Implementasi Modifikasi Diet berbasis International Dysphagia Diet Standardisation Initiative (IDDSI) pada Terapi Gizi Pasien Stroke dengan Disfagia: Studi Kasus

Abstract

Stroke is an acute phase of focal neurological dysfunction that lasts for more than 24 hours. The main complication of acute stroke is dysphagia or swallowing disorders. The study aimed to explore the impact of implementing International Dysphagia Diet Standardization Initiative (IDDSI) framework-based diet modifications in nutrition therapy management of stroke patients with dysphagia. The case was a 50-year-old woman with a medical diagnosis of ischemic stroke with hemorrhagic transformation, hypertension, and type 2 Diabetes Mellitus (DM). The results of the nutritional assessment showed positive dysphagia screening, inadequate energy and nutrient intake, lactose intolerance, hypercholesterolemia and hyperglycemia. The nutritional diagnoses included; 1) (NI-1.2) inadequate energy intake related to decreased ability to consume sufficient energy indicated by energy intake based on 24-hour food recall obtained 53% of requirements and swallowing disorders, 2) (NI-5.8.2) excess carbohydrate intake related to non-compliance with diet indicated by estimated carbohydrate intake based on SQ-FFQ 262g (118% of needs), GDP/GD2pp: 172/183 mg/dl, HBa1c: 8.8%. Intervention on the first day was given enteral intake of 6x200 ml, the second day was given 3x250 and 3x150 ml of lactose-free DM formula via Nasogastric Tube (NGT) route followed by swallowing training using Dysphagia Kit. On the third day, the patient was given a DM diet orally with food textures adjusted to the patient's dysphagia condition, namely puree (Level 4), on the fourth day moist and mince (Level 5), on the fifth day soft and bite size (Level 6), and on the sixth day easy to chew (Level 7) which was combined with the Dietary Approaches to Stop Hypertension (DASH). The Implementation of IDDSI-based nutrition therapy successfully prevents aspiration risk, gradually meets adequate energy requirements according to dysphagia status, and supports the improvement of swallowing function through interprofessional collaboration.