Research Summary

Comparison of Thick, Thin Liquid Diet for Hospitalized Patients With Alzheimer Disease and Related Dementias, Dysphagia

Anthony Calabro, MA

In a large, retrospective cohort study comparing thick and thin liquid diets for patients with Alzheimer disease and related dementias (ADRD) and oropharyngeal dysphagia, researchers found mixed results—while patients receiving thick liquids were less likely to be intubated, they had an increased risk of respiratory complications compared with the thin liquid diet cohort. Additionally, there were no differences in mortality rates between the two groups.

“Although the use of thick liquids in patients with dysphagia has been shown to reduce aspiration on direct visualization, there is no clear evidence that this practice translates into improved clinical outcomes,” Makhnevich and colleagues wrote in their study.

Considering this, the researchers set out to determine any associations, specifically improved outcomes, between a diet of thick or thin liquids for hospitalized patients with ADRD and dysphagia.

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For their study, researchers included adults (65 years of age and older) with ADRD admitted across 11 hospitals in New York between January 1, 2017, and September 20, 2022. The study participants also had a clinical suspicion of dysphagia during hospitalization.

A total of 8916 patients with ADRD and dysphagia were included in the study (mean age, 85.7 years; 54.2% female). Patients were split evenly between thick and thin liquid diet groups (n = 4458 each). To be included in the group, at least 75% of their hospital diet had to consist of either thick or thin liquid. The primary outcome was mortality, with secondary outcomes including respiratory complications, intubation, and length of stay.

The results showed mixed results. For example, there were no notable difference in hospital mortality between the two groups (hazard ratio [HR] = 0.92 [95% CI, 0.75 to 1.14]; p = 0.46). And while patients receiving thick liquids were less likely to be intubated compared with the thin liquid group (odds ratio [OR] = 0.66; [95% CI, 0.54 to 0.80]), they were more likely to have respiratory complications (OR = 1.73; [95% CI, 1.56 to 1.91]).

This study had limitations, most notably that researchers could not confirm the presence or severity of dysphagia in the study participants, meaning that it is possible that patients in one group may have had more severe dysphagia than the other group. The researchers also noted a need for prospective studies on the subject.

“This cohort study emphasizes the need for prospective studies that evaluate whether thick liquids are associated with improved clinical outcomes in hospitalized patients with ADRD and dysphagia,” the researchers concluded.


Makhnevich A, Perrin A, Talukder D, et al. Thick liquids and clinical outcomes in hospitalized patients with Alzheimer disease and related dementias and dysphagia. JAMA Intern Med. Published online May 6, 2024. doi:10.1001/jamainternmed.2024.0736