# Effect of a Large-Scale Production and Quality-Controlled Program for Texture-Modified Diets on Older Hospitalized Patients with Oropharyngeal Dysphagia

## TL;DR

A hospital program improved texture-modified diets for older patients with swallowing issues, increasing meals served and reducing texture variability.

## Contribution

Demonstrates successful large-scale implementation of texture-modified diets with quality control and AI in a real clinical setting.

## Key findings

- TMD meal services increased by 51.60% after program implementation.
- Texture variability in thick purees was significantly reduced.
- Meal intake consumption remained stable at around 70%.

## Abstract

Background/Objectives: Several studies described how diets should be adapted to meet textural, nutritional and organoleptic needs of older people with oropharyngeal dysphagia. However, few studies have evaluated the implementation of texture-modified diets (TMD) in a real clinical context. In 2024, a TMD program was introduced in a 400-bed hospital. The aim of this study was to describe the impact in production, texture standardization and acceptance of this program. Methods: This is an observational study that compares the TMD data of 2023 versus 2024. In this period, AI techniques and clinical staff training were implemented to increase TMD prescriptions. A quantitative weekly quality control was carried out to standardize the rheological and textural properties of the TMD. Qualitative questionnaires were used to evaluate acceptance and palatability in both years. Results: The number of TMD meal services served increased in 51.60% (9766 in 2023, 14,806 in 2024). Viscosity range variability in thick purees (IDDSI Level 4, target shear viscosity of 1500 ± 20% mPa·s) was reduced from 600–4800 mPa·s in 2023 (58.74% variability) to 1000–2400 mPa·s in 2024 (27.91% variability). Fork-mashable TMD (IDDSI Level 6) presented limitations in standardization, due to the lack of quantitative reference values for textural parameters. The meal intake consumption remained around 70% in both years. Conclusions: The large-scale hospital TMD production program was associated with an increased number of patients with dysphagia receiving TMD, reduced texture variability, and high levels of palatability and patient acceptability. These process-level improvements are expected to support swallowing safety, although clinical outcomes were not directly assessed.