Texture-modified Foods Research Articles

Regulating heat-induced fibrous whey protein-wheat starch composite emulsion gels as dysphagia food by preheating temperature: Insights from protein-starch interactions

Heat-induced processes significantly affect the gel behavior of protein and starch, but the mechanism by which preheating temperature affects the quality characteristics of the gel is unclear. Herein, to explore the feasibility of developing texture-modified foods based on proteins, carbohydrates and lipids, the effects of preheating temperatures (40–80 °C) on the texture and starch digestibility of fibrous whey protein (FWP)-wheat starch composite emulsion gels (CEGs) under two-step heating condition were investigated. The rheological and texture properties, protein-starch interactions and microstructure of CEGs were characterized. The results showed that preheating temperature synchronously regulated the texture and starch digestibility of heat-induced CEGs. When preheating temperature is below 60 °C, two-step heated CEGs showed bicontinuous networks with harder texture, similar as one-step heated gels. While temperature exceeds 60 °C, preheating altered FWP conformation and promoted protein-starch interactions, forming protein-starch complexes or protein aggregates. This changed protein distribution and disrupted bicontinuous network, forming more hydrophobic interaction, yielding a soft-textured CEGs. In this case, SDS content increased and RS content decreased. Notably, two-step heating process with high preheating temperature (>60 °C) is universal for softening fibrous whey protein-starch-based composite gels. This study enhances the understanding of traditional heat-induced protein-starch gelation processes and provides a simple and feasible method for developing texture-modified foods.

The Effects of Adding Particles in Texture Modified Food on Tongue Strength and Swallowing Function in Patients with Oropharyngeal Dysphagia: A Proof of Concept Study.

The use of texture modified food (TMF) is widely spread in the daily care of patients with oropharyngeal dysphagia (OD). However, TMF have been shown to have a negative impact on the patients' quality of life. Adherence rates are low, increasing the risk of malnutrition and aspiration in an already vulnerable patient population. The aim of this exploratory study was to gain insight in the feasibility of adding particles to pureed food on tongue strength, swallowing safety and efficiency in patients with OD. Ten adult participants with OD swallowed three different boluses. Bolus 1 consisted of no particles (IDDSI level 4), small and bigger particles were added in bolus 2 and 3. Tongue strength during swallowing (Pswal) was measured using the Iowa Oral Performance Instrument (IOPI). Swallow safety (penetration and aspiration) and swallow efficiency (residu) were quantified during fiberoptic endoscopic evaluation of swallowing by means of the PAS scale and Pooling score. RM Anova and Friedman tests were performed for analyzing the impact of bolus on the outcome parameters. No significant effect of bolus type on Pswal was measured. Neither the PAS nor the Pooling score differed significantly between the three different boluses. Aspiration was never observed during swallowing any bolus with particles. This preliminary study shows that the addition of particles to pureed food had no impact on Pswal, swallowing efficiency or safety in patients with OD. This innovative project is the first step in research to explore the characteristics of TMF beyond bolus volume, viscosity and temperature.

Hydrogel foam with designed structural properties of egg white protein through building aggregates as potential dysphagia food

To address the growing demand for texture-modified foods (TMFs) among individuals with dysphagia, the structural properties of alkali-heat treated egg white protein aggregates (AHEWP) were investigated to developed hydrogel foams as suitable soft gels. The results showed that AHEWP presented partially unfolded and higher content of β-sheet structures. The alkaline shift suppressed thermally denatured molecular unfolding (exposing aromatic and hydrophobic amino acids) and blocked hydrogen bonding, leading to the generation of small-sized AHEWP. Within the pH range of 10.5–11.25, raising temperature promoted more covalent bonding to produce structurally compact aggregates. Compared to EWP, AHEWP exhibited remarkably stable foams (85.62–91.99% of FS) and could form Ca2+ crosslinked cold gels, which were contributed to the formation of hydrogel foam. The alkali-heat treatment of high intensity gave a less increase in surface tension and richer interfacial proteins. SEM and microrheology revealed that the alkaline shift transformed the hydrogel network of AHEWP into a “sheet-like” stacking structure, accompanied by a rise in the macroscopic viscosity index and a change of gelation rate. At pH 11.0 and 11.25, the higher temperature, the denser the pore and the lower the elasticity index. The self-supporting property and water loss of AHEWP hydrogel foam reduced, and their time stability enhanced with increasing pH and/or temperature. According to IDDSI, AHEWP hydrogel and hydrogel foam were attributed to level 4–7 and 4–5, respectively. Overall, AHEWP has the potential to establish hydrogel foam systems that will serve as a valuable reference for designing protein-based soft gel TMFs for dysphagia diets.

COVID-19 infection and 2-year mortality in nursing home residents who survived the first wave of the pandemic

BackgroundDuring the first COVID-19 pandemic wave (1st CoPW), nursing homes (NHs) experienced a high rate of COVID-19 infection and death. Residents who survived the COVID-19 infection may have become frailer. This study aimed to determine the predictive value of having a COVID-19 infection during the 1st CoPW for 2-year mortality in NH residents.MethodsThis was a retrospective study conducted in three NHs. Residents who had survived the 1st CoPW (March to May 2020) were included. The diagnosis of COVID-19 was based on the results of a positive reverse transcriptase-polymerase chain reaction test. The collected data also included age, sex, length of residence in the NH, disability status, legal guardianship status, nutritional status, need for texture-modified food, hospitalization or Emergency Department visits during lockdown and SARS-COV2 vaccination status during the follow-up. Non-adjusted and adjusted Cox models were used to analyse factors associated with 2-year post-1st CoPW mortality.ResultsAmong the 315 CoPW1 survivors (72% female, mean age 88 years, 48% with severe disability), 35% presented with COVID-19. Having a history of COVID-19 was not associated with 2-year mortality: hazard ratio (HR) [95% confidence interval] = 0.96 [0.81–1.13], p = 0.62. The factors independently associated with 2-year mortality were older age (for each additional year, HR = 1.05 [1.03–1.08], p < 0.01), severe disability vs. moderate or no disability (HR = 1.35 [1.12–1.63], p < 0.01) and severe malnutrition vs. no malnutrition (HR = 1.29 [1.04–1.60], p = 0.02). Considering that vaccination campaign started during the follow-up, mortality was associated with severe malnutrition before and severe disability after the start of the campaign. Vaccination was independently associated with better survival (HR 0.71 [0.55–0.93], p = 0.02).ConclusionsHaving survived a COVID-19 infection during the 1st CoPW did not affect subsequent 2-year survival in older adults living in NHs. Severe malnutrition and disability remained strong predictor of mortality in this population, whereas vaccination was associated to better survival.

‘It looks better than a bowl of mush’: Views on the use of food design strategies, including 3D food printing, to improve meals for people with dysphagia

To improve meals for people with dysphagia, we explored the views of people with dysphagia, their supporters and allied health professionals on a range of food design strategies (e.g. food shaping and food presentation techniques), including 3D food printing. From November 2021 to February 2022, an online survey of (1) adults with dysphagia (n = 30) and (2) supporters of people with dysphagia and allied health professionals (n = 22) was conducted. The survey included multiple choice, Likert scale and open-ended questions. Data was analysed descriptively. Most participants across the two groups had used at least one food design strategy for texture-modified foods and none had used 3D food printing. People with dysphagia were less likely to use food shaping techniques in preparing their texture-modified meals than other respondents. Supporters of people with dysphagia and allied health professionals were more likely than people with dysphagia to use food shaping techniques and to consider that 3D food printing could improve the visual appeal and enjoyment of texture-modified foods. A range of issues impacting the feasibility of 3D food printing were identified. The use of food design strategies for texture-modified foods may increase the food choices and mealtime enjoyment of people with dysphagia. Further research exploring how people with dysphagia and their supporters engage with 3D food printing could identify further influences on their future use of these technologies.

Rheological and textural properties of fish gelatine-microbial transglutaminase gel microparticles as thickener for texture-modified food

Gel microparticles are tiny, soft particles made from proteins or polysaccharides using particle size reduction. In creating texture-modified food and thickened liquids, gel microparticles are frequently employed to customise the rheological and textural features of foods or thin liquids. Gel microparticles aid by lowering flow behaviour, and modifying the taste perception of the texture-modified food. By cross-linking fish gelatine with the microbial transglutaminase enzyme (mTGA) using the homogenisation process, fish gelatine has tremendous potential to be used to create gel microparticles. The size measurements, texture profile, viscoelastic characteristics, and impact of sugar content on the texture profile of gel microparticles were all examined in the present work for the developed gel microparticles. The results of a particle size investigation revealed that gel microparticle sizes, which ranged from 18 to 1445 µm, increased with higher enzyme concentrations. With increasing mTGA concentration, the texture profile analysis (TPA) also revealed increasing values for hardness, adhesiveness, springiness, cohesiveness, gumminess, and chewiness parameters. The cross-linked gel microparticles had higher dominance on elastic behaviour than viscous behaviour from the rheological investigation, as evidenced by a higher G' compared to G". Additionally, larger TPA values were seen as the sugar concentration increased. These outcomes are anticipated because sugar will strengthen fish gelatine’s hydrogen bond. Based on all completed analyses, fish gelatine cross-linked with 0.7% mTGA to create gel microparticles has shown encouraging results, which can be used as a thickener in texture-modified food to aid those who have trouble swallowing.

A Study on the Muscle Strengthening Properties of High-Protein Texture-Modified Foods (HPTMF) in Elderly Patients With Clinical Frailty

A Study on the Muscle Strengthening Properties of High-Protein Texture-Modified Foods (HPTMF) in Elderly Patients With Clinical Frailty

'I only eat because I have to-to live': The impacts of dysphagia on quality of life from the perspectives of people with dysphagia, supporters of people with dysphagia and allied health professionals.

A recent literature review identified that past research has described the impacts of dysphagia on quality of life; but there is limited research on these impacts from the perspective of people with dysphagia, their supporters and allied health professionals. Recent qualitative research has provided details about these perspectives, but researchers have also called for verification of these findings with a larger group of participants. To expand upon the findings of the prior qualitative research on the views of people with dysphagia, supporters of people with dysphagia,and allied health professionals on the impacts of dysphagia and texture-modified food on quality of life. An online survey of adults with dysphagia (n = 30), supporters of people with dysphagia (n = 4) and allied health professionals (n = 18) was conducted between November 2021 and February 2022. Categorical questions were analysed descriptively and open-ended questions were analysed for content categories of meaning. Participants with dysphagia reported that dysphagia and texture-modified foods had a greater impact on their physical health than on their choice and control or social engagement. Supporters and allied health professionals viewed that dysphagia impacted the physical health and their choice and control of people with dysphagia. Across groups, participants considered that mealtime enjoyment, participation, and inclusion were influenced by the control the person had over their meals, the accessibility of the mealtime environment, and the attitudes of others. Dysphagia and its interventions negatively impact quality of life for people with dysphagia. People with dysphagia were the most affected by the physical impacts of dysphagia. Their perspectives contrasted with those of supporters and allied health professionals in some domains, highlighting the need for people with dysphagia to be included in research. Future research exploring how these perspectives are integrated into person-centred dysphagia management is warranted. What is already known on the subject Recent qualitative research has provided insights into the impacts of dysphagia on quality of life from the perspective of people with dysphagia, supporters of people with dysphagia, and allied health professionals. However, the small scale of these studies means that further research is needed with a larger group of people with dysphagia, supporters of people with dysphagia, and allied health professionals. What this paper adds to existing knowledge This paper verifies and extends upon the findings of prior qualitive research on the views of people with dysphagia, supporters of people with dysphagia, and allied health professionals on the impacts of dysphagia and its interventions on quality of life, participation, and inclusion. What are the potential or actual clinical implications of this work? This research shows the importance of supporters of people with dysphagia and allied health professionals discussing mealtime quality of life with the person with dysphagia so that their perspectives are considered in the mealtime decision-making process. Furthermore, people with dysphagia should be able to specify strategies they want to trial to enhance their mealtime participation and inclusion.

Co (ne) víme o úpravě konzistence stravy u pacientů s dysfagií a s čím by mohla pomoci iniciativa IDDSI (International Dysphagia Diet Standardization Initiative)

Summary Texture-modified diet and thickening liquids are a therapeutic option for dysphagia. Many of the terms referring to liquid viscosity modifications and solid diet modifications are terminologically ambiguous and vague, e. g. “honey consistency liquid” or “soft-textured diet.” The inconsistent terminology adversely affects patient safety and the efficiency of the application of this therapeutic method. Possible misunderstanding of the vague terms between staff members can result in using a different consistency of the fluid or food from the consistency that was found to be safe during the objective swallowing examination. The International Dysphagia Diet Standardization Initiative (IDDSI) is seeking application of international standardized terminology for texture-modified foods and liquids for use in people with dysphagia of all ages, in all care settings, and in different cultural settings. The goal of IDDSI is to improve patient safety of oral intake and evolve the field of dysphagia research. Key words dysphagia – texture-modified food – thickened liquids – IDDSI

Effect of bolus property on swallowing dynamics in patients with dysphagia.

Modification of foods or liquids is commonly administered as part of dysphagia treatment. However, no consensus exists on the parameters for defining texture-modified food for patients with dysphagia. The aim of this study was to evaluate the effect of food/liquid material on swallowing physiology in patients with dysphagia and to discuss the optimal food choice for direct swallowing therapy. A total of 140 patients underwent a videofluoroscopic swallowing study using three test foods/liquids: 3 mL of mildly thick liquid (Thick liquid), jelly made of agar and polysaccharide (Jelly) and jelly made of pectin (Reset gel). Outcome measures of videofluoroscopic images, bolus transit time and hyoid movements were compared. The frequency of chewing movements was highest for Jelly, followed by Reset gel and Thick liquid. While the probability of oral residue was the highest for Reset gel, pharyngeal residue after swallowing was high for Thick liquid as compared to Jelly and Reset gel. Oral transit time and pharyngeal transit time for Thick liquid were significantly smaller than that for Jelly and Reset gel. Pharyngeal delay time was significantly smaller for Thick liquid than that for Jelly and Reset gel. There was no difference in hyoid elevation time and hyoid movement time among the conditions. Mildly thick liquid material may be optimal for patients with primarily oral motor function impairment and jelly, such as Reset gel, may be more suitable for patients with primarily pharyngeal motor function impairment or oral and pharyngeal coordinative motor function decline.

Rheological, functional properties, and stability of peach puree added with normal and high amylose retrograded starches

ABSTRACT Texture-modified foods have become a growing trend in the market and retrograded starch can enhance the rheological properties of foods. This study assessed the effect of adding 10% (w/w) of normal (RNS) or high amylose (RHS) retrograded starches on the physicochemical and rheological properties of commercial peach puree stored at 4°C. The resistant starch content (RS), syneresis, and rheological behavior were evaluated during 14-day storage. Control puree exhibited high syneresis (60%), low consistency (6 Pa·sn), and decreasing viscosity during storage. These characteristics improved after adding retrograded starches. Samples with RNS exhibited higher viscosity, lower syneresis, lower RS (2%), and poor stability; meanwhile, the systems with RHS exhibited greater stability maintaining their viscosity, syneresis, and RS (10%) relatively constant during storage. Therefore, RHS can be recommended to enhance and maintain the physicochemical, nutraceutical, and rheological properties of a food matrix like peach puree during storage.

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.

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.

Sensory properties of thickened and protein-enriched plant-based frozen desserts.

The number of consumers following plant-based diets has increased and in turn, the variety of plant-based foods available on the market has also increased. Many plant-based foods aim to mimic the functionality and sensory properties of conventional dairy products; however, they may not be suitable for specific populations. Dysphagia, for example, is a swallowing condition requiring texture-modified foods that meet specific criteria. While many conventional thickened products exist that are safe for individuals with dysphagia, the growing interest in plant-based eating alongside the increasing prevalence of dysphagia prompts a need for research on the use and safety of thickened plant-based alternatives. This study investigated the sensory properties of a thickened protein-enhanced ice cream (dairy and whey) compared to thickened protein-enhanced plant-based frozen desserts (cashew and pea, and coconut and pea). The formulations were evaluated using the International Dysphagia Diet Standardization (IDDSI) Spoon Tilt Test and a sensory trial (n = 104 participants, 47 flexitarians and 57 typical consumers) using static (hedonic scales and check-all-that-apply [CATA]), and dynamic (temporal check-all-that-apply (TCATA)) methods. The dairy and whey sample consistently passed the IDDSI test, while the plant-based samples did not. TCATA identified that the plant-based samples had an increased cohesiveness and adhesiveness, and decreased slipperiness when compared to the dairy and whey sample. The differences in textural properties may explain why the plant-based samples did not pass the IDDSI test. The study identified that although plant-based foods strive to mimic conventional dairy products, they have different textural and flavor properties.

Food Processing and Nutrition Strategies for Improving the Health of Elderly People with Dysphagia: A Review of Recent Developments.

Dysphagia, or swallowing difficulty, is a common morbidity affecting 10% to 33% of the elderly population. Individuals with dysphagia can experience appetite, reduction, weight loss, and malnutrition as well as even aspiration, dehydration, and long-term healthcare issues. However, current therapies to treat dysphagia can routinely cause discomfort and pain to patients. To prevent these risks, a non-traumatic and effective treatment of diet modification for safe chewing and swallowing is urgently needed for the elderly. This review mainly summarizes the chewing and swallowing changes in the elderly, as well as important risk factors and potential consequences of dysphagia. In addition, three texture-modified food processing strategies to prepare special foods for the aged, as well as the current statuses and future trends of such foods, are discussed. Nonthermal food technologies, gelation, and 3D printing techniques have been developed to prepare soft, moist, and palatable texture-modified foods for chewing and swallowing safety in elderly individuals. In addition, flavor enhancement and nutrition enrichment are also considered to compensate for the loss of sensory experience and nutrients. Given the trend of population aging, multidisciplinary cooperation for dysphagia management should be a top priority.

Preparation and characterization of 3D printed texture-modified food for the elderly using mung bean protein, rose powder, and flaxseed gum

Preparation and characterization of 3D printed texture-modified food for the elderly using mung bean protein, rose powder, and flaxseed gum

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.

Quantitative Textural and Rheological Data on Different Levels of Texture-Modified Food and Thickened Liquids Classified Using the International Dysphagia Diet Standardisation Initiative (IDDSI) Guideline.

Diet modification is a common compensation strategy to promote swallowing safety in patients with swallowing difficulties. The International Dysphagia Diet Standardisation Initiative (IDDSI) guideline provides qualitative descriptions on texture-modified food and thickened liquid. This study aimed to establish quantitative textural and rheological data on different IDDSI levels based on common Chinese ingredients and dishes. Textural and rheological properties of 226 samples of various food textures and 93 samples of various liquid consistencies were obtained using a texture profile analysis (TPA) and viscometer, respectively. The establishment of such quantitative data can be used for future texture-modified food product development and research purposes.

Influence of Some Hydrocolloids and Sterilization Conditions on the Physical Properties of Texture-Modified Foods Developed for the Swallow Training of Dysphagia Patients.

This research aimed to develop jelly soup for dysphagia patients at the International Dysphagia Diet Standardization Initiative (IDDSI) Framework levels 4 (puree) and 5 (minced and moist), who require swallow training to regain normal swallowing ability due to neurological issues. The study comprised three main parts: (1) an investigation of hydrocolloid types and concentrations for texture-modified foods to aid dysphagia patients during training; (2) a study of sterilization conditions and ascorbic acid's impact on physical properties (e.g., texture, viscosity, color) of the texture-modified foods; and (3) an evaluation of changes in physical, chemical, and microbial properties of the product during storage. Results revealed that the ideal recipe involved using pork bone broth with 1% κ-carrageenan for texture modification, which closely matched the properties of hospital jelly samples in terms of hardness, adhesiveness, and viscosity. Sterilization at 110 °C for 109 min effectively eliminated microorganisms without affecting the product's appearance or texture, albeit causing a slight increase in brownness. Adding ascorbic acid helped to prevent the Maillard reaction but reduced the gel strength of the sample and induced milk protein denaturation, leading to aggregation. During storage at room temperature for 9 weeks, the product became browner and less firm. Notably, no bacteria were detected throughout this period. In conclusion, this heating process is suitable for producing jelly soup to support swallow training for dysphagia patients with neurological problems. It offers invaluable assistance in their daily training to regain normal swallowing function.

Effect of a texture-modified and controlled bolus volume diet on all-cause mortality in older persons with oropharyngeal dysphagia: Secondary analysis of a randomized controlled trial.

Oropharyngeal dysphagia (OD) is common among older adults. Some studies have evaluated the efficacy of a texture-modified diet on mortality but with short-term follow-up. We aimed to evaluate the effect of a texture-modified diet and controlled bolus volume on all-cause mortality after 12 months in older persons with OD. This secondary analysis of a randomized clinical trial included patients aged ≥60 years with a diagnosis of OD. They were concurrently and randomly assigned to receive either a texture-modified food diet and controlled bolus volume (intervention group) or standard treatment (control group) with 12 months of follow-up. Secondary outcomes were oral intake, weight, handgrip strength, phase angle, and aspiration pneumonia. Kaplan-Meier analysis and the Cox proportional hazards model were used for mortality analysis. A total of 127 participants (intervention group: 64 and control group: 63) were recruited, with a mean age of 76 years. The probability of all-cause mortality was significantly lower in the intervention group (n = 8, 12%) than in the control group (n = 18, 29%) (hazard ratio = 0.36 [95% CI = 0.16-0.86]; P = 0.01). There were 5 (7.9%) and 10 (16.1%) aspiration pneumonia events in the intervention and control groups, respectively (not significant) in 12 months of follow-up. Changes were observed in protein consumption (P = 0.01), body weight (P = 0.04), body mass index (P = 0.004), handgrip strength (P = 0.02), and phase angle (P = 0.04) between the treatment groups. Compared with the standard treatment, the dietary intervention improved efficacy by limiting nutrition complications, aspiration pneumonia, and all-cause mortality.