Effectiveness of diet modification on dietary nutrient intake, aspiration, and fluid intake for adults with dysphagia: a meta-analysis of randomized controlled trials

Objectives: To determine and explore the effectiveness of diet modification on dietary nutrient intake, aspiration, and fluid intake in adults with dysphagia. Participants: Adults with dysphagia. Design: A meta-analysis of randomized controlled trials (RCTs). Methods: We conducted a comprehensive literature search in EMBASE, Cochrane Library, Ovid-Medline, CINAHL, Web of Science, PubMed, and reference lists until November 2023. Quality of the included studies was assessed by the Cochrane Risk of Bias Assessment tool 2.0. Data analysis was performed using Comprehensive Meta-analysis 3.0 for pooled Hedges’ g and odds ratios (ORs) with corresponding confidence interval (CI) adopting a random-effects model. A X²- based test using Cochran's Q (P < 0.10) and I² statistics evaluated heterogeneity. Results: In total, 16 RCTs from among 3,854 studies retrieved from the literature search with 1812 adults with dysphagia were included in this meta-analysis. Texture-modified diets revealed a significant small effect on increasing energy intake (g: 0.37, 95% CI = 0.05–0.68) and a medium effect on increasing protein intake (g: 0.56, 95% CI = 0.13–0.99). Thickened fluids revealed a significantly reduced risk of aspiration (OR: 0.59, 95% CI = 0.44–0.79), and thickened fluids combined with water protocol revealed a significant large effect on increasing fluid intake (g: 3.96, 95% C = 0.75–7.16). Conclusions: The findings of this meta-analysis demonstrated that texture-modified diets increase dietary intake of energy and protein for adults with dysphagia. In addition, thickened fluids reduced the risk of aspiration while thickened fluids combined with water protocol increased fluid intake in adults with dysphagia.