Clinical Practice Guidelines for Oropharyngeal Dysphagia / 대한연하장애학회지

Objective@#Dysphagia is a common clinical condition characterized by difficulty in swallowing. It is sub-classified into oropharyngeal dysphagia, which refers to problems in the mouth and pharynx, and esophageal dysphagia, which refers to problems in the esophageal body and esophagogastric junction. Dysphagia can have a significant negative impact one’s physical health and quality of life as its severity increases. Therefore, proper assessment and management of dysphagia are critical for improving swallowing function and preventing complications. Thus a guideline was developed to provide evidence-based recommendations for assessment and management in patients with dysphagia. @*Methods@#Nineteen key questions on dysphagia were developed. These questions dealt with various aspects of problems related to dysphagia, including assessment, management, and complications. A literature search for relevant articles was conducted using Pubmed, Embase, the Cochrane Library, and one domestic database of KoreaMed, until April 2021. The level of evidence and recommendation grade were established according to the Grading of Recommendation Assessment, Development and Evaluation methodology. @*Results@#Early screening and assessment of videofluoroscopic swallowing were recommended for assessing the presence of dysphagia. Therapeutic methods, such as tongue and pharyngeal muscle strengthening exercises and neuromuscular electrical stimulation with swallowing therapy, were effective in improving swallowing function and quality of life in patients with dysphagia. Nutritional intervention and an oral care program were also recommended. @*Conclusion@#This guideline presents recommendations for the assessment and management of patients with oropharyngeal dysphagia, including rehabilitative strategies.

Meal Service and Nutritional Management for Dysphagia: A Nationwide Hospital Survey / 대한연하장애학회지

Objective@#This study enrolls diverse hospitals and analyzes the differences in meal provision and nutrition management services for patients with dysphagia. @*Methods@#A nationwide survey was conducted by mail and mobile for 850 medical institutions, and data were collected from 217 hospitals. We analyzed the status of the dysphagia diet and nutrition management by considering the type of hospital. @*Results@#Among the hospitals surveyed, 167 (77%) provided texture-modified diets for dysphagia patients. The status of providing dysphagia diets and nutrition management for dysphagia differed depending on the institution. In particular, nutrition services for dysphagia patients in long-term care hospitals were poor. Difficulties in providing a dysphagia diet included the complexity of the cooking process, difficulty maintaining constant viscosity, difficulty in hygiene management, and low meal bills. Using commercial thickeners in cooking accounted for 72.5%, and only 41.9% of hospitals provided a commercial thickener with meals. Compared to the regular diet, the additional food cost to provide a single dysphagia diet meal was estimated to be 500-1,000 won. Based on a 5-point scale, we determined that the average scores for the importance and performance of nutrition management in patients with dysphagia were 4.29 and 3.19 points, respectively. Regardless of the type of hospital, performances of all the steps in the nutrition care process were significantly lower than their importance. @*Conclusion@#Several difficulties are encountered in meal provision and nutrition management for patients with dysphagia, including the burden of expenses and human resources. Thus, the medical fees for a dysphagia diet need to be reasonably increased. Moreover, national health insurance should additionally cover nutrition education for dysphagia patients.

Classification of Texture-Modified Korean Soups with a Thickener under IDDSI Criteria / 대한연하장애학회지

Objective@#This study aimed to develop texture-modified soups and classify them based on the International Dysphagia Diet Standardization (IDDSI) and National Dysphagia Diet (NDD) criteria. @*Methods@#Ten soups were selected, and a xanthan gum-based thickener was added to adjust their viscosity. Flow tests with a 10 ml syringe and viscosity measurements using a rheometer were carried out according to the IDDSI and NDD criteria. @*Results@#The addition of 1 g of thickener to the selected commercial soups resulted in different viscosity levels depending on the soup type. Under the IDDSI framework, seven soups (R SMG, BMG, KHG, SLT, B SUG, BGG, DGT) were categorized as level 1, two soups (B MYG, ADG) as level 2, and one soup (R DJJ) as level 3. As per NDD guidelines, seven soups (R SMG, BMG, KHG, SLT, B SUG, BGG, DGT) were classified as Nectar-like and three soups (R DJJ, B MYG, ADG) as Honey-like. However, the addition of 2 g of thickener decreased the fluidity of the soups, with two soups (R SMG, SLT) being classified as level 2 and eight soups (R BMG, DJJ, KHG, B SUG, MYG, ADG, BGG, DGT) as level 3 under the IDDSI criteria. Meanwhile, all soups were classified as Honey-like under the NDD criteria. @*Conclusion@#The viscosity was different due to the varying compositions of guk/tang/jjigae, the concentration of the thickener, and time. Swallowing standardsands and other guidelines applicable specifically to Korean-food for dysphagia patients need to be developed in a further study.

Future Perspective of the Elderly Food in a Super-Aged Society / 대한연하장애학회지

Korea is a country whose society has been aging rapidly. The population aged 65 years is expected to be 20% in 2025 and 42.5% by 2065, which is the definition of a super-aged society. A super-aged society is expected to experience major changes, such as family composition, digital living, and community care. As the population ages further, their degree of independence will be determined by modifying their living environment, eating quality, and habits carrying socio-economic costs. In this report, the domestic and international standards for the elderly food, the guidelines for product development in food companies, nutritional management in elderly facilities, and practical meal management procedures are presented. Considering the physical, mental, and economic capabilities of the aged population, it will be necessary to establish a multifaceted approach that allows them to enjoy the eating pleasure. Desirable meals, appropriate medical services, and social relationships are the key factors that can slow down the transition to long-term care and promote an independent life. In this way, the demands for convenience foods (easy to cook, ready to eat, and fresh cuts) and the customized meal delivery services will increase gradually.To achieve this, accurate market analysis and planning of the target products is a priority that should be supported by active development and commercialization from companies. Furthermore, shared kitchens in local communities that provide activating cooking and eating programs will help the elderly solve the problems with their meals while forming social networks.

Designed Meal Development and Sensory Evaluation for Dysphagia Patients / 대한연하장애학회지

Objective@#Thickening agents used in dysphagia diets to adjust the viscosity of foods adversely affect the inherent food flavors and colors. Chopped and ground foods have unfamiliar flavors, colors and textures, causing a loss of appetite. Therefore, this study aimed to develop a savory and easy-to-make dysphagia diet without changing the appearance and taste of foods, and evaluate the suitability of the newly developed diet for patients with dysphagia. @*Methods@#Twenty participants aged 55-85 years (8 patients with dysphagia and 12 healthy elderly) were recruited.The diet consisted of fried rice, hamburger steak, and soybean paste soup, where the solid foods were categorized as International Dysphagia Diet Standardisation Initiative (IDDSI) Level 5 (Minced and Moist), and the liquid foods were categorized as IDDSI Level 2 (Mildly Thick). To develop the dysphagia diet, textural modifications to the ingredients and viscosity adjustments were applied. A sensory evaluation was conducted by the panel to measure the extent of chewing, swallowing, adhesiveness, choking, and overall flavor and preference. @*Results@#No significant differences in textural properties, such as chewing, swallowing, adhesiveness and choking, were observed between the control and patient groups, but the flavor and preferences in the patient group were statistically significant. @*Conclusion@#The modified and newly designed dysphagia foods positively impacted easy swallowing for patients with dysphagia. Therefore, customized dysphagia foods should be considered in terms of flavor-enhancement to provide tailored diets for patients with dysphagia.

Smartphone Usage Influences the Eating Habits of Middle School Students

This study was a correlation study to analyze the effects of smartphone usage time on food choice perceptions and behavior in middle school students in Seoul areas. The subjects to be surveyed were middle school students attending junior high schools in Mapo-gu, Seoul. A total of 133, 102, and 102 students were in the first second, and third grades, respectively. The usage time of smartphones was the weekday and weekend usage time except for the call function. Food choice perception and its behavior as dietary habits were constructed referring to previous research and food balance wheels data for the correct dietary habits of the Ministry of Health & Welfare and Korean Nutrition Society. The food choice behavior was categorized into non-recommended food and recommended food. The results are summarized as follows. First, the longer the time spent on smartphones, the less favorable the perception of correct food choices. Second, the higher the dependence on smartphones, the less favorable the perception of correct food choices. Third, the correct perception of food choices has been shown to reduce food choices, known as non-recommended foods. In addition, proper perception of food choices has been shown to increase the choice of recommended foods. In conclusion, the usage time and reliance of smartphones of middle school students was found to affect the food choice behavior by lowering the perception of correct food choices. This research is expected to form the basis for the development of programs and educational materials that can be of assistance to adolescents who are experiencing difficulties.

Adaptability and Preference to Korean Food with Foreigners Who Reside in Seoul, Korea / 대한지역사회영양학회지

The purpose of this study was to investigate the Korea-resident foreigners's adaptability and preference to Korean foods. The survey was carried out among 144 foreigners living in Seoul, Korea (male 57, female 87; from the East 109, from the West 35). Based on the first impression of Korean food, 'spicy', 'strong taste of seasoning', 'salty' were most common. About 90 percent of the foreigners adapted to Korean food in six months. It took more time to adapt to Korean food for Western people, compared to people from the East. Factors that influenced their adaption to Korean food were shown to be 'efforts by myself' and 'from friends'. Foreigners posited positive attitude toward Korean food according to their answers like 'nutritionally great food' and 'food with interesting ways of eating'. Westerners appeared to be more satisfied with Korean food. 'Too strong seasoning taste' and 'too sweet' were pointed out for further improvements. Beef Bulgogi, (Korean) fruit, Beef Ribs, Pork Ribs, and Grilled Pork Belly in order were foreigners' favorite foods, but Soju, Korean Sausage, Sliced Rice Cake Soup, Radish Kimchi and Vegetable Side Dishes were not. Taken together, the adaptability and preference to Korean foods to foreigners were different according to the gender and cultural background. Target marketing strategy of Korean Foods should be considered for foreign customers.

Survey on Present Use and Future Demand for the Convenience Food in the Elderly Group / 대한지역사회영양학회지

This study is to research the use and the demand of the elderly generation that pursue economic ability and active lifestyle. The composition of the meals were "homemade meals" 65.3%, "homemade & convenience meals" 26.7% overall. For the "never miss a meal" category, 70~74 years old was 48.3%, over 80 years old was 60.0%. The elderly under 70 years old showed a high frequency in the use of alternative meals (p < 0.05) and the elderly with higher education used the alternative meals more frequently (p < 0.01). The rice-cakes, bread, tuna cans, Korean side-dishes, beverages, meat, cup-noodles and seafood as alternative meals are in the order of most frequency. Also, 96.0%, 59.0% and 46.5% of the elderly had experience in using "Ready to eat (RTE)", "Ready to heat (RTH)" and "Ready to cook (RTC)". The oldest group surveyed, the elderly at the age of 80 years old and above showed lower preference for "completely cooked state" but showed highest results in the "half-cooked state". This shows the difference between people's perception and the behavior that showed high frequency of 96.0% in the experience with "RTE". This can be inferred that the elderly needs the development of convenience food that is moderately packaged according to the newer lifestyle where the elderly live independent from their children. Moreover, there is a higher demand in the healthy convenience food, which means that there is a need for development in the quality of the convenience food that will allow more faith in convenience food by the elderly.

A Comparison Study on Perception of Body Image and Dietary Habits of High School Students between Urban and Rural Areas / 대한지역사회영양학회지

The objective of this research was to study the differences between urban and rural areas high school students in body image and dietary habits. The number of subjects in Seoul and Kyungkido were 902. Based on self-reported height and weight, there was no significant difference between the urban and rural students. However, the rate of obesity was significantly higher in males, whereas the rate of underweight was significantly higher in females, especially for urban females (p < 0.05). Their ideal body image ratio as skinny or slender-type was 91.6% (urban) and 95.7% (rural) for male category while 100% (urban) and 99.4% (rural) for females. Urban females had a strong preference for a skinny body (p < 0.05). Rural students were more highly interested in weight control than urban students were, but they appeared not to care their health. In addition, they had significantly lower levels of weight control knowledge and dietary attitude score (p < 0.001). Subjective assessment of body weight appeared to be more important in terms of body satisfaction, weight control knowledge and dietary attitude than actual measurement of body mass index. Significant test revealed that weight control knowledge was related to dietary attitude (p < 0.01). (p < 0.01).