Airway invasion on videofluoroscopy is associated with short-term nutritional worsening in adults with non-neurologic dysphagia: a prospective study.

BACKGROUND: This study evaluated whether findings of a baseline videofluoroscopic swallowing study (VFSS) were associated with nutritional status at a 3-month follow-up in patients with dysphagia. METHODS: This single-center prospective observational study included adult patients with non-neurologic dysphagia who underwent VFSS between April 2023 and March 2024. Baseline VFSS parameters, including the penetration-aspiration scale (PAS), residue measures, and functional dysphagia scale (FDS), were compared. Nutritional status was assessed using the Mini Nutritional Assessment-Short Form (MNA-SF) at baseline and 3 months. Multivariable linear regression analyses were performed to evaluate the association between baseline VFSS parameters and change in nutritional status (ΔMNA-SF), adjusting for age, sex, Charlson Comorbidity Index, baseline MNA-SF, and baseline functional oral intake scale (FOIS). RESULTS: Of 54 patients, 44 were included in the final analysis. Higher PAS scores were significantly associated with a greater decline in nutritional status (B=-0.423, p=0.009) after adjusting for baseline MNA-SF and clinical covariates. This association remained significant after further adjustment for baseline FOIS (B=-0.428, p=0.012). PAS category also showed a significant association with ΔMNA-SF. Among the evaluated predictors, PAS demonstrated the highest explanatory power across the nested models, whereas residue measures, FDS, and baseline FOIS were not significantly associated with nutritional decline. CONCLUSION: The severity of airway invasion on a VFSS is independently associated with subsequent nutritional decline in patients with non-neurologic dysphagia beyond the effect of baseline functional oral intake. A VFSS-based assessment of swallowing safety may help to identify patients at risk of nutritional deterioration and support early nutritional interventions.