{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T23:34:36Z","timestamp":1785540876045,"version":"3.56.0"},"reference-count":39,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2021,11,10]],"date-time":"2021-11-10T00:00:00Z","timestamp":1636502400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background: Sarcopenic dysphagia, a swallowing disorder caused by sarcopenia, is prevalent in older patients and can cause malnutrition and aspiration pneumonia. This study aimed to develop a simple screening test using image recognition with a low risk of droplet transmission for sarcopenic dysphagia. Methods: Older patients admitted to a post-acute care hospital were enrolled in this cross-sectional study. As a main variable for the development of a screening test, we photographed the anterior neck to analyze the image features of sarcopenic dysphagia. The studied image features included the pixel values and the number of feature points. We constructed screening models using the image features, age, sex, and body mass index. The prediction performance of each model was investigated. Results: A total of 308 patients participated, including 175 (56.82%) patients without dysphagia and 133 (43.18%) with sarcopenic dysphagia. The area under the receiver operating characteristic curve (ROC-AUC), sensitivity, specificity, positive predictive value, negative predictive value, and area under the precision-recall curve (PR-AUC) values of the best model were 0.877, 87.50%, 76.67%, 66.67%, 92.00%, and 0.838, respectively. The model with image features alone showed an ROC-AUC of 0.814 and PR-AUC of 0.726. Conclusions: The screening test for sarcopenic dysphagia using image recognition of neck appearance had high prediction performance.<\/jats:p>","DOI":"10.3390\/nu13114009","type":"journal-article","created":{"date-parts":[[2021,11,11]],"date-time":"2021-11-11T23:04:46Z","timestamp":1636671886000},"page":"4009","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["A Machine Learning-Based Screening Test for Sarcopenic Dysphagia Using Image Recognition"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8700-9029","authenticated-orcid":false,"given":"Kotomi","family":"Sakai","sequence":"first","affiliation":[{"name":"Graduate School of Public Health, St. Luke\u2019s International University, Tokyo 104-0044, Japan"},{"name":"Setagaya Memorial Hospital, Tokyo 158-0092, Japan"},{"name":"Comprehensive Unit for Health Economic Evidence Review and Decision Support (CHEERS), Research Organization of Science and Technology, Ritsumeikan University, Kyoto 600-8815, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6556-0995","authenticated-orcid":false,"given":"Stuart","family":"Gilmour","sequence":"additional","affiliation":[{"name":"Graduate School of Public Health, St. Luke\u2019s International University, Tokyo 104-0044, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eri","family":"Hoshino","sequence":"additional","affiliation":[{"name":"Comprehensive Unit for Health Economic Evidence Review and Decision Support (CHEERS), Research Organization of Science and Technology, Ritsumeikan University, Kyoto 600-8815, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enri","family":"Nakayama","sequence":"additional","affiliation":[{"name":"Department of Dysphagia Rehabilitation, Nihon University School of Dentistry, Tokyo 101-8310, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3274-3952","authenticated-orcid":false,"given":"Ryo","family":"Momosaki","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Mie University Graduate School of Medicine, Tsu 514-8407, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0599-3235","authenticated-orcid":false,"given":"Nobuo","family":"Sakata","sequence":"additional","affiliation":[{"name":"Setagaya Memorial Hospital, Tokyo 158-0092, Japan"},{"name":"Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba 305-8575, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daisuke","family":"Yoneoka","sequence":"additional","affiliation":[{"name":"Graduate School of Public Health, St. Luke\u2019s International University, Tokyo 104-0044, Japan"},{"name":"Department of Health Policy and Management, School of Medicine, Keio University, Tokyo 106-8582, Japan"},{"name":"Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan"},{"name":"Tokyo Foundation for Policy Research, Tokyo 106-6234, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,11,10]]},"reference":[{"key":"ref_1","unstructured":"United Nations Department of Economic and Social Affairs, Population Division (2020). World Population Ageing 2020 Highlights: Living Arrangements of Older Persons, United Nations."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1002\/jcsm.12160","article-title":"Sarcopenia and physical independence in older adults: The independent and synergic role of muscle mass and muscle function","volume":"8","author":"Cyrino","year":"2017","journal-title":"J. Cachexia Sarcopenia Muscle"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"290","DOI":"10.1002\/jcsm.12073","article-title":"Sarcopenia and mortality among a population-based sample of community-dwelling older adults","volume":"7","author":"Brown","year":"2016","journal-title":"J. Cachexia Sarcopenia Muscle"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1007\/s13539-014-0162-x","article-title":"Rehabilitation nutrition for sarcopenia with disability: A combination of both rehabilitation and nutrition care management","volume":"5","author":"Wakabayashi","year":"2014","journal-title":"J. Cachexia Sarcopenia Muscle"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1785","DOI":"10.1111\/j.1532-5415.2012.04123.x","article-title":"Relationship between thinness and swallowing function in Japanese older adults: Implications for sarcopenic dysphagia","volume":"60","author":"Kuroda","year":"2012","journal-title":"J. Am. Geriatr Soc."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1038\/nrgastro.2015.49","article-title":"Dysphagia: Current reality and scope of the problem","volume":"12","author":"Clave","year":"2015","journal-title":"Nat. Rev. Gastroenterol. Hepatol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1007\/s12603-018-1117-2","article-title":"The Prevalence and Prognosis of Sarcopenic Dysphagia in Patients Who Require Dysphagia Rehabilitation","volume":"23","author":"Wakabayashi","year":"2019","journal-title":"J. Nutr. Health Aging"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1016\/j.clnu.2018.01.016","article-title":"Diagnostic accuracy of lip force and tongue strength for sarcopenic dysphagia in older inpatients: A cross-sectional observational study","volume":"38","author":"Sakai","year":"2018","journal-title":"Clin. Nutr."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"576","DOI":"10.1016\/j.jamda.2017.02.015","article-title":"Diagnosis and Management of Oropharyngeal Dysphagia Among Older Persons, State of the Art","volume":"18","author":"Ortega","year":"2017","journal-title":"J. Am. Med. Dir. Assoc."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1111\/ggi.13591","article-title":"Sarcopenia and dysphagia: Position paper by four professional organizations","volume":"19","author":"Fujishima","year":"2019","journal-title":"Geriatr. Gerontol. Int."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1002\/jhm.2313","article-title":"Bedside diagnosis of dysphagia: A systematic review","volume":"10","author":"Robbins","year":"2015","journal-title":"J. Hosp. Med."},{"key":"ref_12","first-page":"103813","article-title":"Dysphagia screening in residential care settings: A scoping review","volume":"114","author":"Regan","year":"2020","journal-title":"Int. J. Nurs. Stud."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"989","DOI":"10.1016\/j.otc.2013.08.004","article-title":"Oropharyngeal Dysphagia: Screening and Assessment","volume":"46","author":"Speyer","year":"2013","journal-title":"Otolaryngol. Clin. N. Am."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"952","DOI":"10.1007\/s12603-018-1079-4","article-title":"Respiratory Muscle Strength as a Discriminator of Sarcopenia in Community-Dwelling Elderly: A Cross-Sectional Study","volume":"22","author":"Ohara","year":"2018","journal-title":"J. Nutr. Health Aging"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"189","DOI":"10.2147\/CIA.S97481","article-title":"Oropharyngeal dysphagia in older persons\u2014From pathophysiology to adequate intervention: A review and summary of an international expert meeting","volume":"11","author":"Wirth","year":"2016","journal-title":"Clin. Interv. Aging"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1164.e7","DOI":"10.1016\/j.jamda.2016.09.013","article-title":"Association between Sarcopenia and Cognitive Impairment: A Systematic Review and Meta-Analysis","volume":"17","author":"Chang","year":"2016","journal-title":"J. Am. Med. Dir. Assoc."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1111\/ggi.13620","article-title":"Relationship between jaw-opening force and neck circumference in healthy older individuals","volume":"19","author":"Yoshida","year":"2019","journal-title":"Geriatr. Gerontol. Int."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1007\/PL00009535","article-title":"The natural history of dysphagia following a stroke","volume":"12","author":"Smithard","year":"1997","journal-title":"Dysphagia"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1016\/j.jamda.2019.12.012","article-title":"Asian Working Group for Sarcopenia: 2019 Consensus Update on Sarcopenia Diagnosis and Treatment","volume":"21","author":"Chen","year":"2020","journal-title":"J. Am. Med. Dir. Assoc."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1007\/s00455-003-0030-x","article-title":"Evaluating Swallowing Dysfunction Using a 100-mL Water Swallowing Test","volume":"19","author":"Wu","year":"2004","journal-title":"Dysphagia"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1007\/s00455-002-0095-y","article-title":"Three tests for predicting aspiration without videofluorography","volume":"18","author":"Tohara","year":"2003","journal-title":"Dysphagia"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1007\/s00455-019-10064-3","article-title":"Use of the Penetration-Aspiration Scale in Dysphagia Research: A Systematic Review","volume":"35","author":"Borders","year":"2020","journal-title":"Dysphagia"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1111\/ger.12347","article-title":"Oral hypofunction in the older population: Position paper of the Japanese Society of Gerodontology in 2016","volume":"35","author":"Minakuchi","year":"2018","journal-title":"Gerodontology"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1177\/0884533615573053","article-title":"Evaluation of muscle and fat loss as diagnostic criteria for malnutrition","volume":"30","author":"Fischer","year":"2015","journal-title":"Nutr. Clin. Pract."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"2389","DOI":"10.1109\/TIP.2007.902329","article-title":"Median filtering in constant time","volume":"16","author":"Perreault","year":"2007","journal-title":"IEEE Trans. Image Process."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Rosten, E., and Drummond, T. (2006). Machine Learning for High-Speed Corner Detection. European Conference on Computer Vision, Springer.","DOI":"10.1007\/11744023_34"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1016\/0021-9681(87)90171-8","article-title":"A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation","volume":"40","author":"Charlson","year":"1987","journal-title":"J. Chronic Dis."},{"key":"ref_28","first-page":"61","article-title":"Functional Evaluation: The Barthel Index","volume":"14","author":"Mahoney","year":"1965","journal-title":"Md. State Med. J."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1516","DOI":"10.1016\/j.apmr.2004.11.049","article-title":"Initial psychometric assessment of a functional oral intake scale for dysphagia in stroke patients","volume":"86","author":"Crary","year":"2005","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1016\/0022-3956(75)90026-6","article-title":"\u201cMini-mental state\u201d. A practical method for grading the cognitive state of patients for the clinician","volume":"12","author":"Folstein","year":"1975","journal-title":"J. Psychiatr. Res."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.clnu.2018.08.002","article-title":"GLIM criteria for the diagnosis of malnutrition\u2014A consensus report from the global clinical nutrition community","volume":"38","author":"Cederholm","year":"2019","journal-title":"Clin. Nutr."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Steyerberg, E.W. (2019). Clinical Prediction Models, Springer.","DOI":"10.1007\/978-3-030-16399-0"},{"key":"ref_33","unstructured":"National Institutes of Health (1998). Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults\u2014The Evidence Report. Obes Res., 6, 51s\u2013209s."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"633","DOI":"10.1002\/oby.20301","article-title":"Healthcare provider accuracy at estimating women\u2019s BMI and intent to provide counseling based on appearance alone","volume":"22","author":"Calhoun","year":"2014","journal-title":"Obesity"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1111\/j.2517-6161.1996.tb02080.x","article-title":"Regression Shrinkage and Selection Via the Lasso","volume":"58","author":"Tibshirani","year":"1996","journal-title":"J. R. Stat. Soc. Ser. B Stat. Methodol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1002\/1097-0142(1950)3:1<32::AID-CNCR2820030106>3.0.CO;2-3","article-title":"Index for rating diagnostic tests","volume":"3","author":"Youden","year":"1950","journal-title":"Cancer"},{"key":"ref_37","unstructured":"Wilson, J.M.G., Jungner, G., and World Health Organization (2021, February 25). Principles and Practice of Screening for Disease. Available online: https:\/\/apps.who.int\/iris\/handle\/10665\/37650."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1016\/j.chest.2016.03.059","article-title":"Screening Accuracy for Aspiration Using Bedside Water Swallow Tests: A Systematic Review and Meta-Analysis","volume":"150","author":"Brodsky","year":"2016","journal-title":"Chest"},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Hastie, T., Tibshirani, R., and Wainwright, M. (2015). Statistical Learning with Sparsity: The Lasso and Generalizations, CRC Press.","DOI":"10.1201\/b18401"}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/13\/11\/4009\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:28:07Z","timestamp":1760167687000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/13\/11\/4009"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,11,10]]},"references-count":39,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2021,11]]}},"alternative-id":["nu13114009"],"URL":"https:\/\/doi.org\/10.3390\/nu13114009","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,11,10]]}}}