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Dysphagia. 2019 Sep 18. doi: 10.1007/s00455-019-10063-4. [Epub ahead of print]

Impact of Multiple Texture-Modified Diets on Oral Intake and Nutritional Status in Older Patients with Pneumonia: A Retrospective Cohort Study.

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Department of Nutrition, Hamamatsu City Rehabilitation Hospital, Hamamatsu-City, Shizuoka, Japan.
Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute-City, Aichi, Japan.
Department of Rehabilitation Medicine, Teikyo University School of Medicine University Hospital, Mizonokuchi, Kawasaki-City, Kanagawa, Japan.
Department of Health Sciences, Faculty of Human Culture and Science, Prefectural University of Hiroshima, Hiroshima-City, Hiroshima, Japan.
Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, Hamamatsu-City, Shizuoka, Japan.


Texture-modified diets (TMD) is often used in clinical practices for the treatment and prevention of pneumonia. However, it is unclear how stages of TMD affect the swallowing ability and nutritional status in patients with pneumonia. This study aimed to investigate the relationship between the various stages of TMD and swallowing ability and nutritional status in older inpatients with pneumonia. In this retrospective cohort study, data for patients aged ≥ 65 years with pneumonia were obtained from the Japan Rehabilitation Nutrition Database. We performed coarsened exact matching with Mini Nutritional Assessment Short Form (MNA-SF) on admission. Ultimately, 218 patients (mean age 82.9 ± 9.8 years) were included and divided into two groups based on the stages of TMD in the facility: multiple TMD (M-TMD) group (stages of TMD ≥ 6) and control group (stages of TMD < 6). The main outcome was the rate of improvement in the Food Intake Level Scale (FILS) and the maintenance or improvement in the MNA-SF score. We used the within-hospital correction with generalized estimation equations that are commonly used to analyze clustered data while correcting for confounding factors by clustering. Multivariate multiple logistic analysis showed that M-TMD was independently associated with FILS improvement rate and the maintenance or improvement in the MNA-SF score (odds ratio [OR] 3.252; 95% confidence interval [CI] 1.602-6.601; p = 0.001 and OR 1.873; 95% CI 1.054-3.330; p = 0.032, respectively). M-TMD in the facility was associated with the maintenance or improvement in swallowing ability and the nutritional status of patients with pneumonia.


Aspiration pneumonia; Deglutition; Deglutition disorders; Nutritional status; Swallowing ability; Texture-modified diet


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