Textural characteristics of safe dishes for dysphagic patients: a multivariate analysis approach

Effect of ultrasound-assisted treatment on meat tenderization for elderly individuals

This study evaluated the effect of ultrasound using papain and sodium bicarbonate (SC) on meat tenderness to achieve the desired texture for elderly individuals. Meats were immersed in distilled water (DW) or papain (PI), ultrasonically treated with papain (UPI), or ultrasonically treated with papain and SC (UPIS). Response surface methodology was used to optimize the processing conditions with the lowest hardness, and the optimal conditions were determined as follows: 400 U/mL papain, ultrasonic for 30 min, and 4% SC. Hardness, color, and myofibrillar fragmentation index (MFI) were investigated. The hardness followed the order of DW (22.50 N), PI (18.62 N), UPI (12.08 N), and UPIS (7.16 N), and UPIS showed the highest MFI. Papain and SC affected the color of the meat. Overall, ultrasound-assisted treatment using papain and SC resulted in hardness levels of less than 7.8 N, which can be easily compressed by low tongue pressure.

Studying process variables to obtain undisturbed shaped soft meat for people with poor oral health

This study evaluated injection (I) and vacuum impregnation (VI) as the best methods to apply papain, and other important processing conditions (batch, aging and cooking conditions), to obtain soft meat (suitable for people with poor oral health) without disturbing its original shape. Two aging times were evaluated and four cooking conditions by immersion in soup. Meat samples were injected or vacuum-impregned (0.85 kPa) with a papain solution (5% w/v). After cooking, they were analyzed by the compression test, and by image and sensory analyses. The results indicated that by using both methods to apply the enzyme, the obtained meat was suitable for people with poor oral health, even if VI was the better method because it minimized the factors batch, aging and cooking condition. Therefore, the best meat processing method to obtain panelists' highest softness values and the best appreciation was employing aged meat pretreated by VI and cooked at 65 °C for 10 min.

Characterization of Dysphagia Thickeners Using Texture Analysis-What Information Can Be Useful?

Besides shear viscosity, other texture parameters (adhesiveness or cohesiveness) might be relevant for safe swallowing in people suffering from oropharyngeal dysphagia. Shear viscosity is assessed through protocols developed using a viscometer or a rheometer. In contrast, protocols and instruments (capillary break-up rheometer) to assess adhesiveness and cohesiveness are less common and much less developed. Other equipment such as texture analyzers can provide useful information on food properties. Here, we aimed to explore different texture analyzer settings (type of test, probe, and protocol) to characterize four commercial dysphagia thickeners at the shear viscosity levels recommended by manufacturers. Among the tests used (extrusion or penetration) with the different probes (disc, cone and shape holder, sphere, or cylinder), cone extrusion provided information about adhesivity, disc extrusion about sample cohesiveness, and sphere about penetration and sample elasticity. The test speeds used influenced the results, but only one speed is needed as the different speeds provided the same fluid information; for easiness, it is proposed to use 1 mm/s. Comparing the texture analyzer results with viscosity values obtained at different shears, the texture analyzer parameters reflected information that differ from shear viscosity. This information could be relevant for the therapeutic effect of thickening products and food characterization.

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.

Assessment of tomato-based thick fluid diet for patients with dysphagia using a simple and cheap test

Swallowing difficulty, also known as dysphagia, is a health condition that can be managed by different approaches, such as changing the viscosity of fluid foods with thickener agents. Tomato-based beverages such as "gazpacho" and "salmorejo" are common foods much appreciated by the populations that adopt a Mediterranean diet, mainly in Spain. These beverages usually present a low viscosity, challenging to include in diets for dysphagia patients. Thus, this work aimed at evaluating the flow properties of tomato-based beverages with or without the addition of thickener agents (based on maltodextrin or gum) using a simple and cheap method proposed by the International Dysphagia Diet Standardization Initiative (IDDSI) to verify the suitability of using those products in a diet of patients with dysphagia. The study also evaluated the differences in using BD-type syringes on the test. Results indicated that the type of thickener significantly (p < .05) affects the samples' flow properties, enhancing their rheological behavior. The type of syringe can also affect the results, as they present different Luer slip tips. The results revealed that tomato-based beverages may have their properties improved simply by using low amounts of thickener agents (1.2-3.0 g 200 ml^-1 ) and that the IDDSI test can be an alternative, cheap and straightforward method for evaluating these types of foods in hospital environments. Including tomato-based beverages in the diet of patients with dysphagia may present many benefits as these products have a rich nutritional composition (fiber) in addition to biocompounds such as lycopene and phenolic compounds.

Malnutrition in Hospitalized Adults With Cerebral Palsy

BACKGROUND

Malnutrition among hospitalized adults with cerebral palsy (CP) has not been extensively explored. We sought to identify impacts of malnutrition on clinical and resource outcomes among hospitalized adults with CP.

METHODS

This retrospective cohort study surveyed years 2016 and 2017 from the National Inpatient Sample database. Regression models evaluated mortality and resource utilization.

RESULTS

154,219 adults with CP were hospitalized. Among them, 21,064/154,219 (13.5%) had malnutrition. Patients with and without malnutrition were similar in age (mean age ± SEM, 45.1 ± 0.30 vs 45.2 ± 0.18 years; P = .70). Patients with malnutrition were more likely male (12,175/21,604 [57.8%] vs 72,929/133,155 [54.8%], P < .01) and had higher comorbidity scores (Charlson comorbidity score ≥ 3; 2,464/21,064 [11.7%] vs 14,380/133,155 [10.8%]; P = .01). Mortality rates were higher among patients with malnutrition (905/21,064 [4.3%] vs 2,796/21,064 [2.1%], P < .01), and they had higher odds for mortality (adjusted odds ratio [aOR] = 2.1; CI, 1.7-2.5; P < .01). Those with malnutrition were less likely discharged home (aOR = 0.52; CI, 0.48-0.56; P < .01). Hospital charges were higher (adjusted mean difference [aMD] = +$42,540; CI, $36,934-48,146; P < .01) and length of stay longer (aMD = +4.3 days; CI, 3.9-4.7; P < .01) among patients with malnutrition.

CONCLUSION

Malnutrition in hospitalized patients with CP is associated with increased mortality and hospital resource utilization. Flagging these patients as being "high risk" when they are hospitalized may result in heightened attentiveness about clinical outcomes in this vulnerable population.