Bolus rheology of texture-modified food: Effect of degree of modification.
Journal of texture studies
Swallowing disorders, or dysphagia, require an intake of texture-modified foods progressively softer, smoother, and moister depending on the severity of the disorder. Bolus rheology was determined for five healthy subjects for a set of such solid foods regularly given to dysphagia patients. The softest class was gel food, then a smooth timbale which both were compared to the corresponding regular, un-modified food. The foods investigated were bread, cheese, tomato, and the combination as a sandwich, all for the respective texture class: gel, timbale, and regular food. The subjects chewed until ready to swallow and the expectorated bolus was immediately measured for complex shear modulus and viscosity, and moisture and saliva content were determined. Rheology show that texture-modification influenced bolus rheology with decreased viscosity and modulus for increased degree of modification. Also saliva content as well as chews-to-swallow decreased with degree of modification. Overall, the bolus saliva content was lower for the combination (sandwich) than for the individual components. Saliva content was fairly constant irrespective of food moisture content. The phase angle for all boluses was also relatively constant, indicating a similar bolus structure. All boluses of the texture-modified foods showed high extensional viscosity, which is important for bolus cohesiveness. Bolus rheology rather than food texture determines if a food is safe to swallow and the results show that the intended texture-modification is reflected in the flow properties of the respective boluses.
10.1111/jtxs.12598
Effects of water viscosity and tongue ingestion site on tongue pressure during food bolus propulsion.
Iguchi T,Ohkubo M,Sugiyama T,Hori K,Ono T,Ishida R
Journal of oral rehabilitation
The purpose of this study was to help provide data to help to implement effective rehabilitation following surgery for oral cancer by comparing tongue pressure production for water and thickened water from the anterior and posterior parts of the tongue during swallowing. Ten healthy volunteers (7 men, 3 women; age 27.6 ± 1.5 years) participated in the experiments. Tongue pressure during 3 mL water and 3 mL thickened water at the anterior and posterior tongue during swallowing was measured using a sensor sheet system with five measuring points on the hard palate. The sequential order of the points, maximal magnitude and duration of tongue pressure at each point were compared based on water viscosity and tongue ingestion site. There was a common pattern in the sequential order of tongue pressure generation among the two swallowing conditions. The maximal magnitude of tongue pressure was significantly higher when swallowing thickened water than when swallowing water at all points except for the anterior-median and mid-median part. Moreover, the pressure at all sites during posterior ingestions was significantly lower than that during anterior ingestion. The present results provide mean values of tongue pressure during voluntarily triggered swallowing in anterior ingestion and posterior ingestion in young, healthy dentate individuals; these values can be clinically referenced for tongue pressure measurement in the evaluation of patients with dysphagia. The use of reference values may help streamline the diagnosis, treatment and rehabilitation of dysphagia.
10.1111/joor.12623
[International Classification Systems for Texture-Modified Foods].
Wang I-Chin
Hu li za zhi The journal of nursing
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.
10.6224/JN.202008_67(4).04
Effects of Food and Liquid Properties on Swallowing Physiology and Function in Adults.
Dysphagia
Foods and liquids have properties that are often modified as part of clinical dysphagia management to promote safe and efficient swallowing. However, recent studies have questioned whether this practice is supported by the evidence. To address this, a scoping review was conducted to answer the question: "Can properties of food and liquids modify swallowing physiology and function in adults?" Online search in six databases yielded a set of 4235 non-duplicate articles. Using COVIDENCE software, two independent reviewers screened the articles by title and abstract, and 229 full-text articles were selected for full-text review. One-hundred eleven studies met the inclusion criteria for qualitative synthesis and assessment of risk of bias. Three randomized controlled trials and 108 non-randomized studies were analyzed. Large amounts of variability in instrumental assessment, properties of food and liquids, and swallowing measures were found across studies. Sour, sweet, and salty taste, odor, carbonation, capsaicin, viscosity, hardness, adhesiveness, and cohesiveness were reported to modify the oral and pharyngeal phase of swallowing in both healthy participants and patients with dysphagia. Main swallow measures modified by properties of food and liquids were penetration/aspiration, oral transit time, lingual pressures, submental muscle contraction, oral and pharyngeal residue, hyoid and laryngeal movement, pharyngeal and upper esophageal sphincter pressures, and total swallow duration. The evidence pooled in this review supports the clinical practice of food texture and liquid consistency modification in the management of dysphagia with the caveat that all clinical endeavors must be undertaken with a clear rationale and patient-specific evidence that modifying food or liquid benefits swallow safety and efficiency while maintaining quality of life.
10.1007/s00455-022-10525-2
Development of International Terminology and Definitions for Texture-Modified Foods and Thickened Fluids Used in Dysphagia Management: The IDDSI Framework.
Dysphagia
Dysphagia is estimated to affect ~8% of the world's population (~590 million people). Texture-modified foods and thickened drinks are commonly used to reduce the risks of choking and aspiration. The International Dysphagia Diet Standardisation Initiative (IDDSI) was founded with the goal of developing globally standardized terminology and definitions for texture-modified foods and liquids applicable to individuals with dysphagia of all ages, in all care settings, and all cultures. A multi-professional volunteer committee developed a dysphagia diet framework through systematic review and stakeholder consultation. First, a survey of existing national terminologies and current practice was conducted, receiving 2050 responses from 33 countries. Respondents included individuals with dysphagia; their caregivers; organizations supporting individuals with dysphagia; healthcare professionals; food service providers; researchers; and industry. The results revealed common use of 3-4 levels of food texture (54 different names) and ≥3 levels of liquid thickness (27 different names). Substantial support was expressed for international standardization. Next, a systematic review regarding the impact of food texture and liquid consistency on swallowing was completed. A meeting was then convened to review data from previous phases, and develop a draft framework. A further international stakeholder survey sought feedback to guide framework refinement; 3190 responses were received from 57 countries. The IDDSI Framework (released in November, 2015) involves a continuum of 8 levels (0-7) identified by numbers, text labels, color codes, definitions, and measurement methods. The IDDSI Framework is recommended for implementation throughout the world.
10.1007/s00455-016-9758-y
Modifying the consistency of food and fluids for swallowing difficulties in dementia.
The Cochrane database of systematic reviews
BACKGROUND:People with dementia can have feeding and swallowing difficulties (dysphagia). Modification of the consistency of food or fluids, or both, is a common management strategy. However, diet modification can affect quality of life and may lead to dehydration and malnutrition. Evidence on the benefits and risks of modifying food and fluids is mandatory to improve the care of people with dementia and dysphagia. OBJECTIVES:To determine the effectiveness and adverse effects associated with modifying the consistency of food and fluids in improving oral intake and eliminating aspiration in adults with dysphagia and dementia. SEARCH METHODS:We searched ALOIS (the Specialised Register of the Cochrane Dementia and Cognitive Improvement Group), the Cochrane Library, MEDLINE via Ovid SP, Embase via Ovid SP, PsycINFO via Ovid SP, CINAHL via EBSCOhost, LILACS via BIREME, ClinicalTrials.gov and the World Health Organization (WHO) Portal on 9 May 2018. We also checked the reference lists of relevant articles to identify any additional studies. SELECTION CRITERIA:We included randomised controlled trials (RCTs), quasi-RCTs and cluster-RCTs published in any language that measured any of the outcomes of interest. We included trials with adults with a clinical diagnosis of dementia with symptoms and signs of dysphagia confirmed on instrumental assessment. We included participants with all types, stages and severities of dementia. Control groups received either no intervention or interventions not involving diet modification or modification to sensory properties of food. DATA COLLECTION AND ANALYSIS:Two review authors independently assessed for inclusion all potential studies identified. Data were extracted independently along with assessment of methodological quality using standard Cochrane methods. We contacted study authors for additional unpublished information. MAIN RESULTS:No trials on modification of food met the inclusion criteria. We included two studies that examined modification to fluids. Both were part of the same large multicentre trial and included people with dementia and people with or without dementia and Parkinson's disease. Participation in the second trial was determined by results from the first trial. With unpublished data supplied by study authors, we examined data from participants with dementia only. The first study, a cross-over trial, investigated the immediate effects on aspiration of two viscosities of liquids (nectar thick and honey thick) compared to regular liquids in 351 participants with dementia using videofluoroscopy. Regular liquids with a chin down head posture, as well as regular liquids without any intervention were also compared. The sequence of interventions during videofluoroscopy may have influenced response to intervention. The second study, a parallel designed RCT, compared the effect of nectar and honey thick liquids with a chin down head posture over a three-month period in a subgroup of 260 participants with dementia. Outcomes were pneumonia and adverse intervention effects. Honey thick liquids, which are more consistent with descriptors for 'spoon thick' or 'extremely thick' liquids, showed a more positive impact on immediate elimination of aspiration during videofluoroscopy, but this consistency showed more adverse effects in the second follow-up study. During the second three-month follow-up trial, there were a greater number of incidents of pneumonia in participants receiving honey thick liquids than those receiving nectar thick liquids or taking regular liquids with a chin down posture. There were no deaths classified as 'definitely related' to the type of fluids prescribed. Neither trial addressed quality of life. Risk of bias for both studies is high. The overall quality of evidence for outcomes in this review is low. AUTHORS' CONCLUSIONS:We are uncertain about the immediate and long-term effects of modifying the consistency of fluid for swallowing difficulties in dementia as too few studies have been completed. There may be differences in outcomes depending on the grade of thickness of fluids and the sequence of interventions trialled in videofluoroscopy for people with dementia. Clinicians should be aware that while thickening fluids may have an immediate positive effect on swallowing, the long-term impact of thickened fluids on the health of the person with dementia should be considered. Further high-quality clinical trials are required.
10.1002/14651858.CD011077.pub2
Texture and texture assessment of thickened fluids and texture-modified food for dysphagia management.
Hadde Enrico K,Chen Jianshe
Journal of texture studies
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.
10.1111/jtxs.12567
Textural Changes by Mastication and Proper Food Texture for Patients with Oropharyngeal Dysphagia.
Matsuo Koichiro,Fujishima Ichiro
Nutrients
Bolus texture is a key factor for safe swallowing in patients with dysphagia since an improper texture may result in aspiration and/or pharyngeal residue. This article discusses swallowing bolus texture from two key aspects: the textural change of solid food by mastication and the current standardized definition of food texture in Japan. When swallowing a liquid bolus, the texture is mostly maintained from ingestion to swallow onset. For solid food, however, the food is crushed by chewing and mixed with saliva before swallowing; the texture of the ingested food is modified to an easily swallowable form at swallow onset by mastication. Understanding the mechanism of mastication and its assessment are therefore important in deciding the proper diet for dysphagic patients. As standardized criteria for classifying the texture of food and liquid are essential as well, this report also describes the Japanese Dysphagia Diet 2013 that is commonly used as the standardized index for dysphagic diets in Japan.
10.3390/nu12061613