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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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Abstract

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.

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Acknowledgements

The authors would like to thank the staff of Atagawa Hospital, Nagasaki Rehabilitation Hospital, Miharu Hospital, Tsurumaki Onsen Hospital, Haradoi Hospital, Nanko Hospital, Nishi-Hiroshima Rehabilitation Hospital, Yasuoka Hospital, Kanazawa Nishi Hospital, Sakurakai Medical Corporation Sakurakai Hospital, Sapporo Nishi-maruyama Hospital, Mihono Hospital, Tamana Regional Health Medical Center, Jikei University Daisan Hospital, Nakanoshima Iwaki Hospital, Nishinomiya Kyoritsu Neurosurgical Hospital, and Minamisoma Municipal General Hospital for providing the patients’ data for the JRND.

Funding

This study was supported by a KAKENHI grant from the Japan Society for Promotion of Science (grant no. 15K01395).

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Authors and Affiliations

  1. Department of Nutrition, Hamamatsu City Rehabilitation Hospital, Hamamatsu-City, Shizuoka, Japan

    Akio Shimizu

  2. Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute-City, Aichi, Japan

    Akio Shimizu

  3. Department of Rehabilitation Medicine, Teikyo University School of Medicine University Hospital, Mizonokuchi, Kawasaki-City, Kanagawa, Japan

    Ryo Momosaki

  4. Department of Health Sciences, Faculty of Human Culture and Science, Prefectural University of Hiroshima, Hiroshima-City, Hiroshima, Japan

    Jun Kayashita

  5. Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, Hamamatsu-City, Shizuoka, Japan

    Ichiro Fujishima

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  1. Akio Shimizu
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Contributions

AS, RM, JK, and IF: study concept and design. AS, RM, JK, and IF: acquisition of data. AS, RM: analysis and interpretation of data. AS, RM, JK, and IF: drafting of the manuscript. AS, RM, JK, and IF: critical revision of the manuscript for important intellectual content.

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Correspondence to Akio Shimizu.

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Shimizu, A., Momosaki, R., Kayashita, J. et al. Impact of Multiple Texture-Modified Diets on Oral Intake and Nutritional Status in Older Patients with Pneumonia: A Retrospective Cohort Study. Dysphagia 35, 574–582 (2020). https://doi.org/10.1007/s00455-019-10063-4

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