How stroke-related dysphagia relates to quality of life: the mediating role of nutritional status and psychological disorders, and the moderating effect of enteral nutrition mode

Hongji Zeng; Xi Zeng; Nana Xiong; Lichun Wang; Ying Yang; Liugen Wang; Heping Li; Weijia Zhao

doi:10.3389/fnut.2024.1339694

How stroke-related dysphagia relates to quality of life: the mediating role of nutritional status and psychological disorders, and the moderating effect of enteral nutrition mode

Front Nutr. 2024 Mar 14:11:1339694. doi: 10.3389/fnut.2024.1339694. eCollection 2024.

Authors

Hongji Zeng¹, Xi Zeng², Nana Xiong^{3

4

5}, Lichun Wang⁶, Ying Yang⁷, Liugen Wang², Heping Li², Weijia Zhao¹

Affiliations

¹ School of Public Health, Zhengzhou University, Zhengzhou, China.
² Department of Rehabilitation Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
³ Peking University Sixth Hospital, Beijing, China.
⁴ NHC Key Laboratory of Mental Health (Peking University), Beijing, China.
⁵ National Clinical Research Centre for Mental Disorders (Peking University Sixth Hospital), Beijing, China.
⁶ Cangzhou Hospital of Integrated Chinese and Western Medicine, Hebei, Cangzhou, China.
⁷ Department of Rehabilitation Medicine, The People's Hospital of Suzhou New District, Suzhou, China.

Abstract

Background: Although stroke-related dysphagia has been shown to influence quality of life (QOL), the underlying mechanisms have yet to be uncovered.

Objective: This study aims to investigate the mediating role of nutritional status and psychological disorders in the relationship between stroke-related dysphagia and QOL in stroke patients and explore the moderating effect of enteral nutrition mode.

Methods: In 2022, A questionnaire survey using stratified random sampling was conducted on 5,322 stroke patients with dysphagia, including Functional Oral Intake Scale (FOIS), Swallowing Quality of Life Questionnaire, Patient Health Questionnaire-9 (PHQ-9), and Generalized Anxiety Disorder-7 (GAD-7) to assess dysphagia, QOL and psychological disorders, respectively, for each participant. Records of serum albumin, Hemoglobin, Total serum protein, serum prealbumin and Body mass index were enrolled to assess nutritional status.

Results: FOIS demonstrated a significant positive predictive effect on QOL. Nutritional status and psychological disorders (PHQ-9 and GAD-7) mediated the relationship between FOIS and QOL. Nutritional status-psychological disorders showed a chain mediation effect in the relationship between FOIS and QOL. The moderating effect of enteral nutrition mode was observed.

Conclusion: The mediating role of nutritional status and psychological disorders with moderating effect of enteral nutrition mode in the relationship between dysphagia and QOL in stroke patients was found.

Keywords: dysphagia; enteral nutrition; intermittent oro-esophageal tube feeding; nutritional status; psychological disorders; quality of life; stroke.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This study was supported by the non-profit Central Research Institute fund of Chinese Academy of Medical Science (2020-PT310-01).