Methodology for design of suitable dishes for dysphagic people

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

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

Modifying Puree Meals in Residential Aged Care Facilities: A Multi-Centre Feasibility and Acceptability Study

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.

Exploring Tools for Designing Dysphagia-Friendly Foods: A Review

Dysphagia is a medical condition that affects normal swallowing. To prevent the risk of aspiration or choking, thickened fluids and texture-modified foods have been used for dysphagia management with the goal of slowing down the flow of liquids and protecting the airway. This article summarizes the available information about the rheological and textural parameters, the characterization of the most-used thickeners and the application of alternative texture modification technologies that are crucial to developing safe dishes for people who suffer from swallowing difficulties. Regarding rheological and textural measurements, fundamental and empirical methods are described.

Dishes Adapted to Dysphagia: Sensory Characteristics and Their Relationship to Hedonic Acceptance

Dishes whose texture has been modified for dysphagia undergo changes in other sensory characteristics as well. Therefore, it is necessary to identify these characteristics in adapted dishes and their relationship to hedonic acceptance. In the present work, the sensory characteristics of five dishes adapted to dysphagia associated with cerebral palsy were investigated using the check-all-that-apply method. A hedonic evaluation with a panel of non-dysphagic judges was performed to relate the degree of acceptance with the sensory characteristics of the adapted dishes. The identification of the original non-adapted dish as well as the relationship between the hedonic evaluation by non-dysphagic judges and dysphagic judges were explored. The main attributes of the dishes adapted to dysphagia were "homogeneity" and "easy-to-swallow". Attributes that increased the hedonic evaluation were "flavorful", "flavor of the original dish", "soft texture", "easy-to-swallow", and "odor of the original dish". The attributes that decreased the hedonic evaluation were "thick mash" and "bland". The fish dish was the only one correctly identified more than 62.5% of the time. The adapted dishes received scores above 4.7 out of 9.0 in the hedonic evaluation. The most accepted dishes were the chicken stew and the chickpea stew. Except for the pasta dish, the test yielded similar results to those obtained with dysphagic judges. The texture-modified dishes were correctly characterized and accepted. This study shows that all the sensory characteristics of the adapted dishes are crucial for acceptance and identification.