咀嚼嚥下者の栄養療法に関するハノイ医大ワークショップ
2018年12月5日ハノイ医学大学講堂にて

ハノイ医大咀嚼嚥下障害栄養療法ワークショップ
2018年12月5日ハノイ医科学堂にて

全国配布用小冊子

ハノイ医学大学栄養学部設立式典2013年10月2日

ベトナムで初めての栄養学部学生 46名

第一期生卒業式 2017年6月

ハノイ医科大学「十文字アジアの栄養・食文化研究所」2018.2.14

RELATIONSHIP BETWEEN DYSPHAGIA AND
NUTRITIONAL STATUS OF ELDERLY IN SOMEVIETNAMESE HOSPITALSTRAN PHUONG THAO
Supervisor: Prof. Yamamoto Shigeru
Hanoi, 5/12/2018

Suitable dysphagia and nutrition screening tools

Sample size is bigger
PurposeDetermine theproportion of dysphagia
on elderly in someVietnamese hospital

Relationship betweendysphagia and nutrition
status8

METHOD• Place: 3 hospitals:
Hanoi Medical University
National geriatric hospital
Dong Da general hosptial• Sample size: 1000 patients• Time: 9-12/2018• Ethical committee (number 1318 HĐĐĐĐHYHN)
9

DYSPHAGIA SCREENING TOOL
Repetitive Saliva Swallowing test(RSST) 反復唾液嚥下テスト<3 times/30 seconds
Dysphagia≥ 3 times/30 seconds
Next step

Horiguchi S, Suzuki Y (2011) Screening tests in evaluating swallowing function. JMAJ 54:31–4

10

Water swallowing test (WST)
3ml water

No choking, no silent
aspiration

Choking, silent
aspiration
dysphagia

30ml water

No choking, no silent
aspiration
Normal≥ 1 time, no choking, nosilent aspiration(>5seconds)
Suspected
11

Horiguchi S, Suzuki Y (2011) Screening tests in evaluating swallowing function. JMAJ 54:31–4

Vietnam EAT-10

Made byTran Phuong Thao, Jumonji
UniversityNguyen Thuy Linh, HMU

EAT-10（イート・テン）• 最近、水やお茶を飲む時むせたり、食事に時間が掛かると感じている方に関しては、飲み込みの状態（嚥下状態）をしっかりと見極め、むせや誤嚥を防いだり、嚥下の状態に合わせた適切な食事形態の調整に努めたいもの。
• 機能状態を見極める方法はいくつかありますが、なかでも「EAT-10」は、簡単に嚥下機能状態がわかる便利なツールとして世界各国で普及が進んでいます。
• 「EAT-10」の実施・評価方法は、飲み込みに関する10 個の質問に答えていき、各質問の評価点数を合計するだけで、嚥下障害の可能性の有無を見極めることができます。短時間で実施でき、様々な状態の方、若年者、高齢者の区別なく利用できます。
• また、現在の嚥下状態あるいは状態の変化に、いち早く気づくこともできます。嚥下障害の方だけでなく、嚥下が気になる方にも有用なツールです。
• 出典 Nestle https://nestle.jp/nutrition/dysphagia/EAT-10.html

Nutrition screening questionnaires on elderly
MNA-SF: Mini nutritional assessment- Short form

15

ORAL FUNCTION TEST
• Open degree• Take the tongue forward• Move the tongue left and right• Push the buccal mucosa with the tongue• Inflating both cheeks• Denture• Atrophy of tougue papilla• Lingual surface drying

16

HAND GRIP STRENGTH TEST

Assess muscle strength17

Table 1: RSST and WST swallowing screeningthe elderly at the hospital

Dysphagia
statusHanoi Medical
University
Hospital(n=268)

RSST
Dysphagia
WST

National geriatrichospital (n= 168)

3
合計
6(2%)

3Dong Da
generalhospital(n=264)50
合計
63(38%)

13Total(n= 700)

27
合計
37(14%)

1080
合計
106(15%)26

Suspected
疑い有132 (19%)

63 (38%)71 (27%)266 (38%)

Normal正常

130 (49%)42 (24%)156 (59%)

328(47%)18

Table 2: Screening for swallowing disorders according to EAT-10
the elderly at the hospital
Dysphagia
statusHanoi Medical

National geriatricDong DaUniversity

hospital(n= 168)

generalHospital(n= 268)

Total(n= 700)

hospital(n= 264)

Eat-10<3

247(92%)85(51%)

201(76%)533(76%)Eat-10≥3(abnormalswallowing)21(8%)

83(49%)

63(24%)

167(24%)19

Table 3: Relationship between EAT-10 and dysphagia
screening test
1-2 điểm(Nodysphagia)≥3 điểm(Dysphagia)

Dysphagia

6(1%)

100(14%)

Suspected205(29%)

61(9%)

Normal322(46%)6(1%)

EAT-10Chi square test

p-value

P<0.00120

Table 4: Relationship between oral function test và EAT-10
Oral function test

Open degree

EAT-10P-value
1-2 points≥3 points(no dysphagia) (dysphagia)

More than 3 fingers 511 (73%)

142 (20%)<0.001Less than 3 fingers 22 (3%)
Take the tongue Can
527 (75%)
forward

25 (4%)
154 (22%)<0.001

Can not
Move tougue to Can
left and right

6 (1%)
521 (74%)

13 (2%)
136 (19%)<0.001

Can not12(2%)

31 (5%)

Can518 (74%)

133 (19%)

Push the buccal
mucosa with theCan not

Khi bình phương test

15 (2%)<0.001
2134 (5%)

EAT-10（イート・テン）評価
Oral function test

EAT-10
Pno dysphagia dysphagia value（1-2 points）（≥3 points)

516 (74%)
17 (2%)
26 (4%)
507 (72%)134 (19%)33 (5%)
29 (4%)
138 (20%)154 (22%)
CanCan not 379 (54%)
48 (7%)
Lingual surface drying Less
salivaEnough 485 (69%)
Khi bình phương test
saliva55 (8%)
112 (16%)23 (3%)Inflating both cheeks
Atrophy of tougue

papillaDenture

CanCan notCan
Can not

0.001
0.001
0.320.075
144 (21%)

22

Table 5: Relationship between dysphagia and muscle strength
Dysphagia

Dysphagia
test

EAT-10Musclestrength

Dysphagia(n=88)

P-value<0.001

Normal(n=323)Eat-10<3(Normal)(n=493)Eat-10≥3(dysphgia)(n=142)
Manwhitney test

<0.00123

Figure 1: Proportion of malnutrition
according to MNA-SF
16%

27%

Tìnhtrạng dinhdưỡng bình thường
Normalnutrition

RiskcơofsuymalnutritionNguy
dinh dưỡngMalnutrition
Suydinh dưỡng
57%

Table 6: Proportion of malnutrition according to MNA-SF
Nutritional
statusin some hospitals
National geriatricHMU
hospital(n=168)(n=268)

Dong Da General
hospital(n=264)

Normal70 (26%)19 (11%)101 (38%)

Risk ofmalnutrition

171 (64%)

87 (52%)142 (54%)

Malnutrition

27 (10%)62 (27%)21 (8%)

24

Conclusion• Proportion of elderly suffer from dysphagia followed
RSST and WST is 15%, and follow EAT-10 is 24%.
• The proportion of malnutrition on hospitalized elderly is16% according to MNA-SF• Relationship between dysphagia and oral dysfunction

and reduce muscle strength.
• The proportion of dysphagia and malnutrition is 16%25IMPROVEMENT THE QUALITY OF MEAL WITHSLICE MEAT AND NUTRITIONAL STATUS FOR ELDERLY
WHO HAVE DIFFICULTY IN CHEWING

Tran Phuong Thao, Master of Science, Jumonji University
Ma Ngoc Yen, Bachelor of Nutrition, HMU
Ngo Thi Thu Hien, Bachelor of Nutrition, HMU
Ta Thi Ngoc, Bachelor of Nutrition, HMU
Supervisor: Nguyen Thuy Linh, HMU & Yamamoto Shigeru, Jumonji UniversityJapan, 6/2018

IMPROVEMENT THE QUALITY OF MEAL WITHSLICE MEAT AND NUTRITIONAL STATUS FOR ELDERLY WHOHAVE DIFFICULTY IN CHEWING
Tran Phuong Thao, Master of Science, Jumonji University
Ma Ngoc Yen, Bachelor of Nutrition, HMU
Ngo Thi Thu Hien, Bachelor of Nutrition, HMU
Ta Thi Ngoc, Bachelor of Nutrition, HMU
Supervisor: Nguyen Thuy Linh, HMU &Yamamoto Shigeru, Jumonji University

Malnutrition
PORRIDGENOODLE (PHỞ)

Low energy and protein intake

Pilot study
General information of a subject• Gender: Female• Age: 69• Current number of teeth: 12• No sore, ulcer, inflammation, swelling• Dysphagia: No

Hand-cut meat(3g)

Sliced meat(3g)

Sliced meat(1.5 g)Times (amount)to chew1756042Time (seconds)
to chew

104

3730

3
Rest amount after
1st swallowing (g)00Sensory test
Indicators Assessment

DIFFERENCEDISH A(slicemeat)• Sense of sight: colour, size, shape, look more
DISH B(normal cut meat)• Sense of smell for the odour• Sense of taste• Sense of touch by mouth feel: hardness, fibermeat• Time (seconds) and times (amount) to chew onepeace• Emotion: comfortable, hurt oral

• Compare the rest amount of slice and normal cutmeat in their mouth after the first swallowing

MINISTRY OF HEALTHHANOI MEDICAL UNIVERSITYNUTRITIONAL MANAGEMENT
IN VIETNAMNGUYEN THUY LINH
Hanoi Medical University

Vietnam country background
Population (2015): 91.7m

Health Facilities and beds

Government Hospital Beds
sectionCentral Hos. 48
31.777- General
hospitals- Specialhospitals

20

20.311209.065

Local Hos.

12.750242.416Total

13.725291.975

SITUATION OF CLINICAL NUTRITION
IN VIETNAM• Nutrition assessment: only 45,9% of the hospitals had
assessment nutrition status and monitoring nutrition forinpatients

Signed /Resource: Ministry of health report, June 2017

SITUATION OF CLINICAL NUTRITION
IN VIETNAM• Providing diet: only 27,6% of the hospitals provided thesuitable diets for patients

Signed /Resource: Ministry of health report, June 2017

EXAMPLE OF DIET IN THE HOSPITAL

Signed /FOR ELDERLY PATIENTS
Figure: Kind of foods using for lunch and dinner

Resource: National Elderly Hospital

FOR OPERATION PATIENTSBMI pre and post operation

FOR ELDERLY PATIENTS

Signed /Resource: National Elderly HospitalTable 7: Relationship between nutritional status and Eat-10
簡易栄養判定とEat-10判定結果の相関
EAT-10

Nutritional status
1-2 điểm(Normal)≥3 điểm(dysphagia)

169 (24%)

21 (3%)

Risk of malnutrition

333 (47%)

67 (10%)Malnutrition

31 (4%)

79 (11%)

MNA- Normal
SFP-value

Chi squaretest<0.00140

INTRODUCTION
Proportion of dysphagia in facilities reported in the worldPlace/disease
場所/病気

Proportion of dysphagia
嚥下障害の割合

Elderly admitted in hospital 入院高齢者

30%

Elderly in nursing home

老人ホーム

68%

Acute general hospital

急性総合病院

1/3 of total patients 全患者の1/3

Acute rehabilitation unit 急性リハビリテーションユニット

1/3 of total patients全患者の1/3Stroke 脳卒中>50% (less than 5 days after stroke)

Head and Neck cancer 頭頸部がん

59%

Parkinson’s disease パーキンソン病

50%Dementia

痴呆

13-57%

Dysphagia is growing health concern in aging population
高齢者の健康問題として嚥下障害が急速に増加している41
Michael E. Groher and Michael A. Crary. (2016) Dysphagia Clinical Management in Adults and Children. Second Edition.