The journal of nutrition, health & aging

, Volume 23, Issue 10, pp 973–978 | Cite as

Burden of Premorbid Consumption of Texture Modified Diets in Daily Life on Nutritional Status and Outcomes of Hospitalization

  • Keisuke MaedaEmail author
  • Y. Ishida
  • T. Nonogaki
  • A. Shimizu
  • Y. Yamanaka
  • R. Matsuyama
  • R. Kato
  • N. Mori



Due to the water-rich cooking process required to soften texture modified diets (TMDs), TMDs may have poorer nutrition. The aim of this study was to investigate the associations between daily premorbid TMD consumption and nutritional status at the time of hospitalization, and its burden on hospitalization outcomes.


Retrospective observational study.


An academic hospital.


The cohort comprised 3,594 older adult patients aged ≥65 years admitted to the hospital.


Patients were interviewed on admission using a premorbid daily consumption meal form to determine whether the patient ate a TMD. Nutritional status was examined using nutritional screening tools (Mini-Nutritional Assessment Short Form [MNA-SF], Malnutrition Universal Screening Tool [MUST], Geriatric Nutritional Risk Index [GNRI]) and the European Society of Clinical Nutrition and Metabolism (ESPEN)-defined criteria of malnutrition at admission. Length of hospital stay (LOS) and in-hospital mortality were considered outcomes of hospitalization. Multivariate analyses were performed to detect associations between premorbid TMD consumption and nutritional status and outcomes.


The mean age of the subjects was 75.9±7.0 years, including 58% males. Overall, 110 (3.1%) patients consuming a premorbid TMD were identified. They were older (p<0.001), had poor nutritional status (lower MNA-SF score [p<0.001] and GNRI value [p<0.001], higher MUST score [p<0.001], and more prevalent ESPEN-defined malnutrition [61.8% vs. 14.0%, p<0.001] than did patients without a TMD. The mortality rate and LOS of patients with TMD was higher (7.3% vs. 2.9%, p=0.017) and longer (19 days vs. 8 days, p<0.001) than those without TMD. Multivariate analyses showed that TMD consumption was independently associated with poor nutritional status and prolonged LOS after adjusting confounders.


Daily consumption of a TMD during the premorbid period affects nutritional status at the time of hospitalization and outcomes. Further studies are necessary to investigate whether nutritional intervention can improve outcomes for people on a TMD.

Key words

Older adults malnutrition swallowing difficulty texture modified food 



Charlson Comorbidity Index


disease-related malnutrition


European Society of Clinical Nutrition and Metabolism


fat-free mass index


Geriatric Nutritional Risk Index


Mini-Nutritional Assessment Short Form


length of stay


Malnutrition Universal Screening Tool


texture modified diet



The authors thank all the collaborators from our nutrition support teams at Aichi Medical University Hospital for their clinical work. This research did not receive any specific grant from funding agencies in the public, commercial, or not-forprofit sectors.

Disclosure statement: Keisuke Maeda received a grant from the Japan Society for the Promotion of Science (grant number: 18K11142) outside the submitted work. Other authors have no conflicts of interests.

Ethical standards: The study was approved by the ethics committee of Aichi Medical University. This study complies with the Japanese ethical guidelines for epidemiological research.


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Copyright information

© Serdi and Springer-Verlag International SAS, part of Springer Nature 2019

Authors and Affiliations

  • Keisuke Maeda
    • 1
    • 2
    Email author
  • Y. Ishida
    • 3
  • T. Nonogaki
    • 4
  • A. Shimizu
    • 5
  • Y. Yamanaka
    • 6
  • R. Matsuyama
    • 6
  • R. Kato
    • 4
  • N. Mori
    • 1
    • 2
  1. 1.Department of Palliative and Supportive Medicine, Graduate School of MedicineAichi Medical UniversityNagakute, AichiJapan
  2. 2.Nutritional Therapy Support CenterAichi Medical University HospitalNagakute, AichiJapan
  3. 3.Department of NutritionAichi Medical University HospitalNagakute, AichiJapan
  4. 4.Department of PharmacyAichi Medical University HospitalNagakute, AichiJapan
  5. 5.Department of NutritionHamamatsu City Rehabilitation HospitalShizuokaJapan
  6. 6.Department of Oral and Maxillofacial Surgery, Graduate School of MedicineAichi Medical UniversityNagakute, AichiJapan

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