Nutritional Assessment in Adult Patients with Dysphagia: A Scoping Review.

Malnutrition negatively affects the quality of life of patients with dysphagia. Despite the need for nutritional status assessment in patients with dysphagia, standard, effective nutritional assessments are not yet available, and the identification of optimal nutritional assessment items for patients with dysphagia is inadequate. We conducted a scoping review of the use of nutritional assessment items in adult patients with oropharyngeal and esophageal dysphagia. The MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials databases were searched to identify articles published in English within the last 30 years. Twenty-two studies met the inclusion criteria. Seven nutritional assessment categories were identified: body mass index (BMI), nutritional screening tool, anthropometric measurements, body composition, dietary assessment, blood biomarkers, and other. BMI and albumin were more commonly assessed in adults. The Global Leadership Initiative on Malnutrition (GLIM), defining new diagnostic criteria for malnutrition, includes the categories of BMI, nutritional screening tool, anthropometric measurements, body composition, and dietary assessment as its required components, but not the blood biomarkers and the "other" categories. We recommend assessing nutritional status, including GLIM criteria, in adult patients with dysphagia. This would standardize nutritional assessments in patients with dysphagia and allow future global comparisons of the prevalence and outcomes of malnutrition, as well as of appropriate interventions.

Influence of potentially inappropriate medications on activities of daily living for patients with osteoporotic vertebral compression fractures: A retrospective cohort study.

PURPOSE: Potentially inappropriate medications (PIMs) are a major concern in geriatric care. Osteoporotic vertebral compression fractures (OVCFs) are more common among the elderly, who are more likely to receive long-term analgesics for pain and additional medications for complications, but no studies have examined the effects of PIMs on OVCFs. The purpose of our study was to clarify the association between PIMs and activities of daily living (ADL) among patients with OVCFs. METHODS: The subjects were 170 patients aged 65 years or older with OVCFs treated conservatively who underwent rehabilitation between October 2014 and August 2019. Patients' clinical information, including age, sex, body mass index, total number of drugs used for treatment at admission, number and type of PIMs used at admission, bone mineral density, use of drugs for osteoporosis, fracture type, comorbidity severity, nutritional status, Barthel Index (BI), presence and extent of lower back pain, and length of hospital stay were examined retrospectively. The possible association between these clinical factors and the BI and use of PIMs was assessed. RESULTS: Ninety-seven patients (57.1%) were prescribed PIMs at admission. Mean BI at discharge was significantly lower among patients receiving PIMS (70 points vs. 83 points; p < 0.001). Multivariate analysis for BI gain after propensity score matching showed that the number of PIMs and BI at admission affected the BI gain. CONCLUSION: The use of PIMs hindered the improvement in ADL. Our results demonstrate the importance of appropriate drug control for patients with OVCFs.

Energy Intake at Admission for Improving Activities of Daily Living and Nutritional Status among Convalescent Stroke Patients.

Our aim was to clarify the nutritional status and energy intake needed for activities of daily living (ADL) improvement among convalescent stroke patients. This retrospective cohort study of stroke patients used data from the Japan Rehabilitation Nutrition Database. Mean energy intake per ideal body weight was 26 kcal/kg/day at 1 week after hospitalization. Patients were divided into two groups according to energy intake: ≥26 kcal/kg/day (high) and <26 kcal/kg/day (low). ADL was evaluated using Functional Independence Measure (FIM), and nutritional status was evaluated using the mini nutritional assessment short form score. We created an inverse probability weighted (IPW) model using propensity scoring to control and adjust for patient characteristics and confounders at the time of admission. The analysis included 290 patients aged 78.1 ± 7.8 years. There were 165 patients with high energy intake and 125 patients with low energy intake. FIM score was significantly higher in the high group compared with the low group (median 113 vs 71, P <0.001). FIM efficiency was also higher in the high group (median 0.31 vs 0.22, P <0.001). FIM efficiency was significantly higher in the high energy intake group than in the low energy intake group after adjustment by IPW (median 0.31 vs 0.25, P = 0.011). Nutritional status improvement was also higher in the high energy intake group after adjustment by IPW (60.6% vs 45.2%, P <0.001). High energy intake was associated with higher FIM efficiency and nutritional status improvement at discharge among convalescent stroke patients.

Effect of fructo-oligosaccharide on nitrogen utilization in guinea pigs.

The present study was conducted to determine the effects of fructo-oligosaccharide (FOS) on the nitrogen (N) utilization and digestibilities of dietary nutrients through cecotrophy in guinea pigs. Adult male guinea pigs that were housed or not housed in wooden frames to prevent cecotrophy were fed a commercial pellet diet (50 g/day) with 3% and 5% glucose or FOS for 8 days in individual metabolism cages. In the guinea pigs allowed cecotrophy, addition of FOS to the diet had no significant effects on body weight gain or apparent digestibility of N, but showed significantly lower value for the urinary N excretion and acid-detergent fiber digestibility (P < 0.05 and P < 0.01, respectively) and significantly higher value for N retention and the N retention rate (P < 0.05). In the guinea pigs prevented from cecotrophy, FOS had no effect on N retention, but showed tendencies toward a higher value for fecal N excretion and a lower value for urinary N excretion. These results suggest that FOS stimulates cecal microbial proliferation, thereby improving N utilization in guinea pigs.

Thermodynamic quantities of surface formation of aqueous electrolyte solutions. VI. Comparison with typical nonelectrolytes, sucrose and glucose.

To demonstrate an important distinction between the electrolytes and nonelectrolytes, surface tension of aqueous solutions of typical nonelectrolytes, sucrose and glucose, was measured as a function of temperature and concentration. The presence of sucrose or glucose molecules in the surface region affects the surface tension in the same way as the presence of an ion does. There is, however, a difference in the temperature coefficient of the surface tension between typical nonelectrolyte solutions, sucrose and glucose, and alkali halide solutions. The entropy of surface formation of sucrose and glucose solutions is the same as that of pure water, while that of alkali halide solutions decreases with concentration. The relation between this entropy change and the formation of electric double layers was discussed.