{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T09:55:50Z","timestamp":1781603750787,"version":"3.54.5"},"reference-count":59,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T00:00:00Z","timestamp":1781568000000},"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>Oropharyngeal dysphagia (OD) is traditionally managed as a mechanical swallowing impairment. This narrative review proposes a conceptual model that reframes chronic, severe OD as a high-risk clinical condition driving systemic malnutrition and progressive nutritional deterioration. We examine the epidemiological burden of OD-associated malnutrition across geriatric, neurological, and oncological populations, exploring how diagnostic heterogeneity influences reported prevalence ranges. The pathophysiological narrative synthesizes hypotheses regarding the potential disruption of the cephalic phase of digestion, the rheological limitations of texture-modified diets (TMDs), and the theoretical bioenergetic cost of impaired swallowing. Central to this review is the hypothetical sarcopenia\u2013dysphagia vicious cycle, evaluating how molecular pathways\u2014such as systemic inflammation, ubiquitin\u2013proteasome-mediated proteolysis, and suppression of muscle protein synthesis\u2014are inferred from broader cachexia models to affect oropharyngeal function. We discuss structured nutritional management strategies, including micro-volume fortification, application of the IDDSI framework with xanthan gum-based thickeners, and monitoring via GLIM criteria, bioelectrical impedance analysis, and routine laboratory parameters. Finally, we analyze the ethical challenges of transitioning to enteral nutrition and outline the translational limitations of emerging fields like 3D food printing. This model aims to encourage clinical focus on comprehensive nutritional restoration alongside airway safety.<\/jats:p>","DOI":"10.3390\/nu18121940","type":"journal-article","created":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T09:06:52Z","timestamp":1781600812000},"page":"1940","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Oropharyngeal Dysphagia as a Metabolic Emergency: A Comprehensive Review on Nutritional Barriers, Sarcopenia, and Management Strategies"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9859-6487","authenticated-orcid":false,"given":"Sebastiano","family":"Mercadante","sequence":"first","affiliation":[{"name":"Main Regional of Supportive\/Palliative Care, La Maddalena Cancer Center, Via San Lorenzo 312, 90146 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,16]]},"reference":[{"key":"ref_1","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_2","doi-asserted-by":"crossref","first-page":"841","DOI":"10.1159\/000520326","article-title":"Prevalence of oropharyngeal dysphagia and risk of pneumonia, malnutrition, and mortality in adults aged 60 years and older: A meta-analysis","volume":"68","author":"Banda","year":"2022","journal-title":"Gerontology"},{"key":"ref_3","first-page":"287","article-title":"Dysphagia in the elderly: Management and nutritional considerations","volume":"7","author":"Sura","year":"2012","journal-title":"Clin. Interv. Aging"},{"key":"ref_4","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":"Shaker","year":"2015","journal-title":"Nat. Rev. Gastroenterol. Hepatol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"436","DOI":"10.1016\/j.clnu.2014.04.014","article-title":"Oropharyngeal dysphagia is a prevalent risk factor for malnutrition in a cohort of older patients admitted with an acute disease to a general hospital","volume":"34","author":"Monteis","year":"2015","journal-title":"Clin. Nutr."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1065","DOI":"10.1007\/s00455-024-10682-6","article-title":"Prevalence of dysphagia and risk of malnutrition in elderly living in nursing homes","volume":"39","author":"Engberg","year":"2024","journal-title":"Dysphagia"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1246","DOI":"10.1007\/s12603-018-1103-8","article-title":"Association between oropharyngeal dysphagia and malnutrition in Dutch nursing home residents: Results of the national prevalence measurement of quality of care","volume":"22","author":"Huppertz","year":"2018","journal-title":"J. Nutr. Health Aging"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Balietti, P., Fedecostante, M., Di Rosa, M., Zengarini, E., Dell\u2019AQuila, G., Soraci, L., Sabbatinelli, J., Fava, G., Iacoviello, L., and Liperoti, R. (2026). Dysphagia in hospitalized older patients: The Report-AGE project. Eur. Geriatr. Med., Epub ahead of print.","DOI":"10.1007\/s41999-026-01451-9"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1016\/S1474-4422(24)00053-X","article-title":"Dysphagia after stroke: Research advances in treatment interventions","volume":"23","author":"Labeit","year":"2024","journal-title":"Lancet Neurol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e70134","DOI":"10.1002\/pri.70134","article-title":"Prevalence of Stroke-Related Sarcopenia: A Systematic Review and Meta-Analysis","volume":"31","author":"Staico","year":"2026","journal-title":"Physiother. Res. Int."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"619","DOI":"10.1002\/jcsm.12528","article-title":"Cancer cachexia and its pathophysiology: Links with sarcopenia, anorexia and asthenia","volume":"11","author":"Santos","year":"2020","journal-title":"J. Cachexia Sarcopenia Muscle"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1016\/j.parkreldis.2011.11.006","article-title":"Prevalence of oropharyngeal dysphagia in Parkinson\u2019s disease: A meta-analysis","volume":"18","author":"Kalf","year":"2012","journal-title":"Park. Relat. Disord."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.archger.2012.04.011","article-title":"Evaluation and management of oropharyngeal dysphagia in different types of dementia: A systematic review","volume":"56","author":"Alagiakrishnan","year":"2013","journal-title":"Arch. Gerontol. Geriatr."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"571","DOI":"10.1002\/ohn.302","article-title":"Expert consensus statement: Management of dysphagia in head and neck cancer patients","volume":"168","author":"Kuhn","year":"2023","journal-title":"Otolaryngol. Head Neck Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"115354","DOI":"10.1016\/j.foodres.2024.115354","article-title":"Review of dysphagia and technological advances in dysphagia food","volume":"199","author":"Liu","year":"2025","journal-title":"Food Res. Int."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e300","DOI":"10.1016\/S1470-2045(25)00087-7","article-title":"Nutrition in head and neck cancer care: A roadmap and call for research","volume":"26","author":"Chen","year":"2025","journal-title":"Lancet Oncol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1991","DOI":"10.1016\/S0140-6736(24)02226-8","article-title":"Oesophageal cancer","volume":"404","author":"Yang","year":"2024","journal-title":"Lancet"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"393","DOI":"10.6004\/jnccn.2023.0019","article-title":"Esophageal and esophagogastric junction cancers, version 2.2023","volume":"21","author":"Ajani","year":"2023","journal-title":"J. Natl. Compr. Cancer Netw."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2241","DOI":"10.1056\/NEJMra035010","article-title":"Esophageal cancer","volume":"349","author":"Enzinger","year":"2003","journal-title":"N. Engl. J. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1016\/j.ejca.2020.04.032","article-title":"Palliation of dysphagia in metastatic oesogastric cancers: An international multidisciplinary position","volume":"135","author":"Levy","year":"2020","journal-title":"Eur. J. Cancer"},{"key":"ref_21","first-page":"427","article-title":"Palliation of dysphagia","volume":"32\u201333","author":"Vermeulen","year":"2018","journal-title":"Best Pract. Res. Clin. Gastroenterol."},{"key":"ref_22","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_23","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1111\/ggi.12486","article-title":"Sarcopenia is an independent risk factor of dysphagia in hospitalized older people","volume":"16","author":"Maeda","year":"2016","journal-title":"Geriatr. Gerontol. Int."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1097\/JES.0b013e3182a4e699","article-title":"Exercise and nutrition to target protein synthesis impairments in aging skeletal muscle","volume":"41","author":"Dickinson","year":"2013","journal-title":"Exerc. Sport Sci. Rev."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1111\/j.1753-4887.2010.00334.x","article-title":"Cephalic phase responses and appetite","volume":"68","author":"Smeets","year":"2010","journal-title":"Nutr. Rev."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1016\/j.physbeh.2011.01.012","article-title":"How neural mediation of anticipatory and compensatory insulin release helps us tolerate food","volume":"103","author":"Teff","year":"2011","journal-title":"Physiol. Behav."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"4101","DOI":"10.1111\/1541-4337.12791","article-title":"Food polysaccharides and roles of rheology and tribology in rational design of thickened liquids for oropharyngeal dysphagia: A review","volume":"20","author":"Methacanon","year":"2021","journal-title":"Compr. Rev. Food Sci. Food Saf."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1007\/s00455-011-9330-8","article-title":"The effect of saliva on the viscosity of thickened drinks","volume":"27","author":"Hanson","year":"2012","journal-title":"Dysphagia"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1186\/1475-2891-12-54","article-title":"Thickening agents used for dysphagia management: Effect on bioavailability of water, medication and feelings of satiety","volume":"12","author":"Cichero","year":"2013","journal-title":"Nutr. J."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1007\/s00455-014-9578-x","article-title":"The influence of food texture and liquid consistency modification on swallowing physiology and function: A systematic review","volume":"30","author":"Steele","year":"2015","journal-title":"Dysphagia"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1016\/j.clnu.2018.05.024","article-title":"ESPEN guideline on clinical nutrition and hydration in geriatrics","volume":"38","author":"Volkert","year":"2019","journal-title":"Clin. Nutr."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1093\/ageing\/afy169","article-title":"Sarcopenia: Revised European consensus on definition and diagnosis (EWGSOP2)","volume":"48","author":"Bahat","year":"2019","journal-title":"Age Ageing"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"E381","DOI":"10.1152\/ajpendo.00488.2005","article-title":"A high proportion of leucine is required for optimal stimulation of the rate of muscle protein synthesis by essential amino acids in the elderly","volume":"291","author":"Katsanos","year":"2006","journal-title":"Am. J. Physiol. Endocrinol. Metab."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1704","DOI":"10.1126\/science.1065874","article-title":"Identification of ubiquitin ligases required for skeletal muscle atrophy","volume":"294","author":"Bodine","year":"2001","journal-title":"Science"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1007\/s00455-016-9751-5","article-title":"Tongue strength is associated with grip strength and nutritional status in older adult inpatients of a rehabilitation hospital","volume":"32","author":"Sakai","year":"2017","journal-title":"Dysphagia"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"100486","DOI":"10.1016\/j.jnha.2025.100486","article-title":"Effectiveness of diet modification on dietary nutrient intake, aspiration, and fluid intake for adults with dysphagia: A meta-analysis of randomized controlled trials","volume":"29","author":"Chu","year":"2025","journal-title":"J. Nutr. Health Aging"},{"key":"ref_37","first-page":"20","article-title":"The use of medium-chain triglycerides in gastrointestinal disorders","volume":"41","author":"Shah","year":"2017","journal-title":"Pract. Gastroenterol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1007\/s40141-013-0024-z","article-title":"The need for international terminology and definitions for texture-modified foods and thickened liquids used in dysphagia management: Foundations of a global initiative (IDDSI)","volume":"1","author":"Cichero","year":"2013","journal-title":"Curr. Phys. Med. Rehabil. Rep."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1159\/000099144","article-title":"Dehydration among long-term care elderly patients with oropharyngeal dysphagia","volume":"53","author":"Leibovitz","year":"2007","journal-title":"Gerontology"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1088","DOI":"10.1016\/S0002-8223(02)90245-2","article-title":"Benefits of nutritional supplementation in free-living, frail, undernourished elderly people: A prospective randomized community trial","volume":"102","author":"Payette","year":"2002","journal-title":"J. Am. Diet. Assoc."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1480","DOI":"10.1016\/j.clnu.2019.02.033","article-title":"GLIM criteria for the diagnosis of malnutrition: A consensus report from the global clinical nutrition community","volume":"38","author":"Cederholm","year":"2019","journal-title":"Clin. Nutr."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"777","DOI":"10.1093\/ajcn\/82.4.777","article-title":"Geriatric Nutritional Risk Index: A new index for evaluating at-risk elderly medical patients","volume":"82","author":"Bouillanne","year":"2005","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1177\/0884533611405793","article-title":"Nutrition for brain recovery after ischemic stroke: An added value to rehabilitation","volume":"26","author":"Aquilani","year":"2011","journal-title":"Nutr. Clin. Pract."},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Sheard, J.M., Ash, S., Mellick, G.D., Silburn, P.A., and Kerr, G.K. (2013). Markers of disease severity are associated with malnutrition in Parkinson\u2019s disease. PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0057986"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"6405278","DOI":"10.1155\/2017\/6405278","article-title":"Role of diet and nutritional supplements in Parkinson\u2019s disease progression","volume":"2017","author":"Mischley","year":"2017","journal-title":"Oxidative Med. Cell. Longev."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"265","DOI":"10.3390\/nu7010265","article-title":"Nutritional interventions in head and neck cancer patients undergoing chemoradiotherapy: A narrative review","volume":"7","author":"Bossola","year":"2015","journal-title":"Nutrients"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1016\/j.clnu.2016.02.006","article-title":"ESPEN guideline on ethical aspects of artificial nutrition and hydration","volume":"35","author":"Druml","year":"2016","journal-title":"Clin. Nutr."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1016\/j.clnu.2017.06.025","article-title":"ESPEN guidelines on nutritional support for polymorbid internal medicine patients","volume":"37","author":"Gomes","year":"2018","journal-title":"Clin. Nutr."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"7739","DOI":"10.3748\/wjg.v20.i24.7739","article-title":"Percutaneous endoscopic gastrostomy: Indications, technique, complications and management","volume":"20","author":"Rahnemaiazar","year":"2014","journal-title":"World J. Gastroenterol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"S360","DOI":"10.1007\/s10072-008-1044-9","article-title":"Dysphagia in multiple sclerosis: From pathogenesis to diagnosis","volume":"29","author":"Tassorelli","year":"2008","journal-title":"Neurol. Sci."},{"key":"ref_51","first-page":"CD007209","article-title":"Enteral tube feeding for older people with advanced dementia","volume":"2009","author":"Sampson","year":"2009","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"580","DOI":"10.1111\/j.1532-5415.2010.02740.x","article-title":"Comfort feeding only: A proposal to bring clarity to decision-making regarding difficulty with eating for persons with advanced dementia","volume":"58","author":"Palecek","year":"2010","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1495","DOI":"10.1136\/bmj.a301","article-title":"Refeeding syndrome: What it is, and how to prevent and treat it","volume":"336","author":"Mehanna","year":"2008","journal-title":"BMJ"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1016\/j.nut.2017.09.007","article-title":"Management and prevention of refeeding syndrome in medical inpatients: An evidence-based and consensus-supported algorithm","volume":"47","author":"Friedli","year":"2018","journal-title":"Nutrition"},{"key":"ref_55","doi-asserted-by":"crossref","unstructured":"Cichero, J.A.Y. (2018). Age-related changes to eating and swallowing impact frailty: Aspiration, choking risk, modified food texture and autonomy of choice. Geriatrics, 3.","DOI":"10.3390\/geriatrics3040069"},{"key":"ref_56","doi-asserted-by":"crossref","unstructured":"Rajasekaran, J.J., Krishnamurthy, H.K., Bosco, J., Jayaraman, V., Krishna, K., Wang, T., and Bei, K. (2024). Oral microbiome: A review of its impact on oral and systemic health. Microorganisms, 12.","DOI":"10.20944\/preprints202406.1923.v1"},{"key":"ref_57","doi-asserted-by":"crossref","unstructured":"Ticinesi, A., Tana, C., Nouvenne, A., Tana, C., Del Rio, D., Maggio, M., Ventura, M., and Meschi, T. (2017). Aging Gut Microbiota at the Cross-Road between Nutrition, Physical Frailty, and Sarcopenia: Is There a Gut-Muscle Axis?. Nutrients, 9.","DOI":"10.3390\/nu9121303"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"23","DOI":"10.18502\/keg.v2i2.591","article-title":"3D printing of food for people with swallowing difficulties","volume":"2","author":"Kouzani","year":"2017","journal-title":"KnE Eng."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1016\/j.meatsci.2019.03.005","article-title":"3D printing of meat","volume":"153","author":"Dick","year":"2019","journal-title":"Meat Sci."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/12\/1940\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T09:50:43Z","timestamp":1781603443000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/12\/1940"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,16]]},"references-count":59,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["nu18121940"],"URL":"https:\/\/doi.org\/10.3390\/nu18121940","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,16]]}}}