One-bite-sized 3D printed finger foods, oriented to malnutrition, sarcopenia and frailty prevention in the older people.

BACKGROUND: In this study, innovative chocolate, citrus and mixture flavoured tofu-based nutritionally customised, dysphagia-oriented, comfortably consumed, appetising, one-bite-sized finger foods, oriented to malnutrition, sarcopenia and frailty prevention in older people were created by using 3D printing technology. Developed products were characterised by evaluating chemical composition and physical properties and performing sensory evaluation among geriatric clinic residents (≥60 years). RESULTS: The dietary composition of the developed foods was: 19-21 g (100 g)-1 protein, 6-8 g (100 g)-1 fibre, 8-9 g (100 g)-1 fat, 11 mg (100 g)-1 iron, 14 mg (100 g)-1 zinc, 70 µg (100 g)-1 selenium. Foods were also enriched with branched-chain amino acids, such as leucine, isoleucine and valine. All formulated foods were classified as level 6 by International Dysphagia Diet Standardisation Initiative classification. Chocolate-flavoured food was much harder (4914 g) with lower adhesiveness value (-33.6 g s), compared to the citrus- or mixture-flavoured foods. Older people evaluated all finger foods as very easy handled by hand, soft, easy to swallow, having a moderate flavour intensity and a weak afterfeel. Despite the fact that the chocolate food was evaluated as having the highest hardness and gumminess values by the instrumental method, this difference was not noticeable to the evaluators. However 7% of the participants said that 3D printed foods were sticky to dentures. CONCLUSION: The results suggest that it is possible to create nutrient-dense comfortably consumed 3D printed foods, oriented to malnutrition, sarcopenia and frailty prevention in older people. © 2024 Society of Chemical Industry.

Outcomes of Serum Food-Specific Immunoglobulin G 4 to Guide Elimination Diet in Patients With Eosinophilic Esophagitis.

INTRODUCTION: Eosinophilic esophagitis (EoE) is associated with atopy; however, recent studies have identified an association with food-specific immunoglobulin G 4 (FS-IgG 4 ) rather than immunoglobulin E antibodies. This study aimed to evaluate the role of serum FS-IgG 4 in guiding an elimination diet and its outcomes. METHODS: Patients with and without EoE were enrolled in a prospective, controlled, single tertiary center trial. Serum FS-IgG 4 titers, esophageal eosinophil counts, and dysphagia symptom questionnaire scores were assessed, and participants with elevated FS-IgG 4 (ImmunoCAP, cutoff of 10 mgA/L) commenced 6-week targeted elimination diet. Repeat serum FS-IgG 4 and endoscopic and histologic examination were performed at 6-week follow-up. RESULTS: Twenty-two patients with active EoE and 13 controls were recruited. Serum FS-IgG 4 to milk, wheat, soy, eggs, and nuts was significantly higher in EoE ( P = 0.0002, P = 0.002, P = 0.003, P = 0.012, and P < 0.001, respectively). Elevated serum FS-IgG 4 to 1 or more food groups (median 2) was identified in 21/22 (95.4%) patients with EoE; 20/21 underwent 6-week dietary elimination. Median reductions in dysphagia symptom questionnaire score and EoE endoscopic reference score after elimination were 8 ( P = 0.0007) and 1 ( P = 0.002), respectively. Nine (45%) patients had histological remission (<15 eosinophils per high-power field). Fall in median esophageal eosinophil count was not statistically significant (50 vs 23; P = 0.068). Serum FS-IgG 4 did not decline by 6-week follow-up. DISCUSSION: Serum FS-IgG 4 to milk, wheat, soy, egg, and nuts was present at higher levels in EoE, with targeted elimination resulting in 45% histologic remission rate. Serum FS-IgG 4 has potential as a noninvasive biomarker in EoE. When successful, FS-IgG 4 -led elimination diet can negate need for medications and be viewed more favorably by patients because of its smaller endoscopic burden compared with empirical elimination diets.

Acceptance of different types of thickeners, with and without flavoring, in hospitalized patients with dysphagia - a pilot study / Aceptación de diferentes tipos de espesante, con y sin saborizante, en pacientes con disfagia hospitalizados: un estudio piloto

Introduction: the goal of this work was to evaluate the acceptance of various types of thickeners, specifically modified starch thickener and gum thickener, both with and without flavoring. Patients and methods: a randomized sample of 40 hospitalized patients with oropharyngeal dysphagia was recruited. The taste, smell, and appearance of each type of thickener were evaluated, as well as the volume of liquid ingested by the patients taking each type of thickener (modified starch thickener vs. gum thickener, both with and without flavoring).Results: the overall acceptance of gum thickener was significantly higher than that of modified starch thickener (7.45 (1.57) vs. 5.10 (2.43), respectively; p = 0.001). When a food flavor was added to the thickened water, the overall rating of the product was higher than when no flavor was added (7.70 (1.53) vs. 4.85 (2.16); p < 0.001). The difference between the daily volume of water consumed by the patients who received gum thickeners (928.33 (331.27) mL) and those who received starch thickeners (670.00 (288.35) mL) was statistically significant (p = 0.012). Patient consumption was also higher when flavoring was added as compared to when it was not (943.33 (302.45) mL) vs. (655.00 (304.60) mL; p = 0.005). Conclusion: the acceptances of the thickener and of water intake by patients with dysphagia were both significantly higher when using gum thickeners compared to starch thickeners, and when adding flavoring. (AU)

Introducción: el objetivo de este trabajo fue evaluar la aceptación de varios tipos de espesantes (almidón modificado frente a gomas) con y sin saborizante. Pacientes y métodos: se reclutaron 40 pacientes hospitalizados con disfagia orofaríngea. Se evaluaron el sabor, el olor y la apariencia de cada tipo de espesante, así como el volumen de líquido ingerido por los pacientes que tomaban cada tipo de espesante (espesante de almidón modificado vs. espesante de goma, ambos con o sin saborizante). Resultados: la aceptación general del espesante de goma fue significativamente mayor que la del almidón modificado (7,45 (1,57) vs. 5,10 (2,43); p = 0,001). Cuando se añadió un saborizante al agua espesada, la calificación general fue mejor (7,70 (1,53) frente a 4,85 (2,16); p < 0,001). La diferencia entre el volumen diario de agua consumida por los pacientes que recibieron espesantes de goma (928,33 (331,27) ml) y los que recibieron espesantes de almidón (670,00 (288,35) ml) fue estadísticamente significativa (p = 0,012). El consumo de líquido también fue mayor cuando se agregó el saborizante (943,33 (302,45) ml frente a 655,00 (304,60) ml; p = 0,005). Conclusión: la aceptación del espesante y la ingesta de agua por parte de los pacientes con disfagia fueron significativamente mayores cuando se utilizaron espesantes de goma, en comparación con los espesantes de almidón, y al agregar saborizantes. (AU)

Effects of a food preparation program on dietary well-being for stroke patients with dysphagia: A pilot study.

BACKGROUND: Dysphagia is one of the common issues observed in patients with stroke. Stroke patients with dysphagia have to eat blended food or similar types of food for each meal, resulting in dietary dissatisfaction. The purpose of this study was to investigate the effects of a food preparation program on dietary well-being for stroke patients with dysphagia. METHODS: This study was a pilot randomized clinical trial. Twenty-two patients were assigned randomly into the food preparation group (n = 11) and control group (n = 11). The food preparation group received oral motor exercises, recognition of food texture and thickener, and hands-on food preparation for 6 weeks. Outcome measures included the Dietary Well-Being Scale, brief version of the World Health Organization Quality of life, Swallowing Quality of Life Questionnaire, and Mini Nutritional Assessment. RESULTS: Patients in the food preparation group showed significant improvements in the Dietary Well-Being Scale, psychological and environmental domains of the brief version of the World Health Organization Quality of life (P = .001-.024) with small to large effect sizes (success rate difference = 0.23-0.46). The Swallowing Quality of Life Questionnaire and Mini Nutritional Assessment displayed non-significant differences (P = .053-.092) and revealed small to moderate effect sizes (success rate difference = 0.23-0.32). CONCLUSIONS: The food preparation program showed a positive impact on dietary well-being and a potential improvement in the health-related quality of life, quality of life related to the process of swallowing, and nutritional status for stroke patients with dysphagia. We recommend that stroke patients with dysphagia receive adequate knowledge and hands-on food preparation training to increase their dietary intake and well-being.

Acceptance of different types of thickeners, with and without flavoring, in hospitalized patients with dysphagia - A pilot study.

INTRODUCTION: Introduction: the goal of this work was to evaluate the acceptance of various types of thickeners, specifically modified starch thickener and gum thickener, both with and without flavoring. Patients and methods: a randomized sample of 40 hospitalized patients with oropharyngeal dysphagia was recruited. The taste, smell, and appearance of each type of thickener were evaluated, as well as the volume of liquid ingested by the patients taking each type of thickener (modified starch thickener vs. gum thickener, both with and without flavoring). Results: the overall acceptance of gum thickener was significantly higher than that of modified starch thickener (7.45 (1.57) vs. 5.10 (2.43), respectively; p = 0.001). When a food flavor was added to the thickened water, the overall rating of the product was higher than when no flavor was added (7.70 (1.53) vs. 4.85 (2.16); p < 0.001). The difference between the daily volume of water consumed by the patients who received gum thickeners (928.33 (331.27) mL) and those who received starch thickeners (670.00 (288.35) mL) was statistically significant (p = 0.012). Patient consumption was also higher when flavoring was added as compared to when it was not (943.33 (302.45) mL) vs. (655.00 (304.60) mL; p = 0.005). Conclusion: the acceptances of the thickener and of water intake by patients with dysphagia were both significantly higher when using gum thickeners compared to starch thickeners, and when adding flavoring.

INTRODUCCIÓN: Introducción: el objetivo de este trabajo fue evaluar la aceptación de varios tipos de espesantes (almidón modificado frente a gomas) con y sin saborizante. Pacientes y métodos: se reclutaron 40 pacientes hospitalizados con disfagia orofaríngea. Se evaluaron el sabor, el olor y la apariencia de cada tipo de espesante, así como el volumen de líquido ingerido por los pacientes que tomaban cada tipo de espesante (espesante de almidón modificado vs. espesante de goma, ambos con o sin saborizante). Resultados: la aceptación general del espesante de goma fue significativamente mayor que la del almidón modificado (7,45 (1,57) vs. 5,10 (2,43); p = 0,001). Cuando se añadió un saborizante al agua espesada, la calificación general fue mejor (7,70 (1,53) frente a 4,85 (2,16); p < 0,001). La diferencia entre el volumen diario de agua consumida por los pacientes que recibieron espesantes de goma (928,33 (331,27) ml) y los que recibieron espesantes de almidón (670,00 (288,35) ml) fue estadísticamente significativa (p = 0,012). El consumo de líquido también fue mayor cuando se agregó el saborizante (943,33 (302,45) ml frente a 655,00 (304,60) ml; p = 0,005). Conclusión: la aceptación del espesante y la ingesta de agua por parte de los pacientes con disfagia fueron significativamente mayores cuando se utilizaron espesantes de goma, en comparación con los espesantes de almidón, y al agregar saborizantes.

Body composition by bioelectrical impedance, muscle strength, and nutritional risk in oropharyngeal dysphagia patients / Composición corporal mediante impedancia bioeléctrica, fuerza muscular y riesgo nutricional en pacientes con disfagia orofaríngea

INTRODUCTION: oropharyngeal dysphagia (OD) has complications such as malnutrition and dehydration. Body composition is an important factor for nutritional status. OBJECTIVE: to evaluate the presence of cachexia, phase angle, muscle strength, and nutritional risk according to the type of feeding regimen tolerated by patients, determined with the volume-viscosity swallow test (V-VST). METHODS: this cross-sectional study included hospitalized adults of both sexes with a diagnosis of OD established by the Eating Assessment Tool and V-VST. Nutritional risk status was assesed using the Nutritional Risk Screening-2002 tool. Phase angle and cachexia were determined through bioelectrical impedance vector analysis (BIVA), and functional capacity through handgrip strength (HGS) and anthropometric parameters. RESULTS: seventy-nine patients with a median age of 73 years (56-79 yrs) were included; 79.9 % of patients were categorized at nutritional risk. According to the V-VST, 27 (34.2 %) patients tolerated nectar viscosity; 27 (34.2 %) belonged to the spoon-thick and 25 (31.6 %) to the exclusive tube feeding groups. In the exclusive tube feeding group a lower phase angle (3.7° ± 0.9) and lower HGS of 9 kg (5-15) were observed in comparison to the nectar and spoon-thick groups (in both, 4.6° ± 1.1, p = 0.005), which featured 20 kg (16-31) and 19 kg (14-26), respectively (p = 0.03). CONCLUSION: nutritional risk was present in 79.9 % of the study population. BIVA allows to evaluate the integrity of muscle mass and tissue hydration, both related to phase angle. A lower phase angle and HGS were observed in the exclusive tube feeding group. These factors are considered important for prognosis

INTRODUCCIÓN: la disfagia orofaríngea (DO) tiene complicaciones tales como la desnutrición y la deshidratación. La composición corporal es un factor importante en el estado nutricional. OBJETIVO: evaluar la presencia de caquexia, el ángulo de fase (AF), la fuerza muscular y el riesgo nutricional según el tipo de alimentación tolerado por los pacientes de acuerdo con la prueba de exploración clínica del volumen-viscosidad (MECV-V). MATERIAL Y MÉTODOS: estudio transversal de pacientes hospitalizados, con DO determinada por el tamiz Eating Assessment Tool y la MECV-V. El riesgo nutricional se evaluó con la herramienta Nutritional Risk Screening-2002. La composición corporal se determinó mediante impedancia eléctrica y la fuerza de prensión por dinamometría, entre otros parámetros antropométricos. RESULTADOS: se incluyeron 79 pacientes con una mediana de edad de 73 años (56-79 años). El 79,9 % de los pacientes presentaban riesgo nutricional. Según el MECV-V, 27 (34,2 %) toleraron la viscosidad néctar y 27 (34,2 %) la viscosidad puré, y 25 (31,6 %) requirieron alimentación exclusiva por sonda. En el grupo de alimentación por sonda se observaron un AF menor (3,7° ± 0,9) y una fuerza de presión más baja de 9 kg (5-15) en comparación con los grupos de néctar y puré (en los dos parámetros: 4,6° ± 1,1, p = 0,005), con 20 kg (16-31) y 19 kg (14-26) (p = 0,03), respectivamente. CONCLUSIÓN: la impedancia eléctrica permite evaluar la integridad y la hidratación de los tejidos, ambas relacionadas con el AF. Se observó que el AF y la fuerza de prensión fueron menores en el grupo con nutrición exclusiva por sonda. Estos factores se consideran importantes para el pronóstico de estos pacientes

Dysphagia management in Parkinson's disease: Comparison of the effect of thickening agents on taste, aroma, and texture.

Dysphagia is a frequent symptom in Parkinson's disease (PD). Thickening liquids facilitates safe swallowing, however, low treatment compliance is a major issue, due to patients' dislike of thickened liquids. Some studies suggest a negative impact of gum-based thickeners, currently most used in clinical practice, on sensory properties compared to starch-based thickeners. This has not yet been investigated in PD. This study's aim was to compare taste, texture, and aroma of gum-based and starch-based thickened soups in participants with PD. Gum-based resource thicken up clear (RTUC) and starch-based kitchen products potato starch (PS) and quinoa flour (QF) were evaluated in broccoli soup. Texture, aroma, and taste were characterized by rheology, volatile, and sensory profiling. Thickened soups were evaluated in participants with PD and controls through a paired comparison test. Reduced release of 61.4%, 46.2%, and 38.5% of volatiles was observed after thickening with RTUC, PS, and QF, respectively. Overall taste intensity was reduced in RTUC- and PS-thickened soup, respectively. Taste and aroma of PS-thickened soup were considered more intense by 70.3% and 63.8% of all participants, respectively (n = 36 PD, n = 41 controls), 56.3% preferred the PS-thickened soup's texture . Taste and aroma of QF-thickened soup were considered more intense by 68.1% and 65.6% of all participants, respectively (n = 47 PD, n = 31 controls), 58.0% preferred the QF-thickened soup's texture. Starch-based thickeners demonstrated higher taste and aroma intensity. However, volatile and sensory profiling demonstrated reduced taste and aroma in all thickeners. Combining kitchen products with flavor enhancers may increase palatability of thickened beverages.

A novel soft surimi gel with functionality prepared using alcalase for people suffering from dysphagia.

In this study, effects of alcalase on physical properties, pepsin digestibility, and antioxidative activity in the heat-induced surimi gel were investigated to develop a novel gel product for people with dysphagia. The heat-induced gelation profile of surimi showed that alcalase activity was maximized at approximately 37 °C. The surimi gel attained an appropriate texture for people with dysphagia, when a combination of 0.3-0.5% alcalase and two-step heating at 37 °C and 90 °C was used. Adding alcalase effectively promoted proteolysis, resulting in softening of the gel. Furthermore, the gel with 0.5% alcalase showed improved pepsin digestibility, when heated at 37 °C and 90 °C. Its antioxidative activity was enhanced by adding 0.5% alcalase. Therefore, a combination of 0.5% alcalase and the two-step heating at 37 °C and 90 °C was useful in improving the physical and functional properties of the surimi gel for people with dysphagia.

Texture and texture assessment of thickened fluids and texture-modified food for dysphagia management.

Thickened fluids and texture-modified foods are commonly used in the medical management of individuals who suffer from swallowing difficulty (known as dysphagia). However, how to reliably assess texture properties of such food systems is still a big challenge both to industry and to academic researchers. This article aims to identify key physical parameters that are important for objective assessment of such properties by reviewing the significance of rheological or textural properties of thickened fluids and texture-modified foods for swallowing. Literature reviews have identified that dominating textural properties in relation to swallowing could be very different for thickened fluids and for texture-modified foods. Important parameters of thickened fluids are generally related with the flow of the bolus in the pharyngeal stage, while important parameters of texture-modified foods are generally related with the bolus preparation in the oral stage as well as the bolus flow in the pharyngeal stage. This review helps to identify key textural parameters of thickened fluids and texture-modified foods in relation to eating and swallowing and to develop objective measuring techniques for quality control of thickened fluids and texture-modified foods for dysphagia management.

The use of diet modifications and third-party disability in adult dysphagia: The unforeseen burden of caregivers in an economically developing country.

BACKGROUND: One of the interventions for dysphagia is diet modifications, involving a variety of resources and consumables. In South Africa, where 49% of the population live below the poverty line, the necessities for it are not always feasible for the patient and their family. This coupled with the responsibility of caring for a loved one with disability can culminate into caregivers experiencing third-party disability (TPD). OBJECTIVE: To describe the experiences of TPD of caregivers when implementing dysphagia management strategies at home within an economically developing country context. METHODS: This was a qualitative study using phenomenological principles. Data were collected using a semi-structured self-developed interview tool at three tertiary level public sector hospitals. Seven participants and six caregivers were interviewed. Rigour was obtained through credibility, triangulation, transferability, dependability and confirmability. The data were analysed using a thematic content analysis technique following a top-down approach to coding. RESULTS: The use of diet modification is an appropriate management strategy if the patients' access and contextual limitations have been taken into consideration. It was evident that the caregivers had multiple International Classification of Functioning, Disability and Health domains affected, which restricted their daily functioning including activities, participation and environmental and personal factors. CONCLUSION: The management of dysphagia needs to be family centred and the caregiver's role and needs have to be considered by all team members when determining long-term management plans. The specific area of how the caregiver's quality of life was experienced also required further exploration.

Appropriate usage of food thickening agents to prevent non-disintegration of magnesium oxide tablets.

Food thickening agents are used to aid the administration of medicine to elderly patients with dysphagia. Magnesium oxide tablets are sometimes administered with food thickening agents. Non-disintegration and disintegration delay of these tablets in the body are problems associated with food thickening agent use. However, the appropriate usage of food thickening agents for administering tablets is not established. Here, the reasons for the non-disintegration of magnesium oxide tablets administered with food thickeners and appropriate usage of food thickeners were examined using a disintegration test of newly opened and moisture-absorbed magnesium oxide tablets. Immersion of magnesium oxide tablets for 10 and 30 min in xanthan and guar gum-based food thickening agents caused disintegration delay and non-disintegration in the first fluid (pH 1.2). However, tablets immersed for 1 min quickly disintegrated. The disintegration of xanthan gum-based food thickening agents was faster than guar gum-based food thickening agents. Moisture absorption by magnesium oxide tablets caused a significant delay in their disintegration in water. The tablets that absorbed moisture disintegrated within 1 min in the first fluid, even when immersed in food thickening agents for a short time. Overall, a short immersion of magnesium oxide tablets in food thickening agents can avoid non-disintegration.

Disfagia en tiempos de COVID-19 / Dysphagia in COVID-19 times

Resumen Los pacientes con COVID-19 pueden presentar dificultades en la alimentación por distintos factores, entre los que destacan el aumento del esfuerzo respiratorio, uso de dispositivos de apoyo ventilatorio, compromiso neurológico y disfagia postextubación. La evaluación clínica es fundamental, pero debe ser realizada con precaución y con elementos de protección personal, ya que es un procedimiento generador de aerosoles, al igual que la evaluación instrumental mediante videofluoroscopía y evaluación fibroendoscópica de la deglución. Las recomendaciones de manejo deben basarse en la evaluación clínica adaptada, tanto para pacientes ambulatorios como hospitalizados, y debe incluir el manejo nutricional, compensatorio y el seguimiento clínico periódico para evitar las consecuencias de la disfagia orofaríngea, y así disminuir la tasa de neumonía aspirativa, causa importante de morbimortalidad.

Abstract Patients with COVID-19 may present feeding difficulties due to different factors, like the increase in respiratory effort, use of ventilatory support devices, neurological compromise and post-extubation dysphagia. Clinical evaluation is essential, but it must be carried out with caution and using personal protection elements, since it is an aerosol-generating procedure, as well as the instrumental evaluation by videofluoroscopy and fiberoptic endoscopic evaluation of swallowing. Treatment should be based on adapted clinical evaluation, for both outpatients and hospitalized patients, and should include nutritional treatment, compensatory management and periodic clinical follow-up to avoid the consequences of oropharyngeal dysphagia and decrease the rate of aspiration pneumonia major cause of morbidity and mortality.

Pureed diets containing a gelling agent to reduce the risk of aspiration in elderly patients with moderate to severe dysphagia: A randomized, crossover trial.

GOALS: The aim of this study was to evaluate the effectiveness of adding a gelling agent to pureed diets to prevent aspiration pneumonia in elderly patients with moderate to severe dysphagia. BACKGROUND: Pureed diets are often used to reduce aspiration in patients with dysphagia. However, the ideal texture of a pureed diet to prevent aspiration pneumonia remains unclear. MATERIALS AND METHODS: We prospectively conducted a randomized, crossover trial of pureed rice with or without a gelling agent in patients with moderate to severe dysphagia (ClincialTrials.gov number, NCT03163355). The primary outcome measure was pharyngeal residuals using an endoscopic scoring system. The secondary outcome was the sense of material remaining in the throat following swallowing. RESULTS: Sixty two patients (58% men), mean age 83 ±â€Š9 years with moderate to severe dysphagia were included. Residuals in the throat were significantly less likely with pureed rice with than without the gelling agent (median cyclic ingestion score (range); 1 (0-4) vs 2 (0-4); P = .001). Irrespective of the presence or absence of the gelling agent, the sense of material remaining in the throat was significantly less frequent in older patients (87 ±â€Š7.6 vs 75 ±â€Š9.1 years, P < .01; 86 ±â€Š7.3 vs 75 ±â€Š8.6 years, P < .01). CONCLUSIONS: Pureed diets containing a gelling agent may reduce the risk of aspiration pneumonia possibly by decreasing pharyngeal residues in elderly patients with moderate to severe dysphagia.

[International Classification Systems for Texture-Modified Foods].

In 2020, the older adult population ( ≥ 65 years old) reached 703 million worldwide and 3.6 million in Taiwan. By 2026, Taiwan will become a super-aged society with at least 20 percent of the population in this category and 180,000 new older adults joining this population annually. The consequences of oropharyngeal physiological degradation include dysphagia, malnutrition, and a negative impact on quality of life. The provision of texture-modified foods and thickened liquids assist users with chewing or swallowing disorders, making foods easier to ingest and improving diet safety. The classification of texture modified foods allows for consistent communication among health professionals, care providers, and industry partners to improve quality of care for users. This article reviews the four texture-modified food classification systems currently in use internationally. 1. International Standardization Committee for Dysphagia: 22 countries implemented this framework, which was developed by a wide range of professions, including nutrition & dietetics, medicine, speech pathology, occupational therapy, nursing, food science & technology. This framework provides internationally standardized terminology and definitions for texture-modified foods and thickened liquids for persons with dysphagia. 2. Japanese Universal Design Foods: This voluntary standard established by the food industry addresses the physical properties related to the texture of food. The four categories in this standard are distinguished based on the hardness and viscosity of food. The category-based terms and the universal design foods logo are displayed on foods to facilitate consumer selection. 3. The smile care food-The Japanese Ministry of Agriculture, Forestry and Fisheries reclassified nursing care food into the following three categories: (i) Food for people without eating problems but with nutrition supplement needs; (ii) Food for people with problems with swallowing functions; and (iii) Food for people with problems with chewing functions. 4. Eatender, Taiwan senior friendly food. This standard designates four texture specifications: Easy to chew, gum mashable, tongue mashable, no chewing needed. This standard is used to grade the texture of packaged foods that use agricultural food ingredients sourced in Taiwan.

[Innovative Development of Texture-Softened Foods for Older Adults Living in Residential Care].

Oropharyngeal dysphagia, a swallowing disorder, is a common problem faced by older adults living in residential care. A direct management strategy for this disorder is to modify the texture of foods prior to serving using techniques such as chopping, mashing, liquid thickening, and reshaping. However, the process of texture modification causes foods to lose a significant amount of their nutritional value and reduces the motivation and fun of eating for diners. Eating is part of the enjoyment of life, and managing the nutrition status of older adults living in residential care is an important issue in aged societies. In this article, issues related to modified-texture foods, including their generally lower nutritional value, are discussed. In addition, combinations of cooking techniques that may increase tenderness in meat are explored to promote the future development of the soft-food meals for older adults living in residential care. One of the described techniques uses fresh fruits to pickle meat and vacuum low-temperature cooking technology that preserves the shape of meat after cooking and makes meat sufficiently soft to be broken up by the tongue. Vacuum low-temperature cooking allows for the precise control of cooking time and temperature, and professional cooking techniques may be used to improve the quality of the texture-softened foods. It is the hope of the authors that this article is used a reference for the future development of texture-softened foods for older adults living in residential care.

Assessment of the risk of malnutrition due to aspiration pneumonia and oral feeding difficulty / Evaluación del riesgo de desnutrición debido a neumonía por aspiración y dificultad para la alimentación oral

INTRODUCTION: many patients with acute-phase swallowing disorders experience malnutrition, which can be caused by oral intake difficulties. Many diseases can cause swallowing difficulties such as aspiration pneumonia, and it is, therefore, necessary to consider the risk of malnutrition during oral feeding therapy in patients with aspiration pneumonia. OBJECTIVES: we aimed to evaluate the risk of malnutrition in patients with aspiration pneumonia and other diseases. METHODS: the participants comprised 62 patients (45 males, 17 females) with acute-phase swallowing disorders who underwent speech therapy (ST) for swallowing rehabilitation. The patients were divided into four groups: 1) oral feeding with pneumonia, 2) parenteral feeding with pneumonia, 3) oral feeding without pneumonia, and 4) parenteral feeding without pneumonia. The serum albumin and total protein levels were measured to evaluate malnutrition, and swallowing ability was assessed using the Fujishima grade. RESULTS: at the time of ST initiation, serum albumin levels were significantly higher in the oral feeding with pneumonia and oral feeding without pneumonia groups than in the parenteral feeding with pneumonia and parenteral feeding without pneumonia groups. The Fujishima grades differed significantly between the pneumonia/parenteral feeding group and the non-pneumonia/parenteral feeding group. CONCLUSIONS: patients with difficulty in swallowing due to aspiration pneumonia were at higher risk of malnutrition than were those without these difficulties. These findings suggest that the nutritional status of parenterally fed patients who developed pneumonia may be inherently poorer than that of orally fed patients

INTRODUCCIÓN: muchos pacientes que padecen trastornos de la deglución en fase aguda experimentan desnutrición, que pueden estar causados por dificultades en la ingesta oral. Muchas enfermedades pueden causar dificultades de la deglución, incluida la neumonía por aspiración, y, por lo tanto, es necesario considerar el riesgo de desnutrición durante la terapia de alimentación oral en los pacientes que padecen neumonía por aspiración. OBJETIVOS: nuestro objetivo fue evaluar el riesgo de desnutrición en pacientes que padecen neumonía por aspiración y otras enfermedades. MÉTODOS: los participantes comprendían 62 pacientes (45 hombres, 17 mujeres) con trastornos de la deglución en fase aguda que se sometieron a tratamiento logopédico (speech therapy, ST) por rehabilitación de la deglución. Los pacientes se dividieron en cuatro grupos: 1) alimentación oral con neumonía, 2) alimentación parenteral con neumonía, 3) alimentación oral sin neumonía y 4) alimentación parenteral sin neumonía. La albúmina sérica y los niveles totales de proteínas se calcularon para evaluar la desnutrición, y la capacidad de deglución se evaluó usando el grado de Fujishima. RESULTADOS: en el momento de iniciar el tratamiento logopédico (speech therapy, ST), los niveles de albúmina en suero fueron significativamente más altos en los grupos de alimentación oral con neumonía y alimentación oral sin neumonía que en los grupos de alimentación parenteral con neumonía y alimentación parenteral sin neumonía. Los grados de Fujishima difieren de forma significativa entre los grupos de alimentación oral/alimentación parenteral con neumonía y los grupos de alimentación oral/alimentación parenteral sin neumonía. CONCLUSIONES: los pacientes que poseen dificultades de la deglución debido a neumonía por aspiración presentan un riesgo mayor de desnutrición que aquellos que no poseen estas dificultades. Estas conclusiones sugieren que el estado nutricional de los pacientes alimentados parenteralmente que desarrollaron una neumonía puede ser inherentemente más pobre que el de los pacientes alimentados oralmente