{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T11:07:15Z","timestamp":1790075235564,"version":"4.0.1"},"reference-count":32,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T00:00:00Z","timestamp":1790035200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background\/Objectives: Texture-modified diets (TMDs) are commonly prescribed after stroke, but the clinical significance of the amount actually consumed remains unclear. We examined the association between TMD intake rate and functional status at discharge and 90 days after stroke. Methods: This retrospective single-center study included 406 patients with ischemic stroke or intracerebral hemorrhage who received TMDs for suspected or confirmed dysphagia between 2012 and 2017. Overall TMD intake was calculated as the meal-count-weighted mean consumption proportion across four TMD levels and analyzed per 10% increase. Ordinal logistic regression models for modified Rankin Scale (mRS) scores were adjusted for age, sex, admission National Institutes of Health Stroke Scale (NIHSS) score, premorbid mRS, stroke type, and admission Geriatric Nutritional Risk Index (GNRI). Binary logistic regression for a favorable outcome (mRS 0\u20132) was performed as a secondary analysis. Results: Each 10% increase in TMD intake was associated with lower odds of a higher mRS category at discharge (adjusted OR, 0.85; 95% CI, 0.77\u20130.94) and at 90 days (adjusted OR, 0.88; 95% CI, 0.80\u20130.96). Higher intake was associated with higher odds of a favorable outcome at discharge (adjusted OR, 1.31; 95% CI, 1.03\u20131.66), whereas the 90-day association was not statistically significant (adjusted OR, 1.15; 95% CI, 0.98\u20131.35). Diet-specific associations were inconsistent. Conclusions: Higher TMD intake rates were associated with better functional status after multivariable adjustment. Because TMD intake may also reflect swallowing impairment, clinical condition, and early recovery, these observational findings do not establish causality. Monitoring TMD intake may help identify patients who warrant closer nutritional and swallowing assessment.<\/jats:p>","DOI":"10.3390\/nu18193114","type":"journal-article","created":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T10:21:48Z","timestamp":1790072508000},"page":"3114","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association Between Texture-Modified Diet Intake Rate and Functional Outcomes After Acute Stroke: A Retrospective Observational Study"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3632-2477","authenticated-orcid":false,"given":"Rie","family":"Motoyama","sequence":"first","affiliation":[{"name":"Department of Neurology, National Cerebral and Cardiovascular Center, Suita 564-8565, Osaka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"}]},{"given":"Tomotaka","family":"Tanaka","sequence":"additional","affiliation":[{"name":"Department of Neurology, National Cerebral and Cardiovascular Center, Suita 564-8565, Osaka, Japan"},{"name":"Department of Neurology, Faculty of Medicine, Shimane University, Izumo 693-0021, Shimane, Japan"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"}]},{"given":"Kazuki","family":"Fukuma","sequence":"additional","affiliation":[{"name":"Department of Neurology, National Cerebral and Cardiovascular Center, Suita 564-8565, Osaka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"methodology","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"given":"Shinsaku","family":"Nakazawa","sequence":"additional","affiliation":[{"name":"Department of Neurology, National Cerebral and Cardiovascular Center, Suita 564-8565, Osaka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1939-6327","authenticated-orcid":false,"given":"Tetsuya","family":"Chiba","sequence":"additional","affiliation":[{"name":"Department of Neurology, National Cerebral and Cardiovascular Center, Suita 564-8565, Osaka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"given":"Shuichi","family":"Tonomura","sequence":"additional","affiliation":[{"name":"Department of Neurology, National Cerebral and Cardiovascular Center, Suita 564-8565, Osaka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7102-4048","authenticated-orcid":false,"given":"Masafumi","family":"Ihara","sequence":"additional","affiliation":[{"name":"Department of Neurology, National Cerebral and Cardiovascular Center, Suita 564-8565, Osaka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"952","DOI":"10.1212\/WNL.55.7.952","article-title":"Predicting prognosis after stroke: A placebo group analysis from the National Institute of Neurological Disorders and Stroke rt-PA Stroke Trial","volume":"55","author":"Frankel","year":"2000","journal-title":"Neurology"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1016\/j.clnu.2017.09.003","article-title":"ESPEN guideline clinical nutrition in neurology","volume":"37","author":"Burgos","year":"2018","journal-title":"Clin. Nutr."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Arnold, M., Liesirova, K., Broeg-Morvay, A., Meisterernst, J., Schlager, M., Mono, M.L., El-Koussy, M., Kagi, G., Jung, S., and Sarikaya, H. (2016). Dysphagia in Acute Stroke: Incidence, Burden and Impact on Clinical Outcome. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0148424"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2756","DOI":"10.1161\/01.STR.0000190056.76543.eb","article-title":"Dysphagia after stroke: Incidence, diagnosis, and pulmonary complications","volume":"36","author":"Martino","year":"2005","journal-title":"Stroke"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"FOOD Trial Collaboration (2003). Poor nutritional status on admission predicts poor outcomes after stroke: Observational data from the FOOD trial. Stroke, 34, 1450\u20131456.","DOI":"10.1161\/01.STR.0000074037.49197.8C"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"707","DOI":"10.2340\/16501977-0415","article-title":"A review of the relationship between dysphagia and malnutrition following stroke","volume":"41","author":"Foley","year":"2009","journal-title":"J. Rehabil. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e98","DOI":"10.1161\/STR.0000000000000098","article-title":"Guidelines for Adult Stroke Rehabilitation and Recovery: A Guideline for Healthcare Professionals from the American Heart Association\/American Stroke Association","volume":"47","author":"Winstein","year":"2016","journal-title":"Stroke"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1007\/s00455-016-9758-y","article-title":"Development of International Terminology and Definitions for Texture-Modified Foods and Thickened Fluids Used in Dysphagia Management: The IDDSI Framework","volume":"32","author":"Cichero","year":"2017","journal-title":"Dysphagia"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1007\/s00455-014-9578-x","article-title":"The influence of food texture and liquid consistency modification on swallowing physiology and function: A systematic review","volume":"30","author":"Steele","year":"2015","journal-title":"Dysphagia"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"100486","DOI":"10.1016\/j.jnha.2025.100486","article-title":"Effectiveness of diet modification on dietary nutrient intake, aspiration, and fluid intake for adults with dysphagia: A meta-analysis of randomized controlled trials","volume":"29","author":"Chu","year":"2025","journal-title":"J. Nutr. Health Aging"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1111\/j.1365-277X.2005.00605.x","article-title":"Comparison of energy and protein intakes of older people consuming a texture modified diet with a normal hospital diet","volume":"18","author":"Wright","year":"2005","journal-title":"J. Hum. Nutr. Diet."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1516","DOI":"10.1016\/j.apmr.2004.11.049","article-title":"Initial psychometric assessment of a functional oral intake scale for dysphagia in stroke patients","volume":"86","author":"Crary","year":"2005","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1111\/j.1365-277X.2009.00944.x","article-title":"Contribution of thickened drinks, food and enteral and parenteral fluids to fluid intake in hospitalised patients with dysphagia","volume":"22","author":"Vivanti","year":"2009","journal-title":"J. Hum. Nutr. Diet."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1007\/s00455-015-9658-6","article-title":"Clinical Variables Associated with Hydration Status in Acute Ischemic Stroke Patients with Dysphagia","volume":"31","author":"Crary","year":"2016","journal-title":"Dysphagia"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Siotto, M., Guerrini, A., Cocco, C., Germanotta, M., Fasano, A., Cipollini, V., Cortellini, L., Pavan, A., Insalaco, S., and Antonacci, E. (2024). Malnutrition Diagnosis and Food Consumption in Subacute Post-Stroke Patients During Rehabilitation. Nutrients, 16.","DOI":"10.3390\/nu16213589"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1454","DOI":"10.1016\/j.clnu.2023.06.012","article-title":"Pre-existing sarcopenia and swallowing outcomes in acute stroke patients","volume":"42","author":"Fukuma","year":"2023","journal-title":"Clin. Nutr."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1200","DOI":"10.1161\/01.STR.27.7.1200","article-title":"Complications and outcome after acute stroke. Does dysphagia matter?","volume":"27","author":"Smithard","year":"1996","journal-title":"Stroke"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"189","DOI":"10.2147\/CIA.S97481","article-title":"Oropharyngeal dysphagia in older persons\u2014From pathophysiology to adequate intervention: A review and summary of an international expert meeting","volume":"11","author":"Wirth","year":"2016","journal-title":"Clin. Interv. Aging"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1007\/s00455-013-9514-5","article-title":"Respiratory infections in acute stroke: Nasogastric tubes and immobility are stronger predictors than dysphagia","volume":"29","author":"Brogan","year":"2014","journal-title":"Dysphagia"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Wu, X.S., Miles, A., and Braakhuis, A.J. (2021). Texture-Modified Diets, Nutritional Status and Mealtime Satisfaction: A Systematic Review. Healthcare, 9.","DOI":"10.3390\/healthcare9060624"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1007\/s12603-011-0160-z","article-title":"Issues associated with the use of modified texture foods","volume":"16","author":"Keller","year":"2012","journal-title":"J. Nutr. Health Aging"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1614","DOI":"10.1016\/j.jada.2006.07.008","article-title":"A novel dysphagia diet improves the nutrient intake of institutionalized elders","volume":"106","author":"Germain","year":"2006","journal-title":"J. Am. Diet. Assoc."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"O\u2019Keeffe, S.T. (2018). Use of modified diets to prevent aspiration in oropharyngeal dysphagia: Is current practice justified?. BMC Geriatr., 18.","DOI":"10.1186\/s12877-018-0839-7"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1744","DOI":"10.1053\/apmr.2001.27379","article-title":"Quantifying fluid intake in dysphagic stroke patients: A preliminary comparison of oral and nonoral strategies","volume":"82","author":"Finestone","year":"2001","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Cho, J.M., Ha, S.W., and Son, M. (2024). Personalized diet order compliance is associated with an improved functional independence measure (FIM) score in elderly patients: An eight-week follow-up study in a convalescent hospital. PLoS ONE, 19.","DOI":"10.1371\/journal.pone.0314394"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"111091","DOI":"10.1016\/j.nut.2020.111091","article-title":"Frequent and personalized nutritional support leads to improved nutritional status, activities of daily living, and dysphagia after stroke","volume":"83","author":"Shimazu","year":"2021","journal-title":"Nutrition"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1016\/j.nutos.2025.03.006","article-title":"Association of changes in the texture level of consumed food with nutritional and functional outcomes among older patients undergoing rehabilitation","volume":"61","author":"Sawa","year":"2025","journal-title":"Clin. Nutr. Open Sci."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1093\/ageing\/afy169","article-title":"Sarcopenia: Revised European consensus on definition and diagnosis","volume":"48","author":"Bahat","year":"2019","journal-title":"Age Ageing"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1044\/1092-4388(2008\/013)","article-title":"A randomized study of three interventions for aspiration of thin liquids in patients with dementia or Parkinson\u2019s disease","volume":"51","author":"Logemann","year":"2008","journal-title":"J. Speech Lang. Hear. Res."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/S1474-4422(05)70252-0","article-title":"Behavioural intervention for dysphagia in acute stroke: A randomised controlled trial","volume":"5","author":"Carnaby","year":"2006","journal-title":"Lancet Neurol."},{"key":"ref_31","first-page":"CD000323","article-title":"Swallowing therapy for dysphagia in acute and subacute stroke","volume":"10","author":"Bath","year":"2018","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"764","DOI":"10.1016\/S0140-6736(05)17983-5","article-title":"The FOOD Trial Collaboration. Effect of timing and method of enteral tube feeding for dysphagic stroke patients (FOOD): A multicentre randomised controlled trial","volume":"365","author":"Dennis","year":"2005","journal-title":"Lancet"}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/19\/3114\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T10:47:10Z","timestamp":1790074030000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/19\/3114"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,22]]},"references-count":32,"journal-issue":{"issue":"19","published-online":{"date-parts":[[2026,10]]}},"alternative-id":["nu18193114"],"URL":"https:\/\/doi.org\/10.3390\/nu18193114","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,22]]}}}