Shirai Yuka, Ueshima Junko, Maeda Keisuke, Egashira Fumie, Horikoshi Yuri, Kamoshita Satoru, Momosaki Ryo
Department of Rehabilitation Medicine, Mie University Graduate School of Medicine, Tsu, JPN.
Clinical Nutrition Unit, Hamamatsu University Hospital, Hamamatsu, JPN.
Cureus. 2025 Jun 17;17(6):e86191. doi: 10.7759/cureus.86191. eCollection 2025 Jun.
This study aimed to investigate the current nutrition support practices for patients with dysphagia in Japanese hospitals and to identify gaps between research-based recommendations and clinical practice. A nationwide questionnaire survey was conducted from April to June 2023 targeting 5,376 hospitals with inpatient beds. The questionnaire, developed by the Japanese Working Group on Integrated Nutrition for Dysphagic People, included items on hospital characteristics and nutrition support systems. Hospitals that consented to participate completed an online questionnaire by a representative dietitian. A total of 905 hospitals responded (response rate: 16.8%). Of these, 94.7% provided texture-modified diets (TMDs). Among 857 hospitals providing TMDs, 511 (59.6%) reported that nutrition support for patients with dysphagia was provided by ward-assigned dietitians. In contrast, 229 hospitals (26.7%) had no clearly designated personnel responsible for such support. Multidisciplinary teams were absent in 58.7% of hospitals. While 84.8% of hospitals reported discrepancies between the names and actual forms of TMDs, only 37.2% shared dietary forms with other facilities. The median energy content of TMDs ranged from 1,200 to 1,400 kcal/day, suggesting inadequate nutritional value. This study revealed insufficient energy content in TMDs and limited use of standardized dietary forms, despite recognition of these issues by nutrition departments. The lack of multidisciplinary collaboration and inconsistent classification may hinder effective nutrition support. Addressing organizational, structural, and communication-related gaps is essential to improve the quality of dysphagia nutrition care.
本研究旨在调查日本医院中吞咽困难患者当前的营养支持做法，并找出基于研究的建议与临床实践之间的差距。2023年4月至6月，针对5376家设有住院床位的医院开展了一项全国性问卷调查。该问卷由日本吞咽困难人群综合营养工作组编制，包括医院特征和营养支持系统等项目。同意参与的医院由一名代表营养师完成在线问卷。共有905家医院做出回应（回应率：16.8%）。其中，94.7%的医院提供质地改良饮食（TMD）。在提供TMD的857家医院中，511家（59.6%）报告称，吞咽困难患者的营养支持由病房指定的营养师提供。相比之下，229家医院（26.7%）没有明确指定负责此类支持的人员。58.7%的医院没有多学科团队。虽然84.8%的医院报告了TMD的名称与实际形式之间存在差异，但只有37.2%的医院与其他机构共享饮食表单。TMD的能量含量中位数为每天1200至1400千卡，表明营养价值不足。这项研究表明，尽管营养部门已经认识到这些问题，但TMD的能量含量不足，标准化饮食表单的使用有限。缺乏多学科协作和分类不一致可能会阻碍有效的营养支持。解决组织、结构和沟通方面的差距对于提高吞咽困难营养护理质量至关重要。
