Background: This investigation explored the clinical utility of the Gugging Swallowing 
Screen (GUSS) in identifying swallowing dysfunction following stroke and examined its 
application in designing individualized nutritional interventions. The study also assessed a 
set of physiological markers—brain-derived neurotrophic factor (BDNF), salivary cortisol, 
leptin, and growth differentiation factor-15 (GDF-15)—to determine their relationship with 
dysphagia severity, neural recovery, and clinical prognosis. 
Methods: A cohort of 174 individuals recovering from stroke underwent swallowing 
assessments using both the GUSS protocol and the traditional water swallow test (WST). 
Participants diagnosed with swallowing impairments were randomized into a control group 
(CG), which received standard medical care, and an observation group (OG), which received 
additional GUSS-guided stratified feeding regimens. Comparative analyses focused on 
changes in swallowing ability, emotional well-being, serum and salivary biomarker profiles, 
and occurrence of medical complications. 
Findings: GUSS outperformed WST in sensitivity and responsiveness (P < 0.05), as shown 
by significantly higher effect size (ES) and standardized response mean (SRM). Patients in 
the OG exhibited notably greater improvement in deglutition function and fewer adverse 
outcomes than those in the CG (P < 0.05). Post-treatment nutritional markers—albumin 
(Alb), prealbumin (PA), and transferrin (TNF)—were also more favorable in the OG. BDNF 
and leptin levels showed strong alignment with dysphagia grading, while elevated salivary 
cortisol was associated with stress-related swallowing issues. GDF-15 levels correlated 
significantly with dysphagia-related complications. Moreover, quality of life indicators—
 including mental, physical, and social dimensions—were significantly enhanced in the OG (P 
< 0.05). 
Conclusion: GUSS proves to be a robust tool for early detection of post-stroke swallowing 
disorders and offers added clinical value when used to guide dietary intervention. The 
inclusion of stress, neuroplasticity, and inflammatory biomarkers—particularly salivary 
cortisol and GDF-15—adds depth to severity assessment and supports the development of 
personalized rehabilitation pathways.