Sarcopenia and dysphagia: Position paper by four professional organizations

Abstract

This report was written by the Japanese Society of Dysphagia Rehabilitation, the Japanese Association of Rehabilitation Nutrition, the Japanese Association on Sarcopenia and Frailty, and the Society of Swallowing and Dysphagia of Japan to consolidate the currently available evidence on the topics of sarcopenia and dysphagia. Histologically, the swallowing muscles are of different embryological origin from somatic muscles, and receive constant input stimulation from the respiratory center. Although the swallowing muscles are striated, their characteristics are different from those of skeletal muscles. The swallowing muscles are inevitably affected by malnutrition and disuse; accumulating evidence is available regarding the influence of malnutrition on the swallowing muscles. Sarcopenic dysphagia is defined as dysphagia caused by sarcopenia of the whole body and swallowing‐related muscles. When sarcopenia does not exist in the entire body, the term “sarcopenic dysphagia” should not be used. Additionally, sarcopenia due to neuromuscular diseases should be excluded; however, aging and secondary sarcopenia after inactivity, malnutrition and disease (wasting disorder and cachexia) are included in sarcopenic dysphagia. The treatment of dysphagia due to sarcopenia requires both dysphagia rehabilitation, such as resistance training of the swallowing muscles and nutritional intervention. However, the fundamental issue of how dysphagia caused by sarcopenia of the swallowing muscles should be diagnosed remains unresolved. Furthermore, whether dysphagia can be caused by primary sarcopenia should be clarified. Additionally, more discussion is required on issues such as the relationship between dysphagia and secondary sarcopenia, as well as the diagnostic criteria and means for diagnosing dysphagia caused by sarcopenia. Geriatr Gerontol Int 2019; 19: 91–97.

Assessment of swallowing function and muscle using ultrasonography in general and family medicine

“…Another advantage is that ultrasonography can evaluate swallowing muscle mass and quality. Sarcopenic dysphagia is defined as dysphagia caused by sarcopenia of the whole body and swallowing‐related muscles . The prevalence of sarcopenic dysphagia in patients who require dysphagia rehabilitation was as high as 32%, and sarcopenic dysphagia was independently associated with poor swallowing function .…”

Impact of edema on length of calf circumference in older adults

“…Calf circumference has been proven to be positively correlated to skeletal muscle mass, and might thus be a potential indicator of decreased muscle mass in clinical practice as an alternative to imaging modalities and bioimpedance analysis. 12,13 However, although calf circumference has been endorsed in as a reliable indicator for evaluating muscle mass, 8,9,14 its use remains controversial. 10 Edema can develop from malnutrition, and renal, hepatic and cardiac diseases, and as a side-effect of medications that increase fluid accumulation in the body; 15,16 thus, edema can increase calf circumference.…”

Association between dysphagia risk and unplanned hospitalization in older patients receiving home medical care

“…The causes of swallowing disorders include cerebrovascular disorders, aging, decreased physical fitness, neuromuscular disease and dementia. Additionally, with these disease conditions, sarcopenia, a decrease in muscle mass and function, is an independent risk factor associated with swallowing disorders in older individuals …”

“…Additionally, with these disease conditions, sarcopenia, a decrease in muscle mass and function, is an independent risk factor associated with swallowing disorders in older individuals. 9 Swallowing disorders can lead to eating problems, which deteriorate nutritional condition, lessen the enjoyment of eating and can lead to pneumonia. 10 The decrease in food consumption leads to malnutrition and reduced body weight.…”