A Comparison of Behavior of Transitional-State Foods Under Varying Oral Conditions

In Vivo Behavior of Transitional Foods as Compared to Purees: A Videofluoroscopic Analysis

PURPOSE

Medically tailored transitional foods (TFs) may be a clinically viable alternative to pureed consistency for individuals requiring texture-modified foods. However, little remains known about the performance of TFs during the swallow. The purpose of this investigation was to describe oropharyngeal swallowing physiology in patients with dysphagia during consumption of TFs as compared to pureed solids.

METHOD

Retrospective chart reviews were conducted on 31 long-term acute care hospital inpatients (23 males; Mage = 57.5 years), who all had a primary medical diagnosis of acute respiratory failure. All patients received a videofluoroscopic swallow study that included both pureed and transitional solid (Savorease Therapeutic Foods) trials. Swallow function was assessed and described following the Modified Barium Swallow Impairment Profile (MBSImP) interpretation approach.

RESULTS

No statistically significant differences in scores were observed between pureed and transitional solids for any of the MBSImP component scores. Similarly, no statistically significant differences were observed in overall oral or pharyngeal composite scores. Although a majority of the individual patients performed similarly on both consistencies across the components scores, there was some variability across a few scores, with a subset of patients performing better with transitional solids for oral and pharyngeal residue and a subset of patients performing better with pureed solids for bolus preparation and initiation of the pharyngeal swallow. No instances of airway invasion were present across any of the solids trialed.

CONCLUSIONS

The findings of this pilot study revealed that high-dissolving transitional solids did not increase apparent risk as compared to pureed textures, as there were no significant differences in swallowing safety and only some differences were observed in performance between the two textures. These findings may support the use of transitional solids as a "bridge" and safe consistency to facilitate progression to higher, more challenging textures in medically complex persons with dysphagia based on individual performance. This work represents an important initial step toward the integration of transitional solids into evaluation protocols, texture recommendations, and, potentially, into treatment.

Management of Children with Swallowing Problems: New Advances in Paediatric Thickeners

A satellite symposium on the evaluation and management of dysphagia in children was held during the 12th Annual Congress of the European Society for Swallowing Disorders (ESSD) in Leuven, Belgium, on 14th September 2022. Dysphagia is the impairment or difficulty in swallowing and may have an oropharyngeal or oesophageal cause. This can result in delayed transit of liquids or solid food from the mouth to the stomach. Food thickening agents can reduce regurgitation and improve swallowing mechanics, particularly in infants and young children. At this symposium, Karen van Hulst, Speech and Language Therapist and Clinical Epidemiologist at Radboud University Medical Center, Amalia’s Children’s Hospital, the Netherlands, introduced the topic of dysphagia and its complications, and the evaluation of dysphagia. She then discussed the use of thickening agents in children with dysphagia. Ben Hanson from the Department of Engineering, University College London, UK, introduced the International Dysphagia Diet Standardization Initiative (IDDSI). The IDDSI has developed a standardised and practical method of measuring the thickness of liquid and food that can be used when preparing foods at home or in the hospital, and may be applied commercially. Analou Sugar, Clinical Lead in Paediatric Speech and Language Therapy at Chelsea and Westminster Hospital Foundation Trust, London, UK, ended the symposium with a presentation of her recent clinical experience using a new thickener (ThickenUp® Junior, Nestlé Health Science, Vevey, Switzerland) in paediatric patients.

Instrumental and sensory techniques to characterize the texture of foods suitable for dysphagic people: A systematic review

The interest to characterize texture-modified foods (TMFs) intended for people with oropharyngeal dysphagia (OD) has grown significantly since 2011. Several instrumental and sensory techniques have been applied in the analysis of these foods. The objective of the present systematic review was to identify the most appropriate techniques, especially for the food industry and clinical setting. The search was carried out in three online databases according to the "Preferred Reporting Items for Systematic Reviews and Meta-Analyses" (PRISMA). Across the multiple trials reviewed, Texture Profile Analysis and the Uniaxial Compression Test were most used as the instrumental technique for solid foods, and the Back Extrusion Test for fluid and semisolid foods. All trials used descriptive analysis as the sensory technique. However, the experimental conditions of the trials lacked standardization. Consequently, the results of the trials were not comparable. To properly characterize the texture of TMFs intended for OD by each technique, an international consensus is needed to establish standardized experimental conditions. Methods based on these techniques should also be validated by collaborative studies to verify repeatability, replicability, and reproducibility.

Sensory-Enhanced, Fortified Snacks for Improved Nutritional Intake Among Nursing Home Residents

The present study aimed to determine if providing sensory-enhanced, fortified snacks changed nutrient consumption among nursing home residents. Nursing home residents were provided typical facility snacks or sensory-enhanced, fortified snacks across two separate 8-week time blocks. The enhanced snack supplements included quick-dissolving (transitional-state) crisps, puree dips, and dry soup blends that are intended to be accessible for individuals with a wide range of masticatory and swallowing abilities (e.g., oral frailty). Snacks were weighed before and after sessions using a food scale. Calories, fat, carbohydrates, protein, sodium, sugar, and fiber consumed were calculated daily. Despite consuming a smaller percentage of snack weight, participants consumed increased protein and fat, and fewer carbohydrates and sugar in the enhanced snack condition, with no significant difference in caloric intake. Sensory-enhanced, fortified snacks may be viable options for increasing the quality of nutritional intake among nursing home residents, particularly in light of decreased quantity of intake.

It's crunch time: Exploring the sensibility of food textural acoustics for individuals with dysphagia

BACKGROUND

Various fields of study have alluded to food textural, and its associated acoustic, properties (i.e. food textural acoustics). However, because of the challenging nature of the inclusion of acoustic properties in diet textural modifications in dysphagia (swallowing disorders), this construct has not been sufficiently considered in the field.

OBJECTIVE

To investigate the sensibility of food textural acoustics as a construct to understand eating for individuals with dysphagia.

METHOD

The study design was based on qualitative evidence synthesis methodologies. This involved revised scoping review methods (peer-reviewed published articles from 1980 to 2020 over seven databases), with an adapted consultation phase through online focus group discussions with six world experts. The data was analysed using frequency and thematic analysis, and ideology critique.

RESULTS

A total of 11 articles were included in the revised scoping review analysis (seven research studies and four review articles). The analysis of these articles revealed a lack of diversity in geography, discipline and perspective exploring the construct of food textural acoustics. A total of three themes with three associated core arguments emerged from the revised scoping review and the consultation phase. These arguments highlighted (1) the need to study food textural acoustics because of its salience and pleasure responses, (2) possible methodological dilemmas in studying food textural acoustics due to the complexity of eating, and (3) considerations with regard to the approach and positioning adopted when studying the construct.

CONCLUSION

Food textural acoustics may be a sensible construct to understand eating for individuals with dysphagia. As eating is a complex process, there is a need to challenge the methods we use when studying this construct of food textural acoustics. We hope that this article inspires researchers and practitioners to think differently by using textural, and its associated acoustic, properties as a way to reimagine dysphagia practice, especially for those from low- to middle-income contexts such as South Africa and Brazil.