Association Between Texture-Modified Diet Intake Rate and Functional Outcomes After Acute Stroke: A Retrospective...

Texture-modified diets (TMDs) are commonly prescribed after stroke, but the clinical significance of the amount actually consumed remains unclear. We examined the association between TMD intake rate and functional status at discharge and 90 days after stroke.

This retrospective single-center study included 406 patients with ischemic stroke or intracerebral hemorrhage who received TMDs for suspected or confirmed dysphagia between 2012 and 2017. Overall TMD intake was calculated as the meal-count-weighted mean consumption proportion across four TMD levels and analyzed per 10% increase. Ordinal logistic regression models for modified Rankin Scale (mRS) scores were adjusted for age, sex, admission National Institutes of Health Stroke Scale (NIHSS) score, premorbid mRS, stroke type, and admission Geriatric Nutritional Risk Index (GNRI). Binary logistic regression for a favorable outcome (mRS 0-2) was performed as a secondary analysis.

Each 10% increase in TMD intake was associated with lower odds of a higher mRS category at discharge (adjusted OR, 0.85; 95% CI, 0.77-0.94) and at 90 days (adjusted OR, 0.88; 95% CI, 0.80-0.96). Higher intake was associated with higher odds of a favorable outcome at discharge (adjusted OR, 1.31; 95% CI, 1.03-1.66), whereas the 90-day association was not statistically significant (adjusted OR, 1.15; 95% CI, 0.98-1.35). Diet-specific associations were inconsistent.

Higher TMD intake rates were associated with better functional status after multivariable adjustment. Because TMD intake may also reflect swallowing impairment, clinical condition, and early recovery, these observational findings do not establish causality. Monitoring TMD intake may help identify patients who warrant closer nutritional and swallowing assessment.