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Sukkar SG, Lorenzoni G, Carraro A, Angioletti F, Gregori D. Comparing Homogenized Instantaneous Meals and Traditional Pureed Foods in Patients Affected by Dysphagia: A Pilot Study. J Clin Med 2024; 13:3160. [PMID: 38892873 PMCID: PMC11173214 DOI: 10.3390/jcm13113160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 05/03/2024] [Accepted: 05/10/2024] [Indexed: 06/21/2024] Open
Abstract
Background: Institutionalized individuals with dysphagia are particularly at risk for malnutrition. This study investigated two texture-modified models for patients with dysphagia, as follows: (i) traditional homemade pureed food (PF) and (ii) homogenized meals obtained from dehydrated and rehydrated instantaneous preparations (IPs). Methods: A retrospective pilot study was performed. It included patients affected by medium-severity dysphagia admitted to the nursing home "Sacra Famiglia" Institute of Cocquio Trevisago, Varese. The patients were aged 41-81 years old and all had complex disabilities. They underwent anthropometric and biochemical parameter assessments at baseline, as well as at two months and four months follow-up. Results: The study involved 30 patients, 15 received the IP meal. The comparison between the baseline and the follow-up did not show significant anthropometric and biochemical parameter differences. Conversely, the IP group reported significantly higher levels of consumption and satisfaction, evaluated using a modified Chernoff scale based on three levels of smiles, than the PF group. Conclusions: The present findings provide promising indications to improve the diet of patients affected by dysphagia, since meal satisfaction is a relevant factor that has been shown to be associated with better patient mood, motivation to eat, and adherence to prescribed diet.
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Affiliation(s)
- Samir Giuseppe Sukkar
- Dietetics and Clinical Nutrition Unit, Ospedale Policlinico “San Martino” IRCCS, 16132 Genova, Italy; (S.G.S.); (A.C.)
| | - Giulia Lorenzoni
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35131 Padova, Italy;
| | - Alice Carraro
- Dietetics and Clinical Nutrition Unit, Ospedale Policlinico “San Martino” IRCCS, 16132 Genova, Italy; (S.G.S.); (A.C.)
| | | | - Dario Gregori
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35131 Padova, Italy;
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Takahashi N, Kikutani T, Ebihara K, Genkai S, Takahashi I, Kodama M, Machida R, Tohara T, Tamura F. Factors associated with the maintenance in food texture for dependent older people with dysphagia living in nursing home - A retrospective cohort study. SPECIAL CARE IN DENTISTRY 2024; 44:886-892. [PMID: 37919247 DOI: 10.1111/scd.12937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 09/19/2023] [Accepted: 10/18/2023] [Indexed: 11/04/2023]
Abstract
OBJECTIVES Maintaining the texture of the food that nursing home residents eat is critical for maintaining quality of life and preventing malnutrition. The aim of the present study was to identify the conditions necessary for maintaining food texture for this population. MATERIALS AND METHODS The study included 143 people for whom reevaluation 1-year post-baseline was possible from among 256 dependent older people who consumed solid food on admission to a nursing home (baseline). The age, sex, primary disease, activities of daily living, nutritional status, oral status, swallowing ability, primitive reflexes, and food texture of the participants were determined. The participants who ate pureed or jelly after 1 year were identified and evaluated to determine factors related to maintenance of a solid diet. RESULTS A total of 21 participants (14.7%) changed to a pureed or jelly diet after 1 year. Multivariate analysis showed good activities of daily living (p < .05), good swallowing ability (p < .05), and maintained nutritional status (p < .05) to be correlated with solid food maintenance. CONCLUSIONS Maintaining activities of daily living, feeding and swallowing ability, and nutritional status appear to be important factors for the maintenance of a solid diet.
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Affiliation(s)
- Noriaki Takahashi
- Division of Rehabilitation for Speech and Swallowing Disorders, The Nippon Dental University, Tama Oral Rehabilitation Clinic, Chiyoda-ku, Tokyo, Japan
- Division of Rehabilitation for Speech and Swallowing Disorders, The Nippon Dental University School of Life Dentistry, Chiyoda-ku, Tokyo, Japan
| | - Takeshi Kikutani
- Division of Rehabilitation for Speech and Swallowing Disorders, The Nippon Dental University, Tama Oral Rehabilitation Clinic, Chiyoda-ku, Tokyo, Japan
- Division of Rehabilitation for Speech and Swallowing Disorders, The Nippon Dental University School of Life Dentistry, Chiyoda-ku, Tokyo, Japan
| | - Katsuko Ebihara
- Division of Rehabilitation for Speech and Swallowing Disorders, The Nippon Dental University School of Life Dentistry, Chiyoda-ku, Tokyo, Japan
| | - Sae Genkai
- Division of Rehabilitation for Speech and Swallowing Disorders, The Nippon Dental University School of Life Dentistry, Chiyoda-ku, Tokyo, Japan
| | - Ikumi Takahashi
- Division of Rehabilitation for Speech and Swallowing Disorders, The Nippon Dental University School of Life Dentistry, Chiyoda-ku, Tokyo, Japan
| | - Miho Kodama
- Division of Rehabilitation for Speech and Swallowing Disorders, The Nippon Dental University School of Life Dentistry, Chiyoda-ku, Tokyo, Japan
| | - Reiko Machida
- Division of Rehabilitation for Speech and Swallowing Disorders, The Nippon Dental University School of Life Dentistry, Chiyoda-ku, Tokyo, Japan
| | - Takashi Tohara
- Division of Rehabilitation for Speech and Swallowing Disorders, The Nippon Dental University, Tama Oral Rehabilitation Clinic, Chiyoda-ku, Tokyo, Japan
- Division of Rehabilitation for Speech and Swallowing Disorders, The Nippon Dental University School of Life Dentistry, Chiyoda-ku, Tokyo, Japan
| | - Fumiyo Tamura
- Division of Rehabilitation for Speech and Swallowing Disorders, The Nippon Dental University, Tama Oral Rehabilitation Clinic, Chiyoda-ku, Tokyo, Japan
- Division of Rehabilitation for Speech and Swallowing Disorders, The Nippon Dental University School of Life Dentistry, Chiyoda-ku, Tokyo, Japan
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Okon M, Chan KY, O’Keeffe ST. "In Limbo"-use of, and alterations to, modified diets by nursing home staff in the absence of timely specialist support. FRONTIERS IN REHABILITATION SCIENCES 2024; 5:1276713. [PMID: 38434233 PMCID: PMC10904530 DOI: 10.3389/fresc.2024.1276713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 02/07/2024] [Indexed: 03/05/2024]
Abstract
Background Dysphagia is common in nursing home (NH) residents. Staff may not always be able to access speech and language therapist (SLT) assessments in a timely manner and there are some reports of nurses initiating or changing modified diets in these circumstances. Methods A mixed quantitative and qualitative approach was used to analyse responses to an online anonymized survey of senior nurses working in Irish NHs. They were asked about their experience of delays accessing SLT services and whether they would ever initiate or change modified diets. Respondents were asked if they would give water to a thirsty resident, prescribed mildly thick liquids, who demanded it on a hot day because thickened fluid was not thirst quenching. Results Of 77 nurses surveyed, 63 (82%) responded. Three quarters reported delays accessing SLT services sometimes or often. Thirty-four (54.0%) would not give the thirsty resident water. About 70% reported that thickened fluids or modified texture diets were started without SLT sometimes or often. A third of respondents would thicken fluids or modify food to a greater extent than previously recommended but very few would make a diet less restrictive. The main themes that emerged from the comments provided were related to the uncertainty and dilemmas created for staff, what mitigating actions they might take in those circumstances and the need for better guidance and better access to SLT services. Discussion Delays accessing SLT services are common for Irish NHs, and staff may initiate or change modified diets themselves in these circumstances. The responses suggest a widespread, and unjustified, belief that thicker or more modified is better for those with dysphagia. Clear and accurate guidance, and a better SLT service, is needed for NH staff.
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Affiliation(s)
| | | | - Shaun T. O’Keeffe
- Department of Geriatric Medicine, Galway University Hospital, Galway, Ireland
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4
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Gallegos C, Turcanu M, Assegehegn G, Brito-de la Fuente E. Rheological Issues on Oropharyngeal Dysphagia. Dysphagia 2023; 38:558-585. [PMID: 34216239 DOI: 10.1007/s00455-021-10337-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 06/23/2021] [Indexed: 10/20/2022]
Abstract
There is an increasing proof of the relevance of rheology on the design of fluids for the diagnosis and management of dysphagia. In this sense, different authors have reported clinical evidence that support the conclusion that an increase in bolus viscosity reduces the risks of airway penetration during swallowing. However, this clinical evidence has not been associated yet to the definition of objective viscosity levels that may help to predict a safe swallowing process. In addition, more recent reports highlight the potential contribution of bolus extensional viscosity, as elongational flows also develops during the swallowing process. Based on this background, the aim of this review paper is to introduce the lecturer (experts in Dysphagia) into the relevance of Rheology for the diagnosis and management of oropharyngeal dysphagia (OD). In this sense, this paper starts with the definition of some basic concepts on Rheology, complemented by a more extended vision on the concepts of shear viscosity and elongational viscosity. This is followed by a short overview of shear and elongational rheometrical techniques relevant for the characterization of dysphagia-oriented fluids, and, finally, an in-depth analysis of the current knowledge concerning the role of shear and elongational viscosities in the diagnosis and management of OD (shear and elongational behaviors of different categories of dysphagia-oriented products and contrast fluids for dysphagia assessment, as well as the relevance of saliva influence on bolus rheological behavior during the swallowing process).
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Affiliation(s)
- Crispulo Gallegos
- Product and Process Engineering Center, Fresenius Kabi Deutschland GmbH, Daimlerstrasse 22, 61352, Bad Homburg, Germany.
| | - Mihaela Turcanu
- Product and Process Engineering Center, Fresenius Kabi Deutschland GmbH, Daimlerstrasse 22, 61352, Bad Homburg, Germany
| | - Getachew Assegehegn
- Product and Process Engineering Center, Fresenius Kabi Deutschland GmbH, Daimlerstrasse 22, 61352, Bad Homburg, Germany
| | - Edmundo Brito-de la Fuente
- Product and Process Engineering Center, Fresenius Kabi Deutschland GmbH, Daimlerstrasse 22, 61352, Bad Homburg, Germany
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O’Keeffe ST, Leslie P, Lazenby-Paterson T, McCurtin A, Collins L, Murray A, Smith A, Mulkerrin S. Informed or misinformed consent and use of modified texture diets in dysphagia. BMC Med Ethics 2023; 24:7. [PMID: 36750907 PMCID: PMC9903443 DOI: 10.1186/s12910-023-00885-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 01/25/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Use of modified texture diets-thickening of liquids and modifying the texture of foods-in the hope of preventing aspiration, pneumonia and choking, has become central to the current management of dysphagia. The effectiveness of this intervention has been questioned. We examine requirements for a valid informed consent process for this approach and whether the need for informed consent for this treatment is always understood or applied by practitioners. MAIN TEXT Valid informed consent requires provision of accurate and balanced information, and that agreement is given freely by someone who knows they have a choice. Current evidence, including surveys of practitioners and patients in different settings, suggests that practice in this area is often inadequate. This may be due to patients' communication difficulties but also poor communication-and no real attempt to obtain consent-by practitioners before people are 'put on' modified texture diets. Even where discussion occurs, recommendations may be influenced by professional misconceptions about the efficacy of this treatment, which in turn may poison the well for the informed consent process. Patients cannot make appropriate decisions for themselves if the information provided is flawed and unbalanced. The voluntariness of patients' decisions is also questionable if they are told 'you must', when 'you might consider' is more appropriate. Where the decision-making capacity of patients is in question, inappropriate judgements and recommendations may be made by substitute decision makers and courts unless based on accurate information. CONCLUSION Research is required to examine the informed consent processes in different settings, but there is ample reason to suggest that current practice in this area is suboptimal. Staff need to reflect on their current practice regarding use of modified texture diets with an awareness of the current evidence and through the 'lens' of informed consent. Education is required for staff to clarify the importance of, and requirements for, valid informed consent and for decision making that reflects people's preferences and values.
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Affiliation(s)
- Shaun T. O’Keeffe
- grid.412440.70000 0004 0617 9371Department of Geriatric Medicine, Galway University Hospitals, Newcastle Rd, Galway, Ireland
| | - Paula Leslie
- grid.420004.20000 0004 0444 2244Northern Medical Physics and Clinical Engineering, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK
| | - Tracy Lazenby-Paterson
- grid.39489.3f0000 0001 0388 0742NHS Lothian Community Learning Disability Service, Leith Community Treatment Centre, Edinburgh, UK
| | - Arlene McCurtin
- grid.10049.3c0000 0004 1936 9692School of Allied Health, University of Limerick, Limerick, Ireland ,grid.10049.3c0000 0004 1936 9692Health Implementation Science and Technology Research Group, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Lindsey Collins
- grid.6268.a0000 0004 0379 5283Centre for Applied Dementia StudiesFaculty of Health Studies, University of Bradford, Bradford, UK
| | - Aoife Murray
- grid.6142.10000 0004 0488 0789School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Alison Smith
- Pharmacy and Medicines Optimisation Team, Herts Valleys Clinical Commissioning Group, Hemel Hempstead, UK
| | - Siofra Mulkerrin
- grid.120073.70000 0004 0622 5016Department of Speech and Language Therapy, Addenbrooke’s Hospital, Cambridge, England, UK
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Nagshabandi BS, Zinnershine L, Shune SE. A Review of Factors Contributing to Adults' Adherence to Dysphagia Dietary Recommendations Through an Ecological Lens. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:341-357. [PMID: 36450148 DOI: 10.1044/2022_ajslp-21-00351] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
PURPOSE The purpose of this review was to identify the factors affecting adherence to dysphagia dietary recommendations, a necessary contributor to the effectiveness of this compensatory strategy. METHOD A rapid review of two electronic databases was conducted in April 2021. Studies were included based on the following criteria: (a) were empirical studies published in English, (b) included data from the adult population, and (c) measured adherence to dietary recommendations. The ecological model and the health belief model were used as frameworks during the analysis process. RESULTS The literature search resulted in 930 unique abstracts, of which 14 articles were included based on the final criteria. Across the literature, multiple factors were identified as having an influence on adherence, classified according to three unique levels: the individual (e.g., dissatisfaction), the caregiver (e.g., knowledge), and the environment (e.g., institutional policies and values). CONCLUSIONS Improving adherence to dysphagia dietary recommendations is crucial for the effectiveness of those recommendations. As suggested by the current review, increased adherence will require careful attention to the multiple levels of factors that likely play a role, acknowledging the multifaceted nature of this complex behavior. Furthermore, characterizing the multilevel factors that influence adherence can contribute to future theoretical models, which could help guide speech-language pathologists in their clinical practices.
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Affiliation(s)
| | - Lauren Zinnershine
- Communication Disorders and Sciences Program, University of Oregon, Eugene
| | - Samantha E Shune
- Communication Disorders and Sciences Program, University of Oregon, Eugene
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Wu XS, Miles A, Braakhuis A. Effects of hydrolysed meat on dietary intake and nutritional status in aged care residents requiring pureed diets: a crossover randomised controlled trial. BMC Geriatr 2022; 22:905. [PMID: 36434542 PMCID: PMC9700874 DOI: 10.1186/s12877-022-03622-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 11/14/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND As a result of the high prevalence of dysphagia in aged care facilities, demand for pureed diets is increasing. One of the biggest challenges for pureed diets is the reduced nutritional density due to the cooking process, such as when blending or softening with liquid. This study aimed to investigate the impact of innovative energy and protein-enriched meat puree on the nutrition intake and nutritional status of aged care residents requiring pureed diets. METHODS This is a single-blinded randomised controlled trial conducted in two aged care facilities using a crossover design. Twenty-two residents aged 83.2 ± 7.3 years participated in a 12-week study. Participants were blocked randomised into two groups and received a 6-week of either control (unaltered freshly made pureed diets by facilities) or intervention diet, followed by a 2-week washout and then 6-week of alternative treatment. During the intervention, freshly made meat pureed portions were swapped to hydrolysed meat, which contained 144 -392 kcal and 5.6-6.8 g more energy and protein per 100 g. Nutrition intake was collected using a validated visual estimation method over 24 h on two non-consecutive days during the control and intervention phases. A two-tailed t-test was used to compare the significance. RESULTS The intervention diet significantly increased energy (147 ± 285 kcal, p = .02), protein (4 ± 7 g, p = .04), and fat (3 ± 8 g, p = .07) intake in comparison to the control diet. Nutritional status was improved by the end of the intervention as evidenced by a higher nutritional assessment score using Mini-Nutritional Assessment - Short Form (9.1 ± 1.8) and a weight gain of 1.3 ± 1.7 g, p = .04. No significant differences were found in body composition using bioelectrical impedance analysis, calf circumference and mid-upper arm circumference. Though handgrip strength did not differ at the end of control and intervention, significance was found between the changes in control and intervention period. Plasma branched-chain amino acid increased significantly with hydrolysed meat consumption. CONCLUSIONS As a dietary enrichment, hydrolysed meat is a promising intervention for pureed diet consumers in aged care facilities, improving residents' dietary intake and reducing malnutrition risk. Future larger multicentre studies with longer intervention periods are required to confirm the effectiveness and residents' acceptance. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ACTRN12622000888763).
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Affiliation(s)
- Xiaojing Sharon Wu
- grid.9654.e0000 0004 0372 3343Department of Nutrition, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Rd, Grafton, Auckland, 1142 New Zealand
| | - Anna Miles
- grid.9654.e0000 0004 0372 3343Department of Speech Science, School of Psychology, University of Auckland, Auckland, New Zealand
| | - Andrea Braakhuis
- grid.9654.e0000 0004 0372 3343Department of Nutrition, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Rd, Grafton, Auckland, 1142 New Zealand
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Sella‐Weiss O. What could go wrong? Non-standardized versus standardized food texture classification. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2022; 57:1244-1254. [PMID: 36398686 PMCID: PMC9796710 DOI: 10.1111/1460-6984.12749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 05/13/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Texture-modified foods (TMF) is a common intervention for improving swallowing safety and efficiency for people with dysphagia. Non-standardized texture classification (NSTC) of foods is used worldwide. However, as this study documents, it can introduce a lack of clarity and confusion over definitions that can potentially harm patients' safety. The International Dysphagia Diet Standardisation Initiative (IDDSI) framework offers international terminology and standardized methods for texture testing that can address this issue AIMS: To document differences between NSTC and standardized texture classification (STC) of the IDDSI, to document changes in the STC in the 30 min following meal delivery, and to explore the relationship between food intake and texture level. METHODS & PROCEDURES In this observational study, data were collected from 24 long-term care departments during five meals served to 624 residents, including at least one breakfast, lunch and dinner. To document differences between NSTC and STC, all NSTC food textures used in the LTC facilities were reclassified to match the IDDSI texture level at the time food left the kitchen (n = 1276). To document time-related changes in texture, the STC texture as food left the kitchen was compared with texture 30 min later (n = 1276). Finally, to explore the relationship between texture and consumption, estimates were made of single-item food consumption (n = 3820) using a subjective evaluation of consumption percentage OUTCOMES & RESULTS: A total of 1276 food items were classified over the course of five meal services (with at least one each from breakfast, lunch and dinner). Statistically significant differences in NSTC and STC texture levels were found that revealed that residents were consuming food that was more difficult to eat than intended by the TMF prescription. In addition, significant changes in food texture were found over time, with texture levels significantly increasing 30 min after food left the kitchen. Finally, greater consumption was found for softer textures in comparison with regular foods; moreover, food consumption was greatest during breakfast and lowest during lunch. CONCLUSIONS & IMPLICATIONS Residents requiring TMF received harder textures than intended which required complex swallowing ability, thus introducing a choking risk. Using the STC as proposed by the IDDSI could improve patient safety, oral intake and nutritional status. Time-related changes should also be considered in circumstances where patients do not consume food soon after service. Lastly, reduced food consumption during lunch might negatively impact overall nutrient intake, particularly in cultures where lunch is the main meal of the day. WHAT THIS PAPER ADDS What is already known on the subject Despite widespread agreement on the importance of STC, institutional care providers widely use NSTC. The IDDSI framework offers international terminology and standardized methods for texture testing. The clinical importance of using STC is not well understood. What this paper adds to existing knowledge This study found that residents who required texture-modified foods were eating food textures that were more challenging to swallow than intended. Differences were found in food texture between when it left the kitchen compared with texture 30 min later. Pureed texture had greater consumption than regular textured food. Food consumption was found to be the highest during breakfast, and reduced during lunch, which might negatively impact overall nutrient intake. What are the potential or actual clinical implications of this work? Accurate food texture prescription is the first step towards increasing patients' safety. However, food preparation and handling are also very important steps, not to be disregarded. Time-related changes in food texture are remarkable and should be considered in circumstances where patients do not consume food soon after service, as these can compromise patients' safety.
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Affiliation(s)
- Oshrat Sella‐Weiss
- Department of Communication Sciences and DisordersUniversity of HaifaHaifaIsrael
- Department of Communication DisordersOno Academic CollageKiryat OnoIsrael
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Okamoto K, Tanaka S, Suzuki Y, Shigematsu T, Kunieda K, Hojo K, Shimizu A, Ohno T, Fujishima I. Food appearance affects reward-related brain activity in healthy adults: a functional magnetic resonance imaging study. Int J Food Sci Nutr 2022; 73:1116-1123. [DOI: 10.1080/09637486.2022.2137784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Affiliation(s)
- Keishi Okamoto
- Department of Rehabilitation, Hamamatsu City Rehabilitation Hospital, Shizuoka, Japan
| | - Satoshi Tanaka
- Department of Psychology, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Yasutaka Suzuki
- Department of Radiological Technology, Seirei Mikatahara General Hospital, Shizuoka, Japan
| | - Takashi Shigematsu
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, Shizuoka, Japan
| | - Kenjiro Kunieda
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, Shizuoka, Japan
- Department of Neurology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Kyoko Hojo
- Department of Rehabilitation, Hamamatsu City Rehabilitation Hospital, Shizuoka, Japan
| | - Akio Shimizu
- Department of Nutrition, Hamamatsu City Rehabilitation Hospital, Shizuoka, Japan
| | - Tomohisa Ohno
- Department of Dentistry, Hamamatsu City Rehabilitation Hospital, Shizuoka,Japan
| | - Ichiro Fujishima
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, Shizuoka, Japan
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10
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Pematilleke N, Kaur M, Adhikari B, Torley PJ. Meat texture modification for dysphagia management and application of hydrocolloids: A review. Crit Rev Food Sci Nutr 2022; 64:1764-1779. [PMID: 36066499 DOI: 10.1080/10408398.2022.2119202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Dysphagia is a medical condition that describes the difficulty of swallowing food, and texture modified food (TMF) is the best intervention for dysphagia. The relevant guidelines to identify dysphagia food are provided by the International Dysphagia Diet Standardization Initiative (IDDSI). Developing texture modified meat is a challenging task due to its fibrous microstructure and harder texture. Various meat tenderization attempts are therefore evaluated in the literature. Meat texture modification for dysphagia is not just limited to tenderization but should be focused on safe swallowing attributes as well. The application of hydrocolloids for designing TMF has a major research focus as it is a cost-effective method and offers an opportunity for careful control. The present review focuses on the meat texture modification attempts that have been used in the past and present, with special attention to the use of hydrocolloids. Several studies have shown improvements in texture upon the addition of various hydrocolloids; however, few studies have attempted to develop texture modified meat for people with dysphagia. This area has to be further developed along with the sensory evaluations conducted with the dysphagia population, to validate the industrial application of hydrocolloids to TMF.
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Affiliation(s)
- Nelum Pematilleke
- Discipline of Biosciences and Food Technology, School of Science, RMIT University, Melbourne, Australia
| | - Mandeep Kaur
- Discipline of Biosciences and Food Technology, School of Science, RMIT University, Melbourne, Australia
| | - Benu Adhikari
- Discipline of Biosciences and Food Technology, School of Science, RMIT University, Melbourne, Australia
| | - Peter J Torley
- Discipline of Biosciences and Food Technology, School of Science, RMIT University, Melbourne, Australia
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Taira K, Watanabe Y, Okada K, Kondo M, Takeda M, Ito K, Nakajima J, Iwasaki M, Itoda M, Inohara K, Sasaki R, Nishi Y, Furuya J, Watanabe Y, Umemoto G, Kishima M, Tohara T, Sato Y, Yoshida M, Yamazaki Y. Association between denture use and food form in older adults requiring long-term care: A multicenter cross-sectional study. J Prosthodont Res 2022. [PMID: 35989265 DOI: 10.2186/jpr.jpr_d_21_00161] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
PURPOSE This study aimed to determine whether denture use contributes to maintaining and improving food forms in long-term care facility (LTCFs) residents. METHODS In 888 residents of 37 LTCFs in Japan, the following were investigated: nutritional intake status, food forms, age, sex, Barthel index (BI), clinical dementia rating (CDR), number of teeth present, number of occlusal supports, swallowing function, and use of dentures. Among all residents, those who were well-nourished and had ≤9 occlusal supports were analyzed. Based on standardized criteria, the food forms consumed by the subjects were divided into two groups: dysphagia and normal diet, which were further classified into four levels. Analysis was performed using a generalized estimation equation with the four levels of food forms as dependent variables and age, sex, BI, CDR, presence of dysphagia, number of teeth present, and use of dentures as independent variables. RESULTS The final analysis included 622 (70.0%) residents. Of these, 380 (61.1%) used dentures. The analyses revealed that food form was significantly associated with age (adjusted odds ratio [OR], 0.98), BI (OR, 1.04), number of teeth present (OR, 1.03), presence of dysphagia (OR, 0.44), and use of dentures (OR, 2.82). CONCLUSION Denture use was associated with food forms among Japanese LTCF residents. This indicates that the use of dentures is related to the maintenance of food forms, even in the elderly who participate in few activities of daily living, have reduced cognitive function, and require long-term care.
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Affiliation(s)
- Kenshu Taira
- Gerodontology, Department of Oral Health Science, Faculty of Dental Medicine, Hokkaido University, Hokkaido, Japan
| | - Yutaka Watanabe
- Gerodontology, Department of Oral Health Science, Faculty of Dental Medicine, Hokkaido University, Hokkaido, Japan
| | - Kazutaka Okada
- Gerodontology, Department of Oral Health Science, Faculty of Dental Medicine, Hokkaido University, Hokkaido, Japan
| | - Miyako Kondo
- Gerodontology, Department of Oral Health Science, Faculty of Dental Medicine, Hokkaido University, Hokkaido, Japan
| | - Maaya Takeda
- Gerodontology, Department of Oral Health Science, Faculty of Dental Medicine, Hokkaido University, Hokkaido, Japan
| | - Kayoko Ito
- Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Junko Nakajima
- Department of Oral Medicine and Hospital Dentistry, Tokyo Dental College, Chiba, Japan
| | | | - Masataka Itoda
- Department of Oral Rehabilitation Osaka Dental University Hospital, Osaka, Japan
| | - Ken Inohara
- Inohara Dental and Rehabilitation Clinic, Hiroshima, Japan.,Ota Memorial Hospital, Hiroshima, Japan
| | - Rikimaru Sasaki
- Rehabilitation Clinic for Speech and Swallowing Disorders, The Nippon Dental University Hospital, Tokyo, Japan
| | - Yasuhiro Nishi
- Department of Oral and Maxillofacial Prosthodontics, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Junichi Furuya
- Department of Geriatric Dentistry, Showa University School of Dentistry, Tokyo, Japan
| | | | - George Umemoto
- Swallowing Disorders Center, Fukuoka University Hospital, Fukuoka, Japan
| | | | - Takashi Tohara
- The Nippon Dental University Tama Oral Rehabilitation Clinic, Tokyo, Japan
| | - Yuji Sato
- Department of Geriatric Dentistry, Showa University School of Dentistry, Tokyo, Japan
| | - Mitsuyohi Yoshida
- Department of Dentistry & Oral-Maxillofacial Surgery Fujita Health University, Aichi, Japan
| | - Yutaka Yamazaki
- Gerodontology, Department of Oral Health Science, Faculty of Dental Medicine, Hokkaido University, Hokkaido, Japan
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Is an Early Resumption of a Regular Diet After Laparoscopic Roux-en-Y Gastric Bypass Safe? Obes Surg 2022; 32:3375-3383. [PMID: 35913602 PMCID: PMC9532321 DOI: 10.1007/s11695-022-06224-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 07/18/2022] [Accepted: 07/24/2022] [Indexed: 11/19/2022]
Abstract
Background
Return to a normal diet is a crucial step after bariatric surgery. Proximal anastomosis is a source of concern for early feeding as the passage of solid food through a recent anastomosis could well increase pressure and the risk of leakage. This study aims to assess the safety of an early normal diet after a laparoscopic Roux-en-Y gastric bypass (LRYGB). Materials and Methods All consecutive patients undergoing primary LRYGB between January 2015 and December 2020 were included prospectively. Three postoperative pureed diets were compared at 4 weeks, 2 weeks, and 1 week. All-cause morbidity at 90 days was the main outcome. Overall complications, severe complications (Clavien-Dindo ≥ grade 3a), length of hospital stay, number of emergency, and unplanned consultations during the 3 postoperative months were recorded for each group. Results Three hundred and sixty-seven patients with a mean BMI of 42.10 kg/m2 (± SD: 4.78) were included. All-cause morbidity at 90 days was 11.7% (43/367) and no significant difference was observed between the 3 groups. Adjustment for patients and operative cofounders did not demonstrate any increased risk of postoperative complications between the 3 groups, with an odds ratio of 1, 1.23(95% CI [0. 55–2.75]), and 1.14 (95% CI [0.49, 2.67]) for groups 1, 2, and 3 respectively. Severe complications (Clavien-Dindo ≥ grade 3a) and emergency or unplanned consultations were also similar in the 3 groups. Conclusion Return to a normal diet 1 week after LRYGB did not increase short-term morbidity and unplanned consultations. It may be safe and contribute to patient comfort. Graphical abstract ![]()
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Wu XS, Miles A, Braakhuis A. Attitudes towards Freshly Made and Readily Prepared Texture-Modified Foods among Speech-Language Therapists, Dietitians, and Community-Dwelling Older Adults. Foods 2022; 11:foods11142157. [PMID: 35885400 PMCID: PMC9317743 DOI: 10.3390/foods11142157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 07/15/2022] [Accepted: 07/19/2022] [Indexed: 02/04/2023] Open
Abstract
Texture-modified foods (TMFs) are recommended for patients suffering from swallowing difficulties. Given the increasing aging population, the use of TMFs is on the rise. Research to date has focused on the nutritional value, malnutrition indices and healthcare practices in relation to TMFs, but the perception of these diets from a patient and healthcare practitioner perspective has received less consideration. This study explored how currently available TMFs (including Soft & Bite-Sized, Minced & Moist, and puree) are perceived by key stakeholders. Four types of TMFs were consumer tested: freshly made TMFs following foodservice recipes and three types of readily prepared TMFs (commercially packaged, sous-vide and hydrolysed). The selected samples were tested through five focus groups (including nine dietitians, seven speech-language therapists, and five community-dwelling older adults), which involved a sensory rating using a validated 7-point scale meal assessment tool and a semi-structured focus group discussion. Analysis was conducted using quantitative and qualitative approaches. Soft & Bite-Sized meals had significantly higher palatability ratings than others. Sous-vide meals were most suitable for Soft & Bite-Sized texture, while commercially packaged samples were most appropriate for minced moist and pureed meals. Three main themes emerged through content analysis: (1) palatability of TMFs, (2) perceived challenges with the currently available TMFs and (3) key differences in opinion between stakeholders. Freshly made TMFs were more appealing and tastier, whereas readily prepared (pre-cooked, packaged and require reheating) TMFs had a more consistent texture. The texture of all TMFs requires enhancement, particularly in pureed meals. Developing nutritious and safe TMFs for people with dysphagia requires the promotion of active insight exchange between dietitians and speech-language therapists.
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Affiliation(s)
- Xiaojing Sharon Wu
- Department of Nutrition, Faculty of Medical and Health Sciences, University of Auckland, Auckland 1023, New Zealand;
- Correspondence: ; Tel.: +64-210-859-9592
| | - Anna Miles
- Department of Speech Science, School of Psychology, University of Auckland, Auckland 1023, New Zealand;
| | - Andrea Braakhuis
- Department of Nutrition, Faculty of Medical and Health Sciences, University of Auckland, Auckland 1023, New Zealand;
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Smith R, Bryant L, Hemsley B. 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. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:1868-1877. [PMID: 35613623 DOI: 10.1044/2022_ajslp-21-00391] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
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.
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Affiliation(s)
- Rebecca Smith
- Graduate School of Health, University of Technology Sydney, New South Wales, Australia
| | - Lucy Bryant
- Graduate School of Health, University of Technology Sydney, New South Wales, Australia
| | - Bronwyn Hemsley
- Graduate School of Health, University of Technology Sydney, New South Wales, Australia
- Faculty of Arts and Education, The University of Newcastle, Callaghan, New South Wales, Australia
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Exploring Meal Provision and Mealtime Challenges for Aged Care Residents Consuming Texture-Modified Diets: A Mixed Methods Study. Geriatrics (Basel) 2022; 7:geriatrics7030067. [PMID: 35735772 PMCID: PMC9222299 DOI: 10.3390/geriatrics7030067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 06/07/2022] [Accepted: 06/14/2022] [Indexed: 11/17/2022] Open
Abstract
Dysphagia has become more prevalent with age. Thus, the demand for texture-modified diets (TMDs) has increased. While the nutritional perspectives have been studied, the provision of TMDs and mealtime practice has received less attention. This study aimed to explore the TMD provision and mealtime challenges of residents requiring TMDs in aged care facilities. The study was conducted across five aged care facilities using a mixed methods design involving 14 TMD menu audits by a foodservice dietitian, 15 mealtime observations, and semi-structured interviews with residents and staff (n = 18). TMD menus failed to meet all nutrition requirements and foodservice and clinical standards based on the dietitian NZ foodservice and nutrition audit tool. A content analysis offered three main themes: (1) Foodservice production. Inconsistent quality and meal portions were observed. The variety, choice, and portion size of TMDs required improvement based on the residents’ preferences; (2) Serving procedures. There was a lack of standardisation of meal distribution and feeding assistance; and (3) Dining environment. The dining room set-up varied across facilities, and residents expressed different preferences towards the dining environment. There is a need to improve staff awareness of mealtime consistency and optimise feeding assistance. The dining environment should be individualised to accommodate residents’ psychosocial needs. Standardised policies and continuous training can facilitate quality mealtime implementation.
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Advances in 3D printing of food and nutritional products. ADVANCES IN FOOD AND NUTRITION RESEARCH 2022; 100:173-210. [PMID: 35659352 DOI: 10.1016/bs.afnr.2021.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The main advantage of both 3D printing (3DP) and 3D food printing (3DFP) over other technologies is the enormous capacity of both techniques for customization. Its use makes it possible to obtain products without planning and implementing a complex and costly manufacturing process. This makes 3DFP a technology of choice for the preparation of food products that meet specific needs, such as controlled nutritional or rheological properties. However, further technological developments are still needed before 3DFP can be considered fully useful for innovative and demanding applications. If both preparation and post-processing of materials based on 3D printing are optimized, aiming to reduce production time and/or complication for non-expert users, this would open a whole new range of possibilities. It is in this sense that the development of advanced 3DFP systems becomes a must. This chapter reviews current advances in extrusion-based 3D food printing systems, with in situ gelation and mixing as key aspects to better exploit the potential of 3DFP. On one hand, 3DFP systems based on in situ gelation (G3DFP) provide greater control over the final properties of the printed products, as the selection of adequate printing parameters gives the possibility of influencing the gelation process. On the other hand, mixing is indispensable for true 3DFP automation, so that the formulations do not have to be prepared by the user. Different innovative 3DFP systems based on gelling and/or mixing are presented in this chapter. Finally, the status and future of extrusion-based 3DFP, and its application in the production of customized foods for specific needs, are also overviewed.
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Dhillon B, Sodhi NS, Singh D, Kaur A. Analyses of functional diets formulated for dysphagia patients under international dysphagia diet standardization initiative (IDDSI) level 3 to level 7. JOURNAL OF FOOD MEASUREMENT AND CHARACTERIZATION 2022. [DOI: 10.1007/s11694-022-01454-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Murray J, Maloney S, Underdown K, Doeltgen S. Patient suitability for free water protocols in acute stroke and general medicine: a qualitative study of clinician perceptions. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2022; 57:630-644. [PMID: 35318783 DOI: 10.1111/1460-6984.12713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 02/09/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND The free water protocol (FWP) is an alternate management strategy for patients with dysphagia, who would otherwise be nil by mouth or prescribed thickened fluids, allowing them to drink and potentially aspirate water under strict guidelines to minimize the risk of adverse consequences. The FWP is not widely implemented in acute settings, and it is unclear whether this is due to the complexity of patient presentations, clinician decision-making or barriers related to the setting. AIMS To explore the perceptions and decision-making process of clinicians about using FWPs to manage dysphagia for patients admitted to acute stroke and general medicine. METHODS & PROCEDURES A qualitative, critical realist approach was adopted to allow for in-depth exploration of the perspectives of four dietitians, seven medical officers, eight registered nurses and 17 speech and language pathologists (SLPs) from three hospitals in a capital city of Australia. Data from semi-structured interviews were analysed using the Situated Clinical Decision-Making Framework (CDF). OUTCOMES & RESULTS Participants were cautious about FWP for patients with neurological conditions, head and neck cancer, dementia, poor immunity, chronic or recurrent respiratory illness, and certain types of stroke. Medical status and the implications for aspiration were paramount, particularly respiratory status, oxygen supplementation, cognitive status, fatigue and mobility. Participants considered patient quality of life, preferences and choices for care, but indicated that factors influencing safety often outweighed patient preference for water. Indirect factors affecting decision-making included the roles of the multidisciplinary team, individual clinical experience and attitude to risk, and availability of supervision. CONCLUSIONS & IMPLICATIONS Despite the benefits of FWPs in other settings, in acute stroke and general medicine, clinicians erred on the side of safety and, in most cases, would not implement an FWP. Future clinical research is needed to systematically design high-quality and feasible clinical trials to determine the benefits and safety of FWPs for patients with dysphagia in these settings. This would lay the foundations for guidelines to support the complex clinical decision-making regarding patient suitability for FWPs. WHAT THIS PAPER ADDS What is already known on the subject FWPs are an alternate management strategy for patients with dysphagia, with systematic reviews recommending their use for adults in inpatient rehabilitation with a low risk of pneumonia. However, evidence from the acute setting is sparse, leaving clinicians unsure about which patients might benefit and which may inadvertently be exposed to increased risk by an FWP. What this paper adds to existing knowledge Participants from all interviewed disciplines agreed that SLPs lead the decision-making process and as such act as 'gatekeepers' for access to an FWP. The decision-making process is complex, and participants acknowledged that disease conditions and illnesses were often used as exclusionary criteria. Although participants reported favourably on the benefits of FWPs, their decision-making privileged risk aversion over patient preference in most settings, except for palliative care. Lack of clinical guidelines and research evidence in acute care settings, as well as the focus on risk aversion, appear to perpetually reinforce the avoidance of FWP in these settings. Of note, more senior clinicians acknowledged being more deliberately guided by patient preference; hence, leadership by senior clinicians appears critical for change in practice in this space. What are the potential or actual clinical implications of this work? If evidence about the safety of FWP in the acute settings is to be collected, a systematic approach to addressing the present barriers is warranted. This may allow rigorous clinical trials to proceed and potentially lead to best-practice guidelines for dysphagia management options for wider populations of patients.
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Affiliation(s)
- Joanne Murray
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
- Swallowing Neurorehabilitation Research Laboratory, Flinders University, Adelaide, SA, Australia
| | - Shannon Maloney
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Kaitlyn Underdown
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Sebastian Doeltgen
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
- Swallowing Neurorehabilitation Research Laboratory, Flinders University, Adelaide, SA, Australia
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Association between food texture levels consumed and the prevalence of malnutrition and sarcopenia in older patients after stroke. Eur J Clin Nutr 2022; 76:1576-1582. [PMID: 35418607 DOI: 10.1038/s41430-022-01126-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 03/10/2022] [Accepted: 03/16/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND/OBJECTIVES Texture-modified diets (TMDs) may affect nutritional status and sarcopenia in patients after stroke. This study aimed to investigate the association of food texture levels consumed by patients after stroke with the prevalence of malnutrition and sarcopenia. SUBJECTS/METHODS This was a two-center cross-sectional study. A total of 443 patients aged ≥65 years undergoing post-stroke rehabilitation and with oral intake in rehabilitation wards in Shizuoka prefecture and Okinawa prefecture, Japan, were included in the analysis. Food textures were categorized according to the International Dysphagia Diet Standardization Initiative (IDDSI) framework. Malnutrition was diagnosed according to the Global Leadership Initiative on Malnutrition and sarcopenia was assess by the European Working Group on Sarcopenia in Older People 2 criteria. The Cochran-Armitage trend test was used to examine the prevalence of malnutrition and sarcopenia by consumption of lower food texture levels. RESULTS Malnutrition and sarcopenia were diagnosed in 245 (55.3%) and 275 (62.1%) participants, respectively. Consumption of lower food texture levels was associated with a higher prevalence of malnutrition and severe malnutrition (P < 0.001 for both). In addition, consumption of lower food texture levels was associated with a higher prevalence of probable sarcopenia and sarcopenia (P < 0.001 for both). On multivariate analysis, significant associations were observed between IDDSI levels 5 (P < 0.001) and 4 (P = 0.009) and malnutrition, and between IDDSI levels 6 (P = 0.015), 5 (P = 0.033), and 4 (P = 0.015) and sarcopenia. CONCLUSIONS In patients with stroke, consumption of lower food texture levels categorized by the IDDSI framework was associated with a higher prevalence of malnutrition and sarcopenia.
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Smith R, Bryant L, Reddacliff C, Hemsley B. A review of the impact of food design on the mealtimes of people with swallowing disability who require texture-modified food. INTERNATIONAL JOURNAL OF FOOD DESIGN 2022. [DOI: 10.1386/ijfd_00034_1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Texture-modified foods are a common component of interventions provided to people with dysphagia (swallowing disorders) to maintain their respiratory health, nutritional health and to reduce the risk of aspiration-related illness or choking on food. However, the unsightly and unappetizing
appearance of texture-modified foods may negatively impact on the mealtime experience and acceptance of texture-modified foods of persons with dysphagia. The aim of this review was to determine what is known about the impact of specific elements of food design ‐ food structure and visual
appeal ‐ on the mealtime experiences of people with dysphagia. This review of 35 studies presents evidence on how the physical characteristics of texture-modified foods for people with dysphagia can be considered during food production, formulation or service to improve their mealtime
experience. Overall, the visual appeal, texture, taste, aroma, temperature, mealtime environment and mealtime assistance all impact upon mealtime experiences and should be considered carefully in the design of a person’s mealtime plan and food-related dysphagia interventions to improve
their mealtime-related quality of life. Further research needs to include the views of people with dysphagia, particularly those with lifelong conditions, who might require texture-modified food for an extended period over their lifespan.
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Shune S, Barewal R. Redefining the value of snacks for nursing home residents: Bridging psychosocial and nutritional needs. Geriatr Nurs 2022; 44:39-47. [DOI: 10.1016/j.gerinurse.2021.12.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 12/29/2021] [Accepted: 12/31/2021] [Indexed: 01/11/2023]
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Wu XS, Miles A, Braakhuis A. An Evaluation of Texture-Modified Diets Compliant with the International Dysphagia Diet Standardization Initiative in Aged-Care Facilities Using the Consolidated Framework for Implementation Research. Dysphagia 2022; 37:1314-1325. [PMID: 34993611 DOI: 10.1007/s00455-021-10393-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 11/22/2021] [Indexed: 11/03/2022]
Abstract
Texture-modified diets (TMDs) are commonly prescribed for older adults with swallowing difficulties to improve swallowing safety. The International Dysphagia Diet Standardization Initiative (IDDSI) provides a framework for terminology, definitions and testing of TMDs. This observational mixed-method study used the consolidated framework for implementation research (CFIR) to establish the barriers and enablers to IDDSI adoption in aged-care facilities (ACFs). Five New Zealand ACFs who had adopted IDDSI > 12 months previously were recruited. Evaluation tools were developed based on CFIR constructs, integrating data from (i) mealtime observations; (ii) manager interviews and (iii) staff (nursing, carers and kitchen) self-administrated surveys. All facility and kitchen managers were IDDSI aware and had access to online resources. Three sites had changed to commercially compliant products post-IDDSI adoption, which had cost implications. Awareness of IDDSI amongst staff ranged from 5 to 79% and < 50% of staff surveyed felt sufficiently trained. Awareness was greater in large sites and where IDDSI was mandated by head office. Managers had not mandated auditing and they felt this had led to reduced perceived importance. Managers felt staff required more training and staff wanted more training, believing it would improve food safety and quality of care. Lack of a dedicated project leader and no speech pathologist on-site were perceived barriers. Collaboration between healthcare assistants, kitchen staff and allied health assisted implementation. ACF staff were aware of IDDSI but staff awareness was low. Using the CFIR, site specific and generic barriers and enablers were identified to improve future implementation effectiveness. Managers and staff want access to regular training. Multidisciplinary collaboration and improving communication are essential. ACFs should consider TMD auditing regularly. Successful implementation of IDDSI allows improvement of quality of care and patient safety but requires a systematic, site-specific implementation plan.
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Affiliation(s)
- Xiaojing Sharon Wu
- Department of Nutrition, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Rd, Grafton, Auckland, 1142, New Zealand.
| | - Anna Miles
- Department of Speech Science, School of Psychology, University of Auckland, Auckland, New Zealand
| | - Andrea Braakhuis
- Department of Nutrition, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Rd, Grafton, Auckland, 1142, New Zealand
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Xuan PJ, Wensheng L, Goh KKT, Dharmawan J. Correlation between Instrumental and Sensory Properties of Texture Modified Carrot Puree. J Texture Stud 2021; 53:72-80. [PMID: 34953142 DOI: 10.1111/jtxs.12658] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 11/13/2021] [Accepted: 12/19/2021] [Indexed: 11/29/2022]
Abstract
This study was undertaken to determine the correlation between instrumental and sensory evaluation on texture modified carrot puree. Texture modified foods (TMF) are prescribed to dysphagia individuals to aid in the oral manipulation and facilitate swallowing of food. There is a lack of correlation between instrumental measurements and sensory attributes on TMF. Understanding this correlation will aid in the formulation of safe foods with desired sensory properties for dysphagia patients. Instrumental measurements of carrot purees were performed by back extrusion method using a texture analyser and the attributes obtained were firmness, consistency, cohesiveness and adhesiveness. Quantitative Descriptive Analysis (QDA) with eight trained panellists was employed to characterize the texture of the carrot puree based on seven sensory attributes: Firmness, viscous, adhesive (mouth), smoothness, adhesive (throat), rate of breakdown, difficulty to swallow. Five thickeners, namely gellan gum, xanthan gum, Suberakaze, UNI-PURE® Dys-sperse instant thickener, ULTRA-SPERSE® M Starch were evaluated against carrot puree without any thickener as control. The correlation results obtained from texture analysis and sensory evaluation were statistically significant (p < 0.05). The firmness attributes from instrumental and sensory results were positively correlated. The consistency parameter was positively correlated to sensory attribute viscous and negatively correlated to smoothness. The sensory attribute rate of breakdown was negatively correlated to instrumental parameter of cohesiveness. Lastly, instrumental adhesiveness was positively correlated to sensory attributes adhesive to mouth and throat, and difficulty to swallow. The correlation results showed a well-designed instrumental technique can be used to understand the impact of thickeners on TMF for dysphagia subjects. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Peh Jie Xuan
- Chemical Engineering and Food Technology Cluster, Singapore Institute of Technology, Singapore, Singapore.,School of Food and Advanced Technology, Massey University, Private Bag 11222, Palmerston North, New Zealand
| | - Lim Wensheng
- School of Food and Advanced Technology, Massey University, Private Bag 11222, Palmerston North, New Zealand
| | - Kelvin Kim Tha Goh
- School of Food and Advanced Technology, Massey University, Private Bag 11222, Palmerston North, New Zealand
| | - Jorry Dharmawan
- Chemical Engineering and Food Technology Cluster, Singapore Institute of Technology, Singapore, Singapore
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Pu D, Choi YY, Chan KMK, Poon MMW. Modifying Puree Meals in Residential Aged Care Facilities: A Multi-Centre Feasibility and Acceptability Study. Geriatrics (Basel) 2021; 6:geriatrics6040108. [PMID: 34842703 PMCID: PMC8628769 DOI: 10.3390/geriatrics6040108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 10/29/2021] [Accepted: 11/02/2021] [Indexed: 11/16/2022] Open
Abstract
Purees are often recommended for older adults in residential aged care facilities (RACFs) to target swallowing difficulties and nutrition. However, they lack appeal and may have negative impacts on nutritional intake. This study investigated the subjective experiences and objective swallowing function and safety of older adults in response to a modified puree. Twenty-eight residents from three RACFs whose regular diets consisted of purees were recruited. Purees were modified to improve visual appeal by adding a commercial enzyme gellant. Each participant was observed during three puree and three modified puree meals, and completed a brief questionnaire after each meal. A videofluoroscopic swallowing study (VFSS) was performed with 16 of the participants. Compared to purees, modified purees were observed to be easier for oral processing and intake amount was higher, but participants required assistance more often and mealtimes were longer. Participants did not show preference for either type of puree. VFSS showed similar swallowing responses between the two puree types; however, a distinction was observed for modified pureed meat compared to other ingredients. Modifying puree meals in RACFs is a feasible approach to improve nutritional intake while maintaining swallowing safety, but their appeal to consumers is not definitive.
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Affiliation(s)
- Dai Pu
- Faculty of Medicine, Nursing and Health Sciences, School of Primary and Allied Health Care, Monash University, Frankston 3199, Australia
- Correspondence: (D.P.); (M.M.-W.P.)
| | - Yuen-Yu Choi
- Swallowing Research Laboratory, Faculty of Education, The University of Hong Kong, Pokfulam, Hong Kong, China; (Y.-Y.C.); (K.M.-K.C.)
| | - Karen Man-Kei Chan
- Swallowing Research Laboratory, Faculty of Education, The University of Hong Kong, Pokfulam, Hong Kong, China; (Y.-Y.C.); (K.M.-K.C.)
| | - May Man-Wai Poon
- ENT Laser Hearing & Speech Therapy Centre, 59–65 Queen’s Road Central, Hong Kong, China
- Correspondence: (D.P.); (M.M.-W.P.)
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Endo A, Watanabe Y, Matsushita T, Okada K, Ohara Y, Iwasaki M, Ito K, Nakajima J, Iwasa Y, Itoda M, Sasaki R, Nishi Y, Furuya J, Watanabe Y, Umemoto G, Kishima M, Hirano H, Sato Y, Yoshida M, Yamazaki Y. Association between Weight Loss and Food Form in Older Individuals Residing in Long-Term Care Facilities: 1-Year Multicenter Longitudinal Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182010776. [PMID: 34682525 PMCID: PMC8535238 DOI: 10.3390/ijerph182010776] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 10/05/2021] [Indexed: 12/17/2022]
Abstract
Changing the food form for older adults requiring nursing care from a regular to dysphagia diet is thought to impact their nutritional status. We assessed the association between changes in food form and weight loss over 1 year in older adults. Older adults residing in long-term care facilities in Japan (n = 455) who participated in the baseline (2018) and follow-up (2019) surveys were divided into two groups (regular diet, n = 284; dysphagia diet, n = 171). The regular diet group was further divided into the weight loss (n = 80; weight loss ≥5% over 1 year) and weight maintenance (n = 204; weight loss <5%) groups. After 1 year, the Barthel Index significantly decreased, and the proportion of participants who switched from a regular diet to a dysphagia diet significantly increased in the weight loss group than in the weight maintenance group. Multivariate logistic regression analysis found that Barthel index variation (odds ratio (OR): 0.97, 95% confidence interval (CI): 0.94‒0.99), change from a regular diet to a dysphagia diet (OR: 4.41, 95% CI: 1.87‒10.41), and body weight at baseline (OR = 1.06, 95% CI: 1.01‒1.11) were significantly associated with weight loss. Our results suggest that maintaining the food form inhibits weight loss and improves health outcomes in older adults.
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Affiliation(s)
- Akemi Endo
- Gerodontology, Department of Oral Health Science, Faculty of Dental Medicine, Hokkaido University, Hokkaido 060-8586, Japan; (A.E.); (T.M.); (K.O.); (Y.Y.)
| | - Yutaka Watanabe
- Gerodontology, Department of Oral Health Science, Faculty of Dental Medicine, Hokkaido University, Hokkaido 060-8586, Japan; (A.E.); (T.M.); (K.O.); (Y.Y.)
- Correspondence: ; Tel./Fax: +81-11-706-4582
| | - Takae Matsushita
- Gerodontology, Department of Oral Health Science, Faculty of Dental Medicine, Hokkaido University, Hokkaido 060-8586, Japan; (A.E.); (T.M.); (K.O.); (Y.Y.)
| | - Kazutaka Okada
- Gerodontology, Department of Oral Health Science, Faculty of Dental Medicine, Hokkaido University, Hokkaido 060-8586, Japan; (A.E.); (T.M.); (K.O.); (Y.Y.)
| | - Yuki Ohara
- Tokyo Metropolitan Institute of Gerontology, Tokyo 173-0015, Japan; (Y.O.); (M.I.); (H.H.)
| | - Masanori Iwasaki
- Tokyo Metropolitan Institute of Gerontology, Tokyo 173-0015, Japan; (Y.O.); (M.I.); (H.H.)
| | - Kayoko Ito
- Oral Rehabilitation, Niigata University Medical and Dental Hospital, Niigata 951-8520, Japan;
| | - Junko Nakajima
- Department of Oral Medicine and Hospital Dentistry, Tokyo Dental College, Chiba 272-8513, Japan;
| | - Yasuyuki Iwasa
- Department of Dentistry, Haradoi Hospital, Fukuoka 813-8588, Japan;
| | - Masataka Itoda
- Department of Oral Rehabilitation, Osaka Dental University Hospital, Osaka 573-1144, Japan;
| | - Rikimaru Sasaki
- Rehabilitation Clinic for Speech and Swallowing Disorders, The Nippon Dental University Hospital, Tokyo 102-8158, Japan;
| | - Yasuhiro Nishi
- Department of Oral and Maxillofacial Prosthodontics, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima 890-8544, Japan;
| | - Junichi Furuya
- Department of Geriatric Dentistry, Showa University School of Dentistry, Tokyo 145-8515, Japan; (J.F.); sato-@dent.showa-u.ac.jp (Y.S.)
| | - Yoshihiko Watanabe
- Department of Healthcare Management, Tohoku Fukushi University, Miyagi 981-8522, Japan;
| | - George Umemoto
- Swallowing Disorders Center, Fukuoka University Hospital, Fukuoka 814-0180, Japan;
| | - Masako Kishima
- Wakakusa-Tatsuma Rehabilitation Hospital, Osaka 574-0012, Japan;
| | - Hirohiko Hirano
- Tokyo Metropolitan Institute of Gerontology, Tokyo 173-0015, Japan; (Y.O.); (M.I.); (H.H.)
| | - Yuji Sato
- Department of Geriatric Dentistry, Showa University School of Dentistry, Tokyo 145-8515, Japan; (J.F.); sato-@dent.showa-u.ac.jp (Y.S.)
| | - Mitsuyoshi Yoshida
- Department of Advanced Prosthodontics, Hiroshima University Graduate School of Biomedical & Health Sciences, Hiroshima 734-8553, Japan;
| | - Yutaka Yamazaki
- Gerodontology, Department of Oral Health Science, Faculty of Dental Medicine, Hokkaido University, Hokkaido 060-8586, Japan; (A.E.); (T.M.); (K.O.); (Y.Y.)
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Shimizu A, Fujishima I, Maeda K, Murotani K, Kayashita J, Ohno T, Nomoto A, Ueshima J, Ishida Y, Inoue T, Mori N. Texture-Modified Diets are Associated with Poor Appetite in Older Adults who are Admitted to a Post-Acute Rehabilitation Hospital. J Am Med Dir Assoc 2021; 22:1960-1965. [PMID: 34139151 DOI: 10.1016/j.jamda.2021.05.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 05/09/2021] [Accepted: 05/11/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE This study aimed to clarify the association between texture-modified diets and poor appetite in older adults, as it is not fully understood. DESIGN Cross-sectional study. SETTING AND PARTICIPANTS We included 208 inpatients who were aged ≥65 years (mean age 78.9 ± 7.6 years, 57.7% female) and admitted to a rehabilitation unit with stroke, musculoskeletal disease, or hospital-associated deconditioning covered by the Japanese insurance system, between January 2019 and January 2020. METHODS Participants were divided into 2 groups according to their food texture level: International Dysphagia Diet Standardization Initiative (IDDSI) levels 3 to 5 for the texture-modified diet group and levels 6 and 7 for the normal diet group. Appetite was assessed using the Simplified Nutritional Appetite Questionnaire for the Japanese elderly, and a score ≤14 was defined as poor appetite. The relationship between IDDSI levels and poor appetite was analyzed using the Cochrane-Armitage trend test. Logistic regression analysis was used to investigate the relationship between the consumption of texture-modified diets and poor appetite. Statistical significance was set at P < .05. RESULTS The numbers of participants on modified diets according to the IDDSI framework were as follows: 4, 11, 41, 76, and 76 in levels 3, 4, 5, 6, and 7, respectively. In total, 152 and 56 patients were classified into the regular diet group and texture-modified diet group, respectively. A significantly higher prevalence of poor appetite was observed with the consumption of texture-modified diets (P < .001 for trend). Logistic regression analysis showed that poor appetite was independently associated with the consumption of texture-modified diets (odds ratio 3.443, P = .011). CONCLUSIONS AND IMPLICATIONS These findings indicate that the consumption of texture-modified diets is associated with poor appetite. Further studies are required to verify whether a multimodal approach involving improvement in the appearance, taste, flavor, and nutrients of the food can improve poor appetite.
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Affiliation(s)
- Akio Shimizu
- Department of Nutrition, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Japan; Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Japan; Department of Geriatric Medicine, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Ichiro Fujishima
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Japan
| | - Keisuke Maeda
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Japan; Department of Geriatric Medicine, National Center for Geriatrics and Gerontology, Obu, Japan.
| | | | - Jun Kayashita
- Department of Health Sciences, Faculty of Human Culture and Science, Prefectural University of Hiroshima, Hiroshima, Japan
| | - Tomohisa Ohno
- Department of Dentistry, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Japan
| | - Akiko Nomoto
- Department of Dentistry, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Japan
| | - Junko Ueshima
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Japan; Department of Clinical Nutrition and Food Service, NTT Medical Center Tokyo, Tokyo, Japan
| | - Yuria Ishida
- Department of Nutrition, Aichi Medical University, Nagakute, Japan
| | - Tatsuro Inoue
- Department of Geriatric Medicine, National Center for Geriatrics and Gerontology, Obu, Japan; Department of Physical Therapy, Niigata University of Health and Welfare, Niigata, Japan
| | - Naoharu Mori
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Japan
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Wu XS, Miles A, Braakhuis AJ. Texture-Modified Diets, Nutritional Status and Mealtime Satisfaction: A Systematic Review. Healthcare (Basel) 2021; 9:624. [PMID: 34073835 PMCID: PMC8225071 DOI: 10.3390/healthcare9060624] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 05/20/2021] [Accepted: 05/21/2021] [Indexed: 12/24/2022] Open
Abstract
While the association between dysphagia and malnutrition is well established, there is a lack of clarity regarding the nutritional status and mealtime satisfaction of those consuming texture-modified diets (TMDs). This systematic review summarises and critically appraises the nutritional status and mealtime satisfaction of adults consuming TMDs. A systematic database search following PICO criteria was conducted using Cochrane Central (via Ovid), MEDLINE, CINAHL, EMBASE and Scopus. Nutritional status, mealtime satisfaction and costs were identified as primary outcomes. Eligible studies were grouped according to outcome measurement. In total, 26 studies met the inclusion criteria. Twenty studies evaluated the nutritional status by weight change or using malnutrition screening tools and found the consumption of TMDs correlated with weight loss or malnutrition. Nine studies evaluated mealtime satisfaction, with two reporting poor satisfaction for people on thickened fluids (TFs). Nutrition intervention through adjusting texture and consistency and nutrition enrichment showed positive effects on weight and mealtime satisfaction. The majority of the studies were rated as 'neutral' quality due to the limited number of experiments. TMD consumers had compromised nutritional status and poor mealtime satisfaction. More research input is required to identify promising strategies for improving the nutritional status and mealtime satisfaction of this population. Food services need to consider texture, consistency and fortification in designing menus for people on TMDs to avoid weight loss and malnutrition, and to enhance mealtime enjoyment.
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Affiliation(s)
- Xiaojing Sharon Wu
- Faculty of Medical and Health Sciences, Discipline of Nutrition, The University of Auckland, Auckland 1010, New Zealand;
| | - Anna Miles
- Faculty of Science, School of Psychology, Speech Science, The University of Auckland, Auckland 1010, New Zealand;
| | - Andrea J. Braakhuis
- Faculty of Medical and Health Sciences, Discipline of Nutrition, The University of Auckland, Auckland 1010, New Zealand;
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Effect of the addition of hydrocolloids on beef texture: Targeted to the needs of people with dysphagia. Food Hydrocoll 2021. [DOI: 10.1016/j.foodhyd.2020.106413] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Okkels SL, Dybdal DR, Pedersen RJ, Klausen TW, Olsen A, Beck AM, Bügel S. A culinary twist of a two-course meals-on-wheels menu in a cluster-randomized controlled trial influencing health-related quality of life in nursing home residents. Clin Nutr ESPEN 2021; 43:137-147. [PMID: 34024505 DOI: 10.1016/j.clnesp.2021.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 02/05/2021] [Accepted: 02/14/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND AIMS Meals-on-wheels in nursing homes are sensory diminished because of the packaging and reheating of the food, which creates less appetite stimulation and an impaired meal experience for nursing home residents. This background is crucial since nursing home residents are a frail and often malnourished group that is physiologically affected by sensory, physical and mental alterations. The study aimed to increase health-related quality of life in nursing home residents receiving meals-on-wheels using an intervention menu with favourite meals that added a culinary twist and were sensory improved by chefs. METHODS A double-blinded cluster-randomized controlled trial with two arms, one group receives an intervention menu, and the other group receives a non-optimized menu. The intervention menu included popular meals-on-wheels (a main meal for dinner and a starter/dessert before or after dinner with culinary improvements). The participants received the same meals without culinary improvements in the control group. Health-related quality of life (EQ5D3L) was the primary outcome of the study. Secondary outcomes were mental and nutritional status and muscle strength. The measurements were assessed at a baseline and end visit (12 weeks after baseline visit). RESULTS Fifty-two nursing home residents were included in the study (There are 20 in the intervention group and 32 in the control group). Following the principle of intention-to-treat, a significant decreasing effect (p-value 0.026) was found between the groups on health-related quality of life. The treated group experienced the largest decrease from the baseline to the end visit. The intervention group had a significant decrease in the second item on Satisfaction With Food-related Life (SWFL2) (I am very pleased with my food). No changes were found either within or between the groups, on the rest of the measured parameters. CONCLUSIONS Nursing home residents are a target group experiencing natural aggravation, why the health-related quality of life might be difficult to improve using a culinary meal intervention. The decreasing effect of Satisfaction With Food-related Life found in the intervention group could be related to these older adults being too unfamiliar with the culinary twist added to the intervention menu. The study was registered on ClinTrials.gov (Identifier NCT03133364).
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Affiliation(s)
- Signe Loftager Okkels
- Dietetic and Nutritional Research Unit, Herlev and Gentofte University Hospital, Gentofte, Denmark; Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Frederiksberg C., Denmark.
| | - Ditte Rokkjær Dybdal
- Dietetic and Nutritional Research Unit, Herlev and Gentofte University Hospital, Gentofte, Denmark.
| | - Rie Johanne Pedersen
- Dietetic and Nutritional Research Unit, Herlev and Gentofte University Hospital, Gentofte, Denmark.
| | | | - Annemarie Olsen
- Department of Food Science, Faculty of Science, University of Copenhagen, Frederiksberg C., Denmark.
| | - Anne Marie Beck
- Dietetic and Nutritional Research Unit, Herlev and Gentofte University Hospital, Gentofte, Denmark; University College Copenhagen, Institute of Nutrition and Nursing, Faculty of Health, Copenhagen, Denmark.
| | - Susanne Bügel
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Frederiksberg C., Denmark.
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Kulvanich S, Ito K, Takei E, Sakai H, Suzumi R, Magara J, Tsujimura T, Inoue M. Impact of Oral and Swallowing Function on the Feeding Status of Older Adults in Nursing Homes. Gerontology 2021; 67:168-176. [PMID: 33454716 DOI: 10.1159/000511912] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 09/22/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND To date, there have been few guidelines proposed for adjustment of the food consistency, particularly to match the oral function of older adults, which will guide clinicians and caregivers in appropriately modifying food. OBJECTIVE We investigated how oral, swallowing, and cognitive conditions of older adults who required daily nursing care in a nursing home were associated with different dietary food consistencies. METHODS Clinical examinations to record dentition status, swallowing, and cognitive functions were performed, and the feeding status, including the food consistencies and need for assistance at lunchtime, was evaluated in 37 older residents in nursing homes. The swallowing function was assessed by performing a modified water-swallowing test, and food swallowing was tested using pudding and rice crackers. The χ2 test was used to determine the relationships among the parameters. RESULTS No participants were able to take cooked rice, nor regular and soft side dishes. There was no significant relationship between dentition status and feeding status. Of the participants, 95% ate pudding without any problems and 49% ate rice crackers without any signs of swallowing difficulty such as coughing or stopping chewing. There was a significant relationship between the food test score using a rice cracker and the level of food consistencies, and between the same test score and the level of mealtime assistance, whereby the better the score of the food test using a rice cracker, the better was the level of food consistencies including use of a thickening agent and the better was the level of mealtime assistance. CONCLUSION The results strongly suggest that the food test using a rice cracker was associated with the level of food consistency and mealtime assistance for older adults in nursing homes.
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Affiliation(s)
- Sirima Kulvanich
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.,Department of Community Dentistry & Gerodontology, Faculty of Dentistry, Thammasat University, Bangkok, Thailand
| | - Kayoko Ito
- Oral Rehabilitation, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Eri Takei
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Haruka Sakai
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Risa Suzumi
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Jin Magara
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Takanori Tsujimura
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Makoto Inoue
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan,
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Kurosu A, Osman F, Daggett S, Peña-Chávez R, Thompson A, Myers SM, VanKampen P, Koenig SS, Ciucci M, Mahoney J, Rogus-Pulia N. Factors Associated with Self-Reported Dysphagia in Older Adults Receiving Meal Support. J Nutr Health Aging 2021; 25:1145-1153. [PMID: 34866141 PMCID: PMC8653989 DOI: 10.1007/s12603-021-1700-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Dysphagia is common in older adults. However, there are no current estimates of dysphagia in community-dwelling older adults those receiving meal support. It is unknown whether dysphagia is associated with other measures of physical function (activities of daily living [ADL] ability or nutrition status). The study purposes were to determine the prevalence of self-reported dysphagia and to identify factors associated with self-reported dysphagia in community-dwelling older adults receiving meal support. DESIGN A cross-sectional study. SETTING AND PARTICIPANTS 476 community-dwelling older adults (78.5±0.51 years) across five Elder Nutrition Program meal services in Wisconsin participated in the study. MEASUREMENTS Data were collected through administration of validated ADL and nutrition questionnaires (nutritional status, functional status with ADLs, chewing ability, dental conditions, and prior diagnoses of dysphagia, pneumonia, and dementia). For self-reported dysphagia, the validated 10-item eating assessment tool (EAT-10) was used. RESULTS The prevalence of self-reported dysphagia (EAT-10 score of ≥ 3) was 20.4%. Multivariate logistic regression results indicated that poor nutritional status (OR=3.1, p=0.04), difficulty chewing (OR=2.2, p=0.03), prior dysphagia diagnosis (OR=34.8, p<0.001), prior pneumonia diagnosis (OR=2.1, p=0.04), and meal service site (OR=2.68, p=0.02) were associated with self-reported dysphagia. CONCLUSION Approximately one in five community-dwelling older adults receiving meal support had self-reported dysphagia. Increased risk for poor nutrition, reduced chewing ability, prior dysphagia and pneumonia diagnosis, and meal service site were identified as factors associated with dysphagia on the EAT-10. Results highlight the need for further studies across more sites to identify dysphagia risk indicators in community-dwelling older adults receiving meal support state-wide.
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Affiliation(s)
- A Kurosu
- Nicole Rogus-Pulia, Division of Otolaryngology- Head and Neck Surgery, Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA,
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Treatment for Adults. Dysphagia 2021. [DOI: 10.1016/b978-0-323-63648-3.00011-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Wu XS, Miles A, Braakhuis A. Nutritional Intake and Meal Composition of Patients Consuming Texture Modified Diets and Thickened Fluids: A Systematic Review and Meta-Analysis. Healthcare (Basel) 2020; 8:healthcare8040579. [PMID: 33371326 PMCID: PMC7767351 DOI: 10.3390/healthcare8040579] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 12/10/2020] [Accepted: 12/17/2020] [Indexed: 12/26/2022] Open
Abstract
Texture-modified diets (TMDs) play an important role in ensuring safety for those with dysphagia but come with risks to nutrition and quality of life. The use of TMDs has been addressed with the increasing prevalence of dysphagia in previous decades. However, there is limited literature that investigates the nutrition perspectives of TMD consumers. This review summarises the nutrition outcomes of adults consuming TMDs and thickened fluids (TFs) and identifies the limitations of TMD and TF productions. A systematic database search following PICO criteria was conducted using Cochrane Central (via Ovid), MEDLINE, CINAHL, EMBASE, and Scopus databases. Nutrition intake, meal consumption, adequacy, and meal composition were identified as relevant outcomes. 35 studies were included for analysis. Consumption of TMDs demonstrated a poorer intake compared to regular diets, in particular significant in energy and calcium. Meta-analysis of mean differences showed favourable effects of shaped TMDs on both energy (−273.8 kJ/d; 95%CI: −419.1 to −128.6, p = 0.0002) and protein (−12.4 g/d; 95%CI: −17.9 to −6.8, p < 0.0001) intake compared to traditional cook-fresh TMDs. Nutrition intake was compromised in TMD consumers. Optimisation of nutrition intake was achievable through enrichment and adjusting meal texture and consistency. However, the heterogeneity of studies and the missing verification of the consistencies lead to difficulty in drawing conclusions regarding particular texture or intervention.
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Affiliation(s)
- Xiaojing Sharon Wu
- Faculty of Medical and Health Sciences, Discipline of Nutrition, The University of Auckland, Auckland 1010, New Zealand;
- Correspondence: ; Tel.: +64-210-859-9592
| | - Anna Miles
- Faculty of Science, School of Psychology, Speech Science, The University of Auckland, Auckland 1010, New Zealand;
| | - Andrea Braakhuis
- Faculty of Medical and Health Sciences, Discipline of Nutrition, The University of Auckland, Auckland 1010, New Zealand;
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Merino G, Gómez I, Marín-Arroyo MR, Beriain MJ, Ibañez FC. Methodology for design of suitable dishes for dysphagic people. INNOV FOOD SCI EMERG 2020. [DOI: 10.1016/j.ifset.2020.102383] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Strother H, Moss R, McSweeney MB. Comparison of 3D printed and molded carrots produced with gelatin, guar gum and xanthan gum. J Texture Stud 2020; 51:852-860. [PMID: 32537768 DOI: 10.1111/jtxs.12545] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 06/06/2020] [Accepted: 06/08/2020] [Indexed: 11/29/2022]
Abstract
This study examined the effects of different hydrocolloids (guar gum, xanthan gum and gelatin) on the sensory and textural properties of pureed carrots. There were eight products involved in the study; 3D printed carrots and molded carrots without the addition of gums and with guar gum, xanthan gum and gelatin. All products were evaluated using trained panelists (n = 12) and underwent a texture profile analysis. No significant differences were found between the molded and 3D printed pureed carrots; instead, the samples were grouped based on the gum used in their production. The samples made with gelatin and xanthan gum were the hardest (texture profile analysis) and the densest samples when evaluated by the trained panelists. The 3D printing did not affect the taste properties of the pureed carrots, as they were evaluated to be similar to that of the molded carrots (p > .05). This study demonstrated that 3D printing did not affect the textural and sensory properties of pureed carrots when compared to molded carrots. However, changes in the printing parameters (infill percentage, nozzle diameter, flow rate, nozzle height) need to be evaluated to determine their effect on the sensory properties of 3D printed pureed carrots.
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Affiliation(s)
- Heather Strother
- School of Nutrition and Dietetics, Acadia University, Wolfville, Nova Scotia, Canada
| | - Rachael Moss
- School of Nutrition and Dietetics, Acadia University, Wolfville, Nova Scotia, Canada
| | - Matthew B McSweeney
- School of Nutrition and Dietetics, Acadia University, Wolfville, Nova Scotia, Canada
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Morley H, Panak V, Mulders WHAM, Goulios H, Martini A, Langdon C. Non-chewing diets and cerumen impaction in the external ear canal in a residential aged care population. Australas J Ageing 2019; 39:131-136. [PMID: 31691470 DOI: 10.1111/ajag.12736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 08/26/2019] [Accepted: 09/13/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To examine whether diets involving reduced chewing affect the degree of cerumen impaction in older people in residential care. METHODS A total of 51 people (53% male) over 65 years (80.5 ± 9.3) were recruited from two residential aged care facilities in Perth, Australia. Participants were classified as "chewers" (on unrestricted or soft food diets), or "non-chewers" (on pureed or nil by mouth diets), and completed a survey about predisposing factors for cerumen impaction. Otoscopy and tympanometry were used to assess cerumen impaction and ear canal occlusion. Participants with excess cerumen were referred for wax removal. RESULTS No significant difference in cerumen accumulation was found between groups. However, 57% of participants showed excess cerumen requiring removal. CONCLUSION Diets involving reduced chewing are not associated with increased cerumen in older people in residential care. The prevalence of cerumen impaction is high in this population, and improved cerumen screening and management is needed in residential aged care.
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Affiliation(s)
- Hannah Morley
- School of Human Sciences, University of Western Australia, Crawley, WA, Australia
| | - Vanessa Panak
- School of Human Sciences, University of Western Australia, Crawley, WA, Australia
| | - Wilhelmina H A M Mulders
- School of Human Sciences, University of Western Australia, Crawley, WA, Australia.,Ear Science Institute Australia, Subiaco, WA, Australia
| | - Helen Goulios
- School of Human Sciences, University of Western Australia, Crawley, WA, Australia
| | | | - Claire Langdon
- School of Surgery, University of Western Australia, Crawley, WA, Australia
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Burger C, Kiesswetter E, Alber R, Pfannes U, Arens-Azevedo U, Volkert D. Texture modified diet in German nursing homes: availability, best practices and association with nursing home characteristics. BMC Geriatr 2019; 19:284. [PMID: 31646961 PMCID: PMC6806511 DOI: 10.1186/s12877-019-1286-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 09/20/2019] [Indexed: 11/21/2022] Open
Abstract
Background For nursing home (NH) residents with swallowing or chewing problems, appealing texture-modified-diets (TMD) need to be available in order to support adequate nutrition. The aim of this study was to describe the availability of TMD and best practices for TMD in German NHs and to identify related NH characteristics. Methods Information on NH characteristics, available texture-modified (TM)-levels (soft, “minced & moist”, pureed) and implemented best practices for TMD (derived from menu plan, separately visible components, re-shaped components, considering individual capabilities of the resident) was collected in a survey in German NHs. The number of TM-levels as well as the number of best practices for TMD were tested for their association with 4 structural, 16 operational and 3 resident-related NH characteristics. Results The response rate was 7.2% (n = 590) and 563 NHs were included. The vast majority of NHs (95.2%) reported offering “minced & moist” texture and 84.2% preparing separately visible meal components. Several operational characteristics were more frequently (p < 0.05) reported from NHs offering three TM-levels (27.7%) or four best practices for TMD (13.0%) compared to NHs offering one TM-level (28.4%) or one best practice for TMD (20.1%): special diets and delivery forms (e.g. fingerfood 71.2% vs 38.8%; 80.8% vs. 44.3%), written recipes (69.9% vs. 53.1%; 68.5% vs. 53.9%), a dietetic counseling service (85.9% vs. 66.3%; 89.0% vs. 65.2%), a quality circle for nutritional care (66.7% vs. 43.8%; 71.2% vs. 50.4%), regular staff training (89.7% vs. 73.1%; 95.9% vs. 74.8%) and process instructions (73.7% vs. 53.1%; 75.3% vs. 47.8%). No associations were found regarding structural and resident-related NH characteristics, except a higher percentage of residents receiving TMD in NHs with three compared to one TM-level (median 16.3% vs. 13.2%, p = 0.037). Conclusion All participating NHs offer some form of TMD, but only a small number offers a selection of TMD and pays adequate attention to its preparation. Operational NH characteristics – which might reflect a general nutritional awareness of the NH – seem to be pivotal for provision of TMD, whereas neither structural nor resident-related characteristics seem to play a role in this regard.
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Affiliation(s)
- Carina Burger
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Kobergerstraße 60, 90408, Nuremberg, Germany.
| | - Eva Kiesswetter
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Kobergerstraße 60, 90408, Nuremberg, Germany
| | - Rowena Alber
- Faculty Life Sciences, University of Applied Sciences Hamburg, Hamburg, Germany
| | - Ulrike Pfannes
- Faculty Life Sciences, University of Applied Sciences Hamburg, Hamburg, Germany
| | | | - Dorothee Volkert
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Kobergerstraße 60, 90408, Nuremberg, Germany
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Impact of Multiple Texture-Modified Diets on Oral Intake and Nutritional Status in Older Patients with Pneumonia: A Retrospective Cohort Study. Dysphagia 2019; 35:574-582. [DOI: 10.1007/s00455-019-10063-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 08/27/2019] [Indexed: 11/26/2022]
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de Villiers M, Hanson B, Moodley L, Pillay M. The impact of modification techniques on the rheological properties of dysphagia foods and liquids. J Texture Stud 2019; 51:154-168. [PMID: 31397895 DOI: 10.1111/jtxs.12476] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 08/01/2019] [Accepted: 08/03/2019] [Indexed: 01/25/2023]
Abstract
Modifying food and the textures of food has been done for decades within the food science and technology field. More recently, modifying the texture of foods has been used to manage swallowing disabilities (dysphagia). Swallowing disabilities are often associated with dehydration and malnutrition, thus nutritional intervention has formed part of serving texture-modified diets. The question remains whether these modification techniques are viable for individuals with swallowing disabilities living in majority world countries. This study used two modification methods on a widely used specialized nutritious food (SNF) to determine whether it may be modified and used in dysphagia management. The techniques had to be ergonomic and economically appropriate for individuals with swallowing disabilities living in majority world countries. The International Dysphagia Diet Standardization Initiative's (IDDSI) standards were used to determine whether the texturally modified SNF is safe for swallowing. Rheological measurements were performed to determine apparent viscosity and structure recovery of each sample. The effects of two modification techniques, aeration and particle separation, on the rheological properties of the SNF were also measured and analyzed. It was determined that both milk and water could be used with this SNF to create a dysphagia diet, but only under certain conditions. The overall results indicated that heating the samples increased the apparent viscosity and exacerbated lumping. Room temperature samples had less lumps and could be classified to the desired levels of the IDDSI (Level 2 and Level 4). Using a whisk to aerate the samples reduced lumps significantly and using a sieve to separate particles of liquid samples eliminated lumps. This study provides new data on how texture modification techniques and the IDDSI framework could be adapted to individuals living in majority world countries. By using modification techniques that are ergonomic and economically viable and an SNF with longevity, this study could be useful in guiding future training of nursing staff and caregivers of individuals living in poverty or resource-constrained communities. This study also adds to the data on the rheological properties of dysphagia foods, although this study did not make use of commercial thickeners generally used in the modification of diets.
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Affiliation(s)
- Marilize de Villiers
- School of Health Sciences, Discipline of Speech-Language Pathology, University of KwaZulu-Natal, Durban, South Africa
| | - Ben Hanson
- UCL Mechanical Engineering, University College London, London, UK
| | - Legini Moodley
- School of Health Sciences, Discipline of Speech-Language Pathology, University of KwaZulu-Natal, Durban, South Africa
| | - Mershen Pillay
- School of Health Sciences, Discipline of Speech-Language Pathology, University of KwaZulu-Natal, Durban, South Africa
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Namasivayam-Macdonald AM, Steele CM, Carrier N, Lengyel C, Keller HH. The Relationship between Texture-Modified Diets, Mealtime Duration, and Dysphagia Risk in Long-Term Care. CAN J DIET PRACT RES 2019; 80:122-126. [PMID: 30907128 DOI: 10.3148/cjdpr-2019-004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Many long-term care (LTC) residents have an increased risk for dysphagia and receive texture-modified diets. Dysphagia has been shown to be associated with longer mealtime duration, and the use of texture-modified diets has been associated with reduced nutritional intake. The current study aimed to determine if the degree of diet modification affected mealtime duration and to examine the correlation between texture-modified diets and dysphagia risk. Data were collected from 639 LTC residents, aged 62-102 years. Nine meal observations per resident provided measures of meal duration, consistencies consumed, coughing and choking, and assistance provided. Dysphagia risk was determined by identifying residents who coughed/choked at meals, were prescribed thickened fluids, and/or failed a formal screening protocol. Degree of texture modification was derived using the International Dysphagia Diet Standardization Initiative Functional Diet Scale. There was a significant association between degree of diet modification and dysphagia risk (P < 0.001). However, there was no association between diet modifications and mealtime duration, even when the provision of physical assistance was considered. Some residents who presented with signs of swallowing difficulties were not prescribed a texture-modified diet. Swallowing screening should be performed routinely in LTC to monitor swallowing status and appropriateness of diet prescription. Physical assistance during meals should be increased.
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Affiliation(s)
| | - Catriona M Steele
- b Toronto Rehabilitation Institute, Toronto, ON.,c University of Toronto, Toronto, ON
| | | | | | - Heather H Keller
- f University of Manitoba, Winnipeg, MB.,g Schlegel-University of Waterloo Research Institute for Aging, Waterloo, ON
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Sharma M, Duizer L. Characterizing the Dynamic Textural Properties of Hydrocolloids in Pureed Foods-A Comparison Between TDS and TCATA. Foods 2019; 8:E184. [PMID: 31151243 PMCID: PMC6617281 DOI: 10.3390/foods8060184] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 05/19/2019] [Accepted: 05/28/2019] [Indexed: 11/16/2022] Open
Abstract
Pureed foods, a compensatory diet for dysphagia, require the incorporation of hydrocolloids in order to be swallowed safely. The effect of hydrocolloid addition on textural dynamics of pureed foods has not yet been investigated. Starch and xanthan were added to levels that allowed products to meet the criteria of the International Dysphagia Diet Standardization Initiative. Nine pureed carrot matrices made with two concentrations of starch, xanthan, and their blends were characterized for textural evolution using two dynamic sensory techniques: Temporal Dominance of Sensations (TDS) and Temporal Check-All-That-Apply (TCATA). Each test, with four replications, was conducted with 16 panelists. Results indicate that purees were divided into two groups based on sensory responses--grainy and smooth were the primary differentiating attributes for these two groups. Grainy was associated with starch-added samples, while samples with xanthan (alone and in blends) were smooth and slippery. For both groups, thickness was perceived during the first half of processing, adhesiveness in the second half of oral processing, and mouthcoating was perceived toward the end of processing. A comparison of results from these tests showed that both TDS and TCATA gave similar information about texture dynamics and product differentiation of pureed foods.
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Affiliation(s)
- Madhu Sharma
- Department of Food Science, University of Guelph, Guelph, ON N1G 2W1, Canada.
| | - Lisa Duizer
- Department of Food Science, University of Guelph, Guelph, ON N1G 2W1, Canada.
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Okkels SL, Dybdal DR, Beck AM, Bügel S, Klausen TW, Olsen A. An investigation of main meal preferences in nursing home residents. J SENS STUD 2019. [DOI: 10.1111/joss.12504] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Signe L. Okkels
- Dietetic and Nutritional Research UnitHerlev and Gentofte University Hospital Gentofte Denmark
- Department of Nutrition, Exercise and Sports, Faculty of ScienceUniversity of Copenhagen Frederiksberg C. Denmark
| | - Ditte R. Dybdal
- Dietetic and Nutritional Research UnitHerlev and Gentofte University Hospital Gentofte Denmark
| | - Anne M. Beck
- Dietetic and Nutritional Research UnitHerlev and Gentofte University Hospital Gentofte Denmark
- Faculty of HealthInstitute of Nutrition and Nursing, University College Copenhagen Copenhagen Denmark
| | - Susanne Bügel
- Department of Nutrition, Exercise and Sports, Faculty of ScienceUniversity of Copenhagen Frederiksberg C. Denmark
| | - Tobias W. Klausen
- Department of HematologyHerlev and Gentofte University Hospital Herlev Denmark
| | - Annemarie Olsen
- Department of Food Science, Faculty of ScienceUniversity of Copenhagen Frederiksberg C. Denmark
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Miles A, Liang V, Sekula J, Broadmore S, Owen P, Braakhuis AJ. Texture‐modified diets in aged care facilities: Nutrition, swallow safety and mealtime experience. Australas J Ageing 2019; 39:31-39. [DOI: 10.1111/ajag.12640] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 01/30/2019] [Accepted: 02/17/2019] [Indexed: 12/26/2022]
Affiliation(s)
- Anna Miles
- Faculty of ScienceSpeech ScienceThe University of Auckland Auckland New Zealand
| | - Victoria Liang
- Faculty of Medical and Health SciencesDiscipline of NutritionThe University of Auckland Auckland New Zealand
| | - Julia Sekula
- Faculty of Medical and Health SciencesDiscipline of NutritionThe University of Auckland Auckland New Zealand
| | | | - Paul Owen
- Auckland District Health Board Auckland New Zealand
| | - Andrea J. Braakhuis
- Faculty of Medical and Health SciencesDiscipline of NutritionThe University of Auckland Auckland New Zealand
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Reyes-Torres CA, Castillo-Martínez L, Reyes-Guerrero R, Ramos-Vázquez AG, Zavala-Solares M, Cassis-Nosthas L, Serralde-Zúñiga AE. Design and implementation of modified-texture diet in older adults with oropharyngeal dysphagia: a randomized controlled trial. Eur J Clin Nutr 2019; 73:989-996. [DOI: 10.1038/s41430-019-0389-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 11/21/2018] [Accepted: 12/28/2018] [Indexed: 12/19/2022]
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45
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Oral processing in elderly: understanding eating capability to drive future food texture modifications. Proc Nutr Soc 2018; 78:329-339. [DOI: 10.1017/s0029665118002768] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Ageing population suffer from increased risk of malnutrition which is a major determinant of accelerated loss of autonomy, adverse health outcomes and substantial health-care costs. Malnutrition is largely attributed to reduced nutrient intake which may be associated with several endogenous factors, such as decline of muscle mass, oral functions and coordination that can make the eating process difficult. From an exogenous viewpoint, nutritionally dense foods with limited innovations in food texture have been traditionally offered to elderly population that negatively affected pleasure of eating and ultimately, nutrient intake. Recent research has recognised that older adults within the same age group are not homogenous in terms of their preferences, nutritional needs, capabilities and impediments in skill-sets. Hence, a new term eating capability (EC) has been coined to describe various quantifiable endogenous factors in the well-coordinated eating process that may permit characterisation of the capabilities of elderly individuals in food handling and oral processing. This review covers current knowledge on EC focusing on parameters, such as hand and oro-facial muscle forces. Although limited in literature, EC score measured using a comprehensive toolkit has shown promise to predict eating difficulty perception and oral processing behaviour. Further systematic studies are required to explore relationships between individual/multiple constituents of EC and oral comfort. Such knowledge base is needed to underpin the creation of next generation personalised texture-modified foods for elderly population using sophisticated technologies, such as 3D printing to enhance eating pleasure, increase nutrient intake that will ultimately contribute to tackling malnutrition.
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Rodríguez-Marin ND, Figueroa-Chaverra AA, Sánchez-Jiménez MA, Orozco-Orrego V, Bohórquez-Orozco C, García OR, Pinzón MI, Sánchez LT, Villa CC. Physicochemical and rheological properties of purees based on Mafafa (Xanthosoma robustum) and quinoa (Chenopodium quinoa Willd.) with the addition of cryoprotectants. J Texture Stud 2018; 50:148-154. [PMID: 30548624 DOI: 10.1111/jtxs.12383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 12/04/2018] [Accepted: 12/06/2018] [Indexed: 11/30/2022]
Abstract
Growing interest in processed frozen products with similar characteristics to natural products has generated the study of new products in the food industry field. The characteristics of each matrix, the process of elaboration, composition, and structure of the additives and the interactions amongst these modify the food's texture, structure, physical and sensory properties and, hence, interfere directly with consumer acceptance. This research studied the effect of adding cryoprotectors during frozen storage on the rheological, physicochemical, structural, and microbiological properties in a Mafafa-quinoa-olive oil puree. To carry out the study, the rheological properties were determined through dynamic oscillatory tests and in steady state; likewise, the physicochemical properties (humidity, color, pH, and syneresis) were analyzed. Regarding physicochemical properties, the humidity content in the purees formulated varied between 57 and 74%, without important variation (p > .05) with respect to the formulation, however, in the storage during the freezing/thawing process, this parameter diminished in greater proportion in those purees containing carrageenan as cryoconservant. Both the addition of cryoconservants and the storage time affected significantly (p < .05) the puree's syneresis, with the degree of exudation being lower in the formulation containing xanthan gum at 1% w/w. During the freezing/thawing process, decreased apparent viscosity was noted. Additionally, the analysis of the viscoelastic properties of the purees evidences that already described, given that a significant effect (p < .05) was observed of the formulation of purees in the elastic component G', in contrast with a notable decrease in the viscous component G″.
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Affiliation(s)
- Nelson D Rodríguez-Marin
- Programa de Ingeniería de Alimentos, Facultad de Ciencias Agroindustriales, Universidad del Quindío, Armenia, Quindío, Colombia
| | - Aylin A Figueroa-Chaverra
- Programa de Ingeniería de Alimentos, Facultad de Ciencias Agroindustriales, Universidad del Quindío, Armenia, Quindío, Colombia
| | - Mayerly A Sánchez-Jiménez
- Programa de Ingeniería de Alimentos, Facultad de Ciencias Agroindustriales, Universidad del Quindío, Armenia, Quindío, Colombia
| | - Vanessa Orozco-Orrego
- Programa de Ingeniería de Alimentos, Facultad de Ciencias Agroindustriales, Universidad del Quindío, Armenia, Quindío, Colombia
| | - Constanza Bohórquez-Orozco
- Programa de Tecnología en Procesos Agroindustriales, Facultad de Ciencias Agroindustriales, Universidad del Quindío, Armenia, Quindío, Colombia
| | - Omar R García
- Programa de Ingeniería de Alimentos, Facultad de Ciencias Agroindustriales, Universidad del Quindío, Armenia, Quindío, Colombia
| | - Magda I Pinzón
- Programa de Ingeniería de Alimentos, Facultad de Ciencias Agroindustriales, Universidad del Quindío, Armenia, Quindío, Colombia
| | - Leidy T Sánchez
- Programa de Ingeniería de Alimentos, Facultad de Ciencias Agroindustriales, Universidad del Quindío, Armenia, Quindío, Colombia
| | - Cristian C Villa
- Programa de Química, Facultad de Ciencias Básicas y Tecnologías, Universidad del Quindío, Armenia, Quindío, Colombia
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Glass TJ, Twadell SL, Valmadrid LC, Connor NP. Early impacts of modified food consistency on oromotor outcomes in mouse models of Down syndrome. Physiol Behav 2018; 199:273-281. [PMID: 30496741 DOI: 10.1016/j.physbeh.2018.11.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 10/16/2018] [Accepted: 11/25/2018] [Indexed: 12/12/2022]
Abstract
Down syndrome (DS) in humans is associated with differences of the central nervous system and oromotor development. DS also increases risks for pediatric feeding challenges, which sometimes involve the use of altered food consistencies. Therefore, experimental food consistency paradigms are of interest to oromotor investigations in mouse models of Down syndrome (DS). The present work reports impacts of an altered food consistency paradigm on the Ts65Dn and Dp(16)1Yey mouse models of DS, and sibling control mice. At weaning, Ts65Dn, Dp(16)1Yey and respective controls were assigned to receive either a hard food or a soft food (eight experimental groups, n = 8-10 per group). Two weeks later, mice were assessed for mastication speeds and then euthanized for muscle analysis. Soft food conditions were associated with significantly smaller weight gain (p = .003), significantly less volitional water intake through licking (p = .0001), and significant reductions in size of anterior digastric myofibers positive for myosin heavy chain isoform (MyHC) 2b (p = .049). Genotype was associated with significant differences in weight gain (p = .004), significant differences in mastication rate (p = .001), significant differences in a measure of anterior digastric muscle size (p = .03), and significant reductions in size of anterior digastric myofibers positive for MyHC 2a (p = .04). In multiple measures, the Ts65Dn model of DS was more affected than other genotype groups. Findings indicate a soft food consistency condition in mice is associated with significant reductions in weight gain and oromotor activity, and may impact digastric muscle. This suggests extended periods of food consistency modifications may have impacts that extend beyond their immediate roles in facilitating deglutition.
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Affiliation(s)
- Tiffany J Glass
- Department of Surgery, University of Wisconsin, Madison, WI, USA.
| | - Sara L Twadell
- Department of Surgery, University of Wisconsin, Madison, WI, USA
| | - Luke C Valmadrid
- Department of Surgery, University of Wisconsin, Madison, WI, USA
| | - Nadine P Connor
- Department of Surgery, University of Wisconsin, Madison, WI, USA; Department of Communication Sciences and Disorders, University of Wisconsin, Madison, WI, USA
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Garcia JM, Chambers E, Russell EG, Katt A. Modifying Food Textures: Practices and Beliefs of Staff Involved in Nutrition Care. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2018; 27:1458-1473. [PMID: 30267081 DOI: 10.1044/2018_ajslp-18-0021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 06/01/2018] [Indexed: 06/08/2023]
Abstract
PURPOSE Modifying food texture is an important part of dysphagia management, yet less is known about the day-to-day practices that might impact the nutritional well-being of patients. This study surveyed staff involved in the service delivery of texture-modified foods with the objectives to gain information about roles and responsibilities, instruction and knowledge about modifying foods, and beliefs about the use of texture-modified foods in nutrition care. METHOD We created a 21-item survey about texture-modified foods. Recruitment efforts focused on both professional and frontline staff involved in service delivery. Practice groups and organizations provided the means of recruiting professionals from different disciplines. Because frontline staff (e.g., certified nursing assistants, cooks) do not have similar membership groups, we recruited them through direct contacts with health care agencies. RESULTS A total of 175 individuals completed the survey. Respondents included 107 professionals (primarily certified dietary managers, registered dietitians, speech-language pathologists) and 68 frontline staff (mostly certified nursing assistants/home health aides). Although the frontline and professional staff showed generally similar patterns of opinions and beliefs about modified food textures, differences emerged in reported experiences, roles, and responsibilities in service delivery. CONCLUSIONS Survey respondents conveyed generally positive attitudes and opinions about the use of texture-modified foods, and respondents perceived them to be easy to execute and beneficial to the nutritional well-being of patients. Survey findings clearly highlight the contributions of frontline staff in the service delivery of modified food textures. Consideration must be given to continued reliance on informal, limited instruction about texture-modified foods and possible implications for safe nutrition care. Both professional and frontline staff convey a willingness to customize or alter food textures and the belief that patients should be able to choose the level of texture modification that they want to eat.
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Affiliation(s)
- Jane Mertz Garcia
- Communication Sciences & Disorders, School of Family Studies & Human Services, Kansas State University, Manhattan
| | - Edgar Chambers
- Center for Sensory Analysis and Consumer Behavior, Food, Nutrition, Dietetics & Health, Kansas State University, Manhattan
| | - Emily Groves Russell
- Communication Sciences & Disorders, School of Family Studies & Human Services, Kansas State University, Manhattan
| | - Abilene Katt
- Communication Sciences & Disorders, School of Family Studies & Human Services, Kansas State University, Manhattan
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49
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O'Keeffe ST. Use of modified diets to prevent aspiration in oropharyngeal dysphagia: is current practice justified? BMC Geriatr 2018; 18:167. [PMID: 30029632 PMCID: PMC6053717 DOI: 10.1186/s12877-018-0839-7] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 06/19/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Although modifying diets, by thickening liquids and modifying the texture of foods, to reduce the risk of aspiration has become central to the current management of dysphagia, the effectiveness of this intervention has been questioned. This narrative review examines, and discusses possible reasons for, the apparent discrepancy between the widespread use of modified diets in current clinical practice and the limited evidence base regarding the benefits and risks of this approach. DISCUSSION There is no good evidence to date that thickening liquids reduces pneumonia in dysphagia and this intervention may be associated with reduced fluid intake. Texture-modified foods may contribute to undernutrition in those with dysphagia. Modified diets worsen the quality of life of those with dysphagia, and non-compliance is common. There is substantial variability in terminology and standards for modified diets, in the recommendations of individual therapists, and in the consistency of diets prepared by healthcare staff for consumption. Although use of modified diets might appear to have a rational pathophysiological basis in dysphagia, the relationship between aspiration and pneumonia is not clear-cut. Clinical experience may be a more important determinant of everyday practice than research evidence and patient preferences. There are situations in the management of dysphagia where common sense and the necessity of intervention will clearly outweigh any lack of evidence or when application of evidence-based principles can enable good decision making despite the absence of robust evidence. Nevertheless, there is a significant discrepancy between the paucity of the evidence base supporting use of modified diets and the beliefs and practices of practitioners. CONCLUSION The disconnect between the limited evidence base and the widespread use of modified diets suggests the need for more careful consideration as to when modified diets might be recommended to patients. Patients (or their representatives) have a choice whether or not to accept a modified diet and must receive adequate information, about the potential risks and impact on quality of life as well as the possible benefits, to make that choice. There is an urgent need for better quality evidence regarding this intervention.
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Affiliation(s)
- Shaun T O'Keeffe
- Department of Geriatric Medicine, Galway University Hospitals, Galway, Ireland.
- Unit 4, Merlin Park University Hospital, Galway, Ireland.
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50
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Icht M, Bergerzon-Bitton O, Kachal J, Goldsmith R, Herzberg O, Endevelt R. Texture-modified foods and thickened fluids used in dysphagia: Israeli standardised terminology and definitions. J Hum Nutr Diet 2018; 31:742-746. [PMID: 29992661 DOI: 10.1111/jhn.12581] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Texture-modified foods and thickened fluids are used as a strategy that aims to compensate for dysphagia and improve the safety and efficiency of swallowing. Currently, in Israel, there are no standardised terminologies and definitions for texture-modified diets. The inconsistent terminology adversely affects patient safety and the efficiency of communication between staff members both within and between health institutions. This present study describes a project of the Israeli Ministry of Health in which the labels and definitions of prevalent foods and fluids used in health institutions are mapped to develop a consensus on national standards. METHODS A multidisciplinary committee of speech-language pathologists (SLPs) and registered dietitians (RDs) was appointed. A questionnaire was developed to identify the labels of texture-modified foods and fluids used in the Israeli healthcare system. The questionnaire included questions on knowledge, attitudes and barriers related to the need for a consistent national terminology for texture-modified diets. Questionnaires were sent to 120 institutions. The project was conducted between September 2016 and December 2017. RESULTS Twenty-six SLPs and 42 RDs responded. The answers revealed that there were 50 labels in use for texture-modified foods. When asked to describe the texture of a particular food item, up to 17 different labels were used. There was broad support for a standardised terminology. CONCLUSIONS The results of the present study confirm the lack of national standards in clinical practice and the need for a consistent terminology. A consensus was achieved between the committee members and the committee adopted the International Dysphagia Diet Standardization Initiative (IDDSI) recommendations and adapted the terminology to Hebrew.
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Affiliation(s)
- M Icht
- Department of Communication Disorders, Ariel University, Ariel, Israel
| | - O Bergerzon-Bitton
- Department of Communication Disorders, Ariel University, Ariel, Israel.,The National Administration of Communication Disorders, Ministry of Health, Tel Hashomer, Israel
| | - J Kachal
- Nutrition Division, Ministry of Health, Jerusalem, Israel
| | - R Goldsmith
- Nutrition Division, Ministry of Health, Jerusalem, Israel
| | - O Herzberg
- The National Administration of Communication Disorders, Ministry of Health, Tel Hashomer, Israel
| | - R Endevelt
- Nutrition Division, Ministry of Health, Jerusalem, Israel.,School of Public Health, University of Haifa, Haifa, Israel
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