The effect of dietitian-controlled IDDSI-based diet modification on nutritional outcomes in patients undergoing...

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).

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.

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).

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.