title: Malnutrition risk predicts recovery of full oral intake among older adult stroke patients undergoing enteral nutrition: Secondary analysis of a multicentre survey (the APPLE study).
abstract: Whether malnutrition risk correlates with recovery of swallowing function of convalescent stroke patients is unknown. This study was conducted to clarify whether malnutrition risks predict achievement of full oral intake in convalescent stroke patients undergoing enteral nutrition.
  
  
  
  We conducted a secondary analysis of 466 convalescent stroke patients, aged 65 years or over, who were undergoing enteral nutrition. Patients were extracted from the "Algorithm for Post-stroke Patients to improve oral intake Level; APPLE" study database compiled at the Kaifukuki (convalescent) rehabilitation wards. Malnutrition risk was determined by the Geriatric Nutritional Risk Index as follows: severe (<82), moderate (82 to <92), mild (92 to <98), and no malnutrition risks (≥98). Swallowing function was assessed by Fujishima's swallowing grade (FSG) on admission and discharge. The primary outcome was achievement of full oral intake, indicated by FSG ≥ 7. Binary logistic regression analysis was performed to identify predictive factors, including malnutrition risk, for achieving full oral intake. Estimated hazard risk was computed by Cox's hazard model.
  
  
  
  Of the 466 individuals, 264 were ultimately included in this study. Participants with severe malnutrition risk showed a significantly lower proportion of achievement of full oral intake than lower severity groups (P = 0.001). After adjusting for potential confounders, binary logistic regression analysis showed that patients with severe malnutrition risk were less likely to achieve full oral intake (adjusted odds ratio: 0.232, 95% confidence interval [95% CI]: 0.047-1.141). Cox's proportional hazard model revealed that severe malnutrition risk was an independent predictor of full oral intake (adjusted hazard ratio: 0.374, 95% CI: 0.166-0.842). Compared to patients who did not achieve full oral intake, patients who achieved full oral intake had significantly higher energy intake, but there was no difference in protein intake and weight change.
  
  
  
  Severe malnutrition risk independently predicts the achievement of full oral intake in convalescent stroke patients undergoing enteral nutrition.
authors.affiliation: Kaifukuki Rehabilitation Ward Association, Kikuya Bldg. 5F, 1-28-19, Higashi-ueno, Taito, Tokyo, Japan; Department of Clinical Nutrition and Food Services, Nagasaki Rehabilitation Hospital, 4-11, Gin-ya Machi, Nagasaki 850-0854, Japan. Electronic address: shintacks@yahoo.co.jp.
authors.forename: Shinta
authors.initials: S
authors.lastname: Nishioka
authors.affiliation: Kaifukuki Rehabilitation Ward Association, Kikuya Bldg. 5F, 1-28-19, Higashi-ueno, Taito, Tokyo, Japan; Department of Rehabilitation Medicine, Nishi-Hiroshima Rehabilitation Hospital, 6-265, Miyake, Saeki-ku, Hiroshima, Japan. Electronic address: takatsugu@amy.hi-ho.ne.jp.
authors.forename: Takatsugu
authors.initials: T
authors.lastname: Okamoto
authors.affiliation: Kaifukuki Rehabilitation Ward Association, Kikuya Bldg. 5F, 1-28-19, Higashi-ueno, Taito, Tokyo, Japan; Department of Nutrition, Kumamoto Kinoh Hospital, 6-8-1, Yamamuro, Kita-ku, Kumamoto, Japan. Electronic address: mcjnutrition@juryo.or.jp.
authors.forename: Masako
authors.initials: M
authors.lastname: Takayama
authors.affiliation: Kaifukuki Rehabilitation Ward Association, Kikuya Bldg. 5F, 1-28-19, Higashi-ueno, Taito, Tokyo, Japan; Department of Nutrition, Yawata Medical Center, 12-7, Yawata-i, Komatsu, Ishikawa, Japan. Electronic address: eiyou@katsuki-g.com.
authors.forename: Maki
authors.initials: M
authors.lastname: Urushihara
authors.affiliation: Kaifukuki Rehabilitation Ward Association, Kikuya Bldg. 5F, 1-28-19, Higashi-ueno, Taito, Tokyo, Japan; Department of Nutrition, Mihara Memorial Hospital, 366, Ohta-machi, Isezaki, Gumma, Japan. Electronic address: mmh-eiyou@mihara-ibbv.jp.
authors.forename: Misuzu
authors.initials: M
authors.lastname: Watanabe
authors.affiliation: Kaifukuki Rehabilitation Ward Association, Kikuya Bldg. 5F, 1-28-19, Higashi-ueno, Taito, Tokyo, Japan; Department of Nutrition, Funabashi Rehabilitation Hospital, 4-26-1, Natsumidai, Funabashi, Chiba, Japan. Electronic address: y-kiriya@kiseikai-reha.com.
authors.forename: Yumiko
authors.initials: Y
authors.lastname: Kiriya
authors.affiliation: Kaifukuki Rehabilitation Ward Association, Kikuya Bldg. 5F, 1-28-19, Higashi-ueno, Taito, Tokyo, Japan; Department of Nutrition, Hatsudai Rehabilitation Hospital, 3-53-3, Hon-machi, Shibuya-ku, Tokyo, Japan. Electronic address: h-eiyo@kiseikai-reha.com.
authors.forename: Keiko
authors.initials: K
authors.lastname: Shintani
authors.affiliation: Kaifukuki Rehabilitation Ward Association, Kikuya Bldg. 5F, 1-28-19, Higashi-ueno, Taito, Tokyo, Japan; Department of Nutrition, Tokyo Bay Rehabilitation Hospital, 4-1-1, Yatsu, Narashino, Chiba, Japan. Electronic address: eiyouka@wanreha.net.
authors.forename: Hiromi
authors.initials: H
authors.lastname: Nakagomi
authors.affiliation: Kaifukuki Rehabilitation Ward Association, Kikuya Bldg. 5F, 1-28-19, Higashi-ueno, Taito, Tokyo, Japan; Department of Nutrition, Nishi-Hiroshima Rehabilitation Hospital, 6-265, Miyake, Saeki-ku, Hiroshima, Japan. Electronic address: wel@welnet.jp.
authors.forename: Noriko
authors.initials: N
authors.lastname: Kageyama
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003289:Convalescence; D003680:Deglutition Disorders / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D004435:Eating; D058620:Elder Nutritional Physiological Phenomena; D002149:Energy Intake; D004750:Enteral Nutrition; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D044342:Malnutrition / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D015596:Nutrition Assessment; D009749:Nutrition Surveys; D011014:Pneumonia / Q000453:epidemiology / Q000209:etiology; D011015:Pneumonia, Aspiration / Q000453:epidemiology / Q000209:etiology; D015995:Prevalence; D012189:Retrospective Studies; D012306:Risk; D000071939:Stroke Rehabilitation
keywords: Achieving full oral intake; Convalescent stroke; Dysphagia; Geriatric nutritional risk index; Malnutrition risk