AIMS: To describe the associations between dysphagia and malnutrition risk and to identify predictors for dysphagia in a group of persons at risk of malnutrition in hospitals and nursing homes. DESIGN: A secondary analysis of cross-sectional data from the years 2012-2016. METHODS: The risk of malnutrition was assessed using the Malnutrition Universal Screening Tool for Adults (MUST). The data were compared regarding malnutrition risk and dysphagia. Regression analyses were conducted to identify variables that were associated with the risk of malnutrition and dysphagia. RESULTS: Patients (N = 17,580) were included in the study sample. The prevalence of dysphagia was 6.6% and the prevalence of malnutrition risk was 18.9%. A multivariable logistic regression analysis resulted in the identification of dysphagia and cancer as variables with the highest odds ratios with regard to malnutrition risk. Patients with cancer, stroke or respiratory diseases represent a high-risk group for the co-occurrence of dysphagia and risk of malnutrition. CONCLUSIONS: Screening for dysphagia should be carried out on patients at risk of malnutrition as an integral part of their admission to a healthcare institution and especially on the higher risk group of patients with cancer, a stroke or a respiratory disease. IMPACT: What problem did the study address? This study identified the relationship between dysphagia and malnutrition risk and associated factors. What were the main findings? Dysphagia among patients in the research sample was associated with more than two times higher prevalence of the malnutrition risk. Where and on whom will the research have an impact? Thorough malnutrition risk and dysphagia screening lead to better nursing care.

目的: 描述吞咽困难和营养不良风险之间的关系并确定一组在医院和疗养院有营养不良风险的人吞咽困难的预测因素。 设计: 对2012-2016年的横向数据进行二次分析。 方法: 营养不良的风险是使用成人营养不良普遍筛查工具(MUST)进行评估的。比较营养不良风险和吞咽困难的数据。进行回归性分析以确定与营养不良和吞咽困难风险相关的变量。 结果: 患者(N = 17580)包含在研究样本中。吞咽困难患病率为6.6%,营养不良风险患病率为18.9%。多变量逻辑回归分析结果表明,吞咽困难和癌症是营养不良风险比值比最高的变量。癌症、中风或呼吸系统疾病患者是同时发生吞咽困难和营养不良风险的高危人群。 结论: 应该对有营养不良风险的患者进行吞咽困难筛查,将其作为进入医疗机构的一个组成部分,尤其是对癌症、中风或呼吸道疾病的高风险患者。 影响: 研究解决了什么问题?本研究明确了吞咽困难与营养不良风险及相关因素之间的关系。主要调查结果是什么?在研究样本中,患者吞咽困难与营养不良风险高于2倍的患病率有关。这项研究将在何处、对谁产生影响?彻底的营养不良风险和吞咽困难筛查会带来更好的护理。.

Department of Nursing Faculty of Health Studies University of Pardubice Pardubice Czech Republic

Faculty of Nursing Universitas Riau Riau Indonesia

Institute of Nursing Science Medical University of Graz Graz Austria

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Allard, J. P., Keller, H., Jeejeebhoy, K. N., Laporte, M., Duerksen, D. R., Gramlich, L., … Lou, W. (2016). Malnutrition at hospital admission-contributors and effect on length of stay: A prospective cohort study from the Canadian malnutrition task force. Journal of Parenteral and Enteral Nutrition, 40(4), 487-497. https://doi.org/10.1177/0148607114567902

Arends, J., Bachmann, P., Baracos, V., Barthelemy, N., Bertz, H., Bozzetti, F., … Preiser, J.-C. (2017). ESPEN guidelines on nutrition in cancer patients. Clinical Nutrition, 36(1), 11-48. https://doi.org/10.1016/j.clnu.2016.07.015

Baugreet, S., Hamill, R. M., Kerry, J. P., & McCarthy, S. N. (2017). Mitigating nutrition and health deficiencies in older adults: a role for food innovation? Journal of Food Science, 82(4), 848-855. https://doi.org/10.1111/1750-3841.13674

Brown, T., Ross, L., Jones, L., Hughes, B., & Banks, M. (2014). Nutrition outcomes following implementation of validated swallowing and nutrition guidelines for patients with head and neck cancer. Supportive Care in Cancer, 22(9), 2381-2391. https://doi.org/10.1007/s00520-014-2180-9

Carrión, S., Cabré, M., Monteis, R., Roca, M., Palomera, E., Serra-Prat, M., … Clavé, P. (2015). Oropharyngeal dysphagia is a prevalent risk factor for malnutrition in a cohort of older patients admitted with an acute disease to a general hospital. Clinical Nutrition, 34(3), 436-442. https://doi.org/10.1016/j.clnu.2014.04.014

Clavé, P., De Kraa, M., Arreola, V., Girvent, M., Farré, R., Palomera, E., & Serra-Prat, M. (2006). The effect of bolus viscosity on swallowing function in neurogenic dysphagia. Alimentary Pharmacology and Therapeutics, 24(9), 1385-1394. https://doi.org/10.1111/j.1365-2036.2006.03118.x

Coffey, M. M., Tolley, N., Howard, D., Drinnan, M., & Hickson, M. (2018). An Investigation of the post-laryngectomy swallow using videofluoroscopy and fiberoptic endoscopic evaluation of swallowing (FEES). Dysphagia, 33(3), 369-379. https://doi.org/10.1007/s00455-017-9862-7

Dijkstra, A., Buist, G., & Dassen, T. (1996). Nursing-care dependency: Development of an assessment scale for demented and mentally handicapped patients. Scandinavian Journal of Caring Sciences, 10(3), 137-143. https://doi.org/10.1111/j.1471-6712.1996.tb00326.x

Dimunová, L., Dankulincová Veselská, Z., Raková, J., & Bednarek, A. (2018). Relationship between quality of life of lung cancer patients and smoking. Central European Journal of Nursing and Midwifery, 9(2), 812. https://doi.org/10.15452/CEJNM.2018.09.0009.

Donabedian, A. (1988). The quality of care. How can it be assessed? JAMA, 260(12), 1743-1748. https://doi.org/10.1001/jama.1988.03410120089033

Eglseer, D., Halfens, R. J. G., & Lohrmann, C. (2017). Is the presence of a validated malnutrition screening tool associated with better nutritional care in hospitalized patients? Nutrition, 37, 104-111. https://doi.org/10.1016/j.nut.2016.12.016

Eglseer, D., Halfens, R. J. G., Schols, J. M. G. A., & Lohrmann, C. (2018). Dysphagia in hospitalized older patients: Associated factors and nutritional interventions. The Journal of Nutrition, Health and Aging, 22(1), 103-110. https://doi.org/10.1007/s12603-017-0928-x

Fávaro-moreira, N. C., Krausch-hofmann, S., Matthys, C., Vereecken, C., Vanhauwaert, E., Declercq, A., … Duyck, J. (2016). Risk factors for malnutrition in older adults: A systematic review of the literature based on longitudinal data. American Society for Nutrition, 7(6), 507-522. https://doi.org/10.3945/an.115.011254.delayed

Ferlay, J., Soerjomataram, I., Dikshit, R., Eser, S., Mathers, C., Rebelo, M., … Bray, F. (2015). Cancer incidence and mortality worldwide: Sources, methods and major patterns in GLOBOCAN 2012. International Journal of Cancer, 136(5), E359-E386. https://doi.org/10.1002/ijc.29210

Field, A. (2016). Discovering statistics using IBM SPSS statistics (4th ed). London, UK: Sage Publications Ltd.

Govender, R., Smith, C. H., Taylor, S. A., Barratt, H., & Gardner, B. (2017). Swallowing interventions for the treatment of dysphagia after head and neck cancer: A systematic review of behavioural strategies used to promote patient adherence to swallowing exercises. BMC Cancer, 17(1), 1-16. https://doi.org/10.1186/s12885-016-2990-x

Guerra, R. S., Sousa, A. S., Fonseca, I., Pichel, F., Restivo, M. T., Ferreira, S., & Amaral, T. F. (2016). Comparative analysis of undernutrition screening and diagnostic tools as predictors of hospitalisation costs. Journal of Human Nutrition and Dietetics, 29(2), 165-173. https://doi.org/10.1111/jhn.12288

Hennessy, M., & Goldenberg, D. (2016). Surgical anatomy and physiology of swallowing. Operative Techniques in Otolaryngology - Head and Neck Surgery, 27(2), 60-66. https://doi.org/10.1016/j.otot.2016.04.002

Holst, M., Rasmussen, H. H., & Unosson, M. (2009). Well-established nutritional structure in Scandinavian hospitals is accompanied by increased quality of nutritional care. E-SPEN, 4(1), 22-29. https://doi.org/10.1016/j.eclnm.2008.09.002

Humbert, I. A., McLaren, D. G., Kosmatka, K., Fitzgerald, M., Johnson, S., Porcaro, E., … Robbins, J. A. (2010). Early deficits in cortical control of swallowing in Alzheimer's disease. Journal of Alzheimers Disease, 19(4), 1185-1197. https://doi.org/10.3233/JAD-2010-1316

Huppertz, V. A. L., Halfens, R. J. G., van Helvoort, A., de Groot, L. C. P. G. M., Baijens, L. W. J., & Schols, J. M. G. A. (2018). Association between oropharyngeal dysphagia and malnutrition in dutch nursing home residents: results of the national prevalence measurement of quality of care. The Journal of Nutrition, Health and Aging, 22(10), 1246-1252. https://doi.org/10.1007/s12603-018-1103-8.

IBM Corp. (2017). IBM SPSS statistics for windows, version 25.0. Armonk, NY: IBM Corp.

Jager-Wittenaar, H., Dijkstra, P. U., Vissink, A., Van Oort, R. P., Van Der Laan, B. F. A. M., & Roodenburg, J. L. N. (2011). Malnutrition in patients treated for oral or oropharyngeal cancer-prevalence and relationship with oral symptoms: An explorative study. Supportive Care in Cancer, 19(10), 1675-1683. https://doi.org/10.1007/s00520-010-1001-z

Khalatbari-Soltani, S., & Marques-Vidal, P. (2016). Impact of nutritional risk screening in hospitalized patients on management, outcome and costs: A retrospective study. Clinical Nutrition, 35(6), 1340-1346. https://doi.org/10.1016/j.clnu.2016.02.012

Laguna, L., Hetherington, M. M., Chen, J., Artigas, G., & Sarkar, A. (2016). Measuring eating capability, liking and difficulty perception of older adults: A textural consideration. Food Quality and Preference, 53, 47-56. https://doi.org/10.1016/j.foodqual.2016.05.013

Lohrmann, C., Dijkstra, A., & Dassen, T. (2003). Care dependency: Testing the German version of the care dependency scale in nursing homes and on geriatric wards. Scandinavian Journal of Caring Sciences, 17(1), 51-56. https://doi.org/10.1046/j.1471-6712.2003.00117.x

MacLean, J., Cotton, S., & Perry, A. (2009). Post-laryngectomy: It's hard to swallow : Alian study of prevalence and self-reports of swallowing function after a total laryngectomy. Dysphagia, 24(2), 172-179. https://doi.org/10.1007/s00455-008-9189-5

Madhavan, A., Lagorio, L. A., Crary, M. A., Dahl, W. J., & Carnaby, G. D. (2016). Prevalence of and risk factors for dysphagia in the community dwelling elderly: A systematic review. Journal of Nutrition, Health and Aging, 20(8), 806-815. https://doi.org/10.1007/s12603-016-0712-3

Mandysova, P., Škvrňáková, J., Ehler, E., & Černý, M. (2011). Development of the brief bedside dysphagia screening test in the Czech Republic. Nursing and Health Sciences, 13(4), 388-395. https://doi.org/10.1111/j.1442-2018.2011.00630.x

Mandysová, P., Trundová, H., & Ehler, E. (2016). Inter-rater agreement of the brief bedside dysphagia screening test-revised in patients with stroke. Central European Journal of Nursing and Midwifery, 7(2), 412-419. https://doi.org/10.15452/CEJNM.2016.07.0009.

Mann, T., Heuberger, R., & Wong, H. (2013). The association between chewing and swallowing difficulties and nutritional status in older adults. Australian Dental Journal, 58(2), 200-206. https://doi.org/10.1111/adj.12064

Meier, R., & Stratton, R. (2008). Basics concepts in nutrition: Epidemiology of malnutrition. E-SPEN, 3(4), https://doi.org/10.1016/j.eclnm.2008.04.002

Middleton, S., Grimley, R., & Alexandrov, A. W. (2015). Triage, treatment and transfer: Evidence-based clinical practice recommendations and models of nursing care for the first 72 hours of admission to hospital for acute stroke. Stroke, 46(2), e18-e25. https://doi.org/10.1161/STROKEAHA.114.006139

Mosselman, M. J., Kruitwagen, C. L. J. J., Schuurmans, M. J., & Hafsteinsdóttir, T. B. (2013). Malnutrition and risk of malnutrition in patients with stroke: Prevalence during hospital stay. Journal of Neuroscience Nursing, 45(4), 194-204. https://doi.org/10.1097/JNN.0b013e31829863cb

Namasivayam, A. M. (2017). Malnutrition, dysphagia and tongue strength in long term care. University of Toronto. Retrieved from https://tspace.library.utoronto.ca/bitstream/1807/79340/1/Namasivayam_Ashwini_M_201706_PhD_thesis.pdf

Namasivayam, A. M., & Steele, C. M. (2015). Malnutrition and dysphagia in long-term care: A systematic review. Journal of Nutrition in Gerontology and Geriatrics, 34(1), 1-21. https://doi.org/10.1080/21551197.2014.1002656

Namasivayam-MacDonald, A. M., Morrison, J. M., Steele, C. M., & Keller, H. (2017). How swallow pressures and dysphagia affect malnutrition and mealtime outcomes in long-term care. Dysphagia, 32(6), 785-796. https://doi.org/10.1007/s00455-017-9825-z

Ney, D. M., Weiss, J. M., Kind, A. J. H., & Robbins, J. (2009). Senescent swallowing: Impact, strategies and interventions. Nutrition in Clinical Practice, 24(3), 395-413. https://doi.org/10.1177/0884533609332005

Norshariza, J., Siti Farrah Zaidah, M. Y., Aini Zaharah, A. J., Betti Sharina, M. H. L., Neoh, M. K., Aeininhayatey, A., & Nur Hafizah, M. S. (2017). Prevalence of malnutrition among hospitalised adult cancer patients at the National Cancer Institute, Putrajaya, Malaysia. Malaysian Journal of Nutrition, 23(2), 161-174.

Popman, A., Richter, M., Allen, J., & Wham, C. (2018). High nutrition risk is associated with higher risk of dysphagia in advanced age adults newly admitted to hospital. Nutrition and Dietetics, 75(1), 52-58. https://doi.org/10.1111/1747-0080.12385

Raynaud-Simon, A., Revel-Delhom, C., & Hébuterne, X. (2011). Clinical practice guidelines from the French health high authority: Nutritional support strategy in protein-energy malnutrition in the elderly. Clinical Nutrition, 30(3), 312-319. https://doi.org/10.1016/j.clnu.2010.12.003

Rofes, L., Muriana, D., Palomeras, E., Vilardell, N., Palomera, E., Alvarez-Berdugo, D., … Clavé, P. (2018). Prevalence, risk factors and complications of oropharyngeal dysphagia in stroke patients: A cohort study. Neurogastroenterology and Motility, 30(8), 1-10. https://doi.org/10.1111/nmo.13338

Roy, N., Roy, N., Stemple, J., Merrill, R. M., & Thomas, L. (2007). Dysphagia in the elderly: Preliminary evidence of prevalence, risk factors and socioemotional effects. The Annals of Otology, Rhinology, and Laryngology, 116(December), 858-865. https://doi.org/10.1177/000348940711601112

Sarabia-Cobo, C. M., Pérez, V., de Lorena, P., Domínguez, E., Hermosilla, C., Nuñez, M. J., … Rodríguez, L. (2016). The incidence and prognostic implications of dysphagia in elderly patients institutionalized: A multicenter study in Spain. Applied Nursing Research, 30, e6-e9. https://doi.org/10.1016/j.apnr.2015.07.001

Schimmel, M., Ono, T., Lam, O. L. T., & Müller, F. (2017). Oro-facial impairment in stroke patients. Journal of Oral Rehabilitation, 44(4), 313-326. https://doi.org/10.1111/joor.12486

Slavíková, M., Procházka, B., Dlouhý, P., Anděl, M., & Rambousková, J. (2018). Prevalence of malnutrition risk among institutionalized elderly from North Bohemia is higher than among those in the Capital City of Prague, Czech Republic. Central European Journal of Public Health, 26(2), 111-117. https://doi.org/10.21101/cejph.a4944

Slouka, D., Kučera, R., Hošek, P., Gál, B., Trčka, O., Kostlivý, T., & Havel, D. (2018). Key problems of the quality of life of patients after total laryngectomy. Kontakt, 3, 249-255. https://doi.org/10.1016/j.kontakt.2018.08.006

Stratton, R. J., Hackston, A., Longmore, D., Dixon, R., Price, S., Stroud, M., … Elia, M. (2004). Malnutrition in hospital outpatients and inpatients: Prevalence, concurrent validity and ease of use of the ‘malnutrition universal screening tool’ (‘MUST’) for adults. British Journal of Nutrition, 92(05), 799. https://doi.org/10.1079/BJN20041258

Streicher, M., Wirth, R., Schindler, K., Sieber, C. C., Hiesmayr, M., & Volkert, D. (2018). Dysphagia in nursing homes-Results from the NutritionDay project. Journal of the American Medical Directors Association, 19(2), 110-116. https://doi.org/10.1016/j.jamda.2017.08.015

Suttrup, I., & Warnecke, T. (2016). Dysphagia in Parkinson's Disease. Dysphagia, 31(1), 24-32. https://doi.org/10.1007/s00455-015-9671-9

Tabor, L., Gaziano, J., Watts, S., Robison, R., & Plowman, E. K. (2016). Defining swallowing-related quality of life profiles in individuals with amyotrophic lateral sclerosis. Dysphagia, 31(3), 376-382. https://doi.org/10.1007/s00455-015-9686-2

Tamura, B. K., Bell, C. L., Masaki, K. H., & Amella, E. J. (2013). Factors associated with weight loss, low BMI and malnutrition among nursing home patients: A systematic review of the literature. Journal of the American Medical Directors Association, 14(9), 649-655. https://doi.org/10.1016/j.jamda.2013.02.022

Tannen, A., & Lohrmann, C. (2013). Malnutrition in Austrian hospital patients: Prevalence, risk factors, nursing interventions and quality indicators: A descriptive multicentre study. Journal of Advanced Nursing, 69(8), 1840-1849. https://doi.org/10.1111/jan.12051

Thomas, M. N., Kufeldt, J., Kisser, U., Hornung, H.-M., Hoffmann, J., Andraschko, M., … Rittler, P. (2016). Effects of malnutrition on complication rates, length of hospital stay and revenue in elective surgical patients in the G-DRG-system. Nutrition, 32(2), 249-254. https://doi.org/10.1016/j.nut.2015.08.021

Van der Maarel-Wierink, C. D., Meijers, J. M. M., De Visschere, L. M. J., de Baat, C., Halfens, R. J. G., & Schols, J. M. G. A. (2014). Subjective dysphagia in older care home residents: A cross-sectional, multi-centre point prevalence measurement. International Journal of Nursing Studies, 51(6), 875-881. https://doi.org/10.1016/j.ijnurstu.2013.10.016

Van Nie-Visser, N. C., Schols, J. M. G. A., Meesterberends, E., Lohrmann, C., Meijers, J. M. M., & Halfens, R. J. G. (2013). An international prevalence measurement of care problems: Study protocol. Journal of Advanced Nursing, 69(9), e18-29. https://doi.org/10.1111/jan.12190

Volkert, D., Beck, A. M., Cederholm, T., Cruz-Jentoft, A., Goisser, S., Hooper, L., … Bischoff, S. C. (2018). ESPEN guideline on clinical nutrition and hydration in geriatrics. Clinical Nutrition, 38(1), 10-47. https://doi.org/10.1016/j.clnu.2018.05.024

Wakabayashi, H., & Matsushima, M. (2016). Dysphagia assessed by the 10-item eating assessment tool is associated with nutritional status and activities of daily living in elderly individuals requiring long-term care. Journal of Nutrition, Health and Aging, 20(1), 22-27. https://doi.org/10.1007/s12603-016-0671-8

WHO (2010). International statistical classification of diseases and related health problems, 10th revision. Retrieved from http://apps.who.int/classifications/icd10/browse/2010/en#/

Wie, G. A., Cho, Y. A., Kim, S. Y., Kim, S. M., Bae, J. M., & Joung, H. (2010). Prevalence and risk factors of malnutrition among cancer patients according to tumor location and stage in the National Cancer Center in Korea. Nutrition, 26(3), 263-268. https://doi.org/10.1016/j.nut.2009.04.013

Yang, E. J., Kim, M. H., Lim, J. Y., & Paik, N. J. (2013). Oropharyngeal dysphagia in a community-based elderly cohort: The Korean longitudinal study on health and aging. Journal of Korean Medical Science, 28(10), 1534-1539. https://doi.org/10.3346/jkms.2013.28.10.1534

Zhang, Z., Pereira, S. L., Luo, M., & Matheson, E. M. (2017). Evaluation of blood biomarkers associated with risk of malnutrition in older adults: A systematic review and meta-analysis. Nutrients, 9(8), 829. https://doi.org/10.3390/nu9080829