Effect of a texture‐modified and controlled bolus volume diet on all‐cause mortality in older persons with oropharyngeal dysphagia: Secondary analysis of a randomized controlled trial

• Published in: Nutrition in clinical practice Vol. 39; no. 3; pp. 665 - 672
• Main Authors: Reyes‐Torres, Carlos A., Castillo‐Martínez, Lilia, Ramos‐Vázquez, Aniela G., Cassis‐Nosthas, Lorena, Zavala‐Solares, Mónica, García‐de‐la‐Torre, Guadalupe, Serralde‐Zúñiga, Aurora E.
• Format: Journal Article
• Language: English
• Published: United States 01-06-2024
• Subjects: Aged; Aged, 80 and over; aspiration pneumonia; Deglutition Disorders - diet therapy; Deglutition Disorders - mortality; Deglutition Disorders - therapy; Diet - methods; dysphagia; Female; Follow-Up Studies; Hand Strength; Humans; Kaplan-Meier Estimate; Male; Middle Aged; mortality; nutrition therapy; older adult; Pneumonia, Aspiration - mortality; Proportional Hazards Models; texture‐modified diet; Treatment Outcome; older adult; aspiration pneumonia; dysphagia; mortality; texture‐modified diet; nutrition therapy
• ISSN: 0884-5336; 1941-2452
• DOI: 10.1002/ncp.11052

Background
Oropharyngeal dysphagia (OD) is common among older adults. Some studies have evaluated the efficacy of a texture‐modified diet on mortality but with short‐term follow‐up. We aimed to evaluate the effect of a texture‐modified diet and controlled bolus volume on all‐cause mortality after 12 months in older persons with OD.
Methods
This secondary analysis of a randomized clinical trial included patients aged ≥60 years with a diagnosis of OD. They were concurrently and randomly assigned to receive either a texture‐modified food diet and controlled bolus volume (intervention group) or standard treatment (control group) with 12 months of follow‐up. Secondary outcomes were oral intake, weight, handgrip strength, phase angle, and aspiration pneumonia. Kaplan‐Meier analysis and the Cox proportional hazards model were used for mortality analysis.
Results
A total of 127 participants (intervention group: 64 and control group: 63) were recruited, with a mean age of 76 years. The probability of all‐cause mortality was significantly lower in the intervention group (n = 8, 12%) than in the control group (n = 18, 29%) (hazard ratio = 0.36 [95% CI = 0.16–0.86]; P = 0.01). There were 5 (7.9%) and 10 (16.1%) aspiration pneumonia events in the intervention and control groups, respectively (not significant) in 12 months of follow‐up. Changes were observed in protein consumption (P = 0.01), body weight (P = 0.04), body mass index (P = 0.004), handgrip strength (P = 0.02), and phase angle (P = 0.04) between the treatment groups.
Conclusion
Compared with the standard treatment, the dietary intervention improved efficacy by limiting nutrition complications, aspiration pneumonia, and all‐cause mortality.