ORIGINAL ARTICLE: EPIDEMIOLOGY, CLINICAL PRACTICE AND HEALTH Texture-modified diets are associated with decreased muscle mass in older adults admitted to a rehabilitation ward Akio Shimizu, 1,2 Keisuke Maeda, 3,4 Kei Tanaka, 5 Mei Ogawa 6 and Jun Kayashita 2 Departments of 1 Nutrition, 5 Internal Medicine, 6 Rehabilitation, Shigei Hospital, Kurashiki, 2 Department of Health Sciences, Faculty of Human Culture and Science, Prefectural University of Hiroshima, Hiroshima, 3 Department of Nutrition and Dysphagia Rehabilitation, Tamana Regional Health Medical Center, Tamana, and 4 Palliative Care Center, Aichi Medical University, Nagakute, Japan Aim: Texture-modified diets (TMD) have significantly lower energy and protein content than normal diets. There- fore, TMD can cause malnutrition and loss of muscle mass. However, few studies have reported the relationship between TMD and decreased skeletal muscle mass. The aim of the present study was to clarify the association between TMD and decreased skeletal muscle mass. Methods: We reviewed data of 188 older adult patients who were admitted to a rehabilitation hospital. TMD were defined based on the Japanese Dysphagia Diet Criteria 2013 proposed by the Japanese Society of Dysphagia Rehabil- itation. The Mini Nutritional Assessment-Short Form was used to assess nutritional status; dual-energy X-ray absorptiometry was used to measure the skeletal muscle mass index, and the cut-off values for decreased skeletal muscle mass index were based on the Asian Working Group for Sarcopenia; the Functional Independence Measure was used to evaluate activities of daily living. Results: The patients’ mean age was 80.6 Æ 7.5 years, and 62% were women. A total of 22 patients (11.7%) con- sumed TMD. A total of 104 patients (55.3%) had decreased skeletal muscle mass, and approximately 90% of them consumed TMD. Decreased skeletal muscle mass index (odds ratio 7.199, 95% confidence interval 1.489–34.805, P ≤ 0.01) and Functional Independence Measure scores (odds ratio 0.972, 95% confidence interval 0.952–0.992, P ≤ 0.01) were independently related to TMD in the multivariate analysis. Conclusions: The TMD group was associated with decreased skeletal muscle mass. Future, prospective studies are necessary to investigate causality. Geriatr Gerontol Int 2017; ••: ••–•• Keywords: decreased muscle mass, dysphagia, sarcopenia, sarcopenic dysphagia, texture-modified diet. Introduction Approximately 80% cases of pneumonia among older adults are reported to be related to aspiration. 1 Dyspha- gia is known to be associated with aspiration pneumo- nia, malnutrition and dehydration, and leads to reduced quality of life. 2 Numerous studies have reported that neurological disorders, such as stroke, neurodegenerative diseases, and head and neck cancer, can cause dysphagia. 3 Additionally, in recent years, a new concept, related to a decline in muscle mass and strength of the swallowing muscle, has been recognized as another dysphagia etiology, called sarcopenic dysphagia. 3–5 Several previous studies have shown the relationship between swallowing ability and loss of skel- etal muscle mass and muscle strength. 6–11 Further- more, rehabilitation, including dysphagia training and nutritional intervention, might be considered an effec- tive treatment for sarcopenic dysphagia. 12,13 In dysphagia rehabilitation patients, texture-modified diets (TMD) and thickened liquids are often used to facilitate and increase oral intake. 3,14 TMD are provided to long-term care patients at a rate of 15–30%. 15 How- ever, TMD consist of lower energy and protein com- pared with normal diets. 15–17 Chronic energy and protein intake deficiency can be considered a cause of malnutrition and loss of skeletal muscle mass; 18–20 therefore, TMD might be associated with poor nutri- tional status and loss of skeletal muscle mass. Although several studies have shown that TMD are related to mal- nutrition, there are no reports of the association between TMD and the loss of skeletal muscle mass. 15–17 The aim of the present study was to clarify the asso- ciation between TMD intake and decreased skeletal Accepted for publication 13 November 2017. Correspondence: Dr Keisuke Maeda MD PhD, Palliative Care Center, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan. Email: kskmaeda@aichi-med-u.ac.jp 1 doi: 10.1111/ggi.13233 | © 2017 Japan Geriatrics Society Geriatr Gerontol Int 2017