Table 1 Summary of potential benefits and harms of modified texture diets
From: Informed or misinformed consent and use of modified texture diets in dysphagia
Intervention | Potential benefit | Potential harm | Comments/evidence |
|---|---|---|---|
Thickened liquids | Reduced penetration–aspiration with liquids from thin to very thick end of the viscosity continuum [55]. Reduced penetration–aspiration might mean less risk of pneumonia with TL | Increased risk of post-swallow pharyngeal residue for liquids with higher viscosities. Increased residue and reduced cilial clearance with TL might mean more risk of pneumonia | There is no evidence to suggest TL reduce pneumonia [50]. There is some limited evidence that very thick liquids lead to more and to more severe pneumonia [54]. Animal studies suggest that aspiration of TL causes more lung inflammation than aspiration of thin liquids [56] |
Easier to control swallowing with TL may mean less distress and coughing when drinking | TL are less thirst quenching and pleasant to drink [57] | The balance of evidence is that TL have an adverse impact on QOL, and many people will not accept them as a result [58] | |
| Â | Reduced fluid intake and greater risk of dehydration and renal impairment | Biochemical indices showing underhydration are common in those receiving TL [43] | |
| Â | Reduced bioavailability of some medications [59] | Particular concern for drugs with a narrow window between toxicity and benefit | |
| Â | Lack of follow-up assessment regarding long-term clinical/QOL impact | Lack of resources especially in residential care facilities [14] | |
Modified food | Reduced risk of asphyxiation and death from large bolus obstruction | Â | Cutting food to bite sized chunks will reduce risk of asphyxiation and death [13] |
| Â | Reduced food intake and increased risk of undernutrition | A reduction in food intake is common with MF [60]. Although changes in the diets prescribed can mitigate to some degree [61], pureed diets contribute to a high prevalence of malnutrition in those with dysphagia and often have poorer calorie, protein and micronutrient content than regular diets | |
| Â | Reduced quality of life and enjoyment of eating | MF have an adverse impact on quality of life. The more modified the food texture, the worse the quality of life [58] | |
| Â | Lack of follow-up assessment regarding long-term clinical/QOL impact | Lack of resources especially in residential care facilities [14] |