Introduction: Enteral nutrition (EN) can improve the prognosis of older patients with oral intake difficulty. However, the decision to administer tube feeding is not easy especially when patients can eat a certain amount of food. In the present study, we examined the acceptable duration in which oral intake should be improved before deciding to administer tube feeding.
Subjects and Methods: The subjects were 112 patients referred to our nutrition support team. The relationship between clinical outcomes and duration for which enteral caloric intake was <60% of the total energy expenditure (TEE) (period of EN < 60%) was examined. The relationship between clinical outcomes and prognostic nutritional index (PNI) was also examined.
Results: 1) Patients in whom the period of EN < 60% was 15 days or longer had a higher incidence of swallowing disorders requiring supplemental nutrition with tube feeding. 2) Those in whom the period of EN < 60% was 29 days or longer had an increased mortality rate. 3) Patients with a PNI of 30 or more had a significantly higher survival rate after tube feeding.
Conclusions: The results suggest that the acceptable period in which oral intake should be improved before deciding to administer tube feeding is within 14 days from the time the patient starts to experience difficulty with adequate oral intake needed to meet the TEE. We consider that tube feeding should be administered between the 15th and 28th day of the period of EN < 60% or before the PNI falls below 30.

Objective: The serum zinc level has been reported to decrease after invasive surgery. It has also been reported that a decreased serum zinc level may lead to poor appetite. This study examined changes in the serum zinc level after surgery, as well as the effect of oral zinc administration on patients with poor appetite, focusing on the maintenance of a favorable postoperative serum zinc level and mean length of hospital stay.

Subjects and Methods: Thirty-nine patients who underwent open heart surgery or coronary artery bypass graft surgery were classified into 2 groups: those with and without postoperative poor appetite. While the former were treated with zinc jelly supplements (Zn: 23 mg/day), the latter were regarded as controls. The serum zinc level was measured before surgery, 1 day after surgery, and on discharge, and changes in the value and the mean length of hospital stay were compared between the 2 groups.

Results: Changes in the serum zinc level in the poor appetite group became similar to those in the control group, and symptoms of poor appetite improved after the initiation of oral zinc administration. Their mean lengths of hospital stay were also similar.

Conclusion: It may be possible to improve poor appetite, and prevent decreases in the serum zinc level and prolonged hospitalization by administering zinc to patients with poor appetite during the perioperative period.

Objective: The aim of the study was to investigate the prevalence of dysphagia assessed by 10-item Eating Assessment Tool (EAT-10), and evaluate the association between dysphagia and nutritional status in older patients admitted to acute hospital.

Methods: A cross-sectional study was performed on 103 older patients (mean age 80 ± 8 years, 45 of men) hospitalized in an acute-phase local hospital. The EAT-10 were used to evaluate dysphagia and the Mini Nutritional Assessment Short Form (MNA^®-SF) were used to evaluate nutritional status. Correlation analysis and multivariate analysis were performed.

Results: The EAT-10 scores of 3 or more, which suggests dysphagia, was found in 27 patients (26.2%). Malnutrition assessed by the MNA^®-SF was found in 13 patients (12.6%). The EAT-10 has an independent effect on the MNA^®-SF after adjusted for covariates such as age, gender, activities of daily living, and hand grip strength in multiple regression analysis (Beta-0.393, p < 0.001).

Conclusions: Dysphagia assessed by the 10-item Eating Assessment Tool is associated with nutritional status in older patients admitted to acute hospital. We should assess swallowing function and nutritional status in older patients admitted to acute hospital whose EAT-10 score is 3 or more.