Nutrition Support in Dysphagia: Japan Nationwide Hospital Survey on Nutritional Values, Diet Characteristics, and Dietitians' Roles in Texture-Modified Diets

This study aimed to investigate the current nutrition support practices for patients with dysphagia in Japanese hospitals and to identify gaps between research-based recommendations and clinical practice. A nationwide questionnaire survey was conducted from April to June 2023 targeting 5,376 hospitals with inpatient beds. The questionnaire, developed by the Japanese Working Group on Integrated Nutrition for Dysphagic People, included items on hospital characteristics and nutrition support systems. Hospitals that consented to participate completed an online questionnaire by a representative dietitian. A total of 905 hospitals responded (response rate: 16.8%). Of these, 94.7% provided texture-modified diets (TMDs). Among 857 hospitals providing TMDs, 511 (59.6%) reported that nutrition support for patients with dysphagia was provided by ward-assigned dietitians. In contrast, 229 hospitals (26.7%) had no clearly designated personnel responsible for such support. Multidisciplinary teams were absent in 58.7% of hospitals. While 84.8% of hospitals reported discrepancies between the names and actual forms of TMDs, only 37.2% shared dietary forms with other facilities. The median energy content of TMDs ranged from 1,200 to 1,400 kcal/day, suggesting inadequate nutritional value. This study revealed insufficient energy content in TMDs and limited use of standardized dietary forms, despite recognition of these issues by nutrition departments. The lack of multidisciplinary collaboration and inconsistent classification may hinder effective nutrition support. Addressing organizational, structural, and communication-related gaps is essential to improve the quality of dysphagia nutrition care.