Texture-Modified Food for Dysphagic Patients: A Comprehensive Review

Clinical Practices and Opinions toward Gastrostomy Use in Patients with Atypical Parkinsonian Syndromes: A National Survey in the UK

BACKGROUND

Severe dysphagia poses a significant challenge for clinicians regarding feeding tube choices, practices, and timing due to a lack of evidence-based guidance.

OBJECTIVES

To assess national clinical practices and opinions on gastrostomy use in patients with atypical parkinsonian syndromes (APS) across the UK.

METHODS

Online survey was administered to clinicians and allied health professionals regarding availability of services, current use, perceived advantages, and problems associated with gastrostomy insertion.

RESULTS

We received responses from 47 respondents across 12 UK centers, including 44 clinicians specialized in APS. Consensus was observed regarding primary indications for gastrostomy insertion and circumstances justifying avoidance of the procedure. Limitations in recommending gastrostomy due to insufficient evidence on safety and outcomes, survival and quality of life were identified. Widespread agreement on delays in gastrostomy discussions was highlighted as a challenge in optimizing patient care, together with variability in current practices and concerns over the lack of a standardized gastrostomy pathway, emphasizing the need for further research to address existing evidence gaps.

CONCLUSION

This multi-center survey highlights agreement among clinicians on key aspects of indication, challenges, and limitations such as delayed decision-making and the absence of standardized pathways regarding the timing, method, and overall approach to gastrostomy insertion in APS. This study identified next steps to facilitate a more structured approach to future research toward a consensus on best practices for gastrostomy in APS. Addressing these challenges is crucial for enhancing patient outcomes and overall care quality in APS.

One-bite-sized 3D printed finger foods, oriented to malnutrition, sarcopenia and frailty prevention in the older people

BACKGROUND

In this study, innovative chocolate, citrus and mixture flavoured tofu-based nutritionally customised, dysphagia-oriented, comfortably consumed, appetising, one-bite-sized finger foods, oriented to malnutrition, sarcopenia and frailty prevention in older people were created by using 3D printing technology. Developed products were characterised by evaluating chemical composition and physical properties and performing sensory evaluation among geriatric clinic residents (≥60 years).

RESULTS

The dietary composition of the developed foods was: 19-21 g (100 g)-1 protein, 6-8 g (100 g)-1 fibre, 8-9 g (100 g)-1 fat, 11 mg (100 g)-1 iron, 14 mg (100 g)-1 zinc, 70 μg (100 g)-1 selenium. Foods were also enriched with branched-chain amino acids, such as leucine, isoleucine and valine. All formulated foods were classified as level 6 by International Dysphagia Diet Standardisation Initiative classification. Chocolate-flavoured food was much harder (4914 g) with lower adhesiveness value (-33.6 g s), compared to the citrus- or mixture-flavoured foods. Older people evaluated all finger foods as very easy handled by hand, soft, easy to swallow, having a moderate flavour intensity and a weak afterfeel. Despite the fact that the chocolate food was evaluated as having the highest hardness and gumminess values by the instrumental method, this difference was not noticeable to the evaluators. However 7% of the participants said that 3D printed foods were sticky to dentures.

CONCLUSION

The results suggest that it is possible to create nutrient-dense comfortably consumed 3D printed foods, oriented to malnutrition, sarcopenia and frailty prevention in older people. © 2024 Society of Chemical Industry.

Nutritional quality of dysphagia-oriented products sold on the Italian market

Introduction

Dysphagia is a condition characterized by swallowing difficulties that affects an estimated 8% of the population. Management of dysphagia often requires the use of specially formulated food products that are easier to swallow, while still meeting the nutritional needs of the patient. Despite the growing market for dysphagia-oriented products, there is a compelling need for comprehensive evaluations of their nutritional quality to ensure that they adequately support the health and well-being of this vulnerable population. The aims of this study were: (i) to investigate the nutritional composition of different dysphagia products currently sold in Italy, from several leading healthcare companies, by collecting the nutritional information on their packaging; (ii) to compare their energy, nutrient and salt content per 100 g and serving.

Methods

A total of 70 items, available in the Italian online market were included in the analysis.

Results

The data showed a wide difference among the six categories of dysphagia-oriented products. Salt content was found to be very high, with medium (>0.3 g/100 g but <1 g/100 g) and high (≥1 g/100 g) content found in 17 and 51% of products, respectively. Overall, the results show high variability in nutritional composition among dysphagia-oriented products currently on the market.

Discussion

The high presence of salt in more than half of the products raises a critical issue, as it is not in accordance with WHO guidelines and especially with the clinical situation of the dysphagia patient. This research seeks to provide valuable insights into the adequacy of these products in meeting the dietary requirements of individuals with dysphagia, thereby guiding toward more informed and suitable food choices.

Cowhide gelatin peptide as a source of antioxidants for inhibiting the deterioration of pudding quality during storage

To investigate the effect of gelatin peptide on the inhibition of quality deterioration in stored pudding, gelatin peptide with antioxidant properties was added to pudding products. For this purpose, a pudding recipe containing gelatin peptides was created. The gelatin peptides were characterized based on their antioxidant activity and protein structure. It was found that gelatin peptides had better antioxidant properties, lower thermal stability and crystallinity, higher hydrophobic amino acid content, and greater surface hydrogen bond exposure than commercially available peptides. Properties such as the pH, colony growth, and sensory characteristics of the pudding were characterized at 4 °C and 25 °C. The results showed that the addition of 0.5-1.0 % gelatin peptide to pudding was capable of significantly (P< 0.05) slowing down the decline in pH and sensory scores of the pudding and significantly inhibiting colony growth. It could prolong its storage life by five days at 4 °C and three days at 25 °C.

Pathways in formulating foods for the elderly

The growth of the elderly population worldwide is posing significant challenges to human society. The progressive physical and physiological changes occur with aging, including decreased appetite, incomplete digestion, and reduced absorption of nutrients. A common feature of many elderly people's diets is a deficiency in proteins (especially easily digestible ones) and micronutrients (e.g., vitamins, zinc, iron, and calcium). One of the solutions to this problem is the incorporation of these components into suitably texture-modified foods. There is a dearth of products that meet the needs of the elderly with special medical/health conditions such as dysphagia, osteoporosis, diabetes, and cardiovascular disease, as well as those who are in hospital and palliative care. Future research and development of foods for the elderly must address specific dietary needs of different subgroups of elderly people with underlying health conditions. The existence of different physical and physiological stages of the elderly means that their specific dietary requirements must be considered. This review summarizes current knowledge on nutritional requirements including those with underlying health problems and outlines the research and innovation pathways for developing new foods considering nutrition, texture, flavor, and other sensory aspects.

Nutritional Issues in Children with Dysphagia

(1) Background: Pediatric dysphagia presents significant nutritional challenges, often impacting growth and development due to reduced oral intake, increased nutritional needs, and gastrointestinal complications; (2) Methods: This prospective quasi-experimental study assessed 117 children under 14 years old (20 patients were under 1 year old, 80 were aged 1-7 years, and 17 were older than 7 years), diagnosed with swallowing disorders, to analyze their caloric, macro-, and micronutrient intake and identify potential deficiencies. The severity of dysphagia was established using functional oral intake scales, and dietary records were reviewed over a 3-day period; (3) Results: The study revealed that 39.8% of participants did not meet their total energy expenditure (TEE), highlighting a high prevalence of malnutrition among these children. Furthermore, patients using feeding devices exhibited a significantly lower caloric intake, and over half required significantly modified food textures. After individualized speech therapy and nutritional rehabilitation, participants showed significant improvements in caloric intake, with their energy coverage increasing from 958% to 1198% of the daily requirement. Rehabilitation also improved tolerance to a broader range of food textures; (4) Conclusions: This research underscores the importance of multidisciplinary, individualized nutritional strategies to address the specific challenges of pediatric dysphagia, emphasizing the role of enteral nutrition and therapeutic interventions in improving the quality of life and nutritional outcomes of these children. Further studies are recommended to assess the long-term impact of such strategies.

Food Processing and Nutrition Strategies for Improving the Health of Elderly People with Dysphagia: A Review of Recent Developments

Dysphagia, or swallowing difficulty, is a common morbidity affecting 10% to 33% of the elderly population. Individuals with dysphagia can experience appetite, reduction, weight loss, and malnutrition as well as even aspiration, dehydration, and long-term healthcare issues. However, current therapies to treat dysphagia can routinely cause discomfort and pain to patients. To prevent these risks, a non-traumatic and effective treatment of diet modification for safe chewing and swallowing is urgently needed for the elderly. This review mainly summarizes the chewing and swallowing changes in the elderly, as well as important risk factors and potential consequences of dysphagia. In addition, three texture-modified food processing strategies to prepare special foods for the aged, as well as the current statuses and future trends of such foods, are discussed. Nonthermal food technologies, gelation, and 3D printing techniques have been developed to prepare soft, moist, and palatable texture-modified foods for chewing and swallowing safety in elderly individuals. In addition, flavor enhancement and nutrition enrichment are also considered to compensate for the loss of sensory experience and nutrients. Given the trend of population aging, multidisciplinary cooperation for dysphagia management should be a top priority.

Investigation of 3D printing of toddler foods with special shape and function based on fenugreek gum and flaxseed protein

The practicability of using corn and flaxseed protein as printing inks for manufacture of printed products specifically designed for toddlers as a dysphagia diet with high precision and special shapes with addition of fenugreek gum (FGG) was investigated. 3D printing was used to process grains and dysphagia-compatible food (corn) into a dietary product with attractive appearance which was also easy to swallow. Rheological measurements shown that appropriate amount of flaxseed protein (FP, 0-10 %) can reduce the stickiness and yield strength of printing material. Based on FTIR measurements, FP weakened the hydrogen bond strength of inks, but it was still an important gradient for the formation of the ink suitable for precision 3D printing. The TPA results shown that the addition of FP (0-10 %) remarkably reduced both the stickiness and hardness of the ink. These results shown that compared with the control group, materials with FGG additions possessed higher printing accuracy and self-supporting ability. Ink with 5 % FP content exhibited the best printability and swallowability, while ink with 10 % FP content had the lowest viscosity and hardness, but it was not suitable for 3D printing. 3D printing of objects printed using Ink-C (5%FP and 0.8 %FGG) showed high support characteristic and attractive appearance. According to the international IDDSI testing standards, Ink-C (5%FP and 0.8 %FGG), Ink-E (15%FP and 0.8 %FGG), and Ink-F (20%FP and 0.8 %FGG) were defined as level 5-minced and moist foods.

Correlating instrumental measurements and sensory perceptions of foods with different textural properties for people with impaired oral and swallowing capabilities - A review

The rising global life expectancy has underlined the necessity of designing novel and tasty food products, suitable for seniors and people with impaired oral and swallowing functions. For developing these products, texture should be optimised from rheological, colloidal, tribological, and masticatory points of view. The current review provides an overview of different studies based on shear rheological, tribological, and in vitro mastication properties of model or real food systems intended for the elderly and/or people with swallowing dysfunctions, with special emphasis on the relation between the instrumental measurements and sensory perceptions of foods. Several works demonstrated that instrumental data from shear rheological and tribological tests complement the sensory evaluations of foods, providing useful information when designing food commodities for specific populations. Conversely, only few works correlated the instrumental data obtained from artificial mouths and/or simulated masticators with the sensory attributes generated by trained assessors. Broaden knowledge of these topics will help in formulating and adapting foods with enhanced functionalities for people with impaired oral and swallowing capabilities. Shear rheology, soft oral tribology, and simulated mastication tests are crucial in designing safe- and easy-swallowing food products.

Evaluation of preventive care for swallowing difficulty through policy changes in Japanese long-term care insurance: analysis of a nationwide claims dataset for long-term care insurance

BACKGROUND

Swallowing/feeding difficulty is a serious hidden health problem in the older population. Although oral intake services based on the degree of this difficulty have been provided and revised in Japanese public long-term care (LTC) insurance since 2006, their implementation has not been examined. We evaluated the impact of policy changes on these services.

METHODS

The nationwide database of LTC service uses in Japan was analysed for three oral intake services: Enhanced Oral Function in daycare facilities whose users were slightly disabled, Maintenance of Oral Ingestion and Transition to Oral Ingestion from tube feeding in residential facilities. Data were extracted for each June from 2015 to 2020 when monthly usage of these services was aligned and each June from 2009 to 2020 for the proportion of users according to LTC insurance certification. The major policy changes were the addition of municipal provision in Enhanced Oral Function and a requirement for multidisciplinary collaboration in Maintenance of Oral Ingestion in 2015. The impact of the medical fee reduction for developing percutaneous gastro-tubing to Transition to Oral Ingestion was also examined.

RESULTS

Between 2015 and 2020, the use of Enhanced Oral Function and Maintenance of Oral Ingestion increased and Transition to Oral Ingestion decreased, resulting in a total increase in use of 275,000 times or approximately 5,000 times per 100,000 among all older adults with LTC insurance certification. Concerning the proportion of users' disability status, the major users of Enhanced Oral Function in 2020 were slightly disabled and independent older adults (70%, up from 55% to 2009). Regarding the major users of Maintenance of Oral Ingestion between 2013 and 2020, care-need level 5 (most severe) decreased by 11%, whereas the total of care-need levels 4 and 3 increased by 9%. The use of Transition to Oral Ingestion, which had been declining, showed a further decline after reduction of the medical fee for percutaneous gastro-tubing in 2014.

CONCLUSIONS

Due to policy changes, Enhanced Oral Function and Maintenance of Oral Ingestion have increased in the number of use among slightly disabled persons. However, this increase may be insufficient given the hidden swallowing/feeding difficulty.

Comparison between the use of hydrocolloids (xanthan gum) and high-pressure processing to obtain a texture-modified puree for dysphagia

Enriched lentil protein vegetable purees (10% zucchini, 10% carrots, 2.5% extra virgin olive oil and 21.8% lentil protein concentrate) suitable for people with dysphagia were developed with 0.8% xanthan gum (XG) or 600 MPa/5 min high pressure processing (HPP) treatment with the aim of comparing their rheological and textural properties. Selection of the appropriate XG % and HPP conditions was made by performing initial pilot trials. Purees showed a good nutritional profile (12% protein, 3.4% fiber, 100 Kcal/100 g), being adequate for people with dysphagia. Microbiological testing of HPP treated purees indicated that it has a good shelf-life under refrigerated conditions 14 days). Both types of purees showed a gel-like character (tan delta 0.161-0.222) and higher firmness, consistency and cohesiveness than control samples. Comparing XG and HPP samples at time 0, HPP treated purees showed the highest stiffness ( G'), the lowest deformability capacity (yield strain_LVR) and the lowest structural stability (yield stress_LVR). With storage, HPP treatment samples showed significant increases in all rheological and textural parameters. These results confirm the suitability of HPP as an alternative technology to hydrocolloids for the obtained dysphagia dishes.

Food biopolymer behaviors in the digestive tract: implications for nutrient delivery

Biopolymers are prevalent in both natural and processed foods, serving as thickeners, emulsifiers, and stabilizers. Although specific biopolymers are known to affect digestion, the mechanisms behind their influence on the nutrient absorption and bioavailability in processed foods are not yet fully understood. The aim of this review is to elucidate the complex interplay between biopolymers and their behavior in vivo, and to provide insights into the possible physiological consequences of their consumption. The colloidization process of biopolymer in various phases of digestion was analyzed and its impact on nutrition absorption and gastrointestinal tract was summarized. Furthermore, the review discusses the methodologies used to assess colloidization and emphasizes the need for more realistic models to overcome challenges in practical applications. By controlling macronutrient bioavailability using biopolymers, it is possible to enhance health benefits, such as improving gut health, aiding in weight management, and regulating blood sugar levels. The physiological effect of extracted biopolymers utilized in modern food structuring technology cannot be predicted solely based on their inherent functionality. It is essential to account for factors such as their initial consuming state and interactions with other food components to better understand the potential health benefits of biopolymers.

The Provision of Texture-Modified Foods in Long-term Care Facilities by Health Professionals: Protocol for a Scoping Review

BACKGROUND

Malnutrition among older adults with dysphagia is common. Texture-modified foods (TMFs) are an essential part of dysphagia management. In long-term care (LTC) facilities, health professionals have implemented TMFs, but their application has not been fully elucidated, making them heterogeneous.

OBJECTIVE

We aim to explore the implementation of TMFs in LTC facilities, particularly focusing on the role of health professionals in nutritional care involving TMFs (eg, deciding the type of food, preparing and giving the food, and evaluating the outcomes).

METHODS

A scoping review using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodological approach will be performed. A comprehensive search for published literature will be systematically performed in PubMed, CINAHL, MEDLINE, ProQuest, PsycINFO, and Science Citation Index (Web of Science). Data screening and extraction will be performed by 2 reviewers independently. The studies included will be synthesized, summarized, and reported, following the preferred reporting items of the Mixed Methods Appraisal Tool. Our review will consider the following study designs: mixed methods, quantitative, and qualitative. Studies with patients who are not older adults will be excluded.

RESULTS

Data extraction will be completed by February 2023. Data presentation and analyses will be completed by April 2023, and the final outcomes will be completed by June 2023. The study findings will be published in a peer-reviewed journal.

CONCLUSIONS

Our scoping review will consider studies related to TMF interventions for older adults in LTC residential facilities, with no exclusion restrictions based on country, gender, or comorbidities. Studies on interventions that address TMF-related issues, such as deciding the type of food, preparing and giving the food, and evaluating the outcomes, are qualified for inclusion.

TRIAL REGISTRATION

OSF Registries 79AFZ; https://osf.io/79afz.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/44201.

Does oral intake of thin fluids increase aspiration pneumonia for dysphagia after head and neck cancer surgery? A retrospective study for a total of 654 cases

OBJECTIVE

Head and neck cancer (HNC) treatment causes dysphagia, which may lead to aspiration pneumonia (AP). Thickened fluids are widely used to prevent aspiration in patients with dysphagia; however, there is little evidence that they can prevent AP. This study aimed to clarify the differences between restriction of oral intake of fluids (R), only thickened fluids (TF), and no restriction of fluids (NR) for AP in patients with dysphagia after HNC treatment.

METHODS

We retrospectively studied 654 patients with dysphagia after HNC surgery between 2012 and 2021. Of these, 255 had some restriction of fluids. The development of possible AP and administration of antibacterial drugs were used as outcomes. Multivariate linear regression and propensity score matching analyses were performed.

RESULTS

The mean patient age was 64 ± 13, 67 ± 11, and 68 ± 10 years, while the Dynamic Imaging Grade of Swallowing Toxicity score 3-4 was 2.8%, 27.5, and 53.3%% water in NR, TF, and R groups, respectively. AP was diagnosed or suspected after starting oral intake in 37 (9.3%), 11 patients (15.9%), and 45 (17.6%) and antibacterial drugs were administered in 11 (2.8%), 7 patients (10.1%), and 25 (9.8%) in NR, TF, and R groups, respectively. R and TF had significant negative impacts on AP.

CONCLUSIONS

Fluid restrictions may not reduce the risk of AP or affect the administration of antibacterial drugs. Medical staff should bear in mind that fluid restrictions do not necessarily prevent AP in patients with HNC.

Enrichment of 3D-Printed k-Carrageenan Food Gel with Callus Tissue of Narrow-Leaved Lupin Lupinus angustifolius

The aim of the study is to develop and evaluate the printability of k-carrageenan inks enriched with callus tissue of lupin (L. angustifolius) and to determine the effect of two lupin calluses (LA14 and LA16) on the texture and digestibility of 3D-printed gel. The results demonstrated that the enriched ink was successfully 3D printed at concentrations of 33 and 50 g/100 mL of LA14 callus and 33 g/100 mL of LA16 callus. The feasibility of 3D printing is extremely reduced at higher concentrations of callus material in the ink. The hardness, cohesiveness, and gumminess of the 3D-printed gel with LA16 callus were weakened compared to the gel with LA14 callus. The results of rheological measurements showed that an increase in the content of LA16 callus interfered with the formation of a k-carrageenan gel network, while LA14 callus strengthened the k-carrageenan gel with increasing concentration. Gel samples at different concentrations of LA14 and LA16 calluses formed a spongy network structure, but the number of pores decreased, and their size increased, when the volume fraction occupied by LA14 and LA16 calluses increased. Simple polysaccharides, galacturonic acid residues, and phenolic compounds (PCs) were released from A-FP gels after sequential in vivo oral and in vitro gastrointestinal digestion. PCs were released predominantly in the simulated intestinal and colonic fluids. Thus, incorporating lupin callus into the hydrocolloid ink for food 3D printing can be a promising approach to developing a gelling material with new mechanical, rheological, and functional properties.

Characteristics and Therapeutic Needs of Older Patients with Oropharyngeal Dysphagia Admitted to a General Hospital

BACKGROUND

Oropharyngeal dysphagia (OD) is a prevalent geriatric syndrome causing severe nutritional and respiratory complications.

OBJECTIVE

We aimed to describe the characteristics and therapeutic needs of older patients with OD admitted to a general hospital.

DESIGN, PARTICIPANTS AND MEASUREMENTS

Prospective cohort study with patients (≥70 years) with OD consecutively admitted to a general hospital. OD was clinically assessed with the Volume-Viscosity Swallowing Test and nutritional status with the Mini Nutritional Assessment-short form. Oral health (OH) and periodontal diseases were evaluated by dentists. Functionality, frailty, sarcopenia, comorbidities, dehydration, quality of life (QoL) and mortality were also assessed.

RESULTS

We included 235 patients (87.3±5.5 years) with OD hospitalized for acute diseases (9.6±7.6 days). On admission, they had low functionality (Barthel: 51.3±25.1), frailty (Fried: 3.9±0.9; Edmonton: 10.3±2.7, 87.2-91.1% frail) and high comorbidities (Charlson: 3.7±2.0). Moreover, 85.1% presented signs of impaired safety and 84.7% efficacy of swallow. Up to 48% required fluid adaptation with a xanthan gum-based thickener (89.4% at 250 mPa·s; 10.6% at 800 mPa·s) and 93.2% a texture-modified diet (TMD) (74.4%, fork-mashable; 25.6%, pureed). A total of 98.7% had nutritional risk, 32.3% sarcopenia and 75.3% dehydration. OH was moderate (Oral Hygiene Index-simplified: 2.0±1.3) and 67.4% had periodontitis. QoL self-perception was 62.2% and 5.5% of patients died during hospitalization.

CONCLUSION

Hospitalized older OD patients have impaired safety of swallow, frailty, malnutrition, dehydration, low functional capacity and poor OH and high risk of respiratory infections. They need a multimodal intervention including fluid thickening, TMD, thickened oral nutritional supplementation and OH care to improve health status and reduce OD-associated complications.

Progress in Extrusion-Based Food Printing Technology for Enhanced Printability and Printing Efficiency of Typical Personalized Foods: A Review

Three-dimensional printing technology enables the personalization and on-demand production of edible products of individual specifications. Four-dimensional printing technology expands the application scope of 3D printing technology, which controllably changes the quality attributes of 3D printing products over time. The concept of 5D/6D printing technology is also gradually developing in the food field. However, the functional value of food printing technology remains largely unrealized on a commercial scale due to limitations of printability and printing efficiency. This review focuses on recent developments in breaking through these barriers. The key factors and improvement methods ranging from ink properties and printer design required for successful printing of personalized foods (including easy-to-swallow foods, specially shaped foods, and foods with controlled release of functional ingredients) are identified and discussed. Novel evaluation methods for printability and printing precision are outlined. Furthermore, the design of printing equipment to increase printing efficiency is discussed along with some suggestions for cost-effective commercial printing.

Patients with dysphagia: How to supply nutrition through non-tube feeding

OBJECTIVE

Dysphagia has become one of the important factors that cause malnutrition in the whole age group. At present, tube feeding is still the mainstream means to solve the problem of dysphagia. However, tube feeding has physical and mental harm to people, and the ways of non-tube feeding are relatively diversified. The significance of the thickening mechanism described in some articles to solve the problem of dysphagia is not clear.

SETTING AND PARTICIPANTS

All patients with dysphagia worldwide, including oropharyngeal dysphagia (OD) and non-oropharyngeal dysphagia.

METHODS

We searched the literature in Pubmed, Web of Science and Cochrane Library and initially browsed the titles and abstracts. We reviewed the full text of the articles that met our topic, and the language of the article was limited to English.

RESULTS

We found that food thickening to a certain degree (350-1,750 cP) can reduce the complications of choking, aspiration, reflux, and other complications in patients with dysphagia, and reduce the social disorder, anxiety, and other psychological problems caused by catheterization and surgery. Significantly, food science engineers should invite clinicians to intervene in the development of specialty foods from different perspectives such as clinical pathophysiology and fluid mechanics.

CONCLUSION AND IMPLICATIONS

It is necessary to develop special foods for patients with dysphagia, which requires scientists from different disciplines to work together.

Enrichment of Agar Gel with Antioxidant Pectin from Fireweed: Mechanical and Rheological Properties, Simulated Digestibility, and Oral Processing

The aims of the study were to evaluate the influence of pectin isolated from fireweed (FP) on the mechanical and rheological properties of agar (A) gel, to investigate the release of phenolic compounds (PCs) and pectin from A-FP gels at simulated digestion in vitro, and to evaluate the oral processing and sensory properties of A-FP gels. The hardness of A-FP gels decreased gradually with the increase in the concentration of FP added (0.1, 0.4, and 1.6%). The hardness of A-FP1.6 gel was 41% lower than A gel. Rheological tests found A gel was a strong physical gel (storage modulus (G′) >>loss modulus (G″)), and the addition of FP up to 1.6% did not significantly change its G’. The G″ value decreased in A-FP gels compared to A gel. The release of galacturonic acid (GalA) was 3.4 ± 0.5, 0.5 ± 0.2, 2.4 ± 1.0, and 2.2 ± 0.7 mg/mL after digestion of A-FP1.6 gel in the oral in vivo phase (OP) and subsequent incubation in simulated gastric (SGF), intestinal (SIF), and colonic (SCF) fluids in vitro. The incubation medium after OP, SGF, and SIF digestion of A-FP1.6 contained 24−64 μg GAE/mL of PCs, while SCF contained 144 μg GAE/mL, supposing a predominant release of antioxidant activity from the gel in the colon. Chewing to readiness for swallowing A-FP gel required less time and fewer chews with less activity of the masseter and temporalis muscles. A-FP1.6 gel had a lower likeness score for taste and consistency and a similar score for appearance and aroma when compared with A gel. Thus, A-FP gels were weakened compared to A gel and required less time and muscle activity for oral processing. A-FP gel had antioxidant activity due to the PCs associated with pectin, while A gel had no antioxidant activity.

Dietary Habits, Food Product Selection Attributes, Nutritional Status, and Depression in Middle-Aged and Older Adults with Dysphagia

Dysphagia, which increases the risk of malnutrition and depression, is an important health concern. A total of 304 people aged 50 years or above (148 subjects with dysphagia and 156 non-dysphagia subjects) were recruited for this survey of dietary habits, meal product selection attributes, nutritional status, and depression. For group comparisons, chi-square tests were performed. Exploratory factor analysis was conducted for the meal product selection attributes. Correlation analyses were performed to investigate links between EAT-10 (The 10-item Eating Assessment Tool), nutrition (Nutrition Quotient/Nutrition Quotient for the Elderly, NQ/NQ-E) and depression (The Short-Form Geriatric Depression Scale for Koreans, SGDS-K). Logistic regression analysis was performed to investigate links between EAT-10, nutritional status, and depressive status. Finally, a correlation analysis and logistic regression analysis of nutritional status, depression status, and some dietary factors were performed, targeting only the responses of the dysphagia patients. The average ages were 73.79 years in the dysphagia group and 70.15 years in the non-dysphagia group, and the total average age was 71.88 years. The overall age range was 50 to 92 years. Dysphagia (EAT-10) had significant effects on malnutrition (β = 0.037, OR = 1.095) and depression (β = 0.090, OR = 1.095) (p < 0.001). There was a significant correlation between SGDS-K, needing help with meals, and the amount of food consumed at mealtimes (p < 0.01). The correlation coefficient between SGDS-K and the need for help with meals was 0.474. Dietary factors that affected depression in dysphagia patients were the increase in the need for meal assistance (β = 1.241, OR = 3.460, p < 0.001) and the amount of food eaten at mealtimes (β = −0.494, OR = 0.702, p < 0.05). Dysphagia can increase the risk of depression and malnutrition. To reduce depression in dysphagia patients, it is necessary to develop meal products that address dietary discomfort among patients with dysphagia.

Relationship between Dysphagia and Home Discharge among Older Patients Receiving Hospital Rehabilitation in Rural Japan: A Retrospective Cohort Study

Dysphagia refers to swallowing difficulty, which impacts patients' quality of life. Dysphagia influences clinical outcomes, including mortality rates and length of hospital stay of older hospitalized patients. Dysphagia may affect the current and future quality of life of these patients. However, its exact impact remains unclear. We aimed to clarify the impact of dysphagia on discharge to home in older patients in a rural rehabilitation unit. We conducted a secondary analysis using data from a retrospective cohort study including patients aged over 65 years who had been discharged from a community hospital rehabilitation unit in rural Japan. Data from the participants had been previously collected from April 2016 to March 2020. The primary outcome was home discharge. The average participant age was 82.1 (standard deviation, 10.8) years; 34.5% were men. Among medical conditions, brain stroke (44.3%) was the most frequent reason for admission; the most frequent orthopedic condition was femoral fracture (42.9%). The presence of dysphagia (odds ratio [OR] = 0.38, 95% confidence interval [CI]: 0.20-0.73), polypharmacy (OR = 0.5, 95% CI: 0.32-0.90), and admission for internal medicine diseases (OR = 0.44, 95% CI: 0.26-0.77) were negatively associated with home discharge. High motor domain scores of the Functional Independence Measure were positively associated with home discharge (OR = 1.07, 95% CI: 1.05-1.08). Dysphagia was negatively associated with home discharge as were polypharmacy and admission for internal medicine diseases and conditions. By clarifying effective interventions through interventional studies, including approaches to managing multimorbidity and polypharmacy through interprofessional collaboration, the health conditions of older patients in rural areas may be improved.

Allied Health Professionals' Views on the Use of 3D Food Printing to Improve the Mealtime Quality of Life for People With Dysphagia: Impact, Cost, Practicality, and Potential

PURPOSE

Much is promised in relation to the use of three-dimensional (3D) food printing to create visually appealing texture-modified foods for people with dysphagia, but little is known of its feasibility. This study aimed to explore the perspective of allied health professionals on the feasibility of using 3D food printing to improve quality of life for people with dysphagia.

METHOD

Fifteen allied health professionals engaged in one of four 2-hr online focus groups to discuss 3D food printing for people with dysphagia. They discussed the need to address the visual appeal of texture-modified foods and watched a video of 3D food printing to inform their discussions on its feasibility. Focus group data were transcribed verbatim, de-identified, and analyzed using thematic content analysis. Participants verified summaries of the researchers' interpretation of the themes in the data.

RESULTS

Participants suggested that 3D food printing could improve the mealtime experience for people with dysphagia but noted several barriers to its feasibility, including the time and effort involved in printing the food and in cleaning the printer. They were not convinced that 3D-printed food held higher visual appeal or looked enough like the "real food" it represented.

CONCLUSIONS

Allied health professionals considered that 3D food printing could benefit people with dysphagia by reducing the negative impacts of poorly presented texture-modified foods. However, they also considered that feasibility barriers could impede uptake and use of 3D food printers. Further research should consider the views of people with dysphagia and address barriers reported in this study.

The Effectiveness of International Dysphagia Diet Standardization Initiative-Tailored Interventions on Staff Knowledge and Texture-Modified Diet Compliance in Aged Care Facilities: A Pre-Post Study

Background

The International Dysphagia Diet Standardization Initiative (IDDSI) has created global standardized definitions for texture-modified diets (TMDs) and thickened liquids to improve the safety and care for individuals with swallowing difficulties. The IDDSI framework guides health care facilities, such as aged care, to provide food to at-risk patients.

Objectives

This study aims to design, deliver, and evaluate a tailored intervention to facilitate IDDSI implementation in aged care.

Methods

Five aged care facilities received tailored interventions, which were guided by the Expert Recommendation for Implementing Change process and used the corresponding barriers identified in the previous study: 1) tailored material, delivery, and planning; 2) opinion leaders and professional input; 3) strategies to attract and involve staff; and 4) reflections and evaluations. Meal compliance against IDDSI standards and staff knowledge acquisition were the primary outcomes evaluating the impact of the intervention. Written consent was obtained from facility managers. Staff trainings were delivered by a dietitian, accompanied with electronic and printed materials. An audit was conducted on all items listed on the TMD daily menu (lunch, dinner, and midmeals). TMD IDDSI audits and staff self-administered surveys were conducted before and 6 mo after the intervention.

Results

Audits of 68 and 79 TMD meals/items were conducted pre- and postintervention, respectively. Significant improvement in meal compliance was found in all 3 levels of TMDs, including soft and bite-sized (50%; P = 0.0001), minced and moist (44%; P = 0.0024), and puréed (42%; P = 0.0024). The overall IDDSI compliance increased by 46% postintervention (P < 0.0001). Staff achieved higher scores in both dysphagia and IDDSI knowledge sections (P < 0.0001).

Conclusions

Tailored interventions facilitated IDDSI implementation in aged care evidenced by increased TMD compliance and staff knowledge, which remained at 6 mo postintervention.

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