Department of Nutrition, Hamamatsu City Rehabilitation Hospital, Hamamatsu 433-8127, Japan.
Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute 480-1195, Japan.
Nutrients. 2021 Feb 11;13(2):596. doi: 10.3390/nu13020596.
This study assessed whether a high provided energy of ≥30 kcal/ideal body weight (IBW)/day (kg) for patients with sarcopenic dysphagia effectively improved swallowing ability and the activities of daily living (ADLs). Among 110 patients with sarcopenic dysphagia (mean age, 84.9 ± 7.4 years) who were admitted to a post-acute hospital, swallowing ability and the ADLs were assessed using the Food Intake LEVEL Scale (FILS) and the Functional Independence Measure (FIM), respectively. The primary outcome was the FILS at discharge, while the secondary outcome was the achievement of the FIM with a minimal clinically important difference (MCID) at discharge. We created a homogeneous probability model without statistically significant differences using the inverse probability of treatment weighting (IPTW) method with and without a mean provided energy of ≥30 kcal/IBW/day (kg) for a period of 1 week of hospitalization and compared the outcomes between groups. A mean provided energy of ≥30 kcal/IBW/day (kg) was achieved in 62.7% of patients. In the IPTW model, the FILS and the rates of achieved MCID of the FIM at discharge were significantly higher in the mean provided energy of ≥30 kcal/IBW/day (kg) group ( = 0.004 and < 0.001, respectively). A high provided energy for patients with sarcopenic dysphagia may improve swallowing ability and produce clinically meaningful functional outcomes.
本研究评估了为患有肌少症性吞咽困难的患者提供 ≥30 千卡/理想体重(IBW)/天(kg)的高能量是否能有效改善吞咽能力和日常生活活动(ADL)。在入住一家康复医院的 110 名肌少症性吞咽困难患者(平均年龄 84.9 ± 7.4 岁)中,使用食物摄入水平量表(FILS)和功能性独立测量(FIM)分别评估吞咽能力和 ADL。主要结局为出院时的 FILS,次要结局为出院时达到具有临床意义最小差异(MCID)的 FIM。我们使用逆概率治疗加权(IPTW)方法创建了一个没有统计学差异的同质概率模型,同时考虑和不考虑住院期间每周提供 ≥30 千卡/IBW/天(kg)的平均能量,并比较两组之间的结局。在 62.7%的患者中达到了 ≥30 千卡/IBW/天(kg)的平均能量供应。在 IPTW 模型中,出院时 FILS 和达到 FIM 的 MCID 的比例在提供 ≥30 千卡/IBW/天(kg)的平均能量组中显著更高(=0.004 和 <0.001,分别)。为患有肌少症性吞咽困难的患者提供高能量可能会改善吞咽能力并产生具有临床意义的功能结局。