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
Posgrado en Ciencias de la Salud, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad Universitaria, Mexico City, Mexico.
Servicio de Nutriología Clínica, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
Nutr Clin Pract. 2024 Jun;39(3):665-672. doi: 10.1002/ncp.11052. Epub 2023 Aug 3.
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.
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.
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.
Compared with the standard treatment, the dietary intervention improved efficacy by limiting nutrition complications, aspiration pneumonia, and all-cause mortality.
口咽吞咽困难（OD）在老年人中很常见。一些研究评估了经调制的饮食对死亡率的影响，但随访时间都较短。我们旨在评估经调制的饮食和控制食团容量对伴有 OD 的老年人 12 个月时全因死亡率的影响。
这是一项随机临床试验的二次分析，纳入了年龄≥60 岁且诊断为 OD 的患者。他们同时被随机分配接受经调制的食物饮食和控制食团容量（干预组）或标准治疗（对照组），随访 12 个月。次要结局是口腔摄入、体重、握力、相位角和吸入性肺炎。采用 Kaplan-Meier 分析和 Cox 比例风险模型进行死亡率分析。
共纳入 127 名参与者（干预组 64 名，对照组 63 名），平均年龄为 76 岁。干预组（n=8，12%）全因死亡率明显低于对照组（n=18，29%）（风险比=0.36 [95%CI=0.16-0.86]；P=0.01）。干预组和对照组在 12 个月的随访中分别有 5 例（7.9%）和 10 例（16.1%）发生吸入性肺炎（无统计学意义）。治疗组在蛋白质摄入量（P=0.01）、体重（P=0.04）、体重指数（P=0.004）、握力（P=0.02）和相位角（P=0.04）方面均有变化。
与标准治疗相比，饮食干预通过限制营养并发症、吸入性肺炎和全因死亡率来提高疗效。
