The MOOD of Stroke Survivors::Interplay between Malnutrition, Oral health, Orofacial dysfunction and Dysphagia

Background: Stroke survivors face convergence of Malnutrition, Oral health, Orofacial dysfunction, and Dysphagia (MOOD), compromising rehabilitation outcomes. While these domains are clinically recognized, their mechanistic interrelationships remain poorly defined. This study investigated their associations using structural equation modelling (SEM).<br/>Methods: Ninety-two stroke survivors underwent oral-orofacial assessments and dysphagia screening at admission and nutritional assessment after four weeks. Bivariate analyses were stratified by dysphagia status. Poor oral health (gingival bleeding, plaque index, halitosis and tongue coating) and orofacial dysfunction (bite force, oral diadochokinesis) were modeled as latent constructs. SEM evaluated direct and indirect pathways linking poor oral health, orofacial dysfunction, dysphagia, and malnutrition.<br/>Results: Dysphagic individuals exhibited higher malnutrition (72.2% vs. 37.7%; p=0.024), oral frailty (60.0% vs. 13.2%; p&lt;0.001), and tube feeding (56.8% vs. 4.7%; p&lt;0.001). They also showed poorer oral health (more plaque, bleeding, halitosis) and increased orofacial dysfunction (reduced tongue, lip, bite force). SEM revealed, poor oral health was associated with orofacial dysfunction (β = −0.41, p&lt;0.001), which was linked to dysphagia severity (β = −0.51, p&lt;0.001). Dysphagia was directly associated with malnutrition (β = 0.31, p=0.031), and poor oral health showed an additional direct association with malnutrition (β = 0.33, p=0.023). The indirect path from orofacial dysfunction to malnutrition via dysphagia was significant (β = −0.16, p=0.050).<br/>Conclusion: The MOOD domains are tightly interlinked in stroke survivors. A clinically relevant pathway from poor oral health to malnutrition, mediated by orofacial dysfunction and dysphagia was identified. Early, interdisciplinary MOOD interventions may help disrupt this cycle and enhance rehabilitation outcomes.<br/>