Association between sarcopenia and constipation in patients with dysphagia: A cross-sectional study

Association between sarcopenia and constipation in patients with dysphagia: A cross-sectional study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Association between sarcopenia and constipation in patients with dysphagia: A cross-sectional study Masako Kishima, Hidetaka Wakabayashi, Masataka Itoda, Chiro Hachiuma, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4815848/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose We investigated the relationship between sarcopenia and constipation at multiple facilities in Japan. Method This cross-sectional study used data from the Japanese Sarcopenic Dysphagia Database. The 19 hospitals included nine acute care hospitals, eight rehabilitation hospitals, two long-term care hospitals, and one home-visiting rehabilitation center. The participants were 460 patients aged 20 years with swallowing disorders. Sarcopenia was diagnosed by the 2019 Asian Working Group for Sarcopenia criteria. Constipation was diagnosed based on the definition of the Japanese Chronic Constipation Treatment Guidelines. We investigated whether there was a significant difference in the prevalence of constipation between patients with and without sarcopenia. Logistic regression analysis was performed to examine the association between sarcopenia and constipation after adjusting for age, sex, facility, CCI, and enteral nutrition. Results The participants were composed of 229 males (50%) and 231 females (50%), with a mean age of 81 ± 10 years. Of the 460 patients, 404 (88%) had sarcopenia, and 72 (16%) had constipation. The logistic regression analysis revealed no significant association between sarcopenia and constipation (odds ratio: 1.279, 95% confidence interval: 0.492, 3.324). Factors associated with constipation were facility-specific (odds ratio: 3.695, 95% confidence interval: 1.955, 6.983). The prevalence of constipation in rehabilitation hospitals and long-term care hospitals was 20% and 26%, respectively. Conclusions The prevalence of constipation in patients with sarcopenia was 16%. There was no statistically significant association between sarcopenia and constipation. Constipation Sarcopenia Geriatrics Dwelling Key summary points Aim To investigate the prevalence of constipation and its association with sarcopenia in different institutions. Findings There is no significant association between sarcopenia and constipation. Message It is important to ensure seamless common constipation assessment and intervention across facilities. Introduction Sarcopenia is characterized by a progressive decline in skeletal muscle mass and strength throughout the body, increasing the risk of physical disability, decreased quality of life, and death. There are reports that the prevalence of sarcopenia is 13%–24% in people aged over 70 years and more than 50% in people aged over 80 years (1). In Japan, approximately 40% of women aged over 75 years develop sarcopenia (2). Since sarcopenia and the state of requiring long-term care are related; hence, early diagnosis and treatment of sarcopenia are important issues in the elderly. Constipation is one of the most common gastrointestinal disorders and can lead to serious intestinal problems such as abdominal pain and intestinal obstruction. The risk factors of constipation are wide-ranging and include age, sex, diet, and lifestyle. In recent years, constipation has been associated with cardiovascular disease (3) and chronic kidney disease (4). The proportion of complaints of constipation among elderly people in Japan is approximately 7% (5), but in a survey of elderly people living in facilities, it was reported that 31.7% had bowel movements less than once every 3 days (6). Defecation control care is frequently provided to elderly people in rehabilitation hospitals, facilities, and people receiving care at home. Thus, its diagnosis and treatment of constipation are important issues for older persons. Sarcopenia and constipation are common conditions in the elderly; however, there are few reports on the relationship between the two conditions. A previous study on the relationship between sarcopenia and constipation revealed that patients with sarcopenia have a higher degree of constipation severity and that there is a correlation between sarcopenia and constipation (7). In contrast, a cohort study of elderly people in Asia reported that constipation is associated with sarcopenia, particularly decreased walking speed (8). However, the association between the two conditions has only been reported in a single institution and older patients in Asia and has not been clarified with studies spanning multiple institutions. Therefore, in this study, we investigated the relationship between sarcopenia and constipation at multiple facilities in Japan, including acute care, rehabilitation, and long-term care hospitals. Methods This is a cross-sectional study that used the Japanese Sarcopenic Dysphagia Database (JSDD), the details of which are described in previous reports (9,10). The database includes patients with dysphagia, which is defined as having a Food Intake Level Scale (FILS) (11)score ≤8 points. FILS score of 1-3 relates to various degrees of non-oral feeding, 4-6 to various degrees of oral food intake and alternative nutrition, 7-8 to various degrees of oral food intake alone, a score of 9 to no dietary restriction but medical consideration given, while a score of 10 indicates normal oral food intake. This study analyzed the information from the time of initial registration in the database. All patients registered in the database were included in the study of the settings. Baseline data from this database were used in this study. The inclusion criterion for this study was database registration, while the exclusion criterion was the absence of data on sarcopenia and/or constipation. Sarcopenia was diagnosed according to the 2019 AWGS criteria (12). Muscle mass was evaluated using dual-energy X-ray absorptiometry (DXA), bioimpedance analysis (BIA), and calf circumference measurements. Handgrip strength was measured to assess muscle strength. Physical function was evaluated using the usual gait speed or the five-time sit-to-stand test. The criteria for the diagnosis of sarcopenia were low muscle mass, plus low muscle strength or low physical performance. The presence or absence of constipation at baseline was assessed by healthcare professionals according to the Japanese Clinical Practice Guidelines for Chronic Constipation (13). We examined whether there was a significant difference with regard to the presence of constipation between patients with and without sarcopenia. The following variables were compared between patients with and without sarcopenia: age, sex, type of dwelling, ADL as assessed by the Barthel Index, which includes bowel control (14),Charlson comorbidity index (CCI) (15), calf circumference, handgrip strength, body mass index, malnutrition as diagnosed by the criteria of the Global Leadership Initiative on Malnutrition (GLIM) (16), C-reactive protein (CRP) level, serum albumin level, and enteral nutrition via a nasogastric tube and/or gastrostomy tube. Statistical analysis was performed using the IBM Statistical Package for the Social Sciences (SPSS) ver. 26 software (IBM Corporation, Armonk, New York, US). Parametric data were expressed as the mean ± standard deviation (SD) and nonparametric data as the median and interquartile range (IQR). The Chi-square test was used for categorical variables, the t-test for continuous variables, and the Mann-Whitney U test for ordinal variables to identify differences between the two groups depending on the variables. Logistic regression analysis with adjustments for the potential confounding factors such as age, sex, sarcopenia, CCI, enteral nutrition, and patient’s living situation was conducted to examine the relationship between sarcopenia and constipation. The type of dwelling was classified as either an acute care hospital or another in the logistic regression analysis. Statistical significance was set at P-value < 0.05. The Yokohama City University Hospital Ethics Committee approved the establishment of the database. For ethical considerations, participants at each research facility were either informed and consented to participate or provided with an opt-out procedure, ensuring their right to withdraw from the study at any time. Results A total of 467 patients were registered in the JSDD. Of the 467 enrolled patients, seven (2%) with missing data regarding the presence or absence of sarcopenia were excluded. The remaining 460 (98%) patients (229 men, 231 women, mean age ± SD, 81 ± 10 years) were included in the study. Table 1 shows the characteristics of the participants according to the presence or absence of sarcopenia. A total of 404 patients (88%) had sarcopenia, and 72 (16%) had constipation. Constipation occurred in 16% of patients with sarcopenia and 11% of patients without sarcopenia. Patients with sarcopenia had significantly lower CC, grip strength, BMI and ALB values than non-sarcopenia patients. According to the GLIM criteria, 72% of patients with sarcopenia had malnutrition, which was significantly more common than in patients without sarcopenia. There were no statistically significant differences in sex, BI, CCI, CRP, ALB and the proportion of parenteral nutrition. Table 2 shows the characteristics of the participants according to the presence or absence of constipation. The proportion of patients with sarcopenia was almost the same in the constipated (63 patients (87.5%)) and non-constipated groups (337 (87.1%)). There were no significant differences in sex, age, BI, CCI, grip strength, BMI, malnutrition based on GLIM criteria, CRP, ALB, or parenteral nutritional management. Table 3 shows the results of logistic regression analysis associated with constipation. There was no significant association between sarcopenia and constipation. However, CCI was significantly associated with constipation (odds ratio: 1.164, 95% confidence interval: 1.012–1.340). Facilities were also significantly associated with constipation (odds ratio: 3.695, 95% confidence interval: 1.955–6.983). Discussion This study investigated the association between sarcopenia and constipation using the JSDD and found two findings. First, systemic sarcopenia and constipation showed no association. Second, constipation was observed in 16% of patients with sarcopenia. Systemic sarcopenia and constipation showed no association. However, there are few reports on the association between these two. A previous single-center cross-sectional study examined the association between constipation severity and sarcopenia in older people (7), and their results differ from those of another previous study that included outpatients aged 65 years or older who were being treated in a gastroenterology department. The present study included a multisite sample of acute care, rehabilitation, and long-term care hospitals. These subjects had recognized primary comorbidities, and it is assumed that they did not show any association due to the environmental changes caused by hospitalization, the diet and rehabilitation of the patients during hospitalization, and daily defecation care. Constipation was found in 16% of patients with sarcopenia in this study. In North America, the prevalence of constipation is estimated to be 10-15% (17). An Asian survey reported constipation in 15-23% of female respondents and 11% of male respondents (18,19). In a Korean study, the prevalence of self-reported constipation was 16.5%, and 9.2% of participants were diagnosed with functional constipation according to the Rome II criteria (20）. The methods for extracting and assessing constipation differed from those used in previous studies. However, the prevalence of constipation by sex and age group in Japan is 2-5% and increases with age, especially at the age of 70 years and above (21). Compared with the Japanese results, the prevalence of constipation in the present study was relatively high possibly due to older age, nutritional disorders, and lower ADL. In this study, the proportion of constipation rates were 7% in acute care hospitals, 20% in convalescent hospitals, and 26% in long-term care hospitals. However, in the acute phase, the proportion of constipation is low. This is due to gastrointestinal motility disorders due to the invasion of the disease and the administration of drugs to treat the disease. These results suggest that acute-phase hospitals may have considered fecal control in conjunction with disease treatment. In contrast, the proportion of patients with constipation was higher in recovery and long-term care hospitals. The length of hospital stay, duration of defecation control, and multidisciplinary staff involved differed by facility. Therefore, it is particularly important to assess constipation in convalescent rehabilitation hospitals and long-term care hospitals and to have a common understanding and information sharing among multidisciplinary staff. The present study had several limitations. A comprehensive assessment of the pathophysiology of constipation and the nature of the stool was not performed. Future studies should use a standardized assessment of constipation, increase the number of participants according to hospital function, and investigate comprehensive interventions for improving defecatory function. In conclusion, no association was observed between systemic sarcopenia and constipation. The prevalence of constipation was higher in the recovery and long-term care hospitals than in the acute care hospitals. The assessment and response to constipation may be more important in rehabilitation and long-term care hospitals in the future. Declarations Acknowledgments The authors declare no conflicts of interest. We thank all the collaborators from the Japanese Working Group on Sarcopenic Dysphagia for their clinical work, data collection, and data registration. Funding This work was supported by JSPS KAKENHI (19H03979). Conflict of interest The authors declare that they have no conflict of interest. Ethics approval The study was approved by the Ethics Committee of Yokohama City University Medical Center (B190700074) and was conducted in accordance with the ethical standards of the Declaration of Helsinki of 1964 and its subsequent amendments Informed consent All participants provided informed consent before enrollment or were given the right to opt out of the study. Financial interests; The authors declare they have no financial interests. Data Availability Statement: The datasets generated and analyzed during the current study are not publicly available due to a license agreement with the Japanese Association of Rehabilitation Nutrition. References Baumgartner RN, Koehler KM, Gallagher D, Romero L, Heymsfield SB, Ross RR, et al . Am J Epidemiol. Epidemiology of sarcopenia among the elderly in New Mexico. Am J Epidemiol . 1998; 147(8):755–763, doi.org/10.1093/oxfordjournals.aje.a009520 Kim H, Suzuki T, Kim M, Kojima N, Yoshida Y, Hirano H, et al . Incidence and predictors of sarcopenia onset in community-dwelling elderly Japanese women: 4-year follow-up study. J Am Med Dir Assoc 2015;16(1): 85.e1-8. doi:110.1016/j.jamda.2014.10.006. Choung RS, Rey E, Richard Locke 3rd, Schleck CD, Banm C, Zinsmeister AR, et al . Chronic constipation and co-morbidities: A prospective population-based nested case-control study. United European Gastroenterol J. 2016;4(1) :142-151, doi: 10.1177/2050640614558476. Sumida K, Molnar MZ, Potukuchi PK, Thomas F, Lu JL, Matsushita K, et al . Constipation and Incident CKD. J Am Soc Nephrol. 2017;28(4);1248-1258. doi: 10.1681/ASN.2016060656. Kessoku T, Nakashima A. Constipation and challenges in the elderly. J Jpn WOCM. 2023;27(1);14-27. Suyama K，Kato M，Akamatu N, et al . The Functional Bowel Disorders and the Factors of Elderly in Long-term Care Facilities. J Jpn Academy of Gerontological Nursing.2006 ;10(2);34-40. Asaoka D, Takeda T, Inami Y, Abe D, Shimada Y, Matsumoto K, et al . Association between the severity of constipation and sarcopenia in elderly adults: A single‑center university hospital‑based, cross‑sectional study. Biomedical Reports. 14: 2, 2021;14(2):1-7. Park H, Lim J, Baek JY, Lee E, Jung HW, Jung IY, et al . Status of Constipation and Its Association with Sarcopenia in Older Adults: A Population-Based Cohort Study. Int J Environ Res Public Health.14: 2, 2021;18(21) :11083. doi: 10.3390/ijerph182111083. Mizuno S, Wakabayashi H, Fujishima I, Kishima M, Itoda M, Yamakawa M, et al . Construction and Quality Evaluation of the Japanese Sarcopenic Dysphagia Database. J Nutr Health Aging. 2021;25(7):926-932. Togashi S, Ohinata H, Noguchi T, Wakabayashi H, Nakamichi M, Shimizu A, et al . Polypharmacy, potentially inappropriate medication, and dysphagia in older inpatients; A multi-center cohort study. Ann Geriatr Med Res. 2024; 27(4) . doi: 10.4235/agmr.23.0203 Kunieda K, Ohno T, Fujishima I, Hojo K, Morita T. Reliability and validity of a tool to measure the severity of dysphagia: the Food Intake LEVEL Scale. J Pain Symptom Manage. 2013;46(2):201-206. Chen LK, Woo J, Assantachai P, Auyeung TW, Chou MY, Iijima K, et al . Asian Working Group for Sarcopenia: 2019 Consensus Update on Sarcopenia Diagnosis and Treatment. J Am Med Dir Assoc. 2020;21:300-307.e2. The Japan Digestive Diseases Association related to the Diagnosis and Therapeutic Research Association. The Japanese Clinical Practice Guidelines for Chronic Constipation 2017. Tokyo, Japan: Nankodo; 2017. Mahoney FI, Barthel DW. Functional evaluation: the Barthel index. Md State Med J. 1965;14:61-5. Quan H, Li B, Couris CM, Fushimi K, Graham P, Hider P, et al . Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries. Am J Epidemiol. 2011;173:676-82. doi:10.1093/aje/kwq433. Cederholm T, Jensen GL, Correia M, Gonzalez MC, Fukushima R, Higashiguchi T, et al . GLIM criteria for the diagnosis of malnutrition - A consensus report from the global clinical nutrition community. J Cachexia Sarcopenia Muscle. 2019;10:207-17. doi:10.1002/jcsm.12383. Suares NC, Ford AC. Prevalence of, and risk factors for, chronic idiopathic constipation in the community: Systematic review and meta-analysis. Am. J. Gastroenterol. 2011;106:1582–1591. doi: 10.1038/ajg.2011.164. Wald A, Scarpignato C, Mueller-Lissner S, Kamm MA, Hinkel U, Helfrich I, et al . A multinational survey of prevalence and patterns of laxative use among adults with self-defined constipation. Aliment. Pharmacol. Ther. 2008;28:917–930. doi: 10.1111/j.1365-2036.2008.03806.x. Wald A, Mueller-Lissner S, Kamm MA, Hinkel U, Richter E, Schuijt C, et al . Survey of laxative use by adults with self-defined constipation in South America and Asia: A comparison of six countries. Aliment. Pharmacol. Ther. 2010;31:274–284. doi: 10.1111/j.1365-2036.2009.04169.x. Jun DW, Park HY, Lee OY, Lee HL, Yoon BC, Choi HS, et al . A population-based study on bowel habits in a Korean community: Prevalence of functional constipation and self-reported constipation. Dig. Dis. Sci. 2006;51:1471–1477. doi: 10.1007/s10620-006-9087-3. Kessoku T, Nakashima A. Constipation and challenges in elderly. J Jpn WOCM.2023;27(1):14-27. Tables Table 1. The demographic characteristics of patients with and without sarcopenia Total Sarcopenia (+) Sarcopenia (-) P-value N=460 N=404 N=56 Age, years, mean ± SD 81±10 82±10 72±13 0.009 a Sex, n (%) 0.144 b Male 229 (50%) 196 (49%) 33 (59%) Female 231 (50%) 208(52%) 23 (41%) Type of dwelling 0.018 b Acute care hospitals 202 (44%) 168 (42%) 34 (61%) Rehabilitation hospitals 205 (45%) 184 (46%) 21 (38%) Long term hospitals 50 (11%) 49 (12%) 1 (2%) Others 3 (1%) 3 (1%) 0 (0%) Constipation 72 (16%) 66 (16%) 6 (11%) 0.278 b Barthel Index, median (IQR) 25 (5, 50) 25 (5, 50) 35 (11, 65) 0.081 c Charlson comorbidity index, median (IQR) 2 (1, 4) 2 (1, 4) 2 (0, 3) 0.876 b Calf circumference (cm), mean ± SD 28.2±4.0 27.3±3.3 34.4±3.1 <0.001 a Handgrip strength (kg), mean ± SD 13.0±9.2 11.8±8.3 22.2±10.4 <0.001 a Body mass index (kg/m2), mean ± SD 20.2±3.8 19.6±3.5 24.1±3.6 <0.001 a GLIM Malnutrition, n (%) 300 (65%) 289 (72%) 11 (20%) <0.001 b C-reactive protein (mg/dL), median (IQR) 0.7 (0.2, 3.2) 0.8 (0.2, 3.5) 0.4 (0.1, 1.5) 0.113 c Serum albumin (g/dL), mean ± SD 3.3±0.6 3.3±0.6 3.5±0.6 0.020 a Parenteral Nutrition, n (%) 32 (7%) 12 (3%) 20 (36%) 0.092 b a: t-test, b: Chi-square, c: Mann-Whitney U test, GLIM: Global Leadership Initiative on Malnutrition, IQR: interquartile range, SD: standard deviation Table 2. The demographic characteristics of patients with and without constipation Constipation (+) Constipation (-) P-value N=72 N=388 Age, years, mean ± SD 81.1±11.6 80.6 ±10.2 0.157 c Sex, n (%) 0.191 b Male 31 (43%) 198 (49%) Female 41 (57%) 190 (51%) Type of dwelling <0.001 b Acute care hospitals 14 (19.4%) 188 (48.5%) Rehabilitation hospitals 42 (58.3%) 163 (42.0%) Long term hospitals 13 (18.1%) 37 (9.5%) Others 3 (4.2%) 0 (0%) Sarcopenia 63 (87.5%) 337 (87.1%) 0.331 b Barthel Index, median (IQR) 20 (9, 45) 28 (5, 50) 0.332 c Charlson comorbidity index, median (IQR) 2 (2, 4) 2 (0, 4) 0.098 c Calf circumference (cm), median (IQR) 28 (25.3, 31) 27.6 (24.5, 31) 0.327 c Handgrip strength (kg), median (IQR) 11.7 (8, 17.8) 12.0 (6, 19) 0.844 c Body mass index (kg/m 2 ), median (IQR) 19.3 (16.7, 22.1) 20.0 (17.3, 22.7) 0.139 c GLIM Malnutrition, n (%) 51 (71.0%) 249 (64.2%) 0.716 c C-reactive protein (mg/dL), median (IQR) 0.7 (0.1, 2.6) 0.8 (0.2, 3.4) 0.183 c Serum albumin (g/dL). median (IQR) 3.5 (3.0, 3.7) 3.3 (2.9, 3.6) 0.080 c Parenteral Nutrition, n (%) 1 (6.9%) 31 (1.5%) 0.611 c a: t-test, b: Chi-square, c: Mann-Whitney U test, GLIM: Global Leadership Initiative on Malnutrition, IQR: interquartile range, SD: standard deviation Table 3. Logistic regression analysis of constipation B Standard error P-value Odds ratio 95% Confidence interval of odds ratio Age -0.11 0.014 0.444 0.989 0.963 1.017 Sex 0.304 0.279 0.275 1.355 0.785 2.34 Sarcopenia 0.246 0.487 0.613 1.279 0.492 3.324 Dwelling 1.307 0.325 <0.001 3.695 1.955 6.983 Charlson comorbidity index 0.152 0.071 0.033 1.164 1.012 1.34 Parenteral Nutrition -1.207 1.046 0.249 0.299 0.038 2.325 Constant -2.402 1.094 0.028 0.091 Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4815848","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":339566894,"identity":"4615f31a-df3b-4e81-a292-42898c174c77","order_by":0,"name":"Masako Kishima","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA90lEQVRIiWNgGAWjYBADAwZm5gMHEiqATGbmBiK1sLclHvhwBqSFkVgtPGeMD85sA7EJaNFtP/7ww48KBmMGiQSDw7zzaqP524FaflRsw6nF7EyOsWTPGQYzoJaEw7zbjufOOMzYwNhz5jZuLQdyGKQZ2xhsgFoOALUcy20AamFmbMOj5fzzx78hWhIbDvPOOZY7n6CWGwlmIFvMGHgOMxyc2VCTu4Gwljdmlj1nJIzZ2NsYDnw4diB3I1DLQbx+OZ/++MaPChvDfmb+zx8Saupy550/fPDBjwrcWqBAgoENwjgMJg8QUo8M6khRPApGwSgYBSMEAACieF22dwUDVwAAAABJRU5ErkJggg==","orcid":"https://orcid.org/0009-0003-7708-9605","institution":"Department of Dentistry Wakakusa-Tatsuma Rehabilitation Hospital","correspondingAuthor":true,"prefix":"","firstName":"Masako","middleName":"","lastName":"Kishima","suffix":""},{"id":339566895,"identity":"5e428ec5-f145-4fd8-bbba-e57e79586932","order_by":1,"name":"Hidetaka Wakabayashi","email":"","orcid":"","institution":"Department of Rehabilitation Medicine, Tokyo Women's Medical University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Hidetaka","middleName":"","lastName":"Wakabayashi","suffix":""},{"id":339566896,"identity":"1c957e5f-c3bb-46a4-95a2-038a40886609","order_by":2,"name":"Masataka Itoda","email":"","orcid":"","institution":"Department of Oral Rehabilitation, Osaka Dental University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Masataka","middleName":"","lastName":"Itoda","suffix":""},{"id":339566897,"identity":"bdd1b518-3fa7-4c71-bbf7-5d82d316c73a","order_by":3,"name":"Chiro Hachiuma","email":"","orcid":"","institution":"Department of Nutrition, Wakakusa-Tatsuma Rehabilitation Hospital","correspondingAuthor":false,"prefix":"","firstName":"Chiro","middleName":"","lastName":"Hachiuma","suffix":""},{"id":339566898,"identity":"393564da-8a36-4bc5-8ad7-4ec10625fbd3","order_by":4,"name":"Shinta Nishioka","email":"","orcid":"","institution":"Department of Clinical Nutrition and Food Service, Nagasaki Rehabilitation Hospital","correspondingAuthor":false,"prefix":"","firstName":"Shinta","middleName":"","lastName":"Nishioka","suffix":""},{"id":339566899,"identity":"ce0ac6dd-9119-42b3-a022-4b773afc104a","order_by":5,"name":"Ryo Momosaki","email":"","orcid":"","institution":"Department of Rehabilitation Medicine, Mie University Graduate School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Ryo","middleName":"","lastName":"Momosaki","suffix":""}],"badges":[],"createdAt":"2024-07-28 08:41:30","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4815848/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4815848/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":65173467,"identity":"9fff36a5-a5d2-4125-99a3-0f1315ccf9e8","added_by":"auto","created_at":"2024-09-24 11:26:22","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":393674,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4815848/v1/df6b1812-e3e0-4d0d-b473-fce0cdf1f96f.pdf"}],"financialInterests":"","formattedTitle":"Association between sarcopenia and constipation in patients with dysphagia: A cross-sectional study","fulltext":[{"header":"Key summary points","content":"\u003cp\u003eAim \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTo investigate the prevalence of constipation and its association with sarcopenia in different institutions.\u003c/p\u003e\n\u003cp\u003eFindings \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThere is no significant association between sarcopenia and constipation.\u003c/p\u003e\n\u003cp\u003eMessage\u003c/p\u003e\n\u003cp\u003eIt is important to ensure seamless common constipation assessment and intervention across facilities.\u003c/p\u003e"},{"header":"Introduction","content":"\u003cp\u003eSarcopenia is characterized by a progressive decline in skeletal muscle mass and strength throughout the body,\u0026nbsp;increasing the risk of physical disability, decreased\u0026nbsp;quality of life, and death. There are reports that the prevalence of sarcopenia is 13%–24% in people aged over 70 years and more than 50% in people aged over 80 years (1). In Japan, approximately 40% of women aged over 75 years develop sarcopenia (2). Since sarcopenia and the state of requiring long-term care are related; hence, early diagnosis and treatment of sarcopenia are important issues in the elderly.\u003c/p\u003e\n\u003cp\u003eConstipation is one of the most common gastrointestinal disorders and can lead to serious intestinal problems such as abdominal pain and intestinal obstruction. The risk factors of constipation are wide-ranging and include age, sex, diet, and lifestyle. In recent years, constipation has been associated with cardiovascular disease\u0026nbsp;(3)\u0026nbsp;and chronic kidney disease (4). The proportion of complaints of constipation among elderly people in Japan is approximately 7% (5), but in a survey of elderly people living in facilities, it was reported that 31.7% had bowel movements less than once every 3 days (6). Defecation control care is frequently provided to elderly people in rehabilitation hospitals, facilities, and people receiving care at home. Thus, its diagnosis and treatment of constipation are important issues for older persons.\u003c/p\u003e\n\u003cp\u003eSarcopenia and constipation are common conditions in the elderly; however, there are few reports on the\u0026nbsp;relationship\u0026nbsp;between the two conditions. A previous study on the relationship between sarcopenia and constipation revealed that patients with sarcopenia have a higher degree of constipation severity and that there is a correlation between sarcopenia and constipation (7).\u0026nbsp;In contrast, a cohort study of elderly people in Asia reported that constipation is associated with sarcopenia, particularly decreased walking speed (8). However, the association between the two conditions has only been reported in a single institution and older patients in Asia and has not been clarified with studies spanning multiple institutions.\u003c/p\u003e\n\u003cp\u003eTherefore, in this study, we investigated the relationship between sarcopenia and constipation at multiple facilities in Japan, including acute care, rehabilitation, and long-term care hospitals.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis is a cross-sectional study that used the Japanese Sarcopenic Dysphagia Database (JSDD), the details of which are described in previous reports\u0026nbsp;(9,10). The database includes patients with dysphagia, which is defined as having a Food Intake Level Scale (FILS) (11)score ≤8 points. FILS score of 1-3 relates to various degrees of non-oral feeding, 4-6 to various degrees of oral food intake and alternative nutrition, 7-8 to various degrees of oral food intake alone, a score of 9 to no dietary restriction but medical consideration given, while a score of 10 indicates normal oral food intake. This study analyzed the information from the time of initial registration in the database. All patients registered in the database were included in the study of\u0026nbsp;the settings. Baseline data from this database were used in this study.\u0026nbsp;The inclusion criterion for this study was\u0026nbsp;database registration, while the exclusion criterion was the absence of data on sarcopenia and/or constipation. Sarcopenia was diagnosed according to the 2019 AWGS criteria (12). Muscle mass was evaluated using dual-energy X-ray absorptiometry (DXA), bioimpedance analysis (BIA), and calf circumference\u0026nbsp;measurements. Handgrip strength was measured to assess muscle strength. Physical function was evaluated\u0026nbsp;using the usual gait speed or the five-time sit-to-stand test. The criteria for the diagnosis of sarcopenia were low muscle mass, plus low muscle strength\u0026nbsp;or low physical performance. The presence or absence of\u0026nbsp;constipation\u0026nbsp;at baseline was assessed by healthcare professionals according to the Japanese Clinical Practice Guidelines for Chronic Constipation (13).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWe examined whether there was a significant difference with regard to the presence of constipation between patients with and without sarcopenia. The following variables were compared between patients with and without sarcopenia: age, sex, type of dwelling, ADL as assessed by the Barthel Index, which includes bowel control (14),Charlson comorbidity index (CCI) (15), calf circumference, handgrip strength, body mass index, malnutrition as diagnosed by the criteria of the Global Leadership Initiative on Malnutrition (GLIM) (16), C-reactive protein (CRP) level, serum albumin level, and enteral nutrition via a nasogastric tube and/or gastrostomy tube.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eStatistical analysis was performed using the IBM Statistical Package for the Social Sciences (SPSS) ver. 26 software (IBM Corporation, Armonk, New York, US). Parametric data were expressed as the mean ± standard deviation (SD) and nonparametric data as the median and interquartile range (IQR). The Chi-square test was used for categorical variables, the t-test for continuous variables, and the Mann-Whitney U test for ordinal variables to identify differences between the two groups depending on the variables.\u0026nbsp;Logistic regression analysis with adjustments for the potential confounding factors such as age, sex, sarcopenia, CCI, enteral nutrition, and patient’s living situation was conducted to examine the relationship between sarcopenia and constipation. The type of dwelling was classified as either an acute care hospital or another in the logistic regression analysis. Statistical significance was set at P-value \u0026lt; 0.05.\u003c/p\u003e\n\u003cp\u003eThe Yokohama City University Hospital Ethics Committee approved the establishment of the database. For ethical considerations, participants at each research facility were either informed and consented to participate or provided with an opt-out procedure, ensuring their right to withdraw from the study at any time.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 467 patients were registered in the JSDD. Of the 467 enrolled patients, seven (2%) with missing data regarding the presence or absence of sarcopenia were excluded. The remaining 460 (98%) patients (229 men, 231 women, mean age \u0026plusmn; SD, 81 \u0026plusmn; 10 years) were included in the study. Table 1 shows the characteristics of the participants according to the presence or absence of sarcopenia. A total of 404 patients (88%) had sarcopenia, and 72 (16%) had constipation. Constipation occurred in 16% of patients with sarcopenia and 11% of patients without sarcopenia. Patients with sarcopenia had significantly lower CC, grip strength, BMI and ALB values than non-sarcopenia patients. According to the GLIM criteria, 72% of patients with sarcopenia had malnutrition, which was significantly more common than in patients without sarcopenia. There were no statistically significant differences in sex, BI, CCI, CRP, ALB and the proportion of parenteral nutrition.\u003c/p\u003e\n\u003cp\u003eTable 2 shows the characteristics of the participants according to the presence or absence of constipation. The proportion of patients with sarcopenia was almost the same in the constipated (63 patients (87.5%)) and non-constipated groups (337 (87.1%)). There were no significant differences in sex, age, BI, CCI, grip strength, BMI, malnutrition based on GLIM criteria, CRP, ALB, or parenteral nutritional management. Table 3 shows the results of logistic regression analysis associated with constipation. There was no significant association between sarcopenia and constipation. However, CCI was significantly associated with constipation (odds ratio: 1.164, 95% confidence interval: 1.012\u0026ndash;1.340). Facilities were also significantly associated with constipation (odds ratio: 3.695, 95% confidence interval: 1.955\u0026ndash;6.983).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study investigated the association between sarcopenia and constipation using the JSDD and found two findings. First, systemic sarcopenia and constipation showed no association. Second, constipation was observed in 16% of\u0026nbsp;patients with sarcopenia.\u003c/p\u003e\n\u003cp\u003eSystemic sarcopenia and constipation showed no association. However, there are few reports on the association between these two. A previous single-center cross-sectional study examined the association between constipation\u0026nbsp;severity and sarcopenia in\u0026nbsp;older people (7), and their\u0026nbsp;results\u0026nbsp;differ from those\u0026nbsp;of another previous study that included outpatients aged 65 years or older who were being treated in a gastroenterology department. The present study included a multisite sample of acute care, rehabilitation,\u0026nbsp;and long-term care hospitals. These subjects had recognized primary comorbidities, and it is assumed that they did not show any association due to the environmental changes caused by hospitalization, the diet and rehabilitation of the patients during hospitalization, and daily defecation care.\u003c/p\u003e\n\u003cp\u003eConstipation was found in 16% of patients with sarcopenia in this study. In North America, the prevalence of constipation is estimated to be 10-15%\u003csup\u003e\u0026nbsp;\u003c/sup\u003e(17). An Asian survey reported constipation in 15-23% of female respondents and 11% of male respondents (18,19).\u0026nbsp;In a Korean study, the prevalence of self-reported constipation was 16.5%, and 9.2% of participants were diagnosed with functional\u0026nbsp;constipation according to\u0026nbsp;the Rome II criteria (20）. The methods for extracting and assessing constipation\u0026nbsp;differed from those used in previous studies. However, the prevalence of constipation by sex and age group in Japan is 2-5% and increases with age, especially at the age of 70 years and above (21).\u0026nbsp;Compared with the Japanese results, the prevalence of constipation in the present study was relatively high possibly due to older age, nutritional disorders, and lower ADL.\u003c/p\u003e\n\u003cp\u003eIn this study, the proportion of constipation rates were 7% in acute care hospitals, 20% in convalescent hospitals, and 26% in long-term care hospitals. However, in the acute phase, the proportion of constipation is low. This is due to gastrointestinal motility disorders due to the invasion of the disease and the administration of drugs to treat the disease. These results suggest that acute-phase hospitals may have considered fecal control in conjunction with disease treatment. In contrast, the proportion of patients with constipation was higher in recovery and long-term care hospitals. The length of hospital stay, duration of defecation control, and multidisciplinary staff involved differed by facility. Therefore, it is particularly important to assess constipation in convalescent rehabilitation hospitals and long-term care hospitals and to have a common understanding and information sharing among multidisciplinary staff.\u003c/p\u003e\n\u003cp\u003eThe present study had several limitations. A comprehensive assessment of the pathophysiology of constipation and the nature of\u0026nbsp;the stool\u0026nbsp;was not performed. Future studies should use a standardized assessment of constipation, increase the number of participants according to hospital function, and investigate comprehensive interventions\u0026nbsp;for improving defecatory function. \u003c/p\u003e\n\u003cp\u003eIn conclusion, no association was observed between systemic sarcopenia and constipation. The prevalence of constipation was higher in the recovery and long-term care hospitals than in the acute care hospitals. The assessment and response to constipation may be more important in rehabilitation and long-term care hospitals in the future.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflicts of interest. We thank all the collaborators from the Japanese Working Group on Sarcopenic Dysphagia for their clinical work, data collection, and data registration.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by JSPS KAKENHI (19H03979).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the Ethics Committee of Yokohama City University Medical Center (B190700074) and was conducted in accordance with the ethical standards of the Declaration of Helsinki of 1964 and its subsequent amendments\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed consent\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll participants provided informed consent before enrollment or were given the right to opt out of the study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFinancial interests;\u003c/strong\u003e The authors declare they have no financial interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability Statement:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and analyzed during the current study are not publicly available due to a license agreement with the Japanese Association of Rehabilitation Nutrition.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eBaumgartner RN, Koehler KM, Gallagher D, Romero L, Heymsfield SB, Ross RR, \u003cem\u003eet al\u003c/em\u003e. Am J Epidemiol. Epidemiology of sarcopenia among the elderly in New Mexico. Am J Epidemiol\u003cem\u003e.\u003c/em\u003e1998; 147(8):755\u0026ndash;763, doi.org/10.1093/oxfordjournals.aje.a009520\u003c/li\u003e\n\u003cli\u003eKim H, Suzuki T, Kim M, Kojima N, Yoshida Y, Hirano H, \u003cem\u003eet al\u003c/em\u003e. Incidence and predictors of sarcopenia onset in community-dwelling elderly Japanese women: 4-year follow-up study. J Am Med Dir Assoc 2015;16(1): 85.e1-8. doi:110.1016/j.jamda.2014.10.006. \u003c/li\u003e\n\u003cli\u003eChoung RS, Rey E, Richard Locke 3rd, Schleck CD, Banm C, Zinsmeister AR, \u003cem\u003eet al\u003c/em\u003e. Chronic constipation and co-morbidities: A prospective population-based nested case-control study. United European Gastroenterol J. 2016;4(1) :142-151, doi: 10.1177/2050640614558476.\u003c/li\u003e\n\u003cli\u003eSumida K, Molnar MZ, Potukuchi PK, Thomas F, Lu JL, Matsushita K, \u003cem\u003eet al\u003c/em\u003e. Constipation and Incident CKD. J Am Soc Nephrol. 2017;28(4);1248-1258. doi: 10.1681/ASN.2016060656. \u003c/li\u003e\n\u003cli\u003eKessoku T, Nakashima A. Constipation and challenges in the elderly. J Jpn WOCM. 2023;27(1);14-27.\u003c/li\u003e\n\u003cli\u003eSuyama K，Kato M，Akamatu N, \u003cem\u003eet al\u003c/em\u003e. The Functional Bowel Disorders and the Factors of Elderly in Long-term Care Facilities. J Jpn Academy of Gerontological Nursing.2006 ;10(2);34-40.\u003c/li\u003e\n\u003cli\u003eAsaoka D, Takeda T, Inami Y, Abe D, Shimada Y, Matsumoto K, \u003cem\u003eet al\u003c/em\u003e. Association between the severity of constipation and sarcopenia in elderly adults: A single‑center university hospital‑based, cross‑sectional study. Biomedical Reports. 14: 2, 2021;14(2):1-7.\u003c/li\u003e\n\u003cli\u003ePark H, Lim J, Baek JY, Lee E, Jung HW, Jung IY, \u003cem\u003eet al\u003c/em\u003e. Status of Constipation and Its Association with Sarcopenia in Older Adults: A Population-Based Cohort Study. Int J Environ Res Public Health.14: 2, 2021;18(21) :11083. doi: 10.3390/ijerph182111083.\u003c/li\u003e\n\u003cli\u003eMizuno S, Wakabayashi H, Fujishima I, Kishima M, Itoda M, Yamakawa M, \u003cem\u003eet al\u003c/em\u003e. Construction and Quality Evaluation of the Japanese Sarcopenic Dysphagia Database. J Nutr Health Aging. 2021;25(7):926-932.\u003c/li\u003e\n\u003cli\u003eTogashi S, Ohinata H, Noguchi T, Wakabayashi H, Nakamichi M, Shimizu A, \u003cem\u003eet al\u003c/em\u003e. Polypharmacy, potentially inappropriate medication, and dysphagia in older inpatients; A multi-center cohort study. Ann Geriatr Med Res. 2024; 27(4) . doi: 10.4235/agmr.23.0203\u003c/li\u003e\n\u003cli\u003eKunieda K, Ohno T, Fujishima I, Hojo K, Morita T. Reliability and validity of a tool to measure the severity of dysphagia: the Food Intake LEVEL Scale. J Pain Symptom Manage. 2013;46(2):201-206.\u003c/li\u003e\n\u003cli\u003eChen LK, Woo J, Assantachai P, Auyeung TW, Chou MY, Iijima K, \u003cem\u003eet al\u003c/em\u003e. Asian Working Group for Sarcopenia: 2019 Consensus Update on Sarcopenia Diagnosis and Treatment. J Am Med Dir Assoc. 2020;21:300-307.e2.\u003c/li\u003e\n\u003cli\u003eThe Japan Digestive Diseases Association related to the Diagnosis and Therapeutic Research Association. The Japanese Clinical Practice Guidelines for Chronic Constipation 2017. Tokyo, Japan: Nankodo; 2017.\u003c/li\u003e\n\u003cli\u003eMahoney FI, Barthel DW. Functional evaluation: the Barthel index. Md State Med J. 1965;14:61-5.\u003c/li\u003e\n\u003cli\u003eQuan H, Li B, Couris CM, Fushimi K, Graham P, Hider P, \u003cem\u003eet al\u003c/em\u003e. Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries. Am J Epidemiol. 2011;173:676-82. doi:10.1093/aje/kwq433.\u003c/li\u003e\n\u003cli\u003eCederholm T, Jensen GL, Correia M, Gonzalez MC, Fukushima R, Higashiguchi T, \u003cem\u003eet al\u003c/em\u003e. GLIM criteria for the diagnosis of malnutrition - A consensus report from the global clinical nutrition community. J Cachexia Sarcopenia Muscle. 2019;10:207-17. doi:10.1002/jcsm.12383.\u003c/li\u003e\n\u003cli\u003eSuares NC, Ford AC. Prevalence of, and risk factors for, chronic idiopathic constipation in the community: Systematic review and meta-analysis. Am. J. Gastroenterol.\u003cem\u003e \u003c/em\u003e2011;106:1582\u0026ndash;1591. doi: 10.1038/ajg.2011.164.\u003c/li\u003e\n\u003cli\u003eWald A, Scarpignato C, Mueller-Lissner S, Kamm MA, Hinkel U, Helfrich I,\u003cem\u003e et al\u003c/em\u003e. A multinational survey of prevalence and patterns of laxative use among adults with self-defined constipation. Aliment. Pharmacol. Ther. 2008;28:917\u0026ndash;930. doi: 10.1111/j.1365-2036.2008.03806.x.\u003c/li\u003e\n\u003cli\u003eWald A, Mueller-Lissner S, Kamm MA, Hinkel U, Richter E, Schuijt C, \u003cem\u003eet al\u003c/em\u003e. Survey of laxative use by adults with self-defined constipation in South America and Asia: A comparison of six countries. Aliment. Pharmacol. Ther.\u003cem\u003e \u003c/em\u003e2010;31:274\u0026ndash;284. doi: 10.1111/j.1365-2036.2009.04169.x. \u003c/li\u003e\n\u003cli\u003eJun DW, Park HY, Lee OY, Lee HL, Yoon BC, Choi HS, \u003cem\u003eet al\u003c/em\u003e. A population-based study on bowel habits in a Korean community: Prevalence of functional constipation and self-reported constipation. Dig. Dis. Sci.\u003cem\u003e \u003c/em\u003e2006;51:1471\u0026ndash;1477. doi: 10.1007/s10620-006-9087-3.\u003c/li\u003e\n\u003cli\u003eKessoku T, Nakashima A. Constipation and challenges in elderly. J Jpn WOCM.2023;27(1):14-27.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1. The demographic characteristics of patients with and without sarcopenia\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"647\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.085007727975274%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"17.31066460587326%\" valign=\"top\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.45595054095827%\" valign=\"top\"\u003e\n \u003cp\u003eSarcopenia (+)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.31066460587326%\" valign=\"top\"\u003e\n \u003cp\u003eSarcopenia (-)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.837712519319938%\" valign=\"top\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.085007727975274%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e \u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.31066460587326%\" valign=\"top\"\u003e\n \u003cp\u003eN=460\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.45595054095827%\" valign=\"top\"\u003e\n \u003cp\u003eN=404\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.31066460587326%\" valign=\"top\"\u003e\n \u003cp\u003eN=56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.837712519319938%\" valign=\"top\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.085007727975274%\" valign=\"top\"\u003e\n \u003cp\u003eAge, years, mean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.31066460587326%\" valign=\"top\"\u003e\n \u003cp\u003e81\u0026plusmn;10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.45595054095827%\" valign=\"top\"\u003e\n \u003cp\u003e82\u0026plusmn;10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.31066460587326%\" valign=\"top\"\u003e\n \u003cp\u003e72\u0026plusmn;13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.837712519319938%\" valign=\"top\"\u003e\n \u003cp\u003e0.009\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.085007727975274%\" valign=\"top\"\u003e\n \u003cp\u003eSex, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.31066460587326%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"15.45595054095827%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"17.31066460587326%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"14.837712519319938%\" valign=\"top\"\u003e\n \u003cp\u003e0.144\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.085007727975274%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; Male\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.31066460587326%\" valign=\"top\"\u003e\n \u003cp\u003e229 (50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.45595054095827%\" valign=\"top\"\u003e\n \u003cp\u003e196 (49%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.31066460587326%\" valign=\"top\"\u003e\n \u003cp\u003e33 (59%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.837712519319938%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.085007727975274%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; Female\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.31066460587326%\" valign=\"top\"\u003e\n \u003cp\u003e231 (50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.45595054095827%\" valign=\"top\"\u003e\n \u003cp\u003e208(52%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.31066460587326%\" valign=\"top\"\u003e\n \u003cp\u003e23 (41%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.837712519319938%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.085007727975274%\" valign=\"top\"\u003e\n \u003cp\u003eType of dwelling\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.31066460587326%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"15.45595054095827%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"17.31066460587326%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"14.837712519319938%\" valign=\"top\"\u003e\n \u003cp\u003e0.018\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.085007727975274%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; Acute care hospitals\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.31066460587326%\" valign=\"top\"\u003e\n \u003cp\u003e202 (44%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.45595054095827%\" valign=\"top\"\u003e\n \u003cp\u003e168 (42%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.31066460587326%\" valign=\"top\"\u003e\n \u003cp\u003e34 (61%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.837712519319938%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.085007727975274%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Rehabilitation hospitals\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.31066460587326%\" valign=\"top\"\u003e\n \u003cp\u003e205 (45%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.45595054095827%\" valign=\"top\"\u003e\n \u003cp\u003e184 (46%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.31066460587326%\" valign=\"top\"\u003e\n \u003cp\u003e21 (38%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.837712519319938%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.085007727975274%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; Long term hospitals\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.31066460587326%\" valign=\"top\"\u003e\n \u003cp\u003e50 (11%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.45595054095827%\" valign=\"top\"\u003e\n \u003cp\u003e49 (12%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.31066460587326%\" valign=\"top\"\u003e\n \u003cp\u003e1 (2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.837712519319938%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.085007727975274%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; Others\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.31066460587326%\" valign=\"top\"\u003e\n \u003cp\u003e3 (1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.45595054095827%\" valign=\"top\"\u003e\n \u003cp\u003e3 (1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.31066460587326%\" valign=\"top\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.837712519319938%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.085007727975274%\" valign=\"top\"\u003e\n \u003cp\u003eConstipation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.31066460587326%\" valign=\"top\"\u003e\n \u003cp\u003e72 (16%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.45595054095827%\" valign=\"top\"\u003e\n \u003cp\u003e66 (16%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.31066460587326%\" valign=\"top\"\u003e\n \u003cp\u003e6 (11%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.837712519319938%\" valign=\"top\"\u003e\n \u003cp\u003e0.278\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.085007727975274%\" valign=\"top\"\u003e\n \u003cp\u003eBarthel Index, median (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.31066460587326%\" valign=\"top\"\u003e\n \u003cp\u003e25 (5, 50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.45595054095827%\" valign=\"top\"\u003e\n \u003cp\u003e25 (5, 50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.31066460587326%\" valign=\"top\"\u003e\n \u003cp\u003e35 (11, 65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.837712519319938%\" valign=\"top\"\u003e\n \u003cp\u003e0.081\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.085007727975274%\" valign=\"top\"\u003e\n \u003cp\u003eCharlson comorbidity index, median (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.31066460587326%\" valign=\"top\"\u003e\n \u003cp\u003e2 (1, 4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.45595054095827%\" valign=\"top\"\u003e\n \u003cp\u003e2 (1, 4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.31066460587326%\" valign=\"top\"\u003e\n \u003cp\u003e2 (0, 3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.837712519319938%\" valign=\"top\"\u003e\n \u003cp\u003e0.876\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.085007727975274%\" valign=\"top\"\u003e\n \u003cp\u003eCalf circumference (cm), mean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.31066460587326%\" valign=\"top\"\u003e\n \u003cp\u003e28.2\u0026plusmn;4.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.45595054095827%\" valign=\"top\"\u003e\n \u003cp\u003e27.3\u0026plusmn;3.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.31066460587326%\" valign=\"top\"\u003e\n \u003cp\u003e34.4\u0026plusmn;3.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.837712519319938%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.085007727975274%\" valign=\"top\"\u003e\n \u003cp\u003eHandgrip strength (kg), mean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.31066460587326%\" valign=\"top\"\u003e\n \u003cp\u003e13.0\u0026plusmn;9.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.45595054095827%\" valign=\"top\"\u003e\n \u003cp\u003e11.8\u0026plusmn;8.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.31066460587326%\" valign=\"top\"\u003e\n \u003cp\u003e22.2\u0026plusmn;10.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.837712519319938%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.085007727975274%\" valign=\"top\"\u003e\n \u003cp\u003eBody mass index (kg/m2), mean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.31066460587326%\" valign=\"top\"\u003e\n \u003cp\u003e20.2\u0026plusmn;3.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.45595054095827%\" valign=\"top\"\u003e\n \u003cp\u003e19.6\u0026plusmn;3.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.31066460587326%\" valign=\"top\"\u003e\n \u003cp\u003e24.1\u0026plusmn;3.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.837712519319938%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.085007727975274%\" valign=\"top\"\u003e\n \u003cp\u003eGLIM Malnutrition, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.31066460587326%\" valign=\"top\"\u003e\n \u003cp\u003e300 (65%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.45595054095827%\" valign=\"top\"\u003e\n \u003cp\u003e289 (72%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.31066460587326%\" valign=\"top\"\u003e\n \u003cp\u003e11 (20%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.837712519319938%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.085007727975274%\" valign=\"top\"\u003e\n \u003cp\u003eC-reactive protein (mg/dL), median (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.31066460587326%\" valign=\"top\"\u003e\n \u003cp\u003e0.7 (0.2, 3.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.45595054095827%\" valign=\"top\"\u003e\n \u003cp\u003e0.8 (0.2, 3.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.31066460587326%\" valign=\"top\"\u003e\n \u003cp\u003e0.4 (0.1, 1.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.837712519319938%\" valign=\"top\"\u003e\n \u003cp\u003e0.113\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.085007727975274%\" valign=\"top\"\u003e\n \u003cp\u003eSerum albumin (g/dL), mean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.31066460587326%\" valign=\"top\"\u003e\n \u003cp\u003e3.3\u0026plusmn;0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.45595054095827%\" valign=\"top\"\u003e\n \u003cp\u003e3.3\u0026plusmn;0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.31066460587326%\" valign=\"top\"\u003e\n \u003cp\u003e3.5\u0026plusmn;0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.837712519319938%\" valign=\"top\"\u003e\n \u003cp\u003e0.020\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.085007727975274%\" valign=\"top\"\u003e\n \u003cp\u003eParenteral Nutrition, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.31066460587326%\" valign=\"top\"\u003e\n \u003cp\u003e32 (7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.45595054095827%\" valign=\"top\"\u003e\n \u003cp\u003e12 (3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.31066460587326%\" valign=\"top\"\u003e\n \u003cp\u003e20 (36%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.837712519319938%\" valign=\"top\"\u003e\n \u003cp\u003e0.092\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003ea: t-test, b: Chi-square, c: Mann-Whitney U test, GLIM: Global Leadership Initiative on Malnutrition, IQR: interquartile range, SD: standard deviation\u003c/p\u003e\n\u003cp\u003eTable 2. \u0026nbsp; The demographic characteristics of patients with and without\u0026nbsp;constipation\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" style=\"margin-right: calc(32%); width: 68%;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.53479853479853%\" valign=\"top\" style=\"width: 32.5009%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"19.047619047619047%\" valign=\"top\" style=\"width: 18.624%;\"\u003e\n \u003cp\u003eConstipation (+)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.047619047619047%\" valign=\"top\" style=\"width: 13.838%;\"\u003e\n \u003cp\u003eConstipation (-)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.36996336996337%\" valign=\"top\" style=\"width: 35.0017%;\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.53479853479853%\" valign=\"top\" style=\"width: 32.5009%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"19.047619047619047%\" valign=\"top\" style=\"width: 18.624%;\"\u003e\n \u003cp\u003eN=72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.047619047619047%\" valign=\"top\" style=\"width: 13.838%;\"\u003e\n \u003cp\u003eN=388\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.36996336996337%\" valign=\"top\" style=\"width: 35.0017%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.53479853479853%\" valign=\"top\" style=\"width: 32.5009%;\"\u003e\n \u003cp\u003eAge, years, mean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.047619047619047%\" valign=\"top\" style=\"width: 18.624%;\"\u003e\n \u003cp\u003e81.1\u0026plusmn;11.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.047619047619047%\" valign=\"top\" style=\"width: 13.838%;\"\u003e\n \u003cp\u003e80.6 \u0026plusmn;10.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.36996336996337%\" valign=\"top\" style=\"width: 35.0017%;\"\u003e\n \u003cp\u003e0.157\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"45.05494505494506%\" valign=\"top\" style=\"width: 32.5009%;\"\u003e\n \u003cp\u003eSex, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.52747252747253%\" valign=\"top\" style=\"width: 18.624%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"19.047619047619047%\" valign=\"top\" style=\"width: 13.838%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"13.36996336996337%\" valign=\"top\" style=\"width: 35.0017%;\"\u003e\n \u003cp\u003e0.191\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.53479853479853%\" valign=\"top\" style=\"width: 32.5009%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Male\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.047619047619047%\" valign=\"top\" style=\"width: 18.624%;\"\u003e\n \u003cp\u003e31 (43%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.047619047619047%\" valign=\"top\" style=\"width: 13.838%;\"\u003e\n \u003cp\u003e198 (49%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.36996336996337%\" valign=\"top\" style=\"width: 35.0017%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.53479853479853%\" valign=\"top\" style=\"width: 32.5009%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Female\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.047619047619047%\" valign=\"top\" style=\"width: 18.624%;\"\u003e\n \u003cp\u003e41 (57%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.047619047619047%\" valign=\"top\" style=\"width: 13.838%;\"\u003e\n \u003cp\u003e190 (51%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.36996336996337%\" valign=\"top\" style=\"width: 35.0017%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.53479853479853%\" valign=\"top\" style=\"width: 32.5009%;\"\u003e\n \u003cp\u003eType of dwelling\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.047619047619047%\" valign=\"top\" style=\"width: 18.624%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"19.047619047619047%\" valign=\"top\" style=\"width: 13.838%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"13.36996336996337%\" valign=\"top\" style=\"width: 35.0017%;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.53479853479853%\" valign=\"top\" style=\"width: 32.5009%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Acute care hospitals\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.047619047619047%\" valign=\"top\" style=\"width: 18.624%;\"\u003e\n \u003cp\u003e14 (19.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.047619047619047%\" valign=\"top\" style=\"width: 13.838%;\"\u003e\n \u003cp\u003e188 (48.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.36996336996337%\" valign=\"top\" style=\"width: 35.0017%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.53479853479853%\" valign=\"top\" style=\"width: 32.5009%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Rehabilitation hospitals\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.047619047619047%\" valign=\"top\" style=\"width: 18.624%;\"\u003e\n \u003cp\u003e42 (58.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.047619047619047%\" valign=\"top\" style=\"width: 13.838%;\"\u003e\n \u003cp\u003e163 (42.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.36996336996337%\" valign=\"top\" style=\"width: 35.0017%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.53479853479853%\" valign=\"top\" style=\"width: 32.5009%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Long term hospitals\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.047619047619047%\" valign=\"top\" style=\"width: 18.624%;\"\u003e\n \u003cp\u003e13 (18.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.047619047619047%\" valign=\"top\" style=\"width: 13.838%;\"\u003e\n \u003cp\u003e37 (9.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.36996336996337%\" valign=\"top\" style=\"width: 35.0017%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.53479853479853%\" valign=\"top\" style=\"width: 32.5009%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Others\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.047619047619047%\" valign=\"top\" style=\"width: 18.624%;\"\u003e\n \u003cp\u003e3 (4.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.047619047619047%\" valign=\"top\" style=\"width: 13.838%;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.36996336996337%\" valign=\"top\" style=\"width: 35.0017%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.53479853479853%\" valign=\"top\" style=\"width: 32.5009%;\"\u003e\n \u003cp\u003eSarcopenia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.047619047619047%\" valign=\"top\" style=\"width: 18.624%;\"\u003e\n \u003cp\u003e63 (87.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.047619047619047%\" valign=\"top\" style=\"width: 13.838%;\"\u003e\n \u003cp\u003e337 (87.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.36996336996337%\" valign=\"top\" style=\"width: 35.0017%;\"\u003e\n \u003cp\u003e0.331\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.53479853479853%\" valign=\"top\" style=\"width: 32.5009%;\"\u003e\n \u003cp\u003eBarthel Index, median (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.047619047619047%\" valign=\"top\" style=\"width: 18.624%;\"\u003e\n \u003cp\u003e20 (9, 45)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.047619047619047%\" valign=\"top\" style=\"width: 13.838%;\"\u003e\n \u003cp\u003e28 (5, 50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.36996336996337%\" valign=\"top\" style=\"width: 35.0017%;\"\u003e\n \u003cp\u003e0.332\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.53479853479853%\" valign=\"top\" style=\"width: 32.5009%;\"\u003e\n \u003cp\u003eCharlson comorbidity index, median (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.047619047619047%\" valign=\"top\" style=\"width: 18.624%;\"\u003e\n \u003cp\u003e2 (2, 4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.047619047619047%\" valign=\"top\" style=\"width: 13.838%;\"\u003e\n \u003cp\u003e2 (0, 4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.36996336996337%\" valign=\"top\" style=\"width: 35.0017%;\"\u003e\n \u003cp\u003e0.098\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.53479853479853%\" valign=\"top\" style=\"width: 32.5009%;\"\u003e\n \u003cp\u003eCalf circumference (cm), median \u0026nbsp;(IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.047619047619047%\" valign=\"top\" style=\"width: 18.624%;\"\u003e\n \u003cp\u003e28 (25.3, 31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.047619047619047%\" valign=\"top\" style=\"width: 13.838%;\"\u003e\n \u003cp\u003e27.6 (24.5, 31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.36996336996337%\" valign=\"top\" style=\"width: 35.0017%;\"\u003e\n \u003cp\u003e0.327\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.53479853479853%\" valign=\"top\" style=\"width: 32.5009%;\"\u003e\n \u003cp\u003eHandgrip strength (kg), median (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.047619047619047%\" valign=\"top\" style=\"width: 18.624%;\"\u003e\n \u003cp\u003e11.7 (8, 17.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.047619047619047%\" valign=\"top\" style=\"width: 13.838%;\"\u003e\n \u003cp\u003e12.0 (6, 19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.36996336996337%\" valign=\"top\" style=\"width: 35.0017%;\"\u003e\n \u003cp\u003e0.844\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.53479853479853%\" valign=\"top\" style=\"width: 32.5009%;\"\u003e\n \u003cp\u003eBody mass index (kg/m\u003csup\u003e2\u003c/sup\u003e), median (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.047619047619047%\" valign=\"top\" style=\"width: 18.624%;\"\u003e\n \u003cp\u003e19.3 (16.7, 22.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.047619047619047%\" valign=\"top\" style=\"width: 13.838%;\"\u003e\n \u003cp\u003e20.0 (17.3, 22.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.36996336996337%\" valign=\"top\" style=\"width: 35.0017%;\"\u003e\n \u003cp\u003e0.139\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.53479853479853%\" valign=\"top\" style=\"width: 32.5009%;\"\u003e\n \u003cp\u003eGLIM Malnutrition, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.047619047619047%\" valign=\"top\" style=\"width: 18.624%;\"\u003e\n \u003cp\u003e51 (71.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.047619047619047%\" valign=\"top\" style=\"width: 13.838%;\"\u003e\n \u003cp\u003e249 (64.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.36996336996337%\" valign=\"top\" style=\"width: 35.0017%;\"\u003e\n \u003cp\u003e0.716\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.53479853479853%\" valign=\"top\" style=\"width: 32.5009%;\"\u003e\n \u003cp\u003eC-reactive protein (mg/dL), median (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.047619047619047%\" valign=\"top\" style=\"width: 18.624%;\"\u003e\n \u003cp\u003e0.7 (0.1, 2.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.047619047619047%\" valign=\"top\" style=\"width: 13.838%;\"\u003e\n \u003cp\u003e0.8 (0.2, 3.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.36996336996337%\" valign=\"top\" style=\"width: 35.0017%;\"\u003e\n \u003cp\u003e0.183\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.53479853479853%\" valign=\"top\" style=\"width: 32.5009%;\"\u003e\n \u003cp\u003eSerum albumin (g/dL). median (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.047619047619047%\" valign=\"top\" style=\"width: 18.624%;\"\u003e\n \u003cp\u003e3.5 (3.0, 3.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.047619047619047%\" valign=\"top\" style=\"width: 13.838%;\"\u003e\n \u003cp\u003e3.3 (2.9, 3.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.36996336996337%\" valign=\"top\" style=\"width: 35.0017%;\"\u003e\n \u003cp\u003e0.080\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.53479853479853%\" valign=\"top\" style=\"width: 32.5009%;\"\u003e\n \u003cp\u003eParenteral Nutrition, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.047619047619047%\" valign=\"top\" style=\"width: 18.624%;\"\u003e\n \u003cp\u003e1 (6.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.047619047619047%\" valign=\"top\" style=\"width: 13.838%;\"\u003e\n \u003cp\u003e31 (1.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.36996336996337%\" valign=\"top\" style=\"width: 35.0017%;\"\u003e\n \u003cp\u003e0.611\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003ea: t-test, b: Chi-square, c: Mann-Whitney U test, GLIM: Global Leadership Initiative on Malnutrition, IQR: interquartile range, SD: standard deviation\u003c/p\u003e\n\u003cp\u003eTable 3. Logistic regression analysis of constipation\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.95575221238938%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"11.68141592920354%\" valign=\"top\"\u003e\n \u003cp\u003eB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.63716814159292%\" valign=\"top\"\u003e\n \u003cp\u003eStandard error\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.08849557522124%\" valign=\"top\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.68141592920354%\" valign=\"top\"\u003e\n \u003cp\u003eOdds ratio\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.95575221238938%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e95% Confidence interval of odds ratio\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.91166077738516%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;Age\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.66077738515901%\" valign=\"top\"\u003e\n \u003cp\u003e-0.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.607773851590107%\" valign=\"top\"\u003e\n \u003cp\u003e0.014\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.070671378091873%\" valign=\"top\"\u003e\n \u003cp\u003e0.444\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.66077738515901%\" valign=\"top\"\u003e\n \u003cp\u003e0.989\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.42756183745583%\" valign=\"top\"\u003e\n \u003cp\u003e0.963\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.66077738515901%\" valign=\"top\"\u003e\n \u003cp\u003e1.017\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.91166077738516%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;Sex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.66077738515901%\" valign=\"top\"\u003e\n \u003cp\u003e0.304\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.607773851590107%\" valign=\"top\"\u003e\n \u003cp\u003e0.279\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.070671378091873%\" valign=\"top\"\u003e\n \u003cp\u003e0.275\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.66077738515901%\" valign=\"top\"\u003e\n \u003cp\u003e1.355\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.42756183745583%\" valign=\"top\"\u003e\n \u003cp\u003e0.785\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.66077738515901%\" valign=\"top\"\u003e\n \u003cp\u003e2.34\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.91166077738516%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;Sarcopenia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.66077738515901%\" valign=\"top\"\u003e\n \u003cp\u003e0.246\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.607773851590107%\" valign=\"top\"\u003e\n \u003cp\u003e0.487\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.070671378091873%\" valign=\"top\"\u003e\n \u003cp\u003e0.613\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.66077738515901%\" valign=\"top\"\u003e\n \u003cp\u003e1.279\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.42756183745583%\" valign=\"top\"\u003e\n \u003cp\u003e0.492\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.66077738515901%\" valign=\"top\"\u003e\n \u003cp\u003e3.324\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.91166077738516%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;Dwelling\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.66077738515901%\" valign=\"top\"\u003e\n \u003cp\u003e1.307\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.607773851590107%\" valign=\"top\"\u003e\n \u003cp\u003e0.325\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.070671378091873%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.66077738515901%\" valign=\"top\"\u003e\n \u003cp\u003e3.695\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.42756183745583%\" valign=\"top\"\u003e\n \u003cp\u003e1.955\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.66077738515901%\" valign=\"top\"\u003e\n \u003cp\u003e6.983\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.91166077738516%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;Charlson comorbidity index\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.66077738515901%\" valign=\"top\"\u003e\n \u003cp\u003e0.152\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.607773851590107%\" valign=\"top\"\u003e\n \u003cp\u003e0.071\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.070671378091873%\" valign=\"top\"\u003e\n \u003cp\u003e0.033\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.66077738515901%\" valign=\"top\"\u003e\n \u003cp\u003e1.164\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.42756183745583%\" valign=\"top\"\u003e\n \u003cp\u003e1.012\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.66077738515901%\" valign=\"top\"\u003e\n \u003cp\u003e1.34\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.91166077738516%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;Parenteral Nutrition\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.66077738515901%\" valign=\"top\"\u003e\n \u003cp\u003e-1.207\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.607773851590107%\" valign=\"top\"\u003e\n \u003cp\u003e1.046\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.070671378091873%\" valign=\"top\"\u003e\n \u003cp\u003e0.249\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.66077738515901%\" valign=\"top\"\u003e\n \u003cp\u003e0.299\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.42756183745583%\" valign=\"top\"\u003e\n \u003cp\u003e0.038\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.66077738515901%\" valign=\"top\"\u003e\n \u003cp\u003e2.325\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.91166077738516%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;Constant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.66077738515901%\" valign=\"top\"\u003e\n \u003cp\u003e-2.402\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.607773851590107%\" valign=\"top\"\u003e\n \u003cp\u003e1.094\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.070671378091873%\" valign=\"top\"\u003e\n \u003cp\u003e0.028\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.66077738515901%\" valign=\"top\"\u003e\n \u003cp\u003e0.091\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.42756183745583%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"11.66077738515901%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Constipation, Sarcopenia, Geriatrics, Dwelling","lastPublishedDoi":"10.21203/rs.3.rs-4815848/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4815848/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose \u003c/strong\u003eWe investigated the relationship between sarcopenia and constipation at multiple facilities in Japan.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethod \u003c/strong\u003eThis cross-sectional study used data from the Japanese Sarcopenic Dysphagia Database. The 19 hospitals included nine acute care hospitals, eight rehabilitation hospitals, two long-term care hospitals, and one home-visiting rehabilitation center. The participants were 460 patients aged 20 years with swallowing disorders. Sarcopenia was diagnosed by the 2019 Asian Working Group for Sarcopenia criteria. Constipation was diagnosed based on the definition of the Japanese Chronic Constipation Treatment Guidelines. We investigated whether there was a significant difference in the prevalence of constipation between patients with and without sarcopenia. Logistic regression analysis was performed to examine the association between sarcopenia and constipation after adjusting for age, sex, facility, CCI, and enteral nutrition.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults \u003c/strong\u003eThe participants were composed of 229 males (50%) and 231 females (50%), with a mean age of 81 ± 10 years. Of the 460 patients, 404 (88%) had sarcopenia, and 72 (16%) had constipation. The logistic regression analysis revealed no significant association between sarcopenia and constipation (odds ratio: 1.279, 95% confidence interval: 0.492, 3.324). Factors associated with constipation were facility-specific (odds ratio: 3.695, 95% confidence interval: 1.955, 6.983). The prevalence of constipation in rehabilitation hospitals and long-term care hospitals was 20% and 26%, respectively.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions \u003c/strong\u003eThe prevalence of constipation in patients with sarcopenia was 16%.\u003cstrong\u003e \u003c/strong\u003eThere was no statistically significant association between sarcopenia and constipation.\u003c/p\u003e","manuscriptTitle":"Association between sarcopenia and constipation in patients with dysphagia: A cross-sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-09-09 12:52:26","doi":"10.21203/rs.3.rs-4815848/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"51dc5d1e-3f02-4158-a564-818d3e9ca156","owner":[],"postedDate":"September 9th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-09-24T11:18:15+00:00","versionOfRecord":[],"versionCreatedAt":"2024-09-09 12:52:26","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4815848","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4815848","identity":"rs-4815848","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}