Systematic review and evidence based recommendations on texture modified foods and thickened fluids for adults (≥18 years) with oropharyngeal dysphagia

SummaryBackground & aimsIn a number of countries, including Denmark, there are written guidelines describing the various types of texture modified foods and thickened fluids. None of these are based on a systematic review of texture modified food and thickened fluid as being more sufficient than regular food and fluid, and thereby preventing or reducing the impact of dysphagia. The present article aims to provide recommendations based on evidence for adults (≥18 years) with oropharyngeal dysphagia as soon as possible after diagnosis in order to ensure sufficient and safe oral consumption of nutrition as long as possible and thereby preventing malnutrition, dehydration, aspiration and aspiration pneumonia.MethodsA systematic review was performed after definition of four clinical questions regarding prevention of malnutrition, dehydration, aspiration and aspiration pneumonia. Answers to the clinical questions led to the development of recommendations according to the evidence hierarchy (A indicates the highest level of recommendation).ResultsTo reduce risk of aspiration pneumonia, “chin down” procedure and thin fluid should be first choice rather than thickened fluid in cases of chronic dysphagia (A), and in the acute phase individual counselling with follow up and adjustment of the consistency of texture modified food and thickened fluid should be given (A). To improve nutritional status, special made and nutritionally enriched, texture modified foods (pureed and minced) and thickened fluids (nectar, honey and pudding consistency) are recommended for elderly persons with chronic dysphagia (B*).ConclusionSince there are only a few, high quality studies, the evidence in favour of texture modified foods and thickened fluids as being effective in preventing or reducing the impact of dysphagia is not strong. More studies are needed to show whether texture modified foods and thickened fluids are effective in the management of chronic and acute dysphagia.