It has been suggested that restricting diets in long term care (LTC) reduces older adults’ food intake and may lead to iatrogenic malnutrition.

To examine if nutritional status, and energy and protein intake of residents is associated with prescription of a modified texture food or therapeutic diet.

The Making the Most of Mealtimes (M3) prevalence study examined determinants of food intake of 639 residents in 32 diverse LTC homes in 4 Canadian provinces (Alberta, Manitoba, Ontario, New Brunswick). Food and beverage intake was collected for a three-day period using weighed and estimated food records for meals and snacks. Malnutrition risk was determined using the Mini-Nutritional Assessment–SF (MNA-SF) and the Patient-Generated-Subjective Global Assessment (PG-SGA). Information on therapeutic diets and modified texture foods were also collected from health records.

The proportion of residents on modified texture foods using the International Dysphagia Diet Standardisation Initiative (IDDSI) categories was: Regular (53%); Soft (14.3%); Minced/Moist (21.8%); Pureed (10.9%). Less than a quarter (22.8%, 137/630; 9 residents removed as < 6 meals recorded) were prescribed a therapeutic diet: Diabetic (80.3%); High Protein (37.2%); High Energy (35.0%); and No Added Salt (17.5%). Energy intake for those on a Minced/Moist diet (1486.5±329.3kcal) was significantly lower as compared to regular texture (1567.1±269.8; p<0.05). Those on texture modified diets were more likely to be malnourished or at risk of malnutrition (p<0.05). No significant differences were found between nutritional status and energy/protein intake of residents on any therapeutic diets as compared to those not on a therapeutic diet, although individual diet differences were seen in anticipated directions.

Modified texture foods are more likely to lead to poor food intake and malnutrition than therapeutic diets. Therapeutic diets do not seem to negatively influence food intake or nutritional status.