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Geriatr Gerontol Int. 2018 May;18(5):698-704. doi: 10.1111/ggi.13233. Epub 2017 Dec 26.

Texture-modified diets are associated with decreased muscle mass in older adults admitted to a rehabilitation ward.

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Department of Nutrition, Shigei Hospital, Kurashiki, Japan.
Department of Health Sciences, Faculty of Human Culture and Science, Prefectural University of Hiroshima, Hiroshima, Japan.
Department of Nutrition and Dysphagia Rehabilitation, Tamana Regional Health Medical Center, Tamana, Japan.
Palliative Care Center, Aichi Medical University, Nagakute, Japan.
Department of Internal Medicine, Shigei Hospital, Kurashiki, Japan.
Department of Rehabilitation, Shigei Hospital, Kurashiki, Japan.



Texture-modified diets (TMD) have significantly lower energy and protein content than normal diets. Therefore, TMD can cause malnutrition and loss of muscle mass. However, few studies have reported the relationship between TMD and decreased skeletal muscle mass. The aim of the present study was to clarify the association between TMD and decreased skeletal muscle mass.


We reviewed data of 188 older adult patients who were admitted to a rehabilitation hospital. TMD were defined based on the Japanese Dysphagia Diet Criteria 2013 proposed by the Japanese Society of Dysphagia Rehabilitation. The Mini Nutritional Assessment-Short Form was used to assess nutritional status; dual-energy X-ray absorptiometry was used to measure the skeletal muscle mass index, and the cut-off values for decreased skeletal muscle mass index were based on the Asian Working Group for Sarcopenia; the Functional Independence Measure was used to evaluate activities of daily living.


The patients' mean age was 80.6 ± 7.5 years, and 62% were women. A total of 22 patients (11.7%) consumed TMD. A total of 104 patients (55.3%) had decreased skeletal muscle mass, and approximately 90% of them consumed TMD. Decreased skeletal muscle mass index (odds ratio 7.199, 95% confidence interval 1.489-34.805, P ≤ 0.01) and Functional Independence Measure scores (odds ratio 0.972, 95% confidence interval 0.952-0.992, P ≤ 0.01) were independently related to TMD in the multivariate analysis.


The TMD group was associated with decreased skeletal muscle mass. Future, prospective studies are necessary to investigate causality. Geriatr Gerontol Int 2018; 18: 698-704.


decreased muscle mass; dysphagia; sarcopenia; sarcopenic dysphagia; texture-modified diet

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