Effects of Physical Rehabilitation and Nutritional Intake Management on Improvement in Tongue Strength in Sarcopenic Patients.

Ayano Nagano,Keisuke Sato,Masaki Suenaga,Yuria Ishida,Akio Shimizu,Masaki Koike,Tatsuro Inoue,Junko Ueshima,Keisuke Maeda,Naoharu Mori,Kenta Murotani

doi:10.3390/nu12103104

Abstract

The study aimed to investigate the impact of physical intervention and the amount of nutritional intake on the increase in tongue strength and swallowing function in older adults with sarcopenia. From November 2018 and May 2019, older patients with sarcopenia who were admitted for rehabilitation were analyzed. The intervention employed in the study was the usual physical and occupational therapy for two months. Tongue strength was measured before and after two months of treatment. Data on tongue strength, the amount of energy and protein intake, intervention time, and swallowing function were examined. A total of 95 sarcopenic older patients were included (mean age 83.4 ± 6.5 years). The mean tongue strength after the intervention was significantly increased from 25.4 ± 8.9 kPa to 30.5 ± 7.6 kPa as a result of the treatment (p < 0.001). After adjusting the confounding factors in the multivariable models, an energy intake of ≥30 kcal/kg/day and a protein intake of ≥1.2 g/kg/day based on the ideal body weight had a significant impact on the increase in tongue strength after the treatment (p = 0.011 and p = 0.020, respectively). Swallowing function assessed using the Mann Assessment of Swallowing Ability was significantly increased after the treatment (mean difference between pairs: 1.12 [0.53–1.70]; p < 0.001). Physical intervention and strict nutritional management for older inpatients with sarcopenia could be effective to improve tongue strength and swallowing function.

Highlights

Sarcopenia is a condition characterized by a decline of muscle mass and muscle function and causes various health problems in older adults [1]
A total of 150 sarcopenic older adults were examined to determine their eligibility to participate in the study
After applying the exclusion criteria, 55 patients were excluded; three were prescribed dysphagia rehabilitation, three had contraindications for bioimpedance analysis (BIA), 44 were unable to comply with the instruction, and five were unexpectedly discharged

Summary

Introduction

Sarcopenia is a condition characterized by a decline of muscle mass and muscle function and causes various health problems in older adults [1]. Sarcopenia occurs in the swallowing muscles and leads to swallowing dysfunction [6,7,8,9,10,11,12], which is referred to as sarcopenic dysphagia. Sarcopenic dysphagia is characterized by a sarcopenia-induced swallowing disorder and the loss of swallowing muscle mass and function [6]. The prevalence of sarcopenic dysphagia is reported to be 13% in older women after hip fracture surgery [12], 33% in hospitalized older patients with sarcopenia [10], and 32% in inpatients who have undergone dysphagia rehabilitation [11]. The risk factors of sarcopenic dysphagia include hospitalization, low physical function, malnutrition, and severe sarcopenia [10,12,13,14]. Decreased hand-grip strength, decreased skeletal muscle mass, and sarcopenia are associated with decreased tongue strength [15,16,17,18,19]

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Conclusion