Texture-modified Diets Research Articles

Survey Report on Provision of Texture-Modified Diets at Hospitals and Long-Term Care Insurance Facilities in Ibaraki Prefecture:

Survey Report on Provision of Texture-Modified Diets at Hospitals and Long-Term Care Insurance Facilities in Ibaraki Prefecture:

Assessing adherence and exploring barriers to provision of prescribed texture modifications for dysphagia in a residential aged care facility in rural Australia

Purpose Purpose: Between 55–65% of residents living in residential aged care facilities (RACFs) experience dysphagia and are prescribed texture-modified diets by a speech-language pathologist (SLP). The aim of this study was to assess current adherence to prescribed texture modification for people with dysphagia; and explore barriers to implementation in a rural aged care setting. Method Method: Meal texture audits (N = 42) were completed with residents with dysphagia in a rural RACF who were prescribed texture-modified diets or fluids by a SLP. Semi-structured focus groups were conducted with nursing and food preparation staff (N = 11) to identify barriers to implementation. Result Result: Mealtime texture audits identified that 54.8% (n = 23) of residents' food modification requirements were incorrectly documented in the manual entry database (kitchen form) and 64.3% (n = 27) of meal trays contained foods that did not meet residents' dysphagia management plans. Focus group data revealed seven main themes impacting on the ability of staff to implement prescribed texture-modified diets. Complicated processes and communication between nursing, food services and SLP staff were identified as major barriers. These were complicated further by time pressures experienced by staff as well as staffing issues, resourcing of the kitchen, accommodating individual dietary preferences and the variety/presentation of dietary options at the aged care facility. Conclusion: There was low adherence to SLP prescribed texture-modified diets and fluids in the participating rural RACF. This study identified major barriers to implementing SLP prescribed texture-modified diets including complicated processes, communication breakdowns, time pressures and limited staffing. Implementation of an online menu management system and regular dysphagia-specific training may address barriers to communication and complicated paper-based menu systems and should be a priority for health services to ensure adequate dysphagia management.

Texture-Modified Diets are Associated with Poor Appetite in Older Adults who are Admitted to a Post-Acute Rehabilitation Hospital

ObjectiveThis study aimed to clarify the association between texture-modified diets and poor appetite in older adults, as it is not fully understood. DesignCross-sectional study. Setting and ParticipantsWe included 208 inpatients who were aged ≥65 years (mean age 78.9 ± 7.6 years, 57.7% female) and admitted to a rehabilitation unit with stroke, musculoskeletal disease, or hospital-associated deconditioning covered by the Japanese insurance system, between January 2019 and January 2020. MethodsParticipants were divided into 2 groups according to their food texture level: International Dysphagia Diet Standardization Initiative (IDDSI) levels 3 to 5 for the texture-modified diet group and levels 6 and 7 for the normal diet group. Appetite was assessed using the Simplified Nutritional Appetite Questionnaire for the Japanese elderly, and a score ≤14 was defined as poor appetite. The relationship between IDDSI levels and poor appetite was analyzed using the Cochrane-Armitage trend test. Logistic regression analysis was used to investigate the relationship between the consumption of texture-modified diets and poor appetite. Statistical significance was set at P < .05. ResultsThe numbers of participants on modified diets according to the IDDSI framework were as follows: 4, 11, 41, 76, and 76 in levels 3, 4, 5, 6, and 7, respectively. In total, 152 and 56 patients were classified into the regular diet group and texture-modified diet group, respectively. A significantly higher prevalence of poor appetite was observed with the consumption of texture-modified diets (P < .001 for trend). Logistic regression analysis showed that poor appetite was independently associated with the consumption of texture-modified diets (odds ratio 3.443, P = .011). Conclusions and ImplicationsThese findings indicate that the consumption of texture-modified diets is associated with poor appetite. Further studies are required to verify whether a multimodal approach involving improvement in the appearance, taste, flavor, and nutrients of the food can improve poor appetite.

Safety and Efficacy of Specially Designed Texture-Modified Foods for Patients with Dysphagia Due to Brain Disorders: A Prospective Study.

Providing texture-modified food for patients with dysphagia is a cornerstone of dysphagia treatment. This study aimed to evaluate the safety and efficacy of a specially designed texture-modified food that can be easily swallowed while maintaining the unique taste by adjusting hardness and adhesiveness in patients with brain disorders using a videofluoroscopic swallowing study. We included 101 patients with oropharyngeal dysphagia due to brain disorders who were referred to the rehabilitation department. To evaluate the safety and efficacy of a specially designed texture-modified food, rice gruel was compared with a regular instant rice porridge, and bulgogi mousse was compared with ground bulgogi, which normally serves as a texture-modified diet for patients with dysphagia in our hospital during the videofluoroscopic swallowing study. The Penetration–Aspiration Scale score, oropharyngeal transit time, number of swallows required to maximally eliminate food materials from the oropharyngeal space, and vallecular and pyriform sinus residue after swallowing scale score were compared. Rice gruel required a shorter oropharyngeal transit time and fewer number of swallowing per the given amount of food than regular instant rice porridge; however, no statistical difference was found in the vallecular and pyriform sinus residue after swallowing scale scores and the Penetration–Aspiration Scale scores. Bulgogi mousse required more swallowing and had lower Penetration–Aspiration Scale scores than ground bulgogi; however, no significant difference was found in the oropharyngeal transit time and the vallecular and pyriform sinus residue after swallowing scale scores. The study foods were safe and efficacious compared to control foods usually provided for patients with dysphagia from various brain disorders.

Texture-Modified Diets, Nutritional Status and Mealtime Satisfaction: A Systematic Review.

While the association between dysphagia and malnutrition is well established, there is a lack of clarity regarding the nutritional status and mealtime satisfaction of those consuming texture-modified diets (TMDs). This systematic review summarises and critically appraises the nutritional status and mealtime satisfaction of adults consuming TMDs. A systematic database search following PICO criteria was conducted using Cochrane Central (via Ovid), MEDLINE, CINAHL, EMBASE and Scopus. Nutritional status, mealtime satisfaction and costs were identified as primary outcomes. Eligible studies were grouped according to outcome measurement. In total, 26 studies met the inclusion criteria. Twenty studies evaluated the nutritional status by weight change or using malnutrition screening tools and found the consumption of TMDs correlated with weight loss or malnutrition. Nine studies evaluated mealtime satisfaction, with two reporting poor satisfaction for people on thickened fluids (TFs). Nutrition intervention through adjusting texture and consistency and nutrition enrichment showed positive effects on weight and mealtime satisfaction. The majority of the studies were rated as ‘neutral’ quality due to the limited number of experiments. TMD consumers had compromised nutritional status and poor mealtime satisfaction. More research input is required to identify promising strategies for improving the nutritional status and mealtime satisfaction of this population. Food services need to consider texture, consistency and fortification in designing menus for people on TMDs to avoid weight loss and malnutrition, and to enhance mealtime enjoyment.

Improving Accuracy of Texture-Modified Diets and Thickened Fluids Provision in the Hospital: Evidence in Action.

Ensuring inpatients with dysphagia receive and consume the correct texture-modified diet and thickened fluid prescriptions is challenging, and errors can result in significant complications for patients and increased costs to hospitals. The aim of this study was to investigate underlying factors that help or hinder receipt and consumption of correct dietary prescriptions for people with dysphagia in the hospital setting then implement and evaluate a range of strategies to address identified issues. A mixed-methods study design, using an integrated knowledge translation approach, was conducted in three phases. In Phase 1, clinical incident data (i.e., documented incidents of diet/fluid errors, with errors defined as the provision or consumption of any food/fluid not appropriate for a patient's dietary prescription) were analyzed, and staff, patients, and family members were interviewed using the Theoretical Domains Framework to identify factors contributing to errors. In Phase 2, health professionals assisted with the development and implementation of interventions targeted at micro (patient/family), meso (staff), and macro (organizational) levels to address factors identified in Phase 1. In Phase 3, outcomes including the change in number of dietary clinical incidents pre- to post-intervention, meal accuracy error rates from mealtime audits post-intervention, and follow-up interviews were evaluated using quantitative and qualitative measures. Post-intervention, there was a 50% reduction in clinical incidents, and a 2.3% meal accuracy error rate was observed. Staff reported most interventions were acceptable and feasible within their workload, although some interventions were not well embedded in everyday practice. This study highlights the value in using an integrated knowledge translation approach to inform tailored interventions targeting improved dietary accuracy in the hospital setting.

Implementing the International Dysphagia Diet Standardization Initiative: Opportunities for Change

Modified-texture foods and thickened liquids are commonly prescribed to minimize the risk of choking or aspirating for patients identified to have dysphagia. With improvements in health care resulting in increased survival of preterm infants and those with congenital anomalies, dysphagia prevalence is increasing in the pediatric population. Children may be prescribed texture-modified diets for various reasons because dysfunction can be present in any of the four phases of swallowing, which may manifest at different stages of development.

Fibre Content and Fibre Fortification of Menu Items Served to Sherbrooke Community Centre Residents on Texture Modified Diets

Background: Research has shown regular and texture modified menus in long term care (LTC) homes provide less than the recommended Dietary Reference Intake for dietary fibre. Constipation may result from inadequate fibre intake and be treated with laxatives and enemas, which may have implications for quality of life. Increasing the amount of fibre provided from texture modified diets may decrease use of such treatments and improve daily fibre intake.&#x0D; Objective: This study was part of a health improvement initiative for residents at Sherbrooke Community Centre (SCC). The goal of this study was to measure the baseline amount of fibre provided to residents on texture modified diets and to increase fibre provision by 5-10 grams per day.&#x0D; Methods: This study involved: 1) determining the fibre content of the texture modified menu for residents on pureed and minced diets; 2) identifying fibres and foods suitable for a fibre fortification trial; 3) conducting a fibre fortification trial and identifying fibre-food combinations for a taste test; and 4) conducting a taste test with SCC staff to assess acceptability of fibre fortified menu items. Thirty SCC staff were included.&#x0D; Results: The average daily fibre provided was 13.4 grams. The fibre fortified foods best accepted by participants were mashed potatoes with red lentils, pudding with pea hull fibre, and gravy with pea hull fibre.&#x0D; Implications: We recommended SCC incorporate the best accepted fibre fortified menu items into their regular and texture modified menus, allowing the daily average amount of fibre to increase by 5.39 grams per day.

Plate waste study among hospitalised patients receiving texture-modified diet.

BACKGROUND/OBJECTIVESWhile plate waste has been widely investigated in hospitals, there have been minimal studies specific to the texture-modified diet (TMD). This study aims to determine the percentage of plate waste among patients prescribed with TMD and its contributory factors.SUBJECTS/METHODSThis was a single-centre study conducted in the university hospital on three types of TMD (blended diet, mixed porridge, minced diet) during lunch and dinner meals. Weighing method and visual estimation method assisted by digital photograph were adopted in this study. Face to face interview was carried out to investigate on 1) the food/food service quality factors in terms of patients' satisfaction level towards sensorial quality of food and food services provided and 2) the clinical/external factors including appetite, the provision of oral nutrition support, time taking the diet, the need for feeding assistance and the length of hospital stay.RESULTSThe mean percentage of overall plate waste of 95 patients receiving TMD was high (47.5%). Blended diet was identified as the most wasted diet (65%) followed by minced diet (56%) and mixed porridge (35%). Satisfaction level among patients was moderate. Patients on TMD in general had higher satisfaction level on the aspect of food service as compared to food quality. Substantial association between sensorial qualities of food and plate waste were varied according to individual TMD type. A multiple linear regression showed that only the satisfaction level toward the aspects of appearance and variety of foods were the predictors of TMD plate waste (R2 = 0.254, P < 0.05).CONCLUSIONSA significant relationship between the percentage of plate waste and the overall satisfaction level of patients receiving TMD suggests that vigorous strategies are needed to reduce the food waste of TMD which will lead to a better nutritional status and clinical outcomes among the patients.

The Impact of Diet Type on Weight Loss in Patients with Alzheimer's Disease.

To compare differences in weight loss in patients with Alzheimer's disease on normal, diabetic, or texture-modified diets. This prospective interventional study examined the data of patients with Alzheimer's disease who were admitted to a long-term care hospital in Japan from February to April 2013. Dietary elements and weight loss over a 3-month period were examined. Results: Of the 75 patients examined, 6 were on a normal diet, 10 were on a diabetic diet, and 59 were on a texture-modified diet. Weight loss was significantly associated with body weight, Mini Nutritional Assessment®, and diet type. In the non-malnourished patients, there was a significant difference between the three types of diets in terms of eating rate and weight loss. Diet type was independently associated with weight loss in patients with Alzheimer's disease. Research using larger sample sizes is necessary to eliminate the differences between these diet types.

Nutritional Intake and Meal Composition of Patients Consuming Texture Modified Diets and Thickened Fluids: A Systematic Review and Meta-Analysis.

Texture-modified diets (TMDs) play an important role in ensuring safety for those with dysphagia but come with risks to nutrition and quality of life. The use of TMDs has been addressed with the increasing prevalence of dysphagia in previous decades. However, there is limited literature that investigates the nutrition perspectives of TMD consumers. This review summarises the nutrition outcomes of adults consuming TMDs and thickened fluids (TFs) and identifies the limitations of TMD and TF productions. A systematic database search following PICO criteria was conducted using Cochrane Central (via Ovid), MEDLINE, CINAHL, EMBASE, and Scopus databases. Nutrition intake, meal consumption, adequacy, and meal composition were identified as relevant outcomes. 35 studies were included for analysis. Consumption of TMDs demonstrated a poorer intake compared to regular diets, in particular significant in energy and calcium. Meta-analysis of mean differences showed favourable effects of shaped TMDs on both energy (−273.8 kJ/d; 95%CI: −419.1 to −128.6, p = 0.0002) and protein (−12.4 g/d; 95%CI: −17.9 to −6.8, p < 0.0001) intake compared to traditional cook-fresh TMDs. Nutrition intake was compromised in TMD consumers. Optimisation of nutrition intake was achievable through enrichment and adjusting meal texture and consistency. However, the heterogeneity of studies and the missing verification of the consistencies lead to difficulty in drawing conclusions regarding particular texture or intervention.

The Failure of Plate Diagrams in Estimating Individualized Offered Portion Size: An enable Study

Background/ObjectivesPlate diagrams (PDs) are commonly used to monitor dietary intake in nursing homes (NHs). PD intake estimation of texture-modified diet (TMD) is reliable, but only if the offered portion is determined by weighing records (WRs). Offered portion size is usually individualized in NHs and WRs are impractical for NH routine. Thus, an estimation of offered portion size by PDs seems to be appropriate but its validity is unknown. Further, validity of PDs for intake estimation based on estimated offer (instead of WRs) is unknown. DesignMain meal dietary offer and intake were assessed via PDs and WRs. Setting and ParticipantsSeventeen NH residents receiving TMD regularly. MethodsOffered portion size and intake of breakfast, lunch, and dinner at 42 days were estimated by nursing personnel via PDs (answer options offered portion size: >standard, standard, ¾, ½, ¼, nothing, I do not know; answer options intake: all plus second helping, all, ¾, ½, ¼, nothing, I do not know). In parallel, scientific personnel weighed all offered food items and leftovers. PD estimation of offered portion size was multiplied by energy and protein content of predefined standard portions. Afterward, PD estimation of intake was multiplied by PD determined energy and protein offer to determine the estimated energy and protein intake. PD determined offer and intake were compared with weighed offer and intake. ResultsSeventeen residents (14 female) with a mean [±standard deviation (SD)] age of 87.1 (±7.5) years participated in the study. Nursing personnel overestimated offer and intake. Mean daily differences (±SD) between WR and PD determined offer were −349.0 (±315.7) kcal, P < .001, (−36.3% of mean weighed energy offer) and −15.0 (±12.8) g protein, P < .001, (−42.2% of mean weighed protein offer). Mean daily differences (±SD) between WR and PD determined intake were −283.0 (±299.8) kcal, P < .001, (−35.1% of mean weighed energy intake) and −12.6 (±12.7)g protein, P < .001, (−43.1% of mean weighed protein intake). Conclusions and ImplicationsPD estimation of individualized offered portion size of TMD by nursing staff is not valid and can, thus, not be recommended. The mistake in estimation of offered portion size is continued on intake estimation but does not become larger, which supports the use of PDs for intake estimation but just in case of a WR determined offer.

Oropharyngeal dysphagia and malnutrition in patients with Covid-19 at the Consorci Sanitari Del Maresme, Catalonia, Spain: Prevalence and needs of compensatory treatment

Rationale: COVID-19 may manifest with a wide range of symptoms and its degree of severity may be from mild to severe. Our aim was to assess the prevalence and pathophysiology of oropharyngeal dysphagia (OD), malnutrition (MN), nutritional risk, and the needs of compensatory treatments in patients admitted due to COVID-19 at the Consorci Sanitari del Marseme (CSdM), Catalonia, Spain. Methods: Prospective observational study with clinical assessment of OD (clinical symptoms, clinical observation and Volume-Viscotisy Swallowing Test) and nutritional screening with NRS2002 and GLIM criteria in consecutive COVID-19 patients admitted at the Hospital de Mataró (CSdM) during 2020 Covid-19 pandemics. Patient’s clinical characteristics and their needs of compensatory treatments for OD and MN were assessed at baseline and will be followed up at 3 and 6 months. Here we present the baseline data. Results: We included 268 hospitalized patients, 52.2% men, with a mean age of 70.2±17.0 yr, severity of disease was moderate-severe in 34%. At hospital admission prevalence of OD was 52.4% (49.4% had impaired efficacy and 44.9% impaired safety of swallow). Pathophysiology of OD includes ICU and post-extubating factors (16%), neurological factors (32%), respiratory insufficiency (42%) and interstitial pneumonia (74%). Up to 43.7% of patients needed thickeners to be safely hydrated (38.7% with 250mPa·s and 5.2% with 800mPa·s of Xanthan Gum thickeners) and 54.5% had mastication impairments needing texture-modified diets (27.7% easy mastication and 28.8% puree). 74.2% of patients presented a NRS2002>3 and were at risk of MN, 46% had MN and 73.8% of patients received ONS. Conclusion: Prevalence of OD, nutritional risk and MN in patients with COVID-19 at admission in a General Hospital is very high. Pathophysiology is multifactorial and not limited to ICU factors. Early treatment includes fluid thickening, texture modified foods and nutritional support.

3D food printing: nutrition opportunities and challenges

PurposeTo explore the nutrition opportunities and challenges for 3D food printing.Design/methodology/approachUsing a qualitative design, semi-structured interviews were conducted with experts from the field of nutrition or with a technical understanding of 3D food printing and a thematic analysis undertaken.FindingsFour themes emerged: potential uses, sustainability, technical issues and ethical and social issues. The primary use identified was for texture-modified diets. Other uses include personalised nutrition and for novelty purposes. Interviewees indicated food printing may aid sustainability by reducing food waste, using food by-products and incorporating eco-friendly foods. The main technical issues were speed, cost and inability of the technology to move between textures. The latter is a limiting issue if the technology is purported to be used for texture-modified diets. Ethical and social issues raised included the acceptability and high degree of processing involved in printed foods.Originality/valueThis research highlights the need for nutrition issues to be considered as 3D food printing technology develops.

Nutritional Status and Feeding Practice among Dysphagic Older Adult Inpatients in Vietnam.

The Vietnamese older adult population has increased rapidly on an annual basis and dysphagia has become a common issue. The nutritional status of older adults in general and of dysphagic older adults in particular has not received adequate attention. The automatic solution for cases of serious choking/aspiration is still a prescription for tube feeding. In developed countries, oral intake is a priority alternative for dysphagia and has positive consequences. This study aimed to investigate the nutritional status of and feeding practices for dysphagic older adult inpatients in some Vietnamese hospitals. The study was designed as a cross-sectional study and was conducted in three large hospitals in northern Vietnam. The data for 1007 older inpatients (58.3% were females, mean age was 75.5±7.3 y) about their dysphagic status, nutritional status and feeding practices were collected by dietitians. About 29% of the older adult inpatients suffered from malnutrition and 54% had a risk of malnutrition. Half of the dysphagia group had malnutrition and 42% were at risk of malnutrition. About 78% of the dysphagic older adults had oral intake of soft foods/regular foods and the remainder had tube feeding. Almost all dysphagic patients had reduced food intake over the prior 3 mo. The rate of pneumonia was quite high among dysphagic patients. The nutritional status of Vietnamese older adult inpatients in general and of dysphagic older adults specifically was poor. Oral intake of a texture-modified diet should be a method with priority over tube feeding or soft foods/regular foods for dysphagic patients.

Implementation Strategies for the International Dysphagia Diet Standardisation Initiative (IDDSI), Part I: Quantitative Analysis of IDDSI Performance Among Varied Participants.

Purpose The International Dysphagia Diet Standardisation Initiative (IDDSI) is an international standardized framework for texture-modified diets (TMDs). However, user accuracy in conducting IDDSI testing methods are unknown. The aims of this study were threefold: (a) to describe performance on two tasks (an IDDSI knowledge quiz and a TMD sample classification task), (b) to determine interrater and intrarater agreement for classification task performance, and (c) to determine predictive relationships between socioeconomic factors or prior knowledge on task performance. Method Sixty-eight participants were recruited, including health care professionals and non-health care-related individuals. A mixed between-subjects and within-subject design was used. All participants completed a baseline knowledge quiz, 30 min of self-study using the IDDSI.org curriculum, a post self-study knowledge quiz, and a TMD classification task of 21 TMD samples with representation across all IDDSI levels. Data were collected via electronic survey. Results There was a significant increase (p < .001) between pre and post self-study knowledge quiz scores. On the classification task, unmodified foods and drinks were most accurately classified with thickened liquids (IDDSI Levels 1, 2, 3) most inaccurately classified. At baseline, moderate interrater agreement was found with intrarater agreement ranging from fair to almost perfect among identical samples. No significant predictive relationships were found between classification task performance and socioeconomic status or prior experience. Conclusions Thirty minutes of self-study using the online IDDSI.org curriculum improved baseline IDDSI knowledge check performance. Overall accuracy of TMD classification was low and warrants further evaluation given potential adverse health outcomes secondary to inappropriate TMD presentation. Given no predictive relationships between socioeconomic factors and prior experience on task performance, the IDDSI curriculum and classification task appear accessible to various users, including non-health care-related participants. Future studies should more closely observe testing behavior to further characterize variation in participants' use of the testing methods.

Texture-Modified Diet for Improving the Management of Oropharyngeal Dysphagia in Nursing Home Residents: An Expert Review

ObjectivesThis paper provides evidence-based and, when appropriate, expert reviewed recommendations for long-stay residents who are prescribed texture-modified diets (TMDs), with the consideration that these residents are at high risk of worsening oropharyngeal dysphagia (OD), malnutrition, dehydration, aspiration pneumonia, and OD-associated mortality, poorer quality of life and high costs.DesignNestlé Health Science funded an initial virtual meeting attended by all authors, in which the unmet needs and subsequent recommendations for OD management were discussed. The opinions, results, and recommendations detailed in this paper are those of the authors, and are independent of funding sources.SettingOD is common in nursing home (NH) residents, and is defined as the inability to initiate and perform safe swallowing. The long-stay NH resident population has specific characteristics marked by a shorter life expectancy relative to community-dwelling older adults, high prevalence of multimorbidity with a high rate of complications, dementia, frailty, disability, and often polypharmacy. As a result, OD is associated with malnutrition, dehydration, aspiration pneumonia, functional decline, and death. Complications of OD can potentially be prevented with the use of TMDs.ResultsThis report presents expert opinion and evidence-informed recommendations for best practice on the nutritional management of OD. It aims to highlight the practice gaps between the evidence-based management of OD and real-world patterns, including inadequate dietary provision and insufficient staff training. In addition, the unmet need for OD screening and improvements in therapeutic diets are explored and discussed.ConclusionThere is currently limited empirical evidence to guide practice in OD management. Given the complex and heterogeneous population of long-stay NH residents, some ‘best practice’ approaches and interventions require extensive efficacy testing before further changes in policy can be implemented.

Suitability of food in a rehabilitation hospital for patients with neurologic dysphagia.

Texture-modified food is a common strategy in dysphagia management for increasing safety of swallowing. It is essential for the patient to receive the prescribed diet based on clinical and instrumental examination of swallowing in order to be able to benefit from rehabilitation and avoid complications. Variations in terminology and definitions regarding texture-modified food and liquids demonstrate the need for international standardized terminology. We aimed to assess suitability of texture-modified diets used at a rehabilitation hospital in terms of the International Dysphagia Diet Standardization Initiative guidelines. A texture-modified main dish was analyzed for 5 days (15 samples of pureed and 10 samples of minced texture) at lunch time by 2 trained assessors using International Dysphagia Diet Standardization Initiative-recommended testing methods. The majority of pureed and minced food samples did not suit the comparable International Dysphagia Diet Standardization Initiative levels. The results underline the need for implementing the International Dysphagia Diet Standardization Initiative guidelines in order to provide an appropriate texture-modified diet for patients with neurogenic dysphagia and support dysphagia management within inpatient rehabilitation.

Validity of Plate Diagrams for Estimation of Energy and Protein Intake of Nursing Home Residents Receiving Texture-Modified Diet: An enable Study

ObjectivesNursing home (NH) residents receiving texture-modified diet (TMD) are at risk of inadequate nutritional intake and subsequent malnutrition. It is essential to monitor dietary intake to take corrective actions, if necessary. Plate diagrams (PDs) are widely used to assess dietary intake in institutions but little is known about their validity for TMD. DesignDietary intake at main meals was assessed by nursing personnel via PDs and scientific personnel via weighing records (WRs). Setting and Participants17 NH residents receiving TMD on a regular basis. MethodsIntake from main meals (breakfast, lunch, and dinner) at 48 days was estimated by nursing personnel in quarters of the offered amount [nothing, ¼, ½, ¾, all, all plus second helping (54), or I do not know] and by scientific personnel via WRs. PD estimation was multiplied by the energy and protein content of the offered meal determined by WR and compared to WR intake results. Sums of daily PD quarters were drawn against WR intake results. ResultsEnergy and protein intake from main meals separately and in total per day were highly correlated (r > 0.854, all P < .001). Paired statistics showed no significant differences between assessment methods (P > .05). Mean differences [±standard deviation (SD)] between PD and WR were 13.9 (±68.6) kcal, which is 1.7% of the mean weighed caloric intake, and 0.2 (±3.3) g protein, which is 0.5% of the mean weighed protein intake per day. Daily energy and protein intake from main meals determined by WR varies widely within each category of summed daily intake quarters; for example, a sum of PD quarters of 12 (ie, “all eaten at all meals”) showed corresponding WR intake levels from 394.6 to 1368.9 kcal and 16.3 to 63.0 g protein. Conclusions and ImplicationsEnergy and protein intake from TMD estimated by PD corresponds very well to WR-determined intake, if the energy and protein content of the offered meals is known.

Modified Diet Use in Adults with Temporomandibular Disorders related to Rheumatoid Arthritis: A Systematic Review.

Objective:Individuals presenting with rheumatoid arthritis (RA) frequently experience temporomandibular disorders (TMDs), which can result in limited ranges of mandibular motion, pain and fatigue on jaw function, and impaired mastication. As such, individuals with RA-related TMDs may consume a texture-modified diet in order to reduce the exacerbation of jaw pain and dysfunction, and to increase the ease of oral intake. These softer food options may not contain the recommended nutrients, vitamins, and minerals, and therefore, may not be nutritionally optimal. As unintentional body composition and weight changes are common in individuals with RA, there may be elevated risks of obesity or malnutrition in this patient subgroup. However, minimal researcth has been conducted to investigate the use of modified diets in this cohort, and therefore, the true level of risk to these patients cannot not be adequately determined. The aim of this study was to determine the prevalence of diet modifications in adults presenting with RA affecting the TMJ.Methods:All available evidence presenting data on adults with RA who consume modified diets was systematically reviewed. A range of electronic databases were searched, including: EMBASE, PubMed, CINAHL, Web of Science, Elsevier Scopus, Science Direct, AMED, The Cochrane Database of Systematic Reviews, and ProQuest Dissertations and Theses A & I. Supplementary Google Scholar, reference list, and grey literature searches were also conducted. Independent reviewers assessed study eligibility, and methodological quality was rated using the Down’s and Black assessment.Results:One study was eligible for inclusion, and half (50.82%; CI: 37.7–63.86) of individuals with RA in this study consumed a modified diet. This study was rated to be of moderate quality. The primary limitation of this review was the lack of studies on this topic which were available for inclusion.Conclusions:Although from clinical practice, it is recognised that adults with TMD related to RA do modify their diets to cope with the functional impairment of TMD, this review confirms that minimal research has been conducted regarding the use of texture modified diets by this population. This is despite concerns regarding unintentional weight changes in this patient group. Further research investigating this area is warranted in order to improve patient outcomes and experience of care.