Impact of sarcopenia and malnutrition on swallowing function utilizing ultrasonography in patients with acute heart failure: A retrospective cohort study

Background & aims: This study aimed to determine the impact of sarcopenia and nutritional risk on swallowing-related muscles by ultrasonography and dysphagia occurrence in older patients with acute heart failure (AHF) during hospitalization. Methods: Patients with AHF aged >= 65 years without dysphagia (Food Intake LEVEL Scale [FILS] score >= 9) before admission were classified into four groups at admission: robust group, sarcopenia group (Asian Working Group for Sarcopenia 2019), nutritional risk group (geriatric nutritional risk index <92), and complicated group (with both sarcopenia and nutritional risk). Swallowing function (maximal hyoid displacement, geniohyoid muscle area and brightness, and maximal tongue pressure) and FILS were investigated from the medical records. Results: In total, 131 patients with AHF (mean age 82.8 +/- 7.1 years, 71 males) were enrolled during the study period; 33, 58, 5, and 35 were classified into the robust, sarcopenia, nutritional risk, and complicated groups, respectively. In the covariance analysis adjusted for age, sex, comorbidities, and cardiac function, the complicated group had significantly worse swallowing function than the sarcopenia and robust groups (P < 0.05). In the Cox proportional hazards model, in which event occurrence was defined as the first-time FILS score of >= 9 obtained during hospitalization, the sarcopenia group (hazard ratio [HR]: 0.83, 95 % confidence interval [CI]: 0.51-1.34, P = 0.438) and nutritional risk group (HR: 0.77, 95 % CI:0.25-2.32, P = 0.637) were not significantly different, but the complicated group (HR: 0.54, 95 % CI: 0.31-0.95, P = 0.033) had significantly lower cumulative event rates with the robust group as the reference. Conclusion: Sarcopenia and nutritional risk in older patients with AHF are risk factors for decreased swallowing function.