高齢のサルコペニック型嚥下障害患者において、栄養管理が嚥下能力の回復を促進する

Nutritional Management Enhances the Recovery of Swallowing Ability in Older Patients with Sarcopenic Dysphagia.

• Akio Shimizu
• Ichiro Fujishima
• Keisuke Maeda
• Hidetaka Wakabayashi
• Shinta Nishioka
• Tomohisa Ohno
• Akiko Nomoto
• Jun Kayashita
• Naoharu Mori
• The Japanese Working Group On Sarcopenic Dysphagia

抄録

本研究では，サルコペニック型嚥下障害患者に対して，30 kcal/理想体重（IBW）・日（kg）以上の高供給エネルギーを与えることで，嚥下能力と日常生活動作（ADL）が効果的に改善するかどうかを評価した．急性期病院に入院したサルコペニック型嚥下障害患者110名（平均年齢84.9±7.4歳）を対象に，Food Intake LEVEL Scale（FILS）とFunctional Independence Measure（FIM）を用いて，嚥下能力とADLをそれぞれ評価した．主要評価項目は退院時のFILSで、副次評価項目は退院時のFIMが臨床的に重要な最小の差（MCID）で達成されたかどうかであった。入院期間1週間の平均提供エネルギーが30kcal/IBW/day（kg）以上の場合とそうでない場合で、IPTW（inverse probability of treatment weighting）法を用いて、統計的に有意な差のない同質確率モデルを作成し、群間で転帰を比較した。平均供給エネルギーが30kcal/IBW/day(kg)以上の患者は62.7％で達成された。IPTWモデルでは、退院時のFILSおよびFIMのMCID達成率は、平均供給エネルギーが30kcal/IBW/day(kg)以上の群で有意に高かった（それぞれ、=0.004および<0.001）。サルコペニックの嚥下障害患者に高い提供エネルギーを与えることで、嚥下能力が向上し、臨床的に意味のある機能的転帰が得られる可能性がある。

This study assessed whether a high provided energy of ≥30 kcal/ideal body weight (IBW)/day (kg) for patients with sarcopenic dysphagia effectively improved swallowing ability and the activities of daily living (ADLs). Among 110 patients with sarcopenic dysphagia (mean age, 84.9 ± 7.4 years) who were admitted to a post-acute hospital, swallowing ability and the ADLs were assessed using the Food Intake LEVEL Scale (FILS) and the Functional Independence Measure (FIM), respectively. The primary outcome was the FILS at discharge, while the secondary outcome was the achievement of the FIM with a minimal clinically important difference (MCID) at discharge. We created a homogeneous probability model without statistically significant differences using the inverse probability of treatment weighting (IPTW) method with and without a mean provided energy of ≥30 kcal/IBW/day (kg) for a period of 1 week of hospitalization and compared the outcomes between groups. A mean provided energy of ≥30 kcal/IBW/day (kg) was achieved in 62.7% of patients. In the IPTW model, the FILS and the rates of achieved MCID of the FIM at discharge were significantly higher in the mean provided energy of ≥30 kcal/IBW/day (kg) group ( = 0.004 and < 0.001, respectively). A high provided energy for patients with sarcopenic dysphagia may improve swallowing ability and produce clinically meaningful functional outcomes.