Clinical nutrition ESPEN · 2026
Baseline nutritional-inflammatory status, rather than in-hospital biochemical deterioration, is associated with swallowing recovery in patients with pneumonia: A retrospective cohort study.
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Watanabe Shinichi, Sakurai Takaaki, Kanaya Takahiro, Iwasaki Takumi, Oshima Hyosuke, Furukawa Tetsuya, Yoshikawa Tomohiro, Nakahashi Seichi, Morita Yasunari
Аннотация
BACKGROUND & AIMS: Dysphagia is common in patients hospitalized for pneumonia and is closely associated with nutritional status. Although poor nutritional status at admission is associated with adverse outcomes, the relationship between short-term in-hospital changes in biochemical nutritional-inflammatory indices and swallowing recovery remains unclear and is difficult to evaluate because such changes are defined using discharge measurements, whereas recovery often occurs earlier. We examined baseline nutritional-inflammatory status as the primary exposure and evaluated longitudinal swallowing trajectories according to eventual in-hospital biochemical deterioration.
METHODS: This retrospective, single-center cohort study included 199 adult patients hospitalized for pneumonia. The Functional Oral Intake Scale (FOIS; range 1-7) was assessed at admission, weekly thereafter, and at discharge. Modified Controlling Nutritional Status (mCONUT; range 0-12) scores were calculated at admission and discharge. The primary exposure was baseline mCONUT, and the primary outcome was time to first achievement of FOIS ≥ 4. The Cox analysis was restricted to patients with baseline dysphagia (FOIS < 4; n = 113, 61 events) and adjusted for baseline covariates. A linear mixed-effects model using repeated FOIS measurements across five timepoints (n = 199 patients, 762 observations) examined whether the rate of FOIS change differed according to eventual mCONUT-worsening status.
RESULTS: Higher baseline mCONUT showed a directionally consistent association with delayed achievement of FOIS ≥ 4, although the association did not reach conventional statistical significance (adjusted hazard ratio 0.88 per 1-point increase, 95% confidence interval 0.77-1.01, p = 0.068). FOIS improved significantly over time (β = +0.060/day, p < 0.001). Higher baseline mCONUT (β = -0.142, p = 0.036) and greater pre-hospital frailty (β = -0.379, p < 0.001) were associated with lower longitudinal FOIS levels. No significant time × mCONUT-worsening interaction was observed (β = +0.009, p = 0.537), providing no evidence that the rate of FOIS change differed according to eventual in-hospital mCONUT-worsening status.
CONCLUSION: Higher baseline mCONUT showed a directionally consistent association with delayed swallowing recovery and was associated with lower longitudinal FOIS levels, while greater pre-hospital frailty was also associated with lower FOIS levels over time. No statistically significant difference in the rate of FOIS change was observed according to eventual in-hospital mCONUT-worsening status. Because in-hospital mCONUT change was defined using discharge measurements, associations with early swallowing recovery should be interpreted cautiously owing to temporal-ordering limitations.
METHODS: This retrospective, single-center cohort study included 199 adult patients hospitalized for pneumonia. The Functional Oral Intake Scale (FOIS; range 1-7) was assessed at admission, weekly thereafter, and at discharge. Modified Controlling Nutritional Status (mCONUT; range 0-12) scores were calculated at admission and discharge. The primary exposure was baseline mCONUT, and the primary outcome was time to first achievement of FOIS ≥ 4. The Cox analysis was restricted to patients with baseline dysphagia (FOIS < 4; n = 113, 61 events) and adjusted for baseline covariates. A linear mixed-effects model using repeated FOIS measurements across five timepoints (n = 199 patients, 762 observations) examined whether the rate of FOIS change differed according to eventual mCONUT-worsening status.
RESULTS: Higher baseline mCONUT showed a directionally consistent association with delayed achievement of FOIS ≥ 4, although the association did not reach conventional statistical significance (adjusted hazard ratio 0.88 per 1-point increase, 95% confidence interval 0.77-1.01, p = 0.068). FOIS improved significantly over time (β = +0.060/day, p < 0.001). Higher baseline mCONUT (β = -0.142, p = 0.036) and greater pre-hospital frailty (β = -0.379, p < 0.001) were associated with lower longitudinal FOIS levels. No significant time × mCONUT-worsening interaction was observed (β = +0.009, p = 0.537), providing no evidence that the rate of FOIS change differed according to eventual in-hospital mCONUT-worsening status.
CONCLUSION: Higher baseline mCONUT showed a directionally consistent association with delayed swallowing recovery and was associated with lower longitudinal FOIS levels, while greater pre-hospital frailty was also associated with lower FOIS levels over time. No statistically significant difference in the rate of FOIS change was observed according to eventual in-hospital mCONUT-worsening status. Because in-hospital mCONUT change was defined using discharge measurements, associations with early swallowing recovery should be interpreted cautiously owing to temporal-ordering limitations.