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Can protein-calorie malnutrition cause dysphagia?

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Abstract

Nutrient deprivation has previously been shown to cause alterations in muscle and nerve function. Although an effect has never been studied in the neuromusculature of deglutition, the authors argue that an effect is likely. The proposed result is an increase in swallowing impairment in dysphagic individuals and associated risk of aspiration. Research studying the relationship between malnutrition and dysphagia is needed to verify clinical significance. Until controlled studies are completed, the authors suggest alternative alimentation in repleting severely malnourished dysphagic patients prior to attempting oral diet. A review of nutritional status indices is included to aid in identifying dysphagic patients at nutritional risk. Early identification of nutritional compromise and intervention can prevent malnutrition and its deleterious effects.

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References

  1. Dodds WJ: The physiology of swallowing.Dysphagia 3: 171–178, 1989

    Article  PubMed  CAS  Google Scholar 

  2. Palmer JB: Electromyography of the muscles of oropharyngeal swallowing: basic concepts.Dysphagia 3:192–198, 1989

    Article  PubMed  CAS  Google Scholar 

  3. O'Gara JA: Dietary adjustments and nutritional therapy during treatment for oral-pharyngeal dysphagia.Dysphagia 4:209–212, 1990

    Article  PubMed  Google Scholar 

  4. Gisel EG, Patrick J: Identification of children with cerebral palsy unable to maintain a normal nutritional state.Lancet 1(8580):283–286, 1988

    Article  PubMed  CAS  Google Scholar 

  5. Sitzmann JV: Nutritional support of the dysphagic patient: methods, risks and complications of therapy.JPEN 14:60–63, 1990

    CAS  Google Scholar 

  6. Moghissi K, Teasdale PR: Parenteral feeding in patients with carcinoma of the eosphagus treated by surgery: energy and nitrogen requirementsJPEN 4:371–375, 1980

    CAS  Google Scholar 

  7. Sheppard JJ, Liou J, Hochman R, Laroia S, Langlois D: Nutritional correlates of individuals institutionalized with mental retardation.Dysphagia 3:85–89, 1988

    Article  PubMed  CAS  Google Scholar 

  8. Keys A, Brozek J, Henschel A, Mickelsen O, Taylor HL:The Biology of Human Starvation, vol 1, Minneapolis: University of Minnesota Press, 1950, pp 184–208

    Google Scholar 

  9. Pingleton SK, Harmon GS: Nutritional management in acute respiratory failure.JAMA 257:3094–3099, 1987

    Article  PubMed  CAS  Google Scholar 

  10. Lewis MI, Lebman MJ: Nutrition and the respiratory muscles.Clin Chest Med 9:337–347, 1988

    PubMed  CAS  Google Scholar 

  11. Arora NS, Rochester DF: Respiratory muscle strength and maximal voluntary ventilation in undernourished patients.Am Rev Respir Dis 126:5–8, 1982

    PubMed  CAS  Google Scholar 

  12. Keys A, Brozek J, Henschel A, Mickelsen O, Taylor HL:The Biology of Human Starvation, vol 2 Minneapolis: University of Minnesota Press, 1950

    Google Scholar 

  13. Hansen JDL, Freesemann C, Moodie AD, Evans DE: What does nutritional growth retardation imply?Pediatrics 47: 299–313, 1971

    PubMed  Google Scholar 

  14. Chandra S, Chandra RK: Nutritional regulation of the immune responses: basic considerations and practical applications.JBCR 6:174–178, 1985

    CAS  Google Scholar 

  15. Niederman MS, Merrill WW, Ferranti RD, Pagano KM, Palmer LB, Reynolds HY: Nutritional status and bacterial binding in the lower respiratory tract in patients with chronic tracheostomy.Ann Intern Med 100:795–800, 1984

    PubMed  CAS  Google Scholar 

  16. Mullen JL, Gertner MH, Buzby GP, Goodhart GL, Rosato EF: Implications of malnutrition in the surgical patient.Arch Surg 114:121–125, 1979

    PubMed  CAS  Google Scholar 

  17. Lennmarken C, Larsson J: Skeletal muscle function and energy metabolites in malnourished surgical patients.Acta Chir Scand 152:169–173, 1986

    PubMed  CAS  Google Scholar 

  18. Parson DB, Riedy M, Moore RL, Gollnick PD: Acute fasting and fiber number in rat soleus muscle.J Appl Physiol 53:1234–1238, 1982

    Google Scholar 

  19. Hegarty PFJ, Kim KO: Changes in skeletal muscle cellularity in starved and refed young rats.Br J Nutr 44:123–127, 1980

    Article  PubMed  CAS  Google Scholar 

  20. Stahl TJ, Alden PB, Madoff RD, Ring WS, Cerra FB: Cardiac beta-adrenergic responsiveness is well preserved in moderate protein caloric malnutrition from semistarvation.JPEN 12:579–586, 1988

    CAS  Google Scholar 

  21. Nutter DO, Murray TG, Heymsfield SB, Fuller EO: The effect of protein-calorie undernutrition in the rat on myocardial function and cardiac function.Circ Res 45:144–152, 1979

    PubMed  CAS  Google Scholar 

  22. Gottdiener JS, Gross HA, Henry WL: Effects of self-induced starvation on cardiac size and function in anorexia nervosa.Circulation 58:425–433, 1978

    PubMed  CAS  Google Scholar 

  23. Heymsfield SB, McManus CB: Tissue components of weight loss in cancer patients.Cancer 55:238–249, 1985

    Article  PubMed  CAS  Google Scholar 

  24. Dureuil B, Viires N, Veber B, Pavlovic D, Pariente R, Desments J, Aubier M: Acute diaphragmatic changes induced by starvation in rats.Am J Clin Nutr 49:738–744, 1989

    PubMed  CAS  Google Scholar 

  25. Lewis MI, Sieck GC, Fournier M, Belman MJ: Effect of nutritional deprivation in diaphragm contractility and muscle fiber size.J Appl Physiol 60:596–603, 1986

    PubMed  CAS  Google Scholar 

  26. Kelsen SG, Ference M, Kapoor S: Effects of prolonged undernutrition on structure and function of the diaphragm.J Appl Physiol 58:1354–1359, 1985

    PubMed  CAS  Google Scholar 

  27. Drew JS, Farkas GA, Pearson RD, Rochester DF: Effects of chronic wasting infection on skeletal muscle size and contractile properties.J Appl Physiol 64:460–465, 1988

    PubMed  CAS  Google Scholar 

  28. Sieck GC, Lewis MI, Blanco CE: Effects of undernutrition on diaphragm fiber size, SDH activity, and fatigue resistance.J Appl Physiol 66:2196–2205, 1989

    PubMed  CAS  Google Scholar 

  29. Russell DMcR, Atwood HL, Whittaker JS, Itakura T, Walker PM, Mickle DAG, Jeejeebhoy KN: The effect of fasting and hypocaloric diets on the functional and metabolic characteristics of rat gastrocnemius muscle.Clin Sci 67:185–194, 1984

    PubMed  CAS  Google Scholar 

  30. Raju NV: Effect of early malnutrition on muscle function and metabolism in rats.Life Sci 15:949–960, 1974

    Article  PubMed  CAS  Google Scholar 

  31. Ardawi SM, Majzoub MF, Masored IM, Newsholme EA: Enzymatic and metabolic adaptations in the gastrocnemius, plantaris and soleus muscles of hypocaloric rats.Biochem J 261:219–225, 1989

    PubMed  CAS  Google Scholar 

  32. Brough W, Horne G, Blount A, Irving MH, Jeejeebhoy KN: Effects of nutrient intake, surgery, sepsis and long term administration of steroids on muscle function.Br Med J 293:983–988, 1986

    CAS  Google Scholar 

  33. Chan STF, McLaughlin SJ, Ponting GA, Biglin J, Dudley HAF: Muscle power after glucose-potassium loading in undernourished patients.Br Med J 293:1055–1056, 1986

    CAS  Google Scholar 

  34. Shizgal HM, Vasilersky CA, Gardiner PF, Wang W, Tuitt DAQ, Brabant GV: Nutritional assessment and skeletal muscle function.Am J Clin Nutr 44:761–771, 1986

    PubMed  CAS  Google Scholar 

  35. Russell DM, Prendergast PJ, Darby PL, Gartinkel PE, Whitwell J, Jeejeebhoy KN: A comparison between muscle function and body composition in anorexia nervosa: the effect of refeeding.Am J Clin Nutr 38:229–237, 1983

    PubMed  CAS  Google Scholar 

  36. Russell DMcR, Leiter LA, Whitwell J, Marliss EB, Jeejeebhoy KN: Skeletal muscle function during hypocaloric diets and fasting: a comparison with standard nutritional assessment parameters.Am J Clin Nutr 37:133–138, 1983

    PubMed  CAS  Google Scholar 

  37. Lopes J, Russell DMcR, Whitwell J, Jeejeebhoy KN: Skeletal muscle function in malnutrition.Am J Clin Nutr 36: 602–610, 1982

    PubMed  CAS  Google Scholar 

  38. Moxham J, Morris AJR, Spiro SG: Contractile properties and fatigue of the diaphragm in man.Thorax 36:164–168, 1981

    PubMed  CAS  Google Scholar 

  39. Arora NS, Rochester DF: Respiratory muscle strength and maximal voluntary ventilation in undernourished patients.Am Rev Respir Dis 126:5–8, 1982

    PubMed  CAS  Google Scholar 

  40. Faridi MMA, Ansari Z, Tyagi SP: Skeletal muscle changes in protein energy malnutrition.J Trop Pediatr 34:238–243, 1988

    PubMed  CAS  Google Scholar 

  41. Marin OSM, Denny-Brown D: Changes in skeletal muscle associated with cachexia.Am J Path 41: 23–39, 1962

    PubMed  CAS  Google Scholar 

  42. Goldspink G, Ward PS: Changes in rodent muscle fibre types during post-natal growth, undernutrition and exercise.J Physiol (Lond) 296:453–469, 1979

    CAS  Google Scholar 

  43. Fong Y, Moldawer LL, Marano MA, Wei, H, Barber A, Fischman DA, Lowry SF: Starvation leads to decreased levels of mRNA for myofibrillar proteins.J Surg Res 46: 457–461, 1989

    Article  PubMed  CAS  Google Scholar 

  44. Kaowaki M, Harada N, Takahashi S, Hoguchi R, Naito H: Differential regulation of the degradation of myofibrillar and total proteins in skeletal muscle in rats: effect of streptozotocin-induced diabetes, dietary protein and starvation.J Nutr 119:471–477, 1989

    Google Scholar 

  45. Binder MD: Properties of motor units. In Patton HD, Fuchs AF, Hille B, Scher AM, Steiner R (eds):Textbook of Physiology, vol 1. Philadelphia: W.B. Saunders, 1989, pp 510–521

    Google Scholar 

  46. Denyer GS, Lam D, Cooney GJ, Caterson ID: Effect of starvation and insulin in vivo on the activity of the pyruvate dehydrogenase complex in rat skeletal muscle.FEBS Lett 250:464–468, 1989

    Article  PubMed  CAS  Google Scholar 

  47. Holness MJ, Sugden MC: Pyruvate dehydrogenase activities during the fed-to-starved transition and on re-feeding after acute or prolonged starvation.Biochem J 258:529–533, 1989

    PubMed  CAS  Google Scholar 

  48. Russell DMcR, Walker PM, Leiter LA, Sims AAF, Tanner WK, Mickle DAG, Whitwell J, Maliss EB, Jeejeebhoy KN: Metabolic and structural changes in skeletal muscle during hypocaloric dieting.Am J Clin Nutr 39:503–513, 1984

    PubMed  CAS  Google Scholar 

  49. Saudek CD, Felig P: The metabolic events of starvation.Am J Med 60:117–126, 1976

    Article  PubMed  CAS  Google Scholar 

  50. Chopra JS, Dhand UK, Mehta S, Bakshi V, Raria S, Helita J: Effect of protein calorie malnutrition on peripheral nerves, a clinical, electrophysiological and histopathological study.Brain 109:307–323, 1986

    PubMed  Google Scholar 

  51. Chopra JS, Mehta S, Kaur U, Bakshi V: Clinical, electrophysical and histopathological study of peripheral nerves in protein calorie nutrition.Acta Neuro Scand [Suppl]73: 135, 1979

    Google Scholar 

  52. Dastur JDJ, Dewan A, Manghani DK, Udani PM: Quantitative histology of nerve in protein-calorie malnutrition and well nourished children.Neuropathol Appl Neurobiol 3:405–422, 1977

    Google Scholar 

  53. Ghosh S, Vaid K, Mohan M, Maheshwari MC: Effect of degree and duration of protein energy malnutrition on peripheral nerves in children.J Neurol Neurosurg Psychiatry 42:760–763, 1979

    PubMed  CAS  Google Scholar 

  54. Kumar A, Ghai OP, Singh N: Delayed nerve conduction velocities in children with protein-calorie malnutrition.J Pediatr 90:149–153, 1977

    Article  PubMed  CAS  Google Scholar 

  55. Osuntokun BO: Motor nerve conduction in kwashiorkor (protein-calorie deficiency) before and after treatment.African J Med Med Sci 2:109–119, 1971

    CAS  Google Scholar 

  56. Singh N, Kumar A, Ghai OP: Conduction velocity of motor nerves in children suffering from protein-calorie malnutrition and marasmus.Electromyogra Neurophysiol 16:381–392, 1976

    CAS  Google Scholar 

  57. Sachdev KK, Taori GM, Pereira SM: Neuromuscular status in protein-calorie malnutrition.Neurology 21:801–805, 1971

    PubMed  CAS  Google Scholar 

  58. Platt BS, Stewart RJC: Effects of protein-calorie deficiency on dogs II. Morphological changes in the nervous system.Dev Med Child Neurol 11:174–192, 1969

    PubMed  CAS  Google Scholar 

  59. Dobbing J, Sands J: Qualitative growth and development of human brain.Arch Dis Child 48:757–767, 1973

    PubMed  CAS  Google Scholar 

  60. Reved B: Contributions to the knowledge of the postnatal development of the peripheral nervous system in man. A study of the basis and scope of systematic investigations into the fibre size in peripheral nerves,Acta Psychiatrica et Neurologica [Suppl 33], 1944.

  61. Mattson RH, Lecocq FL: Nerve conduction velocities in fasting patients.Neurology 18:335, 1968

    Article  PubMed  CAS  Google Scholar 

  62. Idiaquez J: Nutritional status and autonomic nervous system function.Funct Neurol 3:205–209, 1988

    PubMed  CAS  Google Scholar 

  63. Doekel RC, Zwillich CW, Scoggin CH, Dryger M, Weil JV: Clinical semi-starvation. Depression of hypoxic ventilatory response.N Eng J Med 295:358–361, 1976.

    Article  CAS  Google Scholar 

  64. Sakaguchi T, Arase K, Fisher JS, Bray GA: Effect of starvation and food intake on sympathetic activity.Am J Physiol 255:R284–288, 1988

    PubMed  CAS  Google Scholar 

  65. Landsber L, Young JB: Fasting, feeding and regulation of the sympathetic nervous system.N Engl J Med 298:1295–1301, 1978

    Article  Google Scholar 

  66. Roy S, Singh N, Deo MG, Ramalingaswami V: Ultrastructure of skeletal muscle and peripheral nerve in experimental protein deficiency and its correlation with nerve conduction studies.J Neurol Sci 17:399–409, 1972

    Article  PubMed  CAS  Google Scholar 

  67. Oldfors A: Nerve fibre degeneration of the central and peripheral nervous system in severe protein deprivation in rats.Acta Neuropathol (Berl) 54:121–127, 1981

    Article  CAS  Google Scholar 

  68. Wurtman RJ, Fernstrom JD: Control of brain neurotransmitter synthesis by precursor availability and nutritional state.Biochem Pharmacol 25:1691–1696, 1976

    Article  PubMed  CAS  Google Scholar 

  69. Kessler JP, Jean A: Inhibitor of the swallowing reflex by local application of seratonergic agents into the nucleus of the solitary tract.Eur J Pharmacol 118:77–85, 1985

    Article  PubMed  CAS  Google Scholar 

  70. Kessler JP, Jean A: Inhibitory influence of monoamines and brainstem monaminergic regions of the medullary swallowing reflex.Neurosci Lett 65:41–46, 1986

    Article  PubMed  CAS  Google Scholar 

  71. Kessler JP, Jean A: Effect of catecholamines on the swallowing reflex after pressure microinjections into the lateral solitary complex of the medulla oblongata.Brain Res 386: 69–77, 1986

    Article  PubMed  CAS  Google Scholar 

  72. Bray GA, Greenway FL, Molitch ME, Dahms WT, Atkinson RL, Hamilton K: Use of anthropometric measures to assess weight loss.Am J Clin Nutr 31:769–773, 1978

    PubMed  CAS  Google Scholar 

  73. Blackburn GL, Bistrian BR, Maini BS, Schlamm HT, Smith MF: Nutritional and metabolic assessment of the hospitalized patient.JPEN 1:11–22, 1977

    CAS  Google Scholar 

  74. Studley HO: Percentage of weight loss: a basic indicator of surgical risk in patients with chronic peptic ulcer.JAMA 106:458, 1936

    Google Scholar 

  75. Rennie MJ, Edwards RHT, Halliday D, Matthews DE, Wolman SE: Muscle protein synthesis measured by stable isotope techniques in man: the effects of feeding and fasting.Clin Sci 63:519–523, 1984

    Google Scholar 

  76. Alpers DH, Clouse RE, Stenson WF:Manual of Nutritional Therapeutics. Boston: Little, Brown, 1983, pp 161–186

    Google Scholar 

  77. Gray GE, Gray LK: Anthropometric measurements and their interpretation: principles, practices and problems.J Am Diet Assoc 77:534–539, 1980

    PubMed  CAS  Google Scholar 

  78. Walser M: Creatinine excretion as a measure of protein nutrition in adults of varying ages.JPEN 11:73S-78S, 1987

    CAS  Google Scholar 

  79. Ingenbleek Y, Van Den Schrieck HG, De Nayer P, De Visscher M: Albumin, transferrin and thyroxin binding prealbumin retinol binding protein (TBPA-RBP) complex in assessment of malnutrition.Clin Chim Acta 63:61–67, 1975

    Article  PubMed  CAS  Google Scholar 

  80. Carpenteir YA, Bruyns J, Barthel J: Plasma protein concentration in nutritional assessment.Proc Nutr Soc 41:405–417, 1982

    Article  Google Scholar 

  81. Haider MH, Haider SQ: Assessment of protein-calorie malnutrition.Clin Chem 30:1286–1299, 1984

    PubMed  CAS  Google Scholar 

  82. Winkler MF, Gerrior SA, Pomp A, Albina JE: Use of retinol-binding protein and prealbumin as indicators of the response to nutritional therapy.J Am Diet Assoc 89:684–687, 1989

    PubMed  CAS  Google Scholar 

  83. Murray RL: Interpreting the nutrition assessment. In Krey SH, Murray RL (eds):Dynamics of Nutrition Support—Assessment, Implementation, Evaluation, Norwalk, Connecticut: Appleton-Century-Crofts, 1986, pp 155–174

    Google Scholar 

  84. Roza AM, Tuitt D, Shizgal HM: Transferrin—a poor measure of nutritional status.JPEN 8:523–528, 1984

    CAS  Google Scholar 

  85. Twomey P, Ziegler D, Rombeau J: Utility of skin testing in nutritional assessment: a critical review.JPEN 6:50–58, 1982

    CAS  Google Scholar 

  86. Dominioni L, Dionigi R: Immunologic function and nutritional assessment.JPEN 11:70S-72S, 1987

    CAS  Google Scholar 

  87. Edwards RHT: Physiological and metabolic studies of contractile machinery of human muscle in health and disease.Phys Med Biol 24:237–249, 1979

    Article  PubMed  CAS  Google Scholar 

  88. Klidjian AM, Foster KJ, Kammerling RM, Cooper A, Karran SJ: Relation of anthropometric and dynamometric variable to serious postoperative complications.Br Med J 281: 899–901, 1980

    Article  PubMed  CAS  Google Scholar 

  89. Watters DAK, Kaffejee AA, Angorn EB, Duffy KJ: Nutritional assessment by hand grip dynamometry.S Afr Med J 68:585–587, 1985

    PubMed  CAS  Google Scholar 

  90. Dempsey DT, Mullen JL: Prognostic value of nutritional indices.JPEN 11:109S-114S, 1987

    CAS  Google Scholar 

  91. Seltzer MH, Bastidas A, Cooper DM, Engler P, Slocum B, Fletcher HS: Instant nutritional assessment.JPEN 3:157–159, 1979

    CAS  Google Scholar 

  92. Seltzer MH, Fletcher HS, Slocum BA, Engler PE: Instant nutritional assessment in the intensive care unit.JPEN, 5: 70–72, 1981

    CAS  Google Scholar 

  93. Mullen JL, Buzby GP, Waldman MT, Gerther MH, Hobbs SL, Rosato EF: Prediction of operative morbidity and mortality by preoperative nutritional assessment.Surg Forum 30:80–82, 1972

    Google Scholar 

  94. Buzby GP, Mullen JL, Matthews DC, Hobbs CL, Rosato EF: Prognostic nutritional index in gastrointestinal surgery.Am J Surg 139:160–167, 1980

    Article  PubMed  CAS  Google Scholar 

  95. Detsky AS, McLaughlin JR, Baker JP, Johnson N, Whittaker S, Mendelson RA, Jeejeebhoy KN: What is subjective global assessment of nutritional status?JPEN 11:8–13, 1987

    CAS  Google Scholar 

  96. Baker JP, Detsky AS, Wesson DE, Wolman SL, Stewart S, Whitewell J, Langer B, Jeejeebhoy KN: Nutritional assessment. A comparison of clinical judgement and objective measurement.N Engl J Med 306:969–972, 1982

    Article  PubMed  CAS  Google Scholar 

  97. Linn BS: A protein energy malnutrition scale (PEMS).Ann Surg 200:747–752, 1984

    PubMed  CAS  Google Scholar 

  98. Goldstein M, Meyer S, Freund HK: Effects of overfeeding in children with muscle dystrophies.JPEN 13:603–607, 1989

    CAS  Google Scholar 

  99. Patrick J, Boland M, Stoski D, Murray GE: Rapid correction of wasting in children with cerebral palsy.Dev Med Child Neurol 28:734–739, 1986

    Article  PubMed  CAS  Google Scholar 

  100. Arora NS, Rochester DF: Effect of body weight and muscularity on human diaphragm muscle mass, thickness and area.J Appl Physiol 52:64–70, 1982

    PubMed  CAS  Google Scholar 

  101. Asbeck C, Burns BL: Nutritional management of amyotrophic lateral sclerosis.Dietitians in Nutrition Support 10: 9–11, 1988

    Google Scholar 

  102. Veldee MS, Miller RM: Dietary considerations for dysphagia. InManual of Clinical Dietetics. Chicago: American Dietetic Association, 1988, pp 195–200

    Google Scholar 

  103. Coster ST, Schwartz WH: Rheology and the swallow-safe bolus.Dysphagia 1:113–118, 1987

    Article  Google Scholar 

  104. Groher ME: Bolus management and aspiration pneumonia in patients with pseudobulbar dysphagia.Dysphagia 1:215–216, 1987

    Article  Google Scholar 

  105. Ghahremain GG, Gould RJ: Nasoenteric feeding tubes: radiographic detection of complications.Dig Dis Sci 32: 575–585, 1986

    Google Scholar 

  106. McArdle AH, Palmason ART, Morency I, Brown RA: A rationale for enteral feeding as preferable route for hyperalimentation.Surgery 90:616–623, 1981

    PubMed  CAS  Google Scholar 

  107. Jacobs S, Chang RWS, Lee B, Bartkett FW: Continuous enteral feeding: a major cause of pneumonia among ventilated intensive care unit patients.JPEN 14:353–356, 1990

    CAS  Google Scholar 

  108. Ryan JA, Page CP: Intrajejunal feeding: development and current status.JPEN 8:187–198, 1984

    Google Scholar 

  109. Boland MP, Stoski DS, MacDonald NE, Soucy P, Patrick J: Chronic jejunostomy feeding with a non-elemental formula in undernourished patients with cystic fibrosis.Lancet 1(8475):232–234, 1986

    Article  PubMed  CAS  Google Scholar 

  110. Boland MP, Patrick J, Stoski DS, Soucy P: Permanent enteral feeding in cystic fibrosis: advantages of a replaceable jejunostomy tube.J Pediatr Surg 22:843–847, 1987

    PubMed  CAS  Google Scholar 

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Veldee, M.S., Peth, L.D. Can protein-calorie malnutrition cause dysphagia?. Dysphagia 7, 86–101 (1992). https://doi.org/10.1007/BF02493439

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