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

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

Introduction

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

Methods

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

Results

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

Discussion

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

Desserts Enriched with a Nanoemulsion Loaded with Vitamin D3 and Omega-3 Fatty Acids for Older People

The food industry is challenged to develop nutritious and palatable foods that satisfy older people's needs. So, this work aimed to study the incorporation of nanoemulsions enriched with vitamin D3 and omega-3 fatty acids into two desserts (yogurt and fruit puree), characterizing their nutritional profile, viscosity, and color properties and evaluating their in vitro bioaccessibility and sensory response. The results showed that adding nanoemulsion modified the nutrition profile of desserts due to increasing lipids and calories. The desserts' physical properties were also affected, with a decrease in viscosity and a lightening of color. Regarding digestion, the enriched desserts presented a low release of free fatty acids (14.8 and 11.4%, respectively). However, fruit puree showed the highest vitamin D3 and omega-3 fatty acid in vitro bioaccessibility (48.9 and 70.9%, respectively). In addition, older consumers found this dessert more acceptable than yogurt due to the adequate intensity of its sensory attributes (aroma, flavor, sweetness, and consistency). Therefore, the fruit puree can be enriched with nanoemulsions loaded with vitamin D3 and omega-3 fatty acids to improve the bioaccessibility of lipid bioactive compounds and sensory performance, offering a health-enhancing option for older consumers.

Comparison of Check-All-That-Apply (CATA), Rate-All-That-Apply (RATA), Flash Profile, Free Listing, and Conventional Descriptive Analysis for the Sensory Profiling of Sweet Pumpkin Porridge

With significant progress in the use of rapid descriptive methodologies as alternatives to conventional descriptive analysis (DA), several consumer-based approaches have emerged. In this study, we compared four such methodologies-check-all-that-apply (CATA), rate-all-that-apply (RATA), flash profile (FP), and free listing (FL)-for sensory profiling to DA, using six sweet pumpkin porridges. The DA involved eight trained panelists, whereas each consumer evaluation engaged 60 untrained consumers. Overall, the performance of the consumer methods was similar to the DA, and it could effectively profile differences in consumer perceptions of sensory attributes, as evident from high regressor vector (RV) values (>0.89). RATA exhibited the highest similarity to the DA (Rv = 0.96), featuring quicker and less tedious processes compared with FP or FL. Novel combined methods for sensory characterization using the strengths of these four approaches are warranted. This includes leveraging the simplicity and versatility of CATA or RATA coupled with the capacity of FP or FL to capture spontaneous perceptions of products by consumers.

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

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

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.

Texture-Modified Food for Dysphagic Patients: A Comprehensive Review

Food texture is a major food quality parameter. The physicochemical properties of food changes when processed in households or industries, resulting in modified textures. A better understanding of these properties is important for the sensory and textural characteristics of foods that target consumers of all ages, from children to the elderly, especially when food product development is considered for dysphagia. Texture modifications in foods suitable for dysphagic patients will grow as the numbers of elderly citizens increase. Dysphagia management should ensure that texture-modified (TM) food is nutritious and easy to swallow. This review addresses how texture and rheology can be assessed in the food industry by placing particular emphasis on dysphagia. It also discusses how the structure of TM food depends not only on food ingredients, such as hydrocolloids, emulsifiers, and thickening and gelling agents, but also on the applied processing methods, including microencapsulation, microgels as delivery systems, and 3D printing. In addition, we address how to modify texture for individuals with dysphagia in all age groups, and highlight different strategies to develop appropriate food products for dysphagic patients.