyère O (2019) Malnutrition as a strong predictor of the onset of sarcopenia. Nutrients 11:2883. https://doi.org/10.3390/nu11122883

    Article  PubMed  PubMed Central  Google Scholar 

  15. Zhang X, Tang M, Zhang Q, Zhang KP, Guo ZQ, Xu HX et al (2021) The GLIM criteria as an effective tool for nutrition assessment and survival prediction in older adult cancer patients. Clin Nutr 40:1224–1232. https://doi.org/10.1016/j.clnu.2020.08.004

    Article  PubMed  Google Scholar 

  16. Mizuno S, Wakabayashi H, Fujishima I, Kishima M, Itoda M, Yamakawa M et al (2021) Construction and quality evaluation of the japanese sarcopenic dysphagia database. J Nutr Health Aging 25:926–932. https://doi.org/10.1007/s12603-021-1646-y

    Article  CAS  PubMed  Google Scholar 

  17. Kunieda K, Ohno T, Fujishima I, Hojo K, Morita T (2013) Reliability and validity of a tool to measure the severity of dysphagia: the Food Intake LEVEL Scale. J Pain Symptom Manage 46:201–206. https://doi.org/10.1016/j.jpainsymman.2012.07.020

    Article  PubMed  Google Scholar 

  18. Wakabayashi H (2014) Presbyphagia and sarcopenic dysphagia: association between aging, sarcopenia, and deglutition disorders. J Frailty Aging 3:97–103. https://doi.org/10.14283/jfa.2014.8

    Article  CAS  PubMed  Google Scholar 

  19. Mori T, Fujishima I, Wakabayashi H et al (2017) Development and reliability of a diagnostic algorithm for sarcopenic dysphagia. JCSM Clinical Reports 2:e00017. https://doi.org/10.17987/jcsm-cr.v2i2.17

    Article  Google Scholar 

  20. Maeda K, Koga T, Nasu T, Takaki M, Akagi J (2017) Predictive accuracy of calf circumference measurements to detect decreased skeletal muscle mass and european society for clinical nutrition and metabolism-defined malnutrition in hospitalized older patients. Ann Nutr Metab 71:10–15. https://doi.org/10.1159/000478707

    Article  CAS  PubMed  Google Scholar 

  21. Maeda K, Akagi J (2015) Decreased tongue pressure is associated with sarcopenia and sarcopenic dysphagia in the elderly. Dysphagia 30:80–87. https://doi.org/10.1007/s00455-014-9577-y

    Article  PubMed  Google Scholar 

  22. Buehring B, Hind J, Fidler E, Krueger D, Binkley N, Robbins J (2013) Tongue strength is associated with jumping mechanography performance and handgrip strength but not with classic functional tests in older adults. J Am Geriatr Soc 61:418–422. https://doi.org/10.1111/jgs.12124

    Article  PubMed  Google Scholar 

  23. Jensen GL, Cederholm T, Correia MITD, Gonzalez MC, Fukushima R, Higashiguchi T et al (2019) GLIM criteria for the diagnosis of malnutrition: a consensus report from the global clinical nutrition community. JPEN J Parenter Enteral Nutr 43:32–40. https://doi.org/10.1002/jpen.1440

    Article  PubMed  Google Scholar 

  24. Mahoney FI, Barthel DW (1965) Functional evaluation: the Barthel index. Md State Med J 14:61–65

    CAS  PubMed  Google Scholar 

  25. Correia MITD, Tappenden KA, Malone A, Prado CM, Evans DC, Sauer AC, Hegazi R, Gramlich L et al (2022) Utilization and validation of the global leadership initiative on malnutrition (GLIM): a scoping review. Clin Nutr 41:687–697. https://doi.org/10.1016/j.clnu.2022.01.018

    Article  PubMed  Google Scholar 

  26. Joaquín C, Alonso N, Lupón J, Gastelurrutia P, Pérez-Monstesdeoca A, Domingo M et al (2022) Nutritional status according to the GLIM criteria in patients with chronic heart failure: association with prognosis. Nutrients 14:2244. https://doi.org/10.3390/nu14112244

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Bullock AF, Greenley SL, McKenzie GAG, Paton LW, Johnson MJ (2020) Relationship between markers of malnutrition and clinical outcomes in older adults with cancer: systematic review, narrative synthesis and meta-analysis. Eur J Clin Nutr 74:1519–1535. https://doi.org/10.1038/s41430-020-0629-0

    Article  PubMed  PubMed Central  Google Scholar 

  28. Arends J, Strasser F, Gonella S, Solheim TS, Madeddu C, Ravasco P et al (2021) Cancer cachexia in adult patients: ESMO clinical practice guidelines. ESMO Open 6:100092. https://doi.org/10.1016/j.esmoop.2021.100092

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Campo-Rivera N, Ocampo-Chaparro JM, Carvajal-Ortiz R, Reyes-Ortiz CA (2022) Sarcopenic dysphagia is associated with mortality in institutionalized older adults. J Am Med Dir Assoc 23:1720.e11-1720.e17. https://doi.org/10.1016/j.jamda.2022.06.016

    Article  PubMed  Google Scholar 

  30. Matsuo H, Sakuma K (2022) Pathophysiology of cachexia and characteristics of dysphagia in chronic diseases. Asia Pac J Oncol Nurs 9:100120. https://doi.org/10.1016/j.apjon.2022.100120

    Article  PubMed  PubMed Central  Google Scholar 

  31. Morishita T, Uzui H, Sato Y, Mitsuke Y, Tada H (2021) Associations between cachexia and metalloproteinases, haemodynamics and mortality in heart failure. Eur J Clin Invest 51:e13426. https://doi.org/10.1111/eci.13426

    Article  CAS  PubMed  Google Scholar 

  32. Wakabayashi H, Takahashi R, Murakami T (2019) The prevalence and prognosis of sarcopenic dysphagia in patients who require dysphagia rehabilitation. J Nutr Health Aging 23:84–88. https://doi.org/10.1007/s12603-018-1117-2

    Article  CAS  PubMed  Google Scholar 

  33. Shimizu A, Fujishima I, Maeda K, Wakabayashi H, Nishioka S, Ohno T et al (2021) Nutritional management enhances the recovery of swallowing ability in older patients with sarcopenic dysphagia. Nutrients 13:596. https://doi.org/10.3390/nu13020596

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Kakehi S, Isono E, Wakabayashi H, Shioya M, Ninomiya J, Aoyama Y et al (2023) Sarcopenic dysphagia and simplified rehabilitation nutrition care process: an update. Ann Rehabil Med 47:337–347. https://doi.org/10.5535/arm.23101

    Article  PubMed  PubMed Central  Google Scholar 

  35. Hansen T, Nielsen RL, Houlind MB, Tavenier J, Rasmussen LJH, Jørgensen LM et al (2021) Dysphagia prevalence, time course, and association with probable sarcopenia, inactivity, malnutrition, and disease status in older patients admitted to an emergency department: a secondary analysis of cohort study Data. Geriatrics 6(2):46. https://doi.org/10.3390/geriatrics6020046

    Article  PubMed  PubMed Central  Google Scholar 

  36. Maeda K, Ishida Y, Nonogaki T, Shimizu A, Yamanaka Y, Matsuyama R et al (2020) Development and predictors of sarcopenic dysphagia during hospitalization of older adults. Nutrients 12:70. https://doi.org/10.3390/nu12010070

    Article  CAS  Google Scholar 

  37. Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyère O, Cederholm T et al (2019) Writing group for the european working group on sarcopenia in older people 2 (EWGSOP2), and the extended group for EWGSOP2. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing 48:16–31. https://doi.org/10.1093/ageing/afy169

    Article  PubMed  Google Scholar 

  38. Mori T, Wakabayashi H, Kishima M, Itoda M, Fujishima I, Kunieda K et al (2022) Association between Inflammation and functional outcome in patients with sarcopenic dysphagia. J Nutr Health Aging 26:400–406. https://doi.org/10.1007/s12603-022-1769-9

    Article  CAS  PubMed  Google Scholar 

  39. Ueshima J, Momosaki R, Shimizu A, Motokawa K, Sonoi M, Shirai Y et al (2021) Nutritional assessment in adult patients with dysphagia: a scoping review. Nutrients 13:778. https://doi.org/10.3390/nu13030778

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Homem SG, Moreira EAM, da Silva AF, Barni GC, da Rosa JS, Oliveira DL et al (2020) Relationship between oropharyngeal dysphagia, nutritional status, antioxidant vitamins and the inflammatory response in adults and elderly: a cross-sectional study. Clin Nutr ESPEN 38:211–217. https://doi.org/10.1016/j.clnesp.2020.04.011

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We thank the Rehabilitation Nutrition Database Committee of the Japanese Association of Rehabilitation Nutrition and the Japanese Working Group on Sarcopenic Dysphagia that constructed the Japanese sarcopenic dysphagia database used in this study.

Funding

This work was supported by JSPS KAKENHI (19H03979).

Author information

Authors and Affiliations

  1. School of Medicine, Tokyo Women’s Medical University, Tokyo, Japan

    Mai Yamanaka

  2. Department of Rehabilitation Medicine, Tokyo Women’s Medical University Hospital, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-0054, Japan

    Hidetaka Wakabayashi

  3. Department of Clinical Nutrition and Food Service, Nagasaki Rehabilitation Hospital, Nagasaki, Japan

    Shinta Nishioka

  4. Department of Rehabilitation Medicine, Mie University Graduate School of Medicine, Mie, Japan

    Ryo Momosaki

Authors
  1. Mai Yamanaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hidetaka Wakabayashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shinta Nishioka
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ryo Momosaki
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hidetaka Wakabayashi.

Ethics declarations

Conflict of interest

The authors declare no conflicts of interest.

Ethical approval

The study was approved by the Ethics Committee of Yokohama City University Medical Center (B190700074) and was conducted in accordance with the ethical standards of the Declaration of Helsinki of 1964 and its subsequent amendments.

Informed consent

All participants provided informed consent prior to enrollment or were given the right to opt out of the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yamanaka, M., Wakabayashi, H., Nishioka, S. et al. Malnutrition and cachexia may affect death but not functional improvement in patients with sarcopenic dysphagia. Eur Geriatr Med (2024). https://doi.org/10.1007/s41999-024-00984-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s41999-024-00984-1

Keywords

Search

Navigation