Pureed Food Research Articles

Comparing Homogenized Instantaneous Meals and Traditional Pureed Foods in Patients Affected by Dysphagia: A Pilot Study.

Background: Institutionalized individuals with dysphagia are particularly at risk for malnutrition. This study investigated two texture-modified models for patients with dysphagia, as follows: (i) traditional homemade pureed food (PF) and (ii) homogenized meals obtained from dehydrated and rehydrated instantaneous preparations (IPs). Methods: A retrospective pilot study was performed. It included patients affected by medium-severity dysphagia admitted to the nursing home "Sacra Famiglia" Institute of Cocquio Trevisago, Varese. The patients were aged 41-81 years old and all had complex disabilities. They underwent anthropometric and biochemical parameter assessments at baseline, as well as at two months and four months follow-up. Results: The study involved 30 patients, 15 received the IP meal. The comparison between the baseline and the follow-up did not show significant anthropometric and biochemical parameter differences. Conversely, the IP group reported significantly higher levels of consumption and satisfaction, evaluated using a modified Chernoff scale based on three levels of smiles, than the PF group. Conclusions: The present findings provide promising indications to improve the diet of patients affected by dysphagia, since meal satisfaction is a relevant factor that has been shown to be associated with better patient mood, motivation to eat, and adherence to prescribed diet.

The effects of different starches and gums on instant pureed rice porridge for patients with dysphagia

Dysphagia is defined as the difficulty to swallow food and liquid. Pureed food is commonly used in dysphagia management. For patients with dysphagia, a commercially available thickener is usually added during the preparation of pureed food to impart desired consistency which aids in reducing the risk of choking. However, high costs and limited availability of commercial thickener are burdens for some patients. Besides, the foods prepared by the commercial thickener also have consistent viscosity problems. Therefore, the use of instant pureed food has been proposed as an alternative solution for these shortcomings. This study was designed to evaluate the suitability of starch and gum as a thickener in instant pureed rice porridge for patients with dysphagia using rheological and sensory parameters. The experiments were then divided into two main sections: (1) analyses on rice porridge powder and (2) analyses on reconstituted rice porridge. Instant pureed rice porridge was developed for patients with dysphagia according to the framework outlined by the International Dysphagia Diet Standardisation Initiative (IDDSI). Overall, this study has successfully developed instant rice porridge that was suitable for consumption among patients with dysphagia and was proven to be acceptable through sensory study. Xanthan gum was shown to have the greatest potential to be used as a thickener in instant rice porridge. The success of the incorporation of xanthan gum into instant rice porridge can be a cheaper and more convenient option to the existing commercial thickener for dysphagia management.

S2298 Dysphagia Lusoria Secondary to an Aberrant Left Subclavian Artery

Introduction: Dysphagia lusoria, also known as Bayford-Autenrieth dysphagia, is a rare condition with prevalence of approximately 0.5%. First reported by David Bayford in 1790, it is defined as dysphagia secondary to extrinsic compression of the esophagus as a result of congenital abnormality of the aortic arch and its branches. We report a case of Dysphagia lusoria in a patient with congenital heart syndrome. Case Description/Methods: A 36-year-old woman with history of Dysphagia lusoria secondary to an aberrant left subclavian artery (SCA), congenital heart syndrome with known right sided thoracic aorta, tricuspid atresia and stenosis, hypoplastic right ventricle, and aberrant left SCA presented to the hospital with worsening dysphagia. She reported vomiting with any solid foods and only tolerating pureed foods or liquids. She reported a history of progressive dysphagia since 2018, when she underwent an esophagogastroduodenoscopy (EGD) that showed subtle pallor in the upper esophagus concerning for partial obstruction due to aberrant subclavian artery. She also underwent a manometry that was normal. On hospital admission, she underwent an x-ray upper gastrointestinal series that showed unchanged vascular impression of the upper esophagus with mild esophageal dysmotility, consistent with her diagnosis of Dysphagia lusoria (Figure). Cardiology and vascular surgery were consulted and deemed the patient a poor surgical candidate due to her prior operations for congenital disease and fontan physiology. Management was deferred to gastroenterology, who recommended small meals and chewing well and proton pump inhibitor therapy for associated heart burn. The patient reported symptomatic improvement with dietary modification. Discussion: The most common alteration in Dysphagia lusoria is an aberrant right subclavian artery. Most patients are asymptomatic; symptoms usually include dysphagia, regurgitation, chest discomfort, weight loss, and Horner syndrome. Diagnosis is best achieved by barium esophagram, which often shows extrinsic compression above the aortic arch. EGD can further show extrinsic compression of the posterior wall of the esophagus. Mildly symptomatic patients are recommended to chew thoroughly, sip liquids, and avoid exacerbating foods. Surgical intervention with the goal of removing the aberrant vessel and reconstructing a more functional vascular system is rarely performed but reserved for severe cases. The significant risk of morbidity and mortality with surgery needs to be weighed in these patients.Figure 1.: X-ray upper gastrointestinal series showing vascular impression of the upper esophagus secondary to aberrant left subclavian artery.

Oral disease burden of dentate older adults living in long-term care facilities: FINORAL study

BackgroundA growing number of older adults have natural teeth and are at high risk of oral diseases, which are induced by oral bacterial accumulation and proceed unnoticed and quietly. Our aim was (1) to examine the association of oral disease burden (ODB) with health and functioning among dentate long-term care residents, and (2) to find easily detectable signs for nurses to identify residents’ poor oral health.MethodsIn this cross-sectional observational study dentists examined 209 residents’ oral status, and nurses assessed residents for their functioning and nutrition in long-term care facilities in Helsinki, Finland. ODB was defined by asymptotic dental score (ADS). Six clinical signs of residents’ poor oral health were considered as potentially easy for nurses to detect: lesions on lips, teeth with increased mobility, lesions on oral mucosa, eating soft or pureed food, unclear speech, and needing assistance in eating. The association of these was tested with high ODB as outcome.ResultsParticipants were grouped according to their ADS scores: low (n = 39), moderate (n = 96) and high ODB (n = 74). ODB was linearly associated with coronary artery disease and poor cognitive and physical functioning: needing assistance in eating, poor ability to make contact, and unclear speech but not with other diseases including dementia or demographic characteristics. Furthermore, ODB was linearly associated with eating soft or pureed food. Of the six selected, easily detectable signs, having at least two positive signs gave 89% sensitivity to detecting high ODB.ConclusionPoor oral health was common and ODB accumulated among residents with poor functioning. Nurses may use a few easily detectable signs to screen residents’ oral health when considering a resident’s need for consultation with an oral health professional.

Thickened Liquids Using Pureed Foods for Children with Dysphagia: IDDSI and Rheology Measurements.

Children with dysphagia, or swallowing disorder, are at an increased risk for developing respiratory compromise, failure to thrive, and aversion. Thickened liquids can be recommended for children with dysphagia, if shown to be effective on instrumental examination and if strategies/interventions with thin liquids are not successful. Thickened liquids have many benefits, including creating a more cohesive bolus, slowing oropharyngeal transit time, and reducing aspiration. However, preparing thickened liquids withcommercially available thickeners can result in poor compliance due to concerns regarding taste, texture, accessibility, cost, thickness variability, and potential negative impact of these substances on a child's immature digestive tract. The purpose of this study was to determine if liquids could be successfully thickened with widely available, commercial pureed foods, and to assess how these mixtures compare to starch and gum based thickening agents. The International Dysphagia Diet Standardisation Initiative (IDDSI) flow test was performed for each sample of puree thickened liquids, gum based thickened water, and cornstarch based thickened water. In addition, rheology testing was performed on each category of the samples to measure viscosity at various shear rates and temperatures, and to assess the presence of yield stress. Results revealed that liquids thickened with smooth textured purees were comparable to commercial starch and gum based thickeners, and may be offered as a viable alternative.

MEDICAL EDUCATION; IMMERSION LEARNING; EMPATHY; NURSING HOME CARE

Introduction: At the University of New England College of Osteopathic Medicine (UNECOM), a medical student’s ability to both empathize with and understand older adults living in nursing homes is limited without first-hand experience. This case study research project required to answer the question: “What is it like for me to live the life of an older resident?” This article presents one student doctor’s experiences. Methods: Ethnographic/auto-biographic research designs were applied. A 23-year-old male osteopathic medical student was admitted into a nursing home for 10 days with a diagnosis. He was wheelchair reliant, bathed, toileted, fed pureed foods, and cared for by staff as a resident. Data were in journal format for pre-fieldwork, fieldwork, and post-fieldwork including subjective and objective reporting of observations, experiences, and resident encounters. Analyses included journal review and thematic categorization and coding through content analysis. Results: Three significant themes were identified: (1) Adaptation; (2) Communication; and (3) Loss. Being immersed in a nursing home, the student experienced the losses and challenges faced by older nursing home residents and gained perspective on creating community. This process provided the student with meaningful skills and empathy to engage with older adults with functional limitations. The data were integrated into the larger study. Conclusion: This experience imparted knowledge and challenged the student doctor’s attitudes about aging, loss, and the critical role of making meaningful connections in order to adapt to challenging circumstances. These insights provided an understanding of osteopathic care gained through immersion learning that is person-centered, comprehensive, and empathic.

Effect of hydrocolloid type on texture of pureed carrots: Rheological and sensory measures

This research is an investigation of the effect of selected hydrocolloids on the texture of pureed foods. Modified starch, xanthan, carrageenan, carboxymethyl cellulose, pectin, gellan, and two proprietary hydrocolloids were added to pureed carrots and textural properties were examined. ThickenUp®, a commonly used modified corn starch thickener used when making pureed foods, was used as a reference. Rheological measurements, texture profile analysis (TPA), and sensory testing were employed to characterize the texture of the purees. It was hypothesized that hydrocolloids have no effect on texture and sensory properties of pureed carrots once the viscosity is matched at a shear rate of 50 s−1. The results indicated clear differences in the behaviour of hydrocolloids under small and large deformation measures. Carrageenan had a very stiff structure, which was susceptible to fragmentation, while CMC with a weak gel structure was easy to form a swallow-able bolus. It was observed that although pectin had a strong gel structure at rest, it had a high cohesiveness when subjected to large deformation. Trained panel sensory results indicated textural similarities amongst a starch-gum blend, xanthan and CMC. Viscosity at 10 s−1, yield point (rheology) and gumminess (TPA) correlated well with three sensory attributes amongst the five tested by the panel.

Long-term outcomes of four patients with tracheal agenesis who underwent airway and esophageal reconstruction

PurposeThe aim of this study was to evaluate the long-term outcomes of four patients with tracheal agenesis who underwent airway and esophageal/alimentary reconstruction. Materials and MethodsWe reviewed the medical records of four long-term survivors of tracheal agenesis and collected the following data: age, sex, type of tracheal agenesis, method of reconstruction, nutritional management, and physical and neurological development. ResultsThe patients consisted of three boys and one girl, who ranged in age from 77 to 109months. The severity of their condition was classified as Floyd's type I (n=2), II (n=1), or III (n=1). Mechanical respiratory support was not necessary in any of the cases. Esophageal/alimentary reconstruction was performed using the small intestine (n=2), a gastric tube (n=1), and the esophagus (n=1). The age at esophageal reconstruction ranged from 41 to 55months. All of the cases required enteral nutrition via gastrostomy. Three of the patients were able to swallow a small amount of liquid and one was able to take pureed food orally. The physical development of the subjects was moderately delayed–borderline in childhood. Neurological development was normal in two cases and slightly delayed in two cases. ConclusionsNone of the long-term survivors of tracheal agenesis required the use of an artificial respirator, and their development was close to normal. Future studies should aim to elucidate the optimal method for performing esophageal reconstruction to allow tracheal agenesis patients to achieve their full oral intake.

Keeping Consumers Safe: Food Providers' Perspectives on Pureed Food

Twelve focus groups were conducted in five sites with 80 allied health providers to identify their perspectives on providing pureed food to consumers. Thematic care analysis was completed to summarize and interpret these data. Providers' greatest concern was keeping consumers safe, and the right texture was prioritized over sensory appeal and acceptance. Providers recognized that these foods impacted the quality of life of consumers and worked to rationalize these diets with residents/patients and their families. In addition, offering foods they knew to be poorly accepted affected their self-concept as providers. As a result of these challenges, they did whatever they could in the kitchen and tableside to promote intake of pureed foods. Those in the “food chain” of pureed food provision suggested several ways to further improve these products. Greater communication between those who assist consumers with eating and those who produce the pureed food they consume is needed to promote acceptable pureed products.

In-House Pureed Food Production in Long-Term Care: Perspectives of Dietary Staff and Implications for Improvement

Texture modification of foods to a pureed consistency is a common management approach for older adults with dysphagia. Long-term care (LTC) facilities commonly produce some pureed food in-house. This study investigated challenges and preferred practices associated with the production of pureed food in LTC facilities. Nutrition Managers (n = 27) and cooks (n = 26) from 25 Ontario LTC facilities were recruited for one-on-one, semistructured interviews. Interviews were digitally recorded, transcribed, and analyzed using inductive thematic analysis. Four themes arose from the data to exemplify challenges in production, including (a) difficulty in using standardized recipes, (b) varied interpretation of governmental guidelines, (c) lack of consistency in terminology and texture, and (d) wanting to improve the visual appeal. These challenges were reported to reduce the quality of in-house produced pureed food. Preferred practices to overcome these challenges were also provided by participants, such as involving cooks in pureed recipe improvements and tailoring to the specific needs of residents. Incorporation of these practices into pureed food production may help to shape and improve future practice and pureed food products.

Characterizing Commercial Pureed Foods: Sensory, Nutritional, and Textural Analysis

Dysphagia (swallowing impairment) is a common consequence of stroke and degenerative diseases such as Parkinson's and Alzheimer's. Limited research is available on pureed foods, specifically the qualities of commercial products. Because research has linked pureed foods, specifically in-house pureed products, to malnutrition due to inferior sensory and nutritional qualities, commercial purees also need to be investigated. Proprietary research on sensory attributes of commercial foods is available; however direct comparisons of commercial pureed foods have never been reported. Descriptive sensory analysis as well as nutritional and texture analysis of commercially pureed prepared products was performed using a trained descriptive analysis panel. The pureed foods tested included four brands of carrots, of turkey, and two of bread. Each commercial puree was analyzed for fat (Soxhlet), protein (Dumas), carbohydrate (proximate analysis), fiber (total fiber), and sodium content (Quantab titrator strips). The purees were also texturally compared with a line spread test and a back extrusion test. Differences were found in the purees for sensory attributes as well as nutritional and textural properties. Findings suggest that implementation of standards is required to reduce variability between products, specifically regarding the textural components of the products. This would ensure all commercial products available in Canada meet standards established as being considered safe for swallowing.

Price Analysis of Maid Rite Formed Puree Products Versus Facility Made Pureed Food

Price Analysis of Maid Rite Formed Puree Products Versus Facility Made Pureed Food

AN EVALUATION OF TEXTURE MANIPULATIONS TO INCREASE SWALLOWING

The purpose of the current investigation was to identify an appropriate texture for initial treatment of 1 child's feeding problem. Variability in mouth clean (a product measure of swallowing) during a texture assessment suggested that individual pureed foods differentially affected feeding behavior. A single-food assessment identified individual problematic foods. We used the results of these assessments to inform treatment, resulting in high levels of mouth clean across foods.

Perceived chewing ability and need for long‐term care in the elderly: a 5‐year follow‐up study

Increasing need for long-term care in older adults is expected with the ageing of Japan's population. The aim of the present study was to show the relationship between perceived chewing ability and long-term care needs for over 5 years in elderly persons. The chewing ability of 812 elderly persons living independently was evaluated at baseline using self-assessed masticatory ability, and it was classified into one of three categories: ability to chew all foods (good masticatory ability), ability to chew only slightly hard food (fair masticatory ability), and ability to only chew soft or pureed food (poor masticatory ability). Participants' care needs were then followed through Japan's long-term care insurance system for over 5 years. The log-rank test and Cox proportional hazard model were used to examine statistical differences in the frequency of care-needs certification between participants with good and fair or poor masticatory ability. Among participants aged 65-79 years, the frequency of care-needs certification was significantly higher in those with fair or poor masticatory ability than in those with good masticatory ability, and the relative hazard ratio was significantly higher in those with fair or poor masticatory ability than in those with good masticatory ability, after adjusting for age, gender, current employment status, educational background, social interaction, chronic medical conditions and dentition status. These relationships were not found among those aged 80-93 years. Impairment in perceived chewing ability may be associated with higher incidence of certification in Japan's long-term care insurance system among elderly persons aged 65-79.

Unusual technique for caustic esophagitis

We present this case because of its rarity, as we have not found anything similar in young non-neoplastic patients. We describe the case of a 36 years-old woman with long-term dysphagia for solids. Her past medical history reveals an esophagoplasty with subcutaneous colon interposition, which was performed in Romania 15 years before, due to caustic stricture. Stenosis of the cologastric anastomosis, after an occlusive episode, required reintervention in 2008. Currently she only tolerates pureed food. Physical examination showed a scar on the left side of her neck, which extended through the chest and abdomen (a large median laparotomy scar). An esophago-gastroduodenal series was done (Fig. 1), which displayed: “Upper esophageal stricture with pre-stenotic dilatation; the barium contrast material flowed passively into the stomach”. Subsequently, CT scans of the cervical, thoracic and abdominal areas were performed using i.v. contrast with the following results (Fig. 2): “cologastric anastomosis consisting of colon subcutaneous transposition and reentry to abdominal cavity to reach the gastric body”. A gastroscopy demonstrated a recessed area 24 cm below the dental arch, with remaining food debris and a concavity to the left which was not accessible. The patient was not dilated because of lack of wall thickness and perforation risk. Currently awaiting surgery. Discussion

Associations between self-assessed masticatory ability and higher brain function among the elderly

Among the elderly, the quality of higher brain function is a contributing factor in performing activities of daily living. The aim of the study is to elucidate, epidemiologically, associations between mastication and higher brain function. A total of 208 community-dwelling elderly persons, aged 70-74 years, were enrolled. Self-assessed masticatory ability (masticatory ability) was classified into one of three categories: ability to chew all kinds of food, ability to chew only slightly hard food, or ability to chew only soft or pureed food. Brain function was assessed by four neuropsychological tests: Raven's Colored Progressive Matrices (RCPM) test, the Verbal Paired Associates 1 (VerPA) task and the Visual Paired Associates 1 task (from the Wechsler Memory Scale Revised Edition), and the Block Design subtest (from the Wechsler Adult Intelligence Scales-Third Edition). Correlations between masticatory ability and each test were examined using Spearman rank correlation coefficients. Multinominal logistic regression models were conducted with the neuropsychological tests as the dependent variables and masticatory ability as the principal independent variable to adjust for age, gender, educational background, social activity, drinking/smoking habits, chronic medical conditions and dental status. Significant correlations were found between the RCPM test, the VerPA task, the Block Design test and masticatory ability. In multinominal logistic regression models, poor masticatory ability was significantly and independently related to the categories under the mean-s.d. points compared with those of the mean ± s.d. ranges for RCPM test and the VerPA task. Significant associations may exist between mastication and higher brain function among the elderly.

Relationships between perceived chewing ability and muscle strength of the body among the elderly

The aim of the present study was to elucidate whether self-assessed masticatory ability (masticatory ability) is significantly related to muscle strength of the body evaluated as handgrip strength and skeletal muscle mass of the whole body (kg) (SMM) after adjusting for confounding variables, including, age, gender, height, weight, employment status, type of household, educational background, social interaction, chronic medical conditions, smoking habit, drinking habits and dentition status among the elderly. A total of 381 persons aged 67-74 years were enrolled. Masticatory ability was classified into one of three categories: ability to chew all kinds of food, ability to chew only slightly hard food or ability to chew only soft or pureed food. Handgrip strength was measured, and bioimpedance analysis was used to estimate SMM. One-way analysis of variance and Bonferroni methods were used to examine differences in handgrip strength and SMM among the three groups of masticatory ability. An ordinal regression model was conducted with masticatory ability as the dependent variable and handgrip strength as the principal independent variable. Handgrip strength was significantly lower in those individuals who could chew only soft or pureed food than in those individuals who could chew all kinds of food. No significant difference in SMM was found among the three groups of masticatory ability. Masticatory ability was significantly related to handgrip strength after adjusting for SMM, dentition status and background factors. Chewing ability may be related to muscle strength of the body evaluated as handgrip strength, but not evaluated as SMM.

Self-assessed masticatory ability and hospitalisation costs among the elderly living independently

The escalating medical costs are a social problem in many countries. Masticatory ability is thought to be related to the general health conditions. The purpose of this study was to show relationships between self-assessed masticatory ability and medical costs among the elderly living independently in community. Data on background factors and self-assessed masticatory ability were collected from 702 Japanese elderly persons by questionnaires. An intra-oral examination was performed to examine the number of remaining teeth. Self-assessed masticatory ability was classified into one of three categories: ability to chew all kinds of food (Good), ability to chew only slightly hard food (Fair) or ability to chew only soft or pureed food (Poor). Data on the annual medical excluding dental costs were obtained from the Japanese National Health Insurance system. The Kruskal-Wallis test was used to examine differences in outpatient costs and hospitalisation costs among the three groups of self-assessed masticatory ability. Univariate unconditional logistic regression models and multivariate logistic regression models were used with medical costs as the dependent variable and self-assessed masticatory ability as the principal independent variable. A significant difference (P=0·039) in hospitalisation costs but not outpatient costs was found among the three groups of self-assessed masticatory ability. The multivariate logistic regression analysis showed that severely impaired masticatory ability (Poor) was significantly related to higher costs of hospitalisation. Self-assessed impairment of masticatory ability may be a significant and independent indicator of higher costs of hospitalisation among community-dwelling elderly persons.

Life: A Circle With Challenges at Both Ends

Life: A Circle With Challenges at Both Ends

Influence of dehydration-rehydration process on rheological properties of liquid fruit foods

The effects of the dehydration-rehydration process on the recovering of the original rheological characteristics of the re-hydrating solution were studied. Four different fruit fluid products were investigated: apricot, banana purees, non-pureed citrus fruits, i.e mandarin juice and lemon treacle, respectively. The static rheological behavior of both pureed and non-pureed products was measured for the raw material, i.e. before the drying process, and after the rehydration procedure. First of all, the results show that rehydrated materials have different rheological behaviors from fresh ones, especially in the case of starch added non-pureed products. Such differences can be due to both the stress conditions induced by mechanical drying and successive rehydration or to other factors such as, for example, the starch addition. These results were relevant to quantify the rehydration efficacy of pureed and non-pureed foods, suggesting than more than just one parameter should be controlled for liquid foods when the rehydration procedure is carried out.