Impact of nutritional status, muscle mass and oral status on recovery of full oral intake among stroke patients receiving enteral nutrition: A retrospective cohort study
Corresponding Author
Shinta Nishioka MS, RD
Chief of the Department
Department of Clinical Nutrition and Food Services, Nagasaki Rehabilitation Hospital, Nagasaki, Japan
Correspondence
Shinta Nishioka, Department of Clinical Nutrition and Food Services, Nagasaki Rehabilitation Hospital 4-11, Gin-ya Machi, Nagasaki 850-0854, Japan.
Email: [email protected]
Search for more papers by this authorKazumi Yamasaki MD, PhD
Section chief
Clinical Research Center, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
Search for more papers by this authorKenji Ogawa MS, PT
Senior physical therapist
Department of Clinical Services, Nagasaki Rehabilitation Hospital, Nagasaki, Japan
Search for more papers by this authorKana Oishi DH
Senior dental hygienist
Department of Clinical Services, Nagasaki Rehabilitation Hospital, Nagasaki, Japan
Search for more papers by this authorYoko Yano ST
Senior speech-language-hearing therapist
Department of Clinical Services, Nagasaki Rehabilitation Hospital, Nagasaki, Japan
Search for more papers by this authorYuka Okazaki ST
Senior speech-language-hearing therapist
Department of Clinical Services, Nagasaki Rehabilitation Hospital, Nagasaki, Japan
Search for more papers by this authorRyusei Nakashima PT
Physical therapist and Deputy director
Department of Clinical Services, Nagasaki Rehabilitation Hospital, Nagasaki, Japan
Search for more papers by this authorMasaki Kurihara MD, PhD
Chairman
Nagasaki Rehabilitation Hospital, Nagasaki, Japan
Search for more papers by this authorCorresponding Author
Shinta Nishioka MS, RD
Chief of the Department
Department of Clinical Nutrition and Food Services, Nagasaki Rehabilitation Hospital, Nagasaki, Japan
Correspondence
Shinta Nishioka, Department of Clinical Nutrition and Food Services, Nagasaki Rehabilitation Hospital 4-11, Gin-ya Machi, Nagasaki 850-0854, Japan.
Email: [email protected]
Search for more papers by this authorKazumi Yamasaki MD, PhD
Section chief
Clinical Research Center, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
Search for more papers by this authorKenji Ogawa MS, PT
Senior physical therapist
Department of Clinical Services, Nagasaki Rehabilitation Hospital, Nagasaki, Japan
Search for more papers by this authorKana Oishi DH
Senior dental hygienist
Department of Clinical Services, Nagasaki Rehabilitation Hospital, Nagasaki, Japan
Search for more papers by this authorYoko Yano ST
Senior speech-language-hearing therapist
Department of Clinical Services, Nagasaki Rehabilitation Hospital, Nagasaki, Japan
Search for more papers by this authorYuka Okazaki ST
Senior speech-language-hearing therapist
Department of Clinical Services, Nagasaki Rehabilitation Hospital, Nagasaki, Japan
Search for more papers by this authorRyusei Nakashima PT
Physical therapist and Deputy director
Department of Clinical Services, Nagasaki Rehabilitation Hospital, Nagasaki, Japan
Search for more papers by this authorMasaki Kurihara MD, PhD
Chairman
Nagasaki Rehabilitation Hospital, Nagasaki, Japan
Search for more papers by this authorAbstract
Aim
To clarify the correlation between malnutrition, muscle mass and oral status, and swallowing function recovery in stroke patients receiving enteral nutrition.
Methods
Patients with stroke and dysphagia receiving any amount of enteral nutrition in rehabilitation wards from 2012 to 2016 were eligible for inclusion in this retrospective study. On admission, body composition by bioimpedance analysis, malnutrition confirmed by the European Society for Clinical Nutrition and Metabolism criteria, oral status, functional independence measure and demographic data were collected. Characteristics were compared between “oral intake alone” and “artificial nutrition” groups based on the discharge status. Kaplan-Meier methods and the Cox proportional hazards model were used to determine explanatory factors for the probability of full oral intake.
Results
Among 174 patients, 113 were analysed (55 women; median age, 77 years). Overall, 61% and 39% were classified as “oral intake alone” and “artificial nutrition,” respectively. Days from onset to admission to rehabilitation wards and motor Functional Independence Measure were higher in the “oral intake alone” group. Kaplan-Meier analysis demonstrated that patients with lower muscle mass exhibited lower probability of full oral intake (P = .009). The Cox proportional hazards model suggested that lower muscle mass (hazard ratio, 0.493; 95% CI, 0.286-0.850) and poor oral hygiene (hazard ratio, 0.573; 95% CI, 0.333-0.987) were independently correlated with “oral intake alone” status. Malnutrition and other oral status are not related to achieving full oral intake.
Conclusions
Skeletal muscle mass and oral hygiene are independently correlated with full oral intake among stroke patients receiving enteral nutrition during the rehabilitation phase.
CONFLICT OF INTEREST
The authors report no conflicts of interest.
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