Objective: We conducted an olfactory test at a regional comprehensive care ward to assess its utility in nutrition management for inpatients intending to return home.

Subjects and Methods: An olfactory test (5-2 method) was administered to 25 patients, classified into two groups by total test score relative to the total median score: the low score group (0-2 points) and the high score group (3-5 points). Scores of the following assessments were compared between the groups using the unpaired t-test and Mann-Whitney U test: nutrition assessment using the geriatric nutritional risk index (GNRI); intraoral condition assessment using the oral health assessment tool, Japanese version (OHAT-J); assessment of activities of daily living using the Barthel index (BI), and cognitive function assessment using the mini mental state examination, Japanese version (MMSE-J). The survey was conducted at regional comprehensive care units at Niigata Rinko Hospital between June 2018 and September 2018.

Results: Significant differences were found in age (p < 0.001) and GNRI (p = 0.005) between the two groups. The low score group tended to show a higher OHAT-J score (p = 0.063), but a lower BI score (p = 0.062) and a lower MMSE-J score (p = 0.091) than the high score group. The proportion of patients with a poorly cleaned tongue and oral cavity was high in patients with lower olfactory scores, suggesting an association of reduced olfactory sensitivity with deterioration in oral condition.

Conclusions: Comprehensive assessment, including olfactory tests, is useful in nutritional therapy planning and nutrition intervention implementation.

Rationale: In this study, we reviewed and examined a stool chart for evaluating the validity of ongoing tube feeding.

Methods: We modified the King′s stool chart proposed by Whelan et al., and the resulting modified King′s stool chart (MKSC) was used to evaluate 47 patients who were receiving a nutrition support team intervention with tube feeding. MKSC levels and risk factors for diarrhea were analyzed.

Results: Multivariate analysis suggested that hypoalbuminemia was associated with an increase in MKSC level. It was also suggested that the highest MKSC level during intervention was associated with alleviation of diarrhea after intervention. The receiver operating characteristic curve, had an area under the curve (AUC) of 0.75, a cutoff value of 15, sensitivity of 1.0, and specificity of 0.575 (p = 0.038, R² = 0.11). These findings suggest that for patients whose MKSC reached 15 points even if only once, stool form did not improve with a probability of 73%, allowing the discontinuation of tube feeding. Considering these results, we evaluated the details of the chart.

Conclusions: Evaluation of stool using the MKSC is useful for predicting alleviation of diarrhea in nutrition management with tube feeding.

Objective: In this study, we examined clinical features predicting oral intake after onset of pneumonia in patients with Parkinsonism.

Methods: We enrolled 136 patients with Parkinsonism who were admitted to our hospital due to pneumonia. The patients were divided into an oral intake group and a non-oral intake group, and various clinical parameters were compared between the groups. We also investigated the clinical course of patients with severe dysphagia during the early stage of hospitalization.

Results: Multivariate analysis showed that independent clinical parameters related to oral intake at discharge were “severity of dysphagia during the early stage of hospitalization” and “degree of independence in daily living before hospitalization”. Dysphagia rehabilitation started at a relatively early stage in patients who had severe dysphagia during the early stage of hospitalization, but neurologists had little involvement during hospitalization and about half of the patients were treated for Parkinsonism.

Conclusion: Given that medication adjustment, as well as dysphagia rehabilitation, is important for treatment of dysphagia in some patients with Parkinsonism, collaboration with neurologists is necessary so that these patients can regain oral intake ability in the future.

Aim: To investigate factors related to poor dietary intake after gastrojejunal bypass surgery for unresectable malignant tumor.

Subjects and Methods: We retrospectively analyzed data of 40 patients who underwent gastrojejunal bypass surgery for unresectable malignant tumor between April 2007 and March 2016. Patients were divided into two groups by dietary intake. Logistic regression analysis was performed to determine independent risk factors for poor dietary intake. A p value less than 0.05 was considered statistically significant in univariate and multivariate analyses.

Results: The study population comprised 35 cases of gastric cancer and 5 cases of pancreatic cancer. Poor dietary intake was determined in 8 cases (20.0%). Univariate analysis revealed that a survival period ≤ 75 days (p=0.004), neutrophil/lymphocyte ratio (NLR) ≥ 6 (p=0.020), and Controlling Nutritional Status score ≥ 3 (p=0.037) were statistically significant factors associated with poor dietary intake. Multivariate logistic regression analysis revealed that poor dietary intake was associated with a survival period ≤ 75 days (OR: 28.8, 95%CI: 1.53-541.0), and that poor dietary intake had a marginally significant association with NLR ≥ 6 (OR: 14.6, 95%CI: 0.87-247.0).

Conclusion: Preoperative NLR is an important predictor of poor dietary intake after gastrojejunal bypass surgery for unresectable malignant tumor.

Purpose: We examined the current status of polypharmacy and its effects on albumin values.

Subjects and Methods: We evaluated a total of 1,892 patients for concurrent use of multiple medications between April 2 and July 27, 2018, and calculated the proportion of those on 6 or more medications (defined as polypharmacy). We investigated associations of albumin values with patient characteristics, total number of medications, and 12 typical therapeutic chemical classes that are known to decrease appetite.

Results: Of the 1,892 patients, 578 (30.5%) had been prescribed 6 or more medications. No correlation was noted between number of medications and albumin values (r = -0.125, p = 0.003). In addition, multivariate analysis of risk factors for a decrease in albumin values showed odds ratios of 1.105 for number of medications, 0.398 for female sex, 0.572 for antihypertensives, 4.067 for opioids, and 8.874 for antidementia drugs.

Conclusion: No significant correlation was noted between number of medications and albumin values, but number of medications, male sex, opioids, and antidementia drugs were factors associated with a decrease in albumin values.