Can protein-calorie malnutrition cause dysphagia?

Abstract

Nutrient deprivation has previously been shown to cause alterations in muscle and nerve function. Although an effect has never been studied in the neuromusculature of deglutition, the authors argue that an effect is likely. The proposed result is an increase in swallowing impairment in dysphagic individuals and associated risk of aspiration. Research studying the relationship between malnutrition and dysphagia is needed to verify clinical significance. Until controlled studies are completed, the authors suggest alternative alimentation in repleting severely malnourished dysphagic patients prior to attempting oral diet. A review of nutritional status indices is included to aid in identifying dysphagic patients at nutritional risk. Early identification of nutritional compromise and intervention can prevent malnutrition and its deleterious effects.

The Interdependency of Protein-Energy Malnutrition, Aging, and Dysphagia

“…A hypermetabolic disease is characterized by an elevation in basal metabolic rate (BMR) or resting energy expenditure (REE) due to the complications of an associated disease or acute trauma. In addition, Veldee and Peth [40] postulated that the multiplicity of muscles involved in deglutition have a moderate to high percentage of type II fibers present because successful swallowing is characterized by synchronized, rapid contractions requiring speed and short bursts of activity. Type II (fast twitch) muscle fibers are affected by PEM to a much greater extent than are type I fibers (slow twitch) [34,38,39,42].…”

“…Type II (fast twitch) muscle fibers are affected by PEM to a much greater extent than are type I fibers (slow twitch) [34,38,39,42]. Therefore, deglutitive muscles may be among the first to atrophy because of reduced food intake, compromising the integrity of the swallow, further decreasing intakes and increasing the risk of aspiration [40].…”

Treatment of Dysphagia Improves Nutritional Conditions in Stroke Patients

“…Prolonged conditions with protein-energy malnutrition (PEM) can deprive immune functions and increase morbidity from infectious diseases and mortality [6][7][8]. It has also been suggested that PEM may alter muscle and nerve function and thereby increase swallowing impairment [9]. Different therapeutic strategies have been introduced to improve swallowing impairment [10].…”

Dysphagia in a Patient with Wegener's Granulomatosis: Case Report

“…Although our patient was not reported to have a history of cerebrovascular accident, a brainstem event presenting primarily as dysphagia cannot be ruled out [10]. Veldee et al [11] report nutrient deprivation to cause alterations in muscle and nerve function and although an eect has not been studied in the neuromusculature of deglutition, the authors argue that an eect is likely [11].…”