Effect of direct feeding training with xanthan gum-based thickener modified food on the recovery of swallowing safety and efficacy in Chinese patients with post-stroke dysphagia: a randomized controlled study

Background: Increasing the bolus viscosity of food can protect patients with post-stroke dysphagia (PSD) from aspiration. However, conventional starch thickeners increase post-deglutition residue. The aim of this study was to assess the therapeutic effect of direct feeding training with xanthan gum-based thickener (Softia G, NUTRI Co., Ltd., Yokkaichi, Japan) modified food in Chinese PSD patients with a nasogastric tube.Methods: This randomized controlled study enrolled PSD patients with a gastric tube, who were equally divided into the experimental group (E-group) and the control group (C-group) according to a random number table. Both groups were given traditional training for dysphagia. The E-group cases received additional direct feeding training with Softia G-modified training food. The Functional Oral Intake Scale (FOIS) and modified volume-viscosity swallow test (M-VVST) for swallowing safety and efficacy according to adjusted Chinese dietary habits were administered before and after treatment for four weeks. The nasogastric tube removal rate was calculated in both groups post-training.Results: A total of 167 participants completed the study, 82 cases in the E-group and 85 in the C-group. After treatment, the FOIS score of the E-group (median = 5) was better than that of the C-group (median = 3) (p < 0.001). In the E-group, the incidence of coughing, voice changes, and oxygen desaturation of 3% or more was 7.32%, 4.88%, and 2.44%, significantly lower than in the C-group (37.65%, 16.47%, and 11.76%, p < 0.05). The incidence of pharyngeal residue and piecemeal deglutition were 0% and 2.44%, respectively, in the E-group; the differences between the groups were statistically significant (The C-group: 28.24% and 16.47%, p < 0.05). Moreover, the gastric tube removal rate was 100% in the E-group and 28.24% in the C-group (p < 0.001).Conclusion: Direct feeding training with xanthan gum-based thickener Softia G-modified food can effectively promote swallowing safety and efficacy in Chinese patients with PSD. M-VVST is more applicable to the Chinese population than conventional V-VST.Trial registration: Chinese Clinical Trail Registry ChiCTR2100043352, 11/02/2021, Retrospectively registered.