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A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Clinical Nutrition".

Deadline for manuscript submissions: closed (20 January 2023) | Viewed by 28920

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Prof. Dr. Ryo Momosaki

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Guest Editor

Department of Rehabilitation Medicine, Mie University Graduate School of Medicine, Mie 514-8507, Japan
Interests: rehabilitation medicine; dysphagia; clinical nutrition; aspiration pneumonia; health service research
Special Issues, Collections and Topics in MDPI journals

Dr. Yoji Kokura

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Guest Editor

Department of Nutritional Management, Keiju Hatogaoka Integrated Facility for Medical and Long-Term Care, Ishikawa, Japan
Interests: dietetics; clinical nutrition; rehabilitation nutrition; dietetic practice; stroke
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The goal of this Special Issue, “Rehabilitation Nutrition in Older People”, is to focus on the importance of rehabilitation nutrition in improving nutritional status, sarcopenia, and frailty in people with disabilities and frail older people.

Specifically, the aim is to clarify if rehabilitation nutrition (a combination of both rehabilitation and nutritional management) and the rehabilitation nutrition care process can improve body functions, activities, and quality of life.

This Special Issue is to update knowledge on rehabilitation nutrition in older people. All types of manuscripts, including clinical research, epidemiological research, and up-to-date reviews (scoping and systematic reviews, as well as meta-analyses), are welcome.

Dr. Ryo Momosaki
Dr. Yoji Kokura
Guest Editors

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Keywords

rehabilitation nutrition
rehabilitation nutrition care process
aggressive nutrition therapy
rehabilitation
undernutrition
sarcopenia
frailty
older
disability
cachexia

Published Papers (11 papers)

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Editorial

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3 pages, 187 KiB

Open AccessEditorial

Rehabilitation Nutrition in Older People

by Yoji Kokura and Ryo Momosaki

Nutrients 2023, 15(8), 1893; https://doi.org/10.3390/nu15081893 - 14 Apr 2023

Cited by 2 | Viewed by 1508

Abstract

Rehabilitation nutrition is expected to help treat frailty, undernutrition, and sarcopenia [...] Full article

(This article belongs to the Special Issue Rehabilitation Nutrition in Older People)

Research

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10 pages, 388 KiB

Open AccessArticle

Effects of Undernutrition on Swallowing Function and Activities of Daily Living in Hospitalized Patients: Data from the Japanese Sarcopenic Dysphagia Database

by Sayaka Abe, Yoji Kokura, Keisuke Maeda, Shinta Nishioka, Ryo Momosaki, Hiroki Matsuoka, Yasuomi Tomii, Shinnosuke Sugita, Kenta Shimizu, Nanami Esashi and Hidetaka Wakabayashi

Nutrients 2023, 15(5), 1291; https://doi.org/10.3390/nu15051291 - 6 Mar 2023

Cited by 5 | Viewed by 2609

Abstract

This retrospective cohort study examined the effects of undernutrition on swallowing function and activities of daily living in hospitalized patients. Data from the Japanese Sarcopenic Dysphagia Database were used, and hospitalized patients aged ≥20 years with dysphagia were included in the analysis. Participants were assigned to the undernutrition or normal nutritional status group based on the Global Leadership Initiative on Malnutrition criteria. The primary outcome was the Food Intake Level Scale change, and the secondary outcome was the Barthel Index change. Among 440 residents, 281 (64%) were classified under the undernutrition group. The undernutrition group had a significantly higher Food Intake Level Scale score at baseline and Food Intake Level Scale change (p = 0.001) than the normal nutritional status group. Undernutrition was independently associated with the Food Intake Level Scale change (B = −0.633, 95% confidence interval = −1.099 to −0.167) and the Barthel Index change (B = −8.414, 95% confidence interval = −13.089 to −3.739). This was defined as the period from the date of admission to the hospital until discharge or 3 months later. Overall, our findings indicate that undernutrition is associated with reduced improvement in swallowing function and the ability to perform activities of daily living. Full article

(This article belongs to the Special Issue Rehabilitation Nutrition in Older People)

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9 pages, 774 KiB

Open AccessArticle

Predictive Value of Temporal Muscle Thickness for Sarcopenia after Acute Stroke in Older Patients

by Ayano Nagano, Akio Shimizu, Keisuke Maeda, Junko Ueshima, Tatsuro Inoue, Kenta Murotani, Yuria Ishida and Naoharu Mori

Nutrients 2022, 14(23), 5048; https://doi.org/10.3390/nu14235048 - 27 Nov 2022

Cited by 8 | Viewed by 2309

Abstract

The assessment of sarcopenia is part of the nutritional assessment index and is essential in stroke management. This study aimed to identify and validate cutoff values of temporal muscle thickness (TMT) measured using computed tomography to identify sarcopenia after acute stroke. The participants were patients with stroke aged ≥65 years who were admitted to rehabilitation units. The recruited patients were randomly divided into the calculation and validation cohort. In the calculation cohort, TMT cutoff values for identifying sarcopenia were calculated using receiver operating characteristic analysis. The obtained values were validated in the validation cohort using sensitivity and specificity. The calculation cohort included 230 patients (125 men, mean age, 77.2 ± 7.2 years), whereas the validation cohort included 235 patients (125 men, mean age, 76.4 ± 6.95 years). The TMT cutoff values for identifying sarcopenia and low skeletal muscle index were the same: 3.83 mm for men and 2.78 mm for women. The TMT cutoff value for identifying sarcopenia showed a sensitivity and specificity of 0.642 and 0.750, respectively, for men, and 0.660 and 0.567, respectively, for women. We identified a valid cutoff value of temporal muscle thickness for identifying sarcopenia after acute stroke. TMT is easy to measure and may be useful for the early detection of sarcopenia. Full article

(This article belongs to the Special Issue Rehabilitation Nutrition in Older People)

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10 pages, 625 KiB

Open AccessArticle

Validation of Asian Body Mass Index Cutoff Values for the Classification of Malnutrition Severity According to the Global Leadership Initiative on Malnutrition Criteria in Patients with Chronic Obstructive Pulmonary Disease Exacerbations

by Yuka Shirai, Ryo Momosaki, Yoji Kokura, Yuki Kato, Yoshinaga Okugawa and Akio Shimizu

Nutrients 2022, 14(22), 4746; https://doi.org/10.3390/nu14224746 - 10 Nov 2022

Cited by 3 | Viewed by 1968

Abstract

Low body mass index (BMI) is an independent predictor of prolonged hospital stay and mortality in patients with chronic obstructive pulmonary disease (COPD). However, to the best of our knowledge, no studies have examined the validity of Asian BMI cutoff values for classifying severity based on the Global Leadership Initiative on Malnutrition (GLIM) criteria in patients with acute COPD exacerbations. This study sought to validate whether Asian BMI cutoff values can accurately predict 30-day in-hospital mortality, length of stay, and 90-day readmission outcomes for patients with acute COPD exacerbations. The present retrospective cohort study was conducted using a large claims database created by the JMDC. Patients were classified into three groups according to the severity of low BMI assessed using Asian BMI cutoff values. As a result, 624 (29.4%) had severely low BMI, and 444 (20.9%) had moderately low BMI. The severity of low BMI, as assessed by the Asian BMI cutoff values used in the GLIM criteria, was independently associated with 30-day in-hospital mortality (moderately low BMI: HR, 1.87; 95% CI, 1.13–3.08; p = 0.014 and severely low BMI: HR, 2.55; 95% CI, 1.66–3.92; p < 0.001). The Asian BMI cutoff values used to classify the severity of malnutrition in the GLIM criteria are clinically functional for predicting the prognosis of patients with acute COPD exacerbations. Full article

(This article belongs to the Special Issue Rehabilitation Nutrition in Older People)

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11 pages, 901 KiB

Open AccessArticle

Combination of High Energy Intake and Intensive Rehabilitation Is Associated with the Most Favorable Functional Recovery in Acute Stroke Patients with Sarcopenia

by Yoichi Sato, Yoshihiro Yoshimura, Takafumi Abe, Fumihiko Nagano, Ayaka Matsumoto, Yoji Kokura and Ryo Momosaki

Nutrients 2022, 14(22), 4740; https://doi.org/10.3390/nu14224740 - 10 Nov 2022

Cited by 11 | Viewed by 1910

Abstract

Energy intake and rehabilitation time individually contribute to the improvement of activities of daily living (ADL). This study aimed to investigate the additive effect of energy intake and rehabilitation time on ADL improvement in acute stroke patients with sarcopenia. The study included 140 patients (mean age 82.6 years, 67 men) with stroke. Energy intake during the first week of hospitalization was classified as “Sufficiency” or “Shortage” based on the reported cutoff value and rehabilitation time was classified as “Long” or “Short” based on the median. The study participants were categorized into four groups based on the combination of energy intake and rehabilitation time. The primary outcome was the gain of functional independence measure (FIM) motor during hospitalization. The secondary outcomes were length of stay and home discharge rates. Multivariate analysis was performed with primary/secondary outcomes as the dependent variable, and the effect of each group on the outcome was examined. Multivariate analysis showed that “long rehabilitation time and sufficient energy intake” (β = 0.391, p < 0.001) was independently associated with the gain of FIM motor items. The combination of high energy intake and sufficient rehabilitation time was associated with ADL improvement in acute stroke patients with sarcopenia. Full article

(This article belongs to the Special Issue Rehabilitation Nutrition in Older People)

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13 pages, 786 KiB

Open AccessArticle

Sensitivity and Specificity of Body Mass Index for Sarcopenic Dysphagia Diagnosis among Patients with Dysphagia: A Multi-Center Cross-Sectional Study

by Shintaro Togashi, Hidetaka Wakabayashi, Hironori Ohinata, Shinta Nishioka, Yoji Kokura and Ryo Momosaki

Nutrients 2022, 14(21), 4494; https://doi.org/10.3390/nu14214494 - 26 Oct 2022

Cited by 6 | Viewed by 2645

Abstract

The accuracy of body mass index (BMI) for sarcopenic dysphagia diagnosis, which remains unknown, was evaluated in this study among patients with dysphagia. We conducted a 19-site cross-sectional study. We registered 467 dysphagic patients aged ≥ 20 years. Sarcopenic dysphagia was assessed using a reliable and validated diagnostic algorithm. BMI was assessed using the area under the curve (AUC) in the receiver operating characteristic analysis to determine diagnostic accuracy for sarcopenic dysphagia. The study included 460 patients (median age, 83.0 years (76.0–88.0); men, 49.8%). The median BMI was 19.9 (17.3–22.6) kg/m². Two hundred eighty-four (61.7%) patients had sarcopenic dysphagia. The AUC for sarcopenic dysphagia was 0.60–0.62 in the overall patients, male, female, and patients aged ≥ 65 years The BMI cut-off value for sarcopenic dysphagia diagnosis was 20.1 kg/m² in the overall patients (sensitivity, 58.1%; specificity, 60.2%) and patients aged ≥ 65 years (sensitivity, 59.8%; specificity, 61.8%). Conclusion: Although the AUC, sensitivity and specificity of BMI for sarcopenic dysphagia diagnosis was approximately 0.6, BMI < 20.0 kg/m² might be a predictor for sarcopenic dysphagia. In clinical settings, if patients with dysphagia have a BMI < 20.0 kg/m², then sarcopenic dysphagia should be suspected as early as possible after admission. Full article

(This article belongs to the Special Issue Rehabilitation Nutrition in Older People)

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12 pages, 1676 KiB

Open AccessArticle

Preoperative High Visceral Fat Increases Severe Complications but Improves Long-Term Prognosis after Gastrectomy for Patients with Advanced Gastric Cancer: A Propensity Score Matching Analysis

by Ryota Matsui, Noriyuki Inaki, Toshikatsu Tsuji, Yoji Kokura and Ryo Momosaki

Nutrients 2022, 14(20), 4236; https://doi.org/10.3390/nu14204236 - 11 Oct 2022

Cited by 6 | Viewed by 1824

Abstract

This study investigated the paradox of high visceral fat mass increasing severe complications but improving long-term prognosis after radical gastrectomy for gastric cancer. This was a retrospective cohort study of consecutive patients with primary stage I–III gastric cancer who underwent gastrectomy between April 2008 and June 2018. The visceral adipose tissue index (VAI) was calculated by dividing the visceral fat mass preoperatively measured on computed tomography by the square of the height. Patients with VAIs below the median cut-off value were classified as low-VAI, while those above it were classified as high-VAI. We compared the postoperative complication rate and overall survival (OS) in the low- and high-VAI groups after adjusting patient characteristics using propensity score matching (PSM). There were 155 patients in both groups after PSM. After matching, there was no significant difference in factors other than BMI and VAI that were not adjusted. The high-VAI group had more severe postoperative complications (p = 0.018), but the OS was significantly better in the high-VAI group (hazard ratio 0.611, 95%CI 0.403–0.928, p = 0.021). Preoperative high visceral fat mass not only increased severe complications, but also improved OS after gastrectomy in patients with advanced gastric cancer. Full article

(This article belongs to the Special Issue Rehabilitation Nutrition in Older People)

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10 pages, 274 KiB

Open AccessArticle

Association of Existence of Sarcopenia and Poor Recovery of Swallowing Function in Post-Stroke Patients with Severe Deglutition Disorder: A Multicenter Cohort Study

by Shinta Nishioka, Ichiro Fujishima, Masako Kishima, Tomohisa Ohno, Akio Shimizu, Takashi Shigematsu, Masataka Itoda, Hidetaka Wakabayashi, Kenjiro Kunieda, Fumiko Oshima, Sumito Ogawa, Kazuki Fukuma, Nami Ogawa, Jun Kayashita, Minoru Yamada, Takashi Mori and Shinya Onizuka

Nutrients 2022, 14(19), 4115; https://doi.org/10.3390/nu14194115 - 3 Oct 2022

Cited by 5 | Viewed by 2337

Abstract

Background: The effect of sarcopenia on the recovery of swallowing function, and the interaction among sarcopenia, nutrition care, and rehabilitation therapy are inconclusive. Methods: This multicenter cohort study was conducted between November 2018 and October 2020 in convalescent rehabilitation hospitals in Japan and included post-stroke patients aged ≥65 years with dysphagia. All participants were assigned to sarcopenia and non-sarcopenia groups. The primary outcome was the achievement of ≥2 Food Intake Level Scale [FILS] gain, and the secondary outcomes included Functional Independence Measure (FIM) gain and efficiency. Considering the effect modification of energy intake and rehabilitation duration, logistic regression analyses were performed. Results: Overall, 153 participants with (median age, 82 years; 57.5% women) and 40 without (median age 75 years; 35.0% women) sarcopenia were included. The non-sarcopenia group had more patients who achieved an FILS gain of ≥2 (75.0%) than the sarcopenia group (51.0%). Sarcopenia was independently associated with a poor FILS gain (odds ratio:0.34, 95% confidence intervals: 0.13–0.86) but not associated with FIM gain or efficiency. This association was not affected by the rehabilitation duration or energy intake. Conclusions: In conclusion, sarcopenia was negatively associated with the recovery of swallowing function in stroke patients without interaction by energy intake and rehabilitation duration. Full article

(This article belongs to the Special Issue Rehabilitation Nutrition in Older People)

12 pages, 557 KiB

Open AccessFeature PaperArticle

Prevalence of Malnutrition Assessed by the GLIM Criteria and Association with Activities of Daily Living in Older Residents in an Integrated Facility for Medical and Long-Term Care

by Yoji Kokura and Ryo Momosaki

Nutrients 2022, 14(17), 3656; https://doi.org/10.3390/nu14173656 - 4 Sep 2022

Cited by 7 | Viewed by 2523

Abstract

Malnutrition is associated with poor functional outcomes in residents in long-term care facilities. The integrated facility for medical and long-term care (IFMLC) is a new Japanese long-term care facility where medical services can be provided. This study aimed to investigate the prevalence of malnutrition diagnosed based on the Global Leadership Initiative on Malnutrition (GLIM) criteria and its association with activities of daily living (ADL) in older residents in IFMLC. In this cross-sectional study of older residents, we diagnosed mild and severe malnutrition using the GLIM criteria and assessed ADLs using the Barthel index (BI). Multivariate regression analysis was used to investigate the relationship between BI score and GLIM-defined malnutrition. A total of 117 older residents (84 women; median age, 88 years) were analyzed in this study. The prevalence values of mild and severe malnutrition were 29% and 18%, respectively. Multivariate analyses for the BI score after adjusting for potential confounders showed that mild and severe malnutrition were independently associated with BI score (B = −6.113, p < 0.046; B = −8.411, p = 0.015, respectively). GLIM-defined malnutrition is negatively associated with ADLs in older residents in IFMLC. Full article

(This article belongs to the Special Issue Rehabilitation Nutrition in Older People)

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Review

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14 pages, 807 KiB

Open AccessReview

Rehabilitation Nutrition in Patients with Chronic Kidney Disease and Cachexia

by Masatsugu Okamura, Tatsuro Inoue, Masato Ogawa, Kengo Shirado, Nobuyuki Shirai, Takuma Yagi, Ryo Momosaki and Yoji Kokura

Nutrients 2022, 14(22), 4722; https://doi.org/10.3390/nu14224722 - 9 Nov 2022

Cited by 8 | Viewed by 4312

Abstract

Rehabilitation nutrition is a proposed intervention strategy to improve nutritional status and physical function. However, rehabilitation nutrition in patients with cachexia and protein-energy wasting (PEW), which are the main nutrition-related problems in patients with chronic kidney disease (CKD), has not been fully clarified. Therefore, this review aimed to summarize the current evidence and interventions related to rehabilitation nutrition for cachexia and PEW in patients with CKD. CKD is a serious condition worldwide, with a significant impact on patient prognosis. In addition, CKD is easily complicated by nutrition-related problems such as cachexia and PEW owing to disease background- and treatment-related factors, which can further worsen the prognosis. Although nutritional management and exercise therapy are reportedly effective for cachexia and PEW, the effectiveness of combined nutrition and exercise interventions is less clear. In the future, rehabilitation nutrition addressing the nutritional problems associated with CKD will become more widespread as more scientific evidence accumulates. In clinical practice, early intervention in patients with CKD involving both nutrition and exercise after appropriate assessment may be necessary to improve patient outcomes. Full article

(This article belongs to the Special Issue Rehabilitation Nutrition in Older People)

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13 pages, 703 KiB

Open AccessReview

Relationship between Nutrition-Related Problems and Falls in Hemodialysis Patients: A Narrative Review

by Nobuyuki Shirai, Tatsuro Inoue, Masato Ogawa, Masatsugu Okamura, Shinichiro Morishita, Yamamoto Suguru and Atsuhiro Tsubaki

Nutrients 2022, 14(15), 3225; https://doi.org/10.3390/nu14153225 - 6 Aug 2022

Cited by 10 | Viewed by 3679

Abstract

Falls are a social problem that increase healthcare costs. Hemodialysis (HD) patients need to avoid falling because fractures increase their risk of death. Nutritional problems such as frailty, sarcopenia, undernutrition, protein-energy wasting (PEW), and cachexia may increase the risk of falls and fractures in patients with HD. This review aimed to summarize the impact of frailty, sarcopenia, undernutrition, PEW, and cachexia on falls in HD patients. The reported global incidence of falls in HD patients is 0.85–1.60 falls per patient per year. HD patients fall frequently, but few reports have investigated the relationship between nutrition-related problems and falls. Several studies reported that frailty and undernutrition increase the risk of falls in HD patients. Nutritional therapy may help to prevent falls in HD patients. HD patients’ falls are caused by nutritional problems such as iatrogenic and non-iatrogenic factors. Falls increase a person’s fear of falling, reducing physical activity, which then causes muscle weakness and further decreased physical activity; this cycle can cause multiple falls. Further research is necessary to clarify the relationships between falls and sarcopenia, cachexia, and PEW. Routine clinical assessments of nutrition-related problems are crucial to prevent falls in HD patients. Full article

(This article belongs to the Special Issue Rehabilitation Nutrition in Older People)

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