How is malnutrition managed in patients with dysphagia?

Updated: Mar 20, 2020
  • Author: Nam-Jong Paik, MD, PhD; Chief Editor: Elizabeth A Moberg-Wolff, MD  more...
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Answer

The effect of dysphagia on the patient's nutritional status is profound. As the patient's ability to swallow becomes impaired, adequate dietary intake becomes a challenge, and vice versa. Therefore, early detection and management of dysphagia are critical to halting malnutrition. [55]

Malnutrition is a risk factor for pneumonia because it renders patients susceptible to altered microbial colonization in the oropharynx and because it depresses the immune system, reducing resistance to infection. It may also lead to lethargy, weakness, and reduced alertness, all of which may increase the probability of aspiration.

Moreover, malnutrition may reduce the strength of cough and the mechanical clearance of the lungs. It also contributes to overall functional decline, muscle breakdown, osteoporosis, osteopenia, iron-deficiency anemia, skin breakdown, and poor wound healing.

Therefore, in addition to dysphagia screening, formal nutritional assessment is necessary in high-risk patients. Nutritional needs are determined by means of thorough body composition analysis, clinical examination, and biochemical assessment. Energy, protein, and fluid requirements must also be assessed.

In an investigation of the nutritional status of patients admitted to a rehabilitation service, 49% of all patients admitted for stroke were malnourished, [33] and 65% of persons admitted for stroke with dysphagia were malnourished. [28]

Many commercial products are available to provide nutritional support. A patient's protein and calorie intake can be enhanced not only with thickening agents but also with prethickened beverages, prepacked puree molds, oral liquid supplements, and modular components. When oral nutrition is inadequate, enteral nutrition is indicated.


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