{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T16:06:41Z","timestamp":1784131601582,"version":"3.55.0"},"reference-count":26,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T00:00:00Z","timestamp":1784073600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Nutr."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Dysphagia is a critical challenge in nursing homes, associated with malnutrition, aspiration pneumonia, and increased mortality. This study evaluates the impact of an integrated protocol combining instant homogenized meals, nutritional monitoring, and continuous staff training across five Italian nursing homes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Material and methods<\/jats:title>\n                    <jats:p>A multicentric retrospective observational pilot study was conducted on 99 frail residents. The cohort was characterized by high functional dependence (88% total dependence) and severe nutritional vulnerability (99% malnutrited or at risk). Clinical evolution was compared between the 120 days preceding (pre-implementation) and the 120 days following the adoption of the protocol (post-implementation). Parameters analyzed included anthropometric data, bioelectrical impedance analysis (BIA), biochemical tests, adverse events (pneumonia, pressure ulcers), and economic\/organizational impact in the post-implementation period (measured in two nursing homes).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In the post-implementation phase, an attenuation of weight decline was observed compared to the preceding period. BIA parameters showed favorable changes: phase angle increased significantly (\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.001), intracellular water rose while extracellular water decreased, and the ECM\/BCM ratio improved, suggesting a more favorable body-composition and hydration pattern, although these findings should be interpreted cautiously given the possible influence of fluid shifts. Biochemically, increases in transferrin (\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.01), total protein, and albumin were recorded, supporting a coherent pattern of improved protein nutritional status. Clinically relevant adverse events decreased: aspiration pneumonia dropped from 8.2% to 5.1% (a 38.7% reduction), and pressure ulcers decreased from 24.7% to 19.2% (a 22.3% reduction). Economically, the cost per dietary day reduced by 17.5% (-\u20ac1.62), driven by a reduction in meal preparation time from 11 min 22 s to 3 min 21 s per guest. Qualitative analysis highlighted standardized consistencies, improved safety, and increased staff confidence. Likely, the integrated protocol was associated with a possible attenuation of nutritional decline in an extremely frail population, with coherent improvements in selected BIA-derived and biochemical markers and fewer recorded clinical complications.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Process standardization may enhance resident safety and operational efficiency, although these exploratory findings require confirmation in controlled prospective studies. These findings support managing dysphagia as a multidimensional clinical and organizational pathway rather than a simple texture modification strategy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fnut.2026.1882262","type":"journal-article","created":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T15:32:18Z","timestamp":1784129538000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["A multicentric retrospective pilot study on the clinical, nutritional, economic and organizational impact of an integrated protocol for dysphagia management within nursing homes in Italy"],"prefix":"10.3389","volume":"13","author":[{"given":"Antonio","family":"Sebastiano","sequence":"first","affiliation":[{"name":"Observatory on Nursing Homes, LIUC Cattaneo University","place":["Castellanza, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiara","family":"Mazzetti","sequence":"additional","affiliation":[{"name":"Istituto La Provvidenza. 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Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samir Giuseppe","family":"Sukkar","sequence":"additional","affiliation":[{"name":"IRCCS Ospedale Policlinico San Martino","place":["Genoa, Italy"]},{"name":"Dietetics and Clinical Nutrition Unit, University of Genoa","place":["Genoa, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,15]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"259","DOI":"10.1038\/nrgastro.2015.49","article-title":"Dysphagia: current reality and scope of the problem.","volume":"12","author":"Clav\u00e9","year":"2015","journal-title":"Nat Rev Gastroenterol Hepatol."},{"key":"B2","doi-asserted-by":"publisher","first-page":"451","DOI":"10.1111\/1460-6984.12804","article-title":"The true cost of dysphagia on quality of life: the views of adults with swallowing disability.","volume":"58","author":"Smith","year":"2023","journal-title":"Int J Lang Commun 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