Association of changes in the texture level of consumed food with nutritional and functional outcomes among older patients undergoing rehabilitation

Dysphagia is common in older patients, and texture-modified diets are used in its clinical management. However, texture-modified diets can cause malnutrition or poor functional recovery. This study aimed to examine the relationship of changes in the food texture level with nutritional improvement and functional recovery in older patients undergoing rehabilitation. This single-center cross-sectional study included patients aged ≥65 years undergoing rehabilitation and on oral intake (International Dysphagia Diet Standardization Initiative framework level 3–6). We evaluated nutritional status using the Mini Nutritional Assessment Short Form and ADLs using the Functional Independence Measure (FIM). Patients were categorized into two groups: those with increased food texture levels were allocated to the increased food texture level (IF) group, and those with no texture level change or decreased level were assigned to the non-increased food texture level (NIF) group. The discharge outcomes were compared between the groups. Multivariate analyses were performed to determine the association between changes in the food texture level and nutritional improvement, FIM gain, and discharge to home. Among 203 patients (mean age, 86 years; 115 women), 57 (28.1%) and 146 (74.9%) patients were assigned to the IF and NIF groups, respectively. The IF group showed greater nutritional improvement (89.5% vs. 61.6%), greater FIM gain (median, 23 vs. 7.5), and a higher proportion of home discharges (64.9% vs. 39.7%) than did the NIF group. Multivariate analyses showed that an increase in the texture level of the consumed food was independently associated with nutritional improvement (odds ratio [OR] = 3.05, 95% confidence interval [CI] = 1.07 to 8.65) and FIM gain (partial regression coefficient [B] = 10.65, 95% CI = 6.19 to 15.11). The IF group had higher odds of home discharge (OR = 1.94, 95% CI = 0.92 to 4.11). An increase in the texture level of consumed food may be associated with nutritional improvement, ADL recovery, and discharge to home.