Department of Geriatric Medicine, Galway University Hospitals, Galway, Ireland.
Unit 4, Merlin Park University Hospital, Galway, Ireland.
BMC Geriatr. 2018 Jul 20;18(1):167. doi: 10.1186/s12877-018-0839-7.
Although modifying diets, by thickening liquids and modifying the texture of foods, to reduce the risk of aspiration has become central to the current management of dysphagia, the effectiveness of this intervention has been questioned. This narrative review examines, and discusses possible reasons for, the apparent discrepancy between the widespread use of modified diets in current clinical practice and the limited evidence base regarding the benefits and risks of this approach.
There is no good evidence to date that thickening liquids reduces pneumonia in dysphagia and this intervention may be associated with reduced fluid intake. Texture-modified foods may contribute to undernutrition in those with dysphagia. Modified diets worsen the quality of life of those with dysphagia, and non-compliance is common. There is substantial variability in terminology and standards for modified diets, in the recommendations of individual therapists, and in the consistency of diets prepared by healthcare staff for consumption. Although use of modified diets might appear to have a rational pathophysiological basis in dysphagia, the relationship between aspiration and pneumonia is not clear-cut. Clinical experience may be a more important determinant of everyday practice than research evidence and patient preferences. There are situations in the management of dysphagia where common sense and the necessity of intervention will clearly outweigh any lack of evidence or when application of evidence-based principles can enable good decision making despite the absence of robust evidence. Nevertheless, there is a significant discrepancy between the paucity of the evidence base supporting use of modified diets and the beliefs and practices of practitioners.
The disconnect between the limited evidence base and the widespread use of modified diets suggests the need for more careful consideration as to when modified diets might be recommended to patients. Patients (or their representatives) have a choice whether or not to accept a modified diet and must receive adequate information, about the potential risks and impact on quality of life as well as the possible benefits, to make that choice. There is an urgent need for better quality evidence regarding this intervention.
尽管通过增稠液体和改变食物质地来修改饮食以降低误吸风险已成为当前吞咽障碍管理的核心内容，但这种干预措施的有效性一直受到质疑。本叙述性综述探讨并讨论了当前临床实践中广泛使用改良饮食与该方法的益处和风险的有限证据基础之间明显差异的可能原因。
目前没有充分的证据表明增稠液体可减少吞咽障碍患者的肺炎，并且这种干预措施可能与液体摄入减少有关。质地改良的食物可能导致吞咽障碍患者营养不良。改良饮食会降低吞咽障碍患者的生活质量，并且通常不被遵守。改良饮食的术语和标准、个别治疗师的建议以及医护人员为食用而准备的饮食的一致性存在很大差异。尽管在吞咽障碍中，使用改良饮食可能具有合理的病理生理学基础，但误吸与肺炎之间的关系并不明确。临床经验可能比研究证据和患者偏好对日常实践的决定更为重要。在吞咽障碍的管理中，存在一些情况，常识和干预的必要性显然会超过任何缺乏证据的情况，或者在缺乏强有力证据的情况下，应用基于证据的原则可以使做出良好决策成为可能。然而，支持使用改良饮食的证据基础匮乏与从业者的信念和实践之间存在显著差异。
支持使用改良饮食的证据基础有限与广泛使用之间的脱节表明，需要更加仔细地考虑何时向患者推荐改良饮食。患者（或其代表）是否接受改良饮食有选择，并且必须获得足够的信息，包括潜在风险、对生活质量的影响以及可能的益处，以便做出选择。迫切需要对此干预措施进行更高质量的证据研究。
