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Nutrition in acute and chronic diseases

Association between food texture levels consumed and the prevalence of malnutrition and sarcopenia in older patients after stroke

European Journal of Clinical Nutrition volume 76, pages 1576–1582 (2022)Cite this article

Subjects

Abstract

Background/objectives

Texture-modified diets (TMDs) may affect nutritional status and sarcopenia in patients after stroke. This study aimed to investigate the association of food texture levels consumed by patients after stroke with the prevalence of malnutrition and sarcopenia.

Subjects/methods

This was a two-center cross-sectional study. A total of 443 patients aged ≥65 years undergoing post-stroke rehabilitation and with oral intake in rehabilitation wards in Shizuoka prefecture and Okinawa prefecture, Japan, were included in the analysis. Food textures were categorized according to the International Dysphagia Diet Standardization Initiative (IDDSI) framework. Malnutrition was diagnosed according to the Global Leadership Initiative on Malnutrition and sarcopenia was assess by the European Working Group on Sarcopenia in Older People 2 criteria. The Cochran–Armitage trend test was used to examine the prevalence of malnutrition and sarcopenia by consumption of lower food texture levels.

Results

Malnutrition and sarcopenia were diagnosed in 245 (55.3%) and 275 (62.1%) participants, respectively. Consumption of lower food texture levels was associated with a higher prevalence of malnutrition and severe malnutrition (P < 0.001 for both). In addition, consumption of lower food texture levels was associated with a higher prevalence of probable sarcopenia and sarcopenia (P < 0.001 for both). On multivariate analysis, significant associations were observed between IDDSI levels 5 (P < 0.001) and 4 (P = 0.009) and malnutrition, and between IDDSI levels 6 (P = 0.015), 5 (P = 0.033), and 4 (P = 0.015) and sarcopenia.

Conclusions

In patients with stroke, consumption of lower food texture levels categorized by the IDDSI framework was associated with a higher prevalence of malnutrition and sarcopenia.

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Fig. 1: Flowchart of study participants.
Fig. 2: Association of food textures with the nutritional status and sarcopenia status of patients undergoing post-stroke rehabilitation.

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Data availability

The dataset generated and analyzed in this study is not available to the public because it is a new database containing a lot of important information.

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Acknowledgements

The authors are thankful to all the participants for their time and dedication.

Funding

This study was supported by the Japan Society for the Promotion of Science (grant number 21H03390 to KM) and the Nakatani Suzuyo Memorial Fund For Nutrition and Dietetics (AS).

Author information

Authors and Affiliations

  1. Department of Nutrition, Hamamatsu City Rehabilitation Hospital, Wago-kita, Hamamatsu, Japan

    Akio Shimizu

  2. Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Yazakokarimata, Nagakute, Japan

    Akio Shimizu, Keisuke Maeda, Ayano Nagano, Junko Ueshima, Yuria Ishida & Naoharu Mori

  3. Department of Geriatric Medicine, National Center for Geriatrics and Gerontology, Morioka, Obu, Japan

    Akio Shimizu, Keisuke Maeda & Tatsuro Inoue

  4. Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, Wago-kita, Hamamatsu, Japan

    Ichiro Fujishima

  5. Okinawa Chuzan Clinical Research Center, Chuzan Hospital, Matsumoto, Okinawa, Japan

    Keisuke Maeda, Keisuke Sato & Masaki Suenaga

  6. Biostatistics Center, Kurume University, Asahimachi, Kurume, Japan

    Kenta Murotani

  7. Department of Dentistry, Hamamatsu City Rehabilitation Hospital, Wago-kita, Hamamatsu, Japan

    Tomohisa Ohno & Akiko Nomoto

  8. Department of Speech Language Pathology and Audiology, Faculty of Rehabilitation, Kawasaki University of Medical Welfare, Matsushima, Kurashiki, Japan

    Shinsuke Nagami

  9. Department of Nursing Care, Nishinomiya Kyoritsu Neurosurgical Hospital, Imazuyamanaka, Nishinomiya, Japan

    Ayano Nagano

  10. Department of Clinical Nutrition and Food Service, NTT Medical Center Tokyo, Higashi-Gotanda, Tokyo, Japan

    Junko Ueshima

  11. Department of Physical Therapy, Niigata University of Health and Welfare, Shimami-cho, Niigata, Japan

    Tatsuro Inoue

  12. Department of Nutrition, Hamamatsu University Hospital, Handayama, Hamamatsu, Japan

    Midori Shimizu

  13. Department of Nutrition, Aichi Medical University, Yazakokarimata, Nagakute, Japan

    Yuria Ishida

  14. Department of Health Sciences, Faculty of Human Culture and Science, Prefectural University of Hiroshima, Ujina-higashi, Hiroshima, Japan

    Jun Kayashita

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  1. Akio Shimizu
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Contributions

AS, IF, KM, KM, TO, AN, SN, AN, KS, JU, TI, MS, YI, JK, MS, and NM contributed to the concept and design; AS, IF, KM, KM, TO, AN, KS, and MS contributed to the acquisition and analysis of the data; AS, IF, KM contributed to data interpretation and drafting the paper. All authors have read and agreed to the published version of the paper.

Corresponding author

Correspondence to Keisuke Maeda.

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Competing interests

The authors declare no competing interests.

Ethics approval

This study was approved by the Ethics Committee of the Hamamatsu City Rehabilitation Hospital (ID: 19-77). Owing to the retrospective design, it was not possible to obtain written informed consent; therefore, instead of exempting the requirement for written informed consent, participants were informed of their right to withdraw from the study via posts on the hospital website and bulletin board. This consent procedure was reviewed and approved by the Ethics Committee of the Hamamatsu City Rehabilitation Hospital, approval number (ID: 19-77). The authors comply with the guidelines for human studies and conducted the study ethically in accordance with the World Medical Association Declaration of Helsinki.

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Shimizu, A., Fujishima, I., Maeda, K. et al. Association between food texture levels consumed and the prevalence of malnutrition and sarcopenia in older patients after stroke. Eur J Clin Nutr 76, 1576–1582 (2022). https://doi.org/10.1038/s41430-022-01126-1

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