Nutritional Intake and Meal Composition of Patients Consuming Texture Modified Diets and Thickened Fluids: A Systematic Review and Meta-Analysis

Abstract

Texture-modified diets (TMDs) play an important role in ensuring safety for those with dysphagia but come with risks to nutrition and quality of life. The use of TMDs has been addressed with the increasing prevalence of dysphagia in previous decades. However, there is limited literature that investigates the nutrition perspectives of TMD consumers. This review summarises the nutrition outcomes of adults consuming TMDs and thickened fluids (TFs) and identifies the limitations of TMD and TF productions. A systematic database search following PICO criteria was conducted using Cochrane Central (via Ovid), MEDLINE, CINAHL, EMBASE, and Scopus databases. Nutrition intake, meal consumption, adequacy, and meal composition were identified as relevant outcomes. 35 studies were included for analysis. Consumption of TMDs demonstrated a poorer intake compared to regular diets, in particular significant in energy and calcium. Meta-analysis of mean differences showed favourable effects of shaped TMDs on both energy (−273.8 kJ/d; 95%CI: −419.1 to −128.6, p = 0.0002) and protein (−12.4 g/d; 95%CI: −17.9 to −6.8, p < 0.0001) intake compared to traditional cook-fresh TMDs. Nutrition intake was compromised in TMD consumers. Optimisation of nutrition intake was achievable through enrichment and adjusting meal texture and consistency. However, the heterogeneity of studies and the missing verification of the consistencies lead to difficulty in drawing conclusions regarding particular texture or intervention.

Texture-Modified Diets, Nutritional Status and Mealtime Satisfaction: A Systematic Review

“…Though nutritional status was found to be routinely screened in nursing homes, diet quality is one of the biggest challenges of clinical management which can result in malnutrition [ 68 , 69 ]. The previous review summarised that the positive improvement in nutrition intake was found using fortification and shaped TMDs [ 32 ]. Implementing nutrition enrichment strategies such as fortified food or supplements should be considered in dysphagic management for malnourished patients and those who are at risk of malnutrition [ 68 , 70 ].…”

“…Improved energy and protein intake were achieved by optimising the texture modification [ 32 , 71 ]. The quality of TMDs is highly related to mealtime acceptance and compliance.…”

“…This systematic review was conducted alongside our previous review assessing the nutrition intake and meal content of TMDs in May 2019 [ 32 ]. The authors used the same database (Cochrane Central (via Ovid), MEDLINE, EMBASE, SCOPUS and CINAHL), and searching strategies, and updated the search in April 2021 (see Supplementary Data S1 for search strategy).…”

“…Therefore, while the safety and prevalence aspects of dysphagia have received research attention, the nutritional implications and mealtime satisfaction of TMDs have not been so thoroughly summarised and analysed. In a previous systematic review, we investigated nutritional intake in those on texture-modified diets [ 32 ]. The purpose of this paper was to systematically identify and examine the available evidence on nutritional status and mealtime satisfaction of adults using TMDs and TFs.…”

Modifying Puree Meals in Residential Aged Care Facilities: A Multi-Centre Feasibility and Acceptability Study

“…Second, the nutritional value of TMDs can be compromised. Textures such as purees tend to be less nutritiously dense compared to regular-textured diets [ 6 , 7 ], which may place those who rely on them for sustenance at a higher risk for malnutrition [ 8 ]. Lastly, those who eat and prepare TMDs have reported dissatisfaction with all aspects of the foods [ 8 , 9 , 10 ].…”