International Dysphagia Diet Standardisation Initiative Research Articles

Natural product nobiletin-loaded Pickering emulsion stabilized by bovine serum albumin/carboxymethyl inulin complexes: preparation and digestive characteristics.

To expand the application of nobiletin (NOB) in semi-solid functional foods, bovine serum albumin (BSA)/carboxymethyl inulin (CMI) complexes-stabilized Pickering emulsion (BCPE) (φoil = 60%, v/v) was fabricated, and the swallowing index and bioavailability of the NOB-loaded Pickering emulsion was evaluated. Confocal laser scanning microscope (CLSM) and cryo-scanning electron microscopy (cryo-SEM) images revealed that BSA/CMI complexes attached to the oil-water interface. NOB-loaded BCPE exhibited a viscoelastic and shear-thinning behavior. Fork drip test results suggested that the textural value of unloaded and NOB-loaded emulsions was International Dysphagia Diet Standardisation Initiative Level 4, which could be swallowed directly without chewing. The in vitro lipolysis model suggested that NOB had a faster digestive profile and a higher bioaccessibility in the BCPE than in the oil suspension. The in vivo rat model revealed that the oral bioavailability of NOB was increased by 2.07 folds in BCPE compared to its bioavailability in unformulated oil. Moreover, BCPE led to a higher plasma concentration of the major demethylated metabolite of NOB (4'-demethylnobiletin) than the unformulated oil. Accordingly, BCPE enhanced the oral bioavailability of NOB by improving bioaccessibility, absorption, and biotransformation.

Dysphagia food: Impact of soy protein isolate (SPI) addition on textural, physicochemical and microstructural properties of peach complex gels

In this study, dysphagia-friendly diets were prepared based on the interaction between polysaccharides from peach, namely Meirui (MR), Yangshan (YS) and Cons758 (Cons), and soy protein isolate (SPI). MR-alcohol insoluble residues (AIR) and YS-AIR were low methoxylated polymers, while Cons-AIR was high methoxylated polymer. According to the international dysphagia diet standardization initiative, YS-SPI and MR-SPI could be qualified as level 5-minced/moist dysphagia diets. Following SPI addition, the apparent viscosity, G′ and G″ of peach pulp-SPI complexes were significantly increased. At the shear rate of 10 s−1, corresponding to oral processing, MR-SPI performed the highest apparent viscosity (35.2 Pa s), followed by YS-SPI (33.5 Pa s). Additionally, the SPI-treated strategy pronounced improved the hardness, springiness, adhesiveness and chewiness of complexes. Both YS-SPI and Cons-SPI showed the reduced particle size, alongside the uniform distribution, owing to the strong hydrogen bonding and electrostatic interaction between peach pulp substances and SPI, which was confirmed by FT-IR result. The biggest ζ-potential value (−23.55 mV) was found in YS-SPI. Meanwhile, compared with peach pulps, the highest increase ratio (87.94%) of water holding capacity was depicted in MR-SPI. LF-NMR analysis revealed immobilized water was dominant in peach pulp-SPI. The results suggested that MR was promising for the optimal choice to form gel food for people with swallowing problems.

Characterization of Chinese shrimp (Fenneropenaeus chinensis) powder and corn starch composite gels as dysphagia diet

In the present study, the effects of corn starch (CS) on the properties of Chinese shrimp (Fenneropenaeus chinensis) powder (SP) were characterized to explore the feasibility of developing dysphagia diet. The SP/CS gels were prepared by adding CS at different concentrations. The SP/CS mixture presented low gel properties at CS concentrations ranging from 12 to 48 mg/mL, but did demonstrate gelation behavior with the highest G′ value of 1134.2 Pa and a water holding capacity of 90% at 60 mg/mL. As the CS concentration increased, the stability of the SP/CS mixture also improved, as evidenced by the significantly reduced relaxation times T22 and T23, enhanced gel network formation, and the presence of hydrogen bonding and electrostatic interactions between SP and CS. Furthermore, the international dysphagia diet standardisation initiative (IDDSI) swallowing level of the SP/CS mixtures were 2, 3, 4, and 5 at CS concentrations of 12, 24, 36, 48 and 60 mg/ml, respectively. The SP/CS-60 mixture gel was considered suitable for dysphagia patients. These findings suggest that the gel properties of SP can be modified by CS, and that the SP/CS mixture gels have the potential to be used as a texture-modified diet with high-quality protein for dysphagia patients.

Structural changes of flaxseed protein modified by fermentation and the gel properties and swallowing characteristics of its composite system with mung bean starch

The fermentation modification of plant-based proteins has attracted extensive attention recently. This study was to investigate the effect of fermentation on molecular structures of flaxseed protein (FP), and evaluate the gel properties and swallowing characteristics of the composite gel composed of mung bean starch (MBS) and fermented FP (FFP). After 10 h of fermentation, the content of free amino acids in FFP increased ∼14.3 times over that of the unfermented FP, while the proportion of small peptides increased by ∼37.2%. Fermentation reduced the α-helical conformation in FFP. After heating, FFP was easier to cross-link with MBS to form strengthened composite gel network with denser and larger pores as well as thicker pore wall, in which the maximum gel hardness increased by 2.6 times. MBS-FFP composite gels also exhibited increase in viscoelastic moduli, cohesiveness, thermal stability, and water-holding capacity (WHC) than the control gel. The WHC was increased from 63.4% to 92.3% when composite gel contained 10 h fermented FP. Furthermore, international dysphagia diet standardization initiative (IDDSI) tests indicated that all MBS-FFP composite gels could be categorized as level 7 dysphagia food. These findings provide new insights into the structural nature and potential application of plant protein-based fermentation-induced gel systems.

Tailoring the high-protein texture-modified foods for the dysphagia elderly by heating whey protein isolate-pectin complexes

Adequate dietary protein intake is an effective way to combat muscle wasting disorders in the elderly, who are highly susceptible to dysphagia due to declining physiological functions. Herein, whey protein isolate (WPI) and pectin electrostatic complexes were chosen to prepare texture-modified foods with high protein (15%, w/v) for dysphagia elderly. Firstly, the region of soluble complex formation was initially identified as pH 4.2–5.5 by determination of the zeta potential of both biopolymers. Following this, it was found that the stability of WPI-pectin complexes was significantly dependent on the increase in the amount of pectin (from 1.0 to 2.0 %, w/v). However, the viscoelasticity and the degree of WPI aggregation of these complexes after heat treatment (90 °C, 20 min) both showed the lowest level at pH 4.6 (it was fluid state) regardless of the pectin content, and the degree of protein aggregation weakened with the increase of pectin content. Additionally, the shear viscosity, yield stress, and tribological properties of the thermal complexes were also positively correlated with the degree of protein thermal aggregation. Moreover, based on the dietary texture classes developed by the International Dysphagia Diet Standardisation Initiative (IDDSI), unlike pure WPI thermally-induced gels that are attributed to level 6, the WPI-pectin thermal complexes can achieve texture class coverage from level 3 to level 6. These findings suggest that by modulating the electrostatic binding strength and positive-negative charge balance between WPI and pectin, tailored design of high-protein diets for elderly people with varying degrees of dysphagia may be achieved.

Validation of the IDDSI funnel for liquid flow testing.

In 2017, the International Dysphagia Diet Standardisation Initiative (IDDSI) introduced the IDDSI flow test which enables patients, clinicians, caregivers, food service professionals and researchers to classify liquid thickness into five levels based on the volume of liquid remaining in a standard 10 mL slip tip syringe after 10 s of flow under gravity. Within a few months of publishing the IDDSI flow test instructions, several barriers emerged: (1) the preferred model of syringe (BD 303134) was not equally accessible around the world, causing some users to perform flow tests with alternate models of syringe; (2) differences in syringe geometry across models led to variations in IDDSI flow test results; and (3) the need to use a second syringe for sample loading added complexity and cost to end users. To address these barriers, IDDSI designed the IDDSI funnel, a novel device, which combines the geometry of the BD 303134 syringe with a kitchen funnel to facilitate easy loading of liquid samples without need for a second syringe. In this report, we compare the IDDSI flow test results across two devices: syringe BD 303134 and IDDSI funnel. IDDSI level classifications were in complete agreement with the syringe reference test results in 67/73 (92%) of the test fluids and temperature conditions with mean difference of residual liquid across devices of 0.2 (2% full scale). These results demonstrate excellent correspondence between the two devices.

IDDSI-compliant recipes containing oral contrast agents for radiological dysphagia diagnostics.

Videofluoroscopic swallowing study (VFSS), alongside flexible endoscopic evaluation of swallowing, represents the gold standard for diagnosing swallowing disorders and to determine severity, pathophysiology, and effective interventions, including texture modification. The clinical swallowing examination and assessment supplements these instrumental methods and serves as the basis for the modules of swallowing diagnostics. The adaptation of food and drink consistencies in dysphagia management has become widespread. For valid results of a VFSS with respect to confirming swallowing safety and efficiency of different liquid and food consistencies and textures, the use of uniform recipes containing radio-opaque contrast media is important. Our goal was to identify recipes that would produce consistencies that conform to the liquid and food levels of 0-7, as defined by the International Dysphagia Diet Standardization Initiative (IDDSI), with barium- and iodine-based contrast media, xanthan gum-based thickeners, and other edible components, which also show sufficient contrast on VFSS. In this study, we determined the different recipes using IDDSI testing methods and explored their radiological characteristics using a Philips MultiDiagnost Eleva fluoroscopy system and two different fluid contrast agents: barium- (Micropaque®) and iodine-based (Telebrix®). All recipes showed sufficient contrast on fluoroscopy and could be visualized in the amounts used for swallowing examinations. They were practical and easy to implement in terms of production and availability of the components. The homogeneity of the recipes diminished with higher IDDSI levels, which represent transitional food, but appeared still sufficient for fluoroscopic examination. The opacity did not significantly differ between the barium- and iodine-based contrast media.

Spray‐Drying Assisted 3D Printing to Manufacture Beef Products

AbstractPotato starch (PS), a naturally occurring carbohydrate biopolymer, is commonly used in the meat industry to enhance the processing and nutritional properties of meat products. This study utilizes spray drying to produce PS‐based powders for the production of 3D printed beef products. The effects of incorporating PS‐based materials at 1% concentrations into beef pastes are investigated, focusing on the impact on product texture, cooking properties, printing accuracy, freeze‐thaw stability, and color. Additionally, the suitability of the 3D printed beef products for individuals with dysphagia is assessed using the International Dysphagia Diet Standardization Initiative (IDDSI). The 3D printed beef products containing PS‐based powders are successfully manufactured and maintained their structure during printing and cooking. The addition of these powders improve moisture content, cooking yield, lightness, and reduced diameter reduction, redness, hardness, cohesiveness, and chewiness. Moreover, the results suggest that P‐N, can be classified as potential level 6 diets (soft and bite‐sized) according to the IDDSI framework.

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

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). 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. 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.

Potentially texture-modified food for dysphagia: Gelling, rheological, and water fixation properties of rice starch–soybean protein composite gels in various ratios

Starch and protein are essential biomacromolecules ubiquitous in foods that contribute to nutritional and textural properties. Understanding the gelling behavior of starch and proteins can help develop texture-modified foods. Herein, composite gels were created with various ratios of rice starch to soybean protein (constant solid content 12%). The International dysphagia diet standardization initiative (IDDSI) levels of rice starch–soybean protein composite gels with various ratios were evaluated. The texture, gelling behavior, rheological properties, and water fixation properties of rice starch–soybean protein gel were characterized. The results showed that soybean protein inhibit the gelatinization of rice starch by reducing the gelatinization viscosity. Rice starch could prevent the denaturation of soybean protein by preventing the structural transformation of protein. Rice starch and soybean protein antagonize each other to inhibit gelation. In addition, rice starch precedes soybean protein gel so that the network formation of rice starch and soybean protein is hindered by each other in the composite system. Obvious phase separation was observed in the rice starch–soybean protein composite gel. Disulfide and hydrogen bonds are affected by the proportions of rice starch and soybean protein and are the main intermolecular forces to maintain structure. Gels prepared with a mixture of rice starch and soybean protein had lower IDDSI levels, gel strength, modulus, and strain compared to single-component gels. All gels exhibit excellent water-holding capacity. Therefore, the rice starch–soybean protein composite gel can be used to prepare soft and moist texture-modified foods to meet the needs of patients with dysphagia.

The effect of early childhood caries on chewing function and tolerated food texture levels in preschool children.

The early form of caries can affect solid food consumption. The aim of the study was to evaluate the effect of oral health status on chewing performance, and tolerated food texture among preschool children suffering from early childhood caries (ECC). A cross-sectional study was conducted with a sample of 109 children aged between 3 and 6 years, who were allocated to three groups (severe-ECC (s-ECC), ECC and control) on the basis of their caries. Chewing function was evaluated by using the 'Karaduman Chewing Performance Scale (KCPS)' and the Turkish version of the 'Mastication Observation and Evaluation instrument (T-MOE)', and the tolerated food texture was determined by the 'International Dysphagia Diet Standardization Initiative (IDDSI)'. Carious lesions, oral hygiene and gingival health status were evaluated by using the 'decayed, missing, filled tooth/surface indices (dmft/s)', 'plaque and gingival indices'; respectively. A total of 56 children (51.4%) had s-ECC, 39 (35.8%) had ECC and 14 (12.8%) had no caries (control group). KCPS showed that 26 (86.7%) children suffering from s-ECC were at level 1, and 11 (100%) children were at level 2. Seven (100%) children with s-ECC had IDDSI level-5. All children with healthy oral status had IDSSI level-7. Compared to the ECC and control groups, the s-ECC group had significantly lower scores from the T-MOE total and subscale scores (p < .001). The evaluation of chewing performance during routine dental examinations of children with ECC (especially s-ECC) may considerably contribute to the early diagnosis of chewing problems and the provision of necessary oral rehabilitation.

Examining the effect of intensive individual swallowing exercise therapy protocol on swallowing physiology in geriatric patients hospitalized in the thoracic diseases service with a complaint of major swallowing dysfunction with multiple prognoses

Objectives: The study aimed to compare the effectiveness of short-term (one month) and long-term (three months) individual swallowing therapy programs in the geriatric individuals diagnosed with dysphagia by instrumental evaluation. Patients and methods: Hospital records of 31 patients (16 females, 15 males; mean age: 66.8±16.4 years; range, 66 to 83 years) were prospectively examined between April 1, 2019, and September 30, 2022. Fiberoptic endoscopic swallowing study recordings were made at the beginning of the study. The recordings were scanned and examined, and individuals with observed problems in swallowing safety and efficacy, having the same severity of dysphagia, were identified. Patients were randomly assigned to long-term (51.2%; n=16; 8 males, 8 females) and short-term (48.8%; n=15; 7 males, 8 females) therapy groups. During fiberoptic endoscopy, patients were given food of different consistencies (thin liquid, honey, nectar, pudding, and solid consistency) according to the International Dysphagia Diet Standardization Initiative protocol, and they were evaluated before therapy and one week, one month, and three months after therapy using the penetration-aspiration scale and the Yale Pharyngeal Residue Severity Scale-Vallecula/Pyriform Sinus. Functional Oral Intake Scale and Turkish Eating Assessment Tool-10 (T-EAT-10) results were compared between the groups. An exercise-based individual swallowing therapy program of one and three months was applied to short-term and long-term therapy groups, respectively. Results: When the post-therapy penetration aspiration scores and pharyngeal residual severity scores of individuals receiving long-term and short-term therapy were compared, a higher score was found in the group receiving shortterm therapy than the long-term group, and a significant difference was found (p&lt;0.001). Pharyngeal phase abnormalities were detected in 27 (88.4%) patients, whereas laryngeal penetration/aspiration status was found in 23 (75.3%) patients, and both variables were found to be significantly higher in the short-term group (p=0.015 and p=0.014, respectively). The T-EAT-10 scores obtained before therapy in the long-term therapy group were significantly higher than T-EAT-10 scores obtained at the third month after therapy (p=0.004, p&lt;0.001, and p&lt;0.05, respectively). Silent aspiration of thin liquid, nectar, and solid consistency was experienced in 78% of patients before therapy. Conclusion: Long-term swallowing therapy program appears to be more effective than short-term in geriatric individuals with dysphagia.

Inter-rater reliability in the Testing methods of the International Dysphagia Diet Standardization Initiative (IDDSI) in Slovenian language

Background: Texture modification of drinks and food is a widespread clinical intervention for managing dysphagia. The descriptive and experiential approach to measurement is mainly used by healthcare professionals, caregivers, and patients. This study examines the inter-rater reliability of the International Dysphagia Diet Standardization Initiative (IDDSI) Testing methods on different food samples from the hospital’s central kitchen.&#x0D; Methods: Nine previously trained healthcare professionals of different professional backgrounds and working experiences independently evaluated 34 food samples in IDDSI levels 4, 5, 6, and 7.1, using a Slovenian translation of the IDDSI Audit Tools. The 12 descriptive food characteristics were observed during the two consecutive days of data collection, representing 7 IDDSI Testing Methods. The Fleiss’ Kappa was used as a measure of agreement.&#x0D; Results: Perfect agreement among raters was found for the Fork drip test regarding both observed parameters: dripping and holding shape. All ratings of participants were completely the same. Therefore, Fleiss’ Kappa is considered (κ =1) in both cases. Moderate agreement (κ = 0.583) was found in particle size assessment. Fair agreement was observed in the Fork Pressure Test (κ = 0.361) and Finger Test, indicating bolus separation (κ = 0.328), pressure (κ = 0.305), and moisture (κ = 0.297). Fair agreement was also found for the Fork/Spoon Separation Test (κ = 0.265) and the Spoon Tilt Test in parameters of holding shape on the spoon (κ =0.233) and stickiness (κ = 0.327). No statistically significant results were found in the assessment of adhesiveness (κ = 0.059) in the Spoon Tilt Test and assessment of a typical pattern (κ = 0.039) in the Fork Pressure Test.&#x0D; Conclusions: The study proved the Fork Drip Test to be a comprehensive and highly reliable assessment tool, while the other IDDSI Testing Methods showed low inter-rater reliability. The study highlights the risks of low agreement among raters. It draws attention to the IDDSI descriptors, which should be improved with additional instructions or standardised training protocol for learning the IDDSI Testing Methods.

Formulation of Functional Liquid Diets Under IDDSI Levels 0 to 2 for Dysphagia Patients: Physico-Chemical, Sensory, Antioxidant and Electromyographic Oral Processing Analyses.

Dysphagia is a significant health concern especially amongst the old age population. It is an ailment brought on by the weakening of the swallowing muscles. To reduce the risk of choking in dysphagia patients, the food is usually diluted to suit their swallowing ability. But dilution results in reducing the nutritional density of the foods thus causing undernutrition and malnutrition in patients. In this study, functional liquid diets were formulated under International Dysphagia Diet Standardization Initiative (IDDSI) levels 0-2. The developed diets were analysed for their proximate composition, colour, antioxidant and sensory properties. Antioxidant activities were determined using 2,2'-azino-bis(3-ethylbenzothiazoline-6-sulfonic acid) (ABTS+), 2,2-diphenyl-1-picrylhydrazyl (DPPH), ferric reducing antioxidant power (FRAP) and total phenolic content (TPC) methods. The highest ABTS+ value was observed in pumpkin puree (level-2) i.e. 98.59%. Black carrot juice (level-1) showed the highest DPPH free radical scavenging activity and FRAP value viz. 88.43% and 689.33µM TE/g, respectively. Electromyography (EMG) is an upcoming technique of food texture evaluation which provides real-time information about food oral processing. In this study, an EMG was conducted to measure the myoelectrical activity of human suprahyoid and masseter muscles by placing electrodes on the skin's surface during the oral processing of liquid. The EMG parameters correlated significantly with viscosity, ease of swallowing and IDDSI levels of the formulated diets. Hence EMG can be used as a tool for design and development of textured-modified diets for dysphagia patients. The sensory scores of formulated diets in this study were high indicating that these liquid diets may be incorporated into the diet plans of dysphagia patients.

Evaluation of the Whiteout During Fiberoptic Endoscopic Evaluation of Swallowing and Examination of Its Correlation with Pharyngeal Residue and Aspiration.

To evaluate the whiteout duration (WOd) and intensity (WOi) during Fiberoptic Endoscopic Evaluation of Swallowing (FEES) and examine their correlation with each other and age, gender, bolus consistencies, residue, and aspiration. Retrospective review of 75 videorecorded FEES.The first swallow of each of the following were scored: "Empty" swallow, semisolids, solids, and liquids (International dysphagia diet standardization initiative (IDDSI) 4, 7, 0, respectively). Data scored for each swallow included WOd, WOi, Penetration and aspiration scale (PAS), Pharyngeal residue (Yale Pharyngeal Residue Severity Rating Scale, YPR-SRS), and saliva pooling (Murray Secretion scale, MSS). The highest PAS and YPR-SRS for each consistency during the entire examination were also collected. WOd was significantly longer for stronger WOi in IDDSI4 swallows (p = 0.019). WOi was weaker for IDDSI0 swallows compared to IDDSI7, IDDSI4, and empty swallows (p < 0.05). Patients with saliva pooling had significantly shorter WOd (0.81 ± 0.3 s for MSS = 0 vs. 0.62 ± 0.24 for MSS = 3, p = 0.04). Lower WOi was associated with higher mean age for IDDSI0 (mean ages of 73 ± 12, 64 ± 14, 73 ± 7, 59 ± 16years for intensity levels 1-4 respectively, p = 0.019). Swallows with weaker WOi and longer WOd had significantly more aspirations in IDDSI7 (28.8% of PAS ≥ 6 for intensity 2 vs 0% for intensity 4, p = 0.003 and 0.77 ± 0.4 s for PAS 1-2 vs. 1.02 ± 0.08 for PAS 6-8, p = 0.049). WOi and WOd are significantly associated with each other. WOi may vary for different bolus consistencies and decreases with age. Longer WOd and weaker WOi are associated with penetration-aspiration. Shorter WOd is associated with saliva pooling.

Improving swallowing function in a child with cerebral palsy: A single case study on the efficacy of intervention strategies

The study explored the efficacy of Oromotor exercises and proprioceptive neuromuscular facilitation (PNF) to improve swallowing abilities pre- and post-behavioral intervention in a child with cerebral palsy (CP). A 4-year-old female child diagnosed with global developmental delay secondary to spastic quadriplegic CP and poor feeding skills was taken up for study. Oro-motor stimulation and PNF with taste, temperature, and texture were used. Therapy was given twice a week for 30 min. Pre- and post-intervention, a detailed Oro motor and feeding evaluation was performed. Post-therapy evaluation revealed significant increase in body weight, oromotor movements, International Dysphagia Diet Standardization Initiative, Eating Drinking Ability Classification System level, frequency of water, and meal intake. The intense application of oromotor and PNF stimulation seemed to have effected significant improvements in feeding and swallowing abilities which translated to increased weight and positive parental feedback. This might have been responsible for positive outcomes seen in the present study as well.

Supporting safe swallowing of care home residents with dysphagia: How does the care delivered compare with guidance from speech and language therapists?

Dysphagia affects up to 70% of care home residents, increasing morbidity and hospital admissions. Speech and language therapists make recommendations to support safe nutrition but have limited capacity to offer ongoing guidance. This study aimed to understand if recommendations made to support safe and effective care are implemented and how these relate to the actual care delivered. Eleven mealtimes with residents with dysphagia were observed during 2020 using a tool capturing 12 elements of expected practice. Staff actions during mealtimes were compared with adherence to residents' care plans and speech and language therapist recommendations. Written recommendations predominantly focused on food and fluid modification.Observations (n = 66) revealed food texture, posture, and alertness were adhered to on 90% of occasions, but alternating food and drink, prompting and ensuring swallow completed adherence was less than 60%. Thickened fluids frequently did not align with required International Dysphagia Diet Standardisation Initiative levels. Nutrition care provided in the dining room was less safe due to a lack of designated supervision. Care homes need to be supported to establish a safe swallowing culture to improve residents' safety and care experience. What is already known on this subject? Dysphagia is associated with considerable morbidity and mortality and has been identified as an independent risk factor for mortality in nursing home residents. There is evidence that compensatory swallowing strategies, safe feeding advice and dietary modifications can reduce the risk of aspiration pneumonia. Care for nursing home residents at mealtimes is often task-centred and delegated to those with limited training and who lack knowledge of useful strategies to support the nutrition and hydration needs of residents with dysphagia. What this study adds? Written advice from speech and language therapists on safe nutrition and hydration for residents with dysphagia is focused mainly on food and fluid modification. Nurses and healthcare assistants have limited understanding of International Dysphagia Diet Standardisation Initiative levels or safe swallowing strategies and recommended practices to support safe nutrition care for residents with dysphagia are inconsistently applied especially when residents are eating in dining areas. Care homes are not aware of Royal College of Speech and Language Therapists guidance on how safe nutrition care of residents with dysphagia should be supported. What are the clinical implications of this work? Care homes need to prioritise a safe swallowing culture that ensures that residents with swallowing difficulties are assisted to eat and drink in a way that enhances their mealtime experience and minimises adverse events that may result in hospital admission. Speech and language therapists could play an important role in training and supporting care home staff to understand and use safe swallowing strategies with residents with dysphagia. The Royal College of Speech and Language Therapists could provide more assistance to care homes to support and guide them in how to implement safe feeding routines. Care home staff have limited knowledge about how to implement safe feeding routines and need more guidance from speech and language specialists on how they can support residents with dysphagia to eat safely. Creating a safe swallowing culture within care homes could help to improve nutrition care and enhance patient safety.

Moving towards a personalised understanding of the nutritional impact of self-expanding metallic stents (SEMS) in gastro-oesophageal cancer: A retrospective case note review of a tertiary referral oncology centre.

301 Background: Dysphagia is a common life-impacting complication for patients with gastro-oesophageal (O-G) cancer. Options to alleviate dysphagia include insertion of SEMS or percutaneous endoscopic gastrostomy (PEG). SEMS improve quality of life by enabling a person to eat a varied diet, but are associated with complications including pain and need for reintervention. Although studies have shown SEMS improve dysphagia, consequent longitudinal impact on nutritional status has not been evaluated. There is a need to better characterise risks and benefits of SEMS to allow a personalised approach to both insertion and follow-up. Methods: We identified patients with a confirmed diagnosis of O-G cancer, who underwent SEMS insertion at The Christie NHS Foundation Trust in 2021 and 2022. Data was retrospectively collected about patient and stent characteristics, and patient outcomes to quantify benefits and risks of SEMS. Results: 112 patients had 127 SEMS inserted at The Christie. Patients’ International Dysphagia Diet Standardisation Initiative (IDDSI) score significantly improved after SEMS insertion (N=120); prior to SEMS 62% were only managing liquids and purees (IDDSI 3 and 4) and 24% were not able to eat enterally. Post SEMS, 76% tolerated textured foods (IDDSI 5 and above) and only 21.5% were limited to liquids/purees. We observed a significant reduction in the rate of weight loss (% body weight/10 days) following SEMS insertion (-0.010 ± 0.009 vs. -0.001 ± 0.010, P &lt; 0.001). 12% of patients experienced grade 3 SEMS-related toxicity or stent failure within 30 days, and 20% developed significant pain within 24 hours of SEMS insertion. Conclusions: SEMS provide meaningful nutritional benefit in the majority of patients with O-G cancer, as weight loss is significantly slowed following insertion. However, we identified two groups of patients who did not benefit from SEMS; those who continued to lose weight and those who had stent failure. We did not find predictive factors for stent failure from multivariate analysis of baseline demographics or stent characteristics. Therefore, more detailed analysis of tumour factors, imaging findings and SEMS location from a larger cohort of patients may be required to identify patients who are unlikely to benefit from SEMS, and alternative interventions such as PEG feeding could be considered.

Modified consistency dysphagia diet protocol for Pakistan: Development perspective

Background: Increased in life expectancy has led to the increased need for texture-modified foods for dysphagia patients, to maintain their nutrition status. At present clinical practices in Pakistan are marred with no standard diet protocols resulting in misunderstanding in recommended consistencies of both food and fluid, hence compromising patients’ safety, necessitating the work of dysphagia diet protocol. Objectives: To develop a dysphagia diet consistency protocol for Pakistan. Methods: A descriptive study recruited 16 Speech-Language Pathologists and dieticians from Rawalpindi &amp; Islamabad using convenient sampling from October 2018 to March 2019. The sample included SLPs and dieticians working for at least 1 year with dysphagia patients. To ensure the process of standardization list of food and fluids was generated by the professionals to analyze the various food textures with the help of a viscometer that contributed to labeling and defining the textures. With the help of the International Dysphagia Diet Standardization Initiative Flow Test, Fork Drip Test, Spoon tilt test, Fork Pressure Test, Spoon Pressure Test, and Finger Test, a list of food and fluid items categorized into 8 levels which help the management of dysphagia patients in clinical practice. Results: The current study developed a dysphagia diet protocol and categorized 29 foods and fluids as per the IDDSI framework. 10 items were placed in level 0 (Thin). 2 items were placed in level 1 (slightly thick). 2 items were placed in 2 (mildly thick) 1 item was placed at level 3. Level 4 included 2 items. Level 5 included 3 items. Level 6 included 4 items and Level 7 included 6 regular daily food items. Conclusion: The study successfully developed a standardized dysphagia diet consistency protocol consisting of 29 commonly readily available and popular foods consumed by Pakistanis and placed these items under 8 levels of the International Dysphagia Diet Standardization Initiative (IDDSI) recommendations. Keywords: Dysphagia; food consistency; IDDSI; swallowing disorders; texture modification.

Characterizing Gelatin-Based Desserts Using International Dysphagia Diet Standardisation Initiative Testing Methods

Purpose: Gelatin-based desserts are a popular method to promote liquid consumption for individuals with dysphagia. Unique characteristics of these desserts in the United States pose a challenge for appropriate presentation to patients in relation to their clinically approved International Dysphagia Diet Standardisation Initiative (IDDSI) level. The purpose of this study was to determine the constancy of IDDSI level and transitional food status for 16 nationally available gelatin-based desserts based on preparation (premade and ready-to-make) and formulation (regular and sugar-free). Method: Three semiblinded raters used IDDSI testing methods to assign an IDDSI level and transitional food rating immediately, 15 min, and 60 min after removing from the refrigerator. Results: The majority (89.6%) of the samples were rated as Level 7 Easy to Chew, across all time intervals, with good interrater agreement (Mann–Whitney U Test, immediately U = 101.0, p = .934; 15 min U = 101.0, p = .934; 60 min U = 94.5, p = .711). Approximately a quarter of samples were categorized as a transitional food, though 4% could not be categorized using current IDDSI characteristics. Conclusions: Overall, this study presents that the current characteristics and physiological rationale may overestimate the skills required for gelatin-based desserts and inappropriately classify them as nontransitional foods. As with all products, individual gelatin-based desserts should be tested at the time of presentation to the patient. However, clinical evaluation should further determine the appropriateness of the dessert for each patient.