The effect of dietitian‐controlled IDDSI‐based diet modification on nutritional outcomes in patients undergoing neurological rehabilitation: A retrospective study

OBJECTIVE: This study aimed to evaluate the association between IDDSI-based versus traditional R1-2-3 texture modifications and nutritional outcomes in patients undergoing neurological rehabilitation who required dietary modification after videofluoroscopic swallowing study (VFSS). MATERIALS AND METHODS: Patients hospitalized for neurological rehabilitation who underwent VFSS between February and December 2023 were retrospectively analyzed. Patients received either the traditional R1-2-3 diet system or IDDSI-based modification, according to the hospitalization period. In both groups, individualized energy and protein requirements were determined by a clinical dietitian. Body mass index (BMI), NRS-2002 scores, hematological parameters, and biochemical parameters were recorded at admission and discharge. Intra- and intergroup comparisons and correlation analyses were performed. RESULTS: A total of 288 patients were included (mean age, 60.59 ± 19.26 years; 44.8% female). Pre-discharge BMI was higher in the IDDSI group (p = 0.046), while the proportions of patients with low protein and albumin levels were lower (p = 0.038 and p = 0.024, respectively). Serum 25-hydroxyvitamin D levels were also higher (p = 0.019). Improvements in BMI, NRS-2002 scores, nutritional risk, hemoglobin, total lymphocyte count, and vitamin D levels were greater in the IDDSI group (p = 0.006-0.045). IDDSI-based modification was negatively associated with underweight BMI, nutritional risk, low protein, and low albumin levels (p < 0.05). CONCLUSION: Within dietitian-supervised nutritional care, IDDSI-based texture modification was associated with more favorable nutrition-related outcomes than the traditional R1-2-3 system. Given the retrospective, nonrandomized design, these findings should not be interpreted as evidence of causality.