Airway invasion on videofluoroscopy is associated with short-term nutritional worsening in adults with non-neurologic dysphagia: a prospective study.

BACKGROUND

This study evaluated whether findings of a baseline videofluoroscopic swallowing study (VFSS) were associated with nutritional status at a 3-month follow-up in patients with dysphagia.

METHODS

This single-center prospective observational study included adult patients with non-neurologic dysphagia who underwent VFSS between April 2023 and March 2024. Baseline VFSS parameters, including the penetration-aspiration scale (PAS), residue measures, and functional dysphagia scale (FDS), were compared. Nutritional status was assessed using the Mini Nutritional Assessment-Short Form (MNA-SF) at baseline and 3 months. Multivariable linear regression analyses were performed to evaluate the association between baseline VFSS parameters and change in nutritional status (ΔMNA-SF), adjusting for age, sex, Charlson Comorbidity Index, baseline MNA-SF, and baseline functional oral intake scale (FOIS).

RESULTS

Of 54 patients, 44 were included in the final analysis. Higher PAS scores were significantly associated with a greater decline in nutritional status (B=-0.423, p=0.009) after adjusting for baseline MNA-SF and clinical covariates. This association remained significant after further adjustment for baseline FOIS (B=-0.428, p=0.012). PAS category also showed a significant association with ΔMNA-SF. Among the evaluated predictors, PAS demonstrated the highest explanatory power across the nested models, whereas residue measures, FDS, and baseline FOIS were not significantly associated with nutritional decline.

CONCLUSION

The severity of airway invasion on a VFSS is independently associated with subsequent nutritional decline in patients with non-neurologic dysphagia beyond the effect of baseline functional oral intake. A VFSS-based assessment of swallowing safety may help to identify patients at risk of nutritional deterioration and support early nutritional interventions.