Diet Texture Research Articles

Clinical, Patient And Service Outcomes For Patients In A Rehabilitation Hospital With An Onsite Flexible Endoscopic Evaluation Of Swallowing Service

Abstract Background Dysphagia has been reported in almost half of hospital patients who are over 65 years.1 In 2023 a Flexible Endoscopic Evaluation of Swallowing (FEES) service was introduced into the hospital. The purpose of this study was to profile the patients who were referred for FEES and determine the prevalence and severity of dysphagia. Methods Information on patient diagnosis, dysphagia related clinical outcome measures and waiting times when compared to Videofluoroscopy referral were collected from 30 patients who attended for FEES assessment in a rehabilitation hospital from August 2023 - May 2024. Results 97% of the patients who engaged in FEES were above the age of 65. Patients presented with a range of diagnoses including frailty (20%), progressive neurological conditions (18%), other (16.6%), stroke (13.3%), Chronic Obstructive Pulmonary Disease (13.3%), Acquired Brain Injury (3%), Gastroenterology (3%), and surgical (3%). Dysphagia was identified in 97% of patients, with 60% presenting within the moderate to severe range on the Australian Therapy Outcome Measures. 33% of patients presented with silent aspiration, with a third of these patients presenting as clinically asymptomatic. Following FEES evaluation, 40% of patients were recommended a change in diet texture or fluid consistency, with 54% and 70% of these patients being recommended a downgrade in diet or fluids respectively. The service has allowed for more timely access to instrumental swallow assessment with completion of FEES within an average of 4 days compared to referral for Videofluoroscopy; 24 days average. Conclusion This study has enabled us to profile patients accessing FEES. FEES facilitates quicker access to instrumental swallow assessment and identification of aspiration. It has also enabled targeted person centered dysphagia rehab. Reference 1. Doan, T.N et al (2022) Prevalence and methods for assessment of oropharyngeal dysphagia in older adults: a systematic review and meta-analysis. Journal of Clinical Medicine, 11(9), p.2605.

Food texture and vitamin D influence mouse mandible form and molar roots.

Industrialization influenced several facets of lifestyle, including softer nutrient-poor diets that contributed to vitamin D deficiency in post-industrzialized populations, with concomitantly increased dental problems. Here we simulated a post-industrialized diet in a mouse model to test the effects of diet texture and vitamin D level on mandible and third molar (M3) forms. Mice were raised on a soft diet with vitamin D (VitD) or without it (NoD), or on a hard diet with vitamin D. We hypothesized that a VitD/hard diet is optimal for normal mandible and tooth root form, as well as for timely M3 initiation. Subsets of adult NoD/soft and VitD/soft groups were bred to produce embryos that were micro-computed tomography (μCT) scanned to stage M3 development. M3 stage did not differ between embryos from mothers fed VitD and NoD diets, indicating that vitamin D does not affect timing of M3 onset. Sacrificed adult mice were μCT-scanned, their mandibles 3D-landmarked and M3 roots were measured. Principal component (PC) analysis described the largest proportion of mandible shape variance (PC1, 30.1%) related to diet texture, and nominal shape variance (PC2, 13.8%) related to vitamin D. Mice fed a soft diet had shorter, relatively narrower, and somewhat differently shaped mandibles that recapitulated findings in human populations. ANOVA and other multivariate tests found significantly wider M3 roots and larger root canals in mice fed a soft diet, with vitamin D having little effect. Altogether our experiments using a mouse model contribute new insights about how a post-industrial diet may influence human craniodental variation.

How Should Patients with Dementia and Food Refusal Be Managed?

Anorexia of ageing is contributed by physiological changes, comorbidities, medications, and social factors. Food refusal in older adults with dementia is one of the behavioural and psychological symptoms of dementia. Modifying diet texture, fluid consistency, feeding techniques, and environmental factors can assist in overcoming food refusal. This case illustrates the challenges encountered in patients with dementia demonstrating food refusal behaviour, measures that can be taken to optimise their nutrition, and how these challenges may impact their long-term care.

Feed preference, body condition scoring, and growth performance of Dohne Merino ram fed varying levels of fossil shell flour

Abstract Acceptability of a diet is one factor that determines an animal’s growth performance. Some feed additives in the category of dietary clay, including fossil shell flour (FSF), have been identified to enhance performance of livestock. Therefore, the influence of varying inclusion levels of FSF supplementation on feed acceptability, body condition scores, and growth performance of Dohne Merino sheep was evaluated. Twenty-four Dohne Merino rams were completely randomised and individually housed in pens for 90 days. Four different supplementation levels of FSF (0, 20, 40, and 60g/kg) were considered treatments for the rams. The average daily feed intake, body condition score, average daily weight gain (g), and coefficient of preference were significantly higher in rams supplemented with 60 g FSF/kg than the other treatments (P < 0.05). The experimental diet colour was brown for 0 g FSF/kg, while in 20, 40, and 60 g FSF/kg, it ranged from light brown to slightly deep brown. The texture of diets with 0 g FSF/kg was moderately firm, while diets with 20, 40, and 60 g FSF/kg had a firm texture. The order of preference of diets supplemented with FSF in feed intake by Dohne Merino rams was: 60 g FSF/kg > 40 g FSF/kg > 20 g FSF/kg > 0 g FSF/kg. Therefore, FSF at a minimum inclusion level of 40 g FSF/kg can improve feed intake, body condition score, and feeding behaviour of Dohne Merino rams by increasing the acceptability of the diet.

Multidisciplinary Assessment and Individualized Nutritional Management of Dysphagia in Older Outpatients.

The evidence on the efficacy of nutrition therapy to prevent complications of dysphagia is based on observational studies that used different tools for nutritional and dysphagia assessment, and different scales for the definition of diet textures, rendering their results incomparable and the knowledge on dysphagia management inconclusive. This retrospective observational study was performed in 267 older outpatients who were assessed for dysphagia and nutritional status by a multidisciplinary team at the Clinical Nutrition Unit of IRCCS INRCA geriatric research hospital (Ancona, Italy) from 2018 to 2021. GUSS test and ASHA-NOMS measurement systems were used for dysphagia assessment, GLIM criteria for the assessment of nutritional status, and the IDDSI framework to describe the texture-modified diets. Descriptive statistics were used to summarize the characteristics of the subjects evaluated. Sociodemographic, functional and clinical parameters were compared between patients with and without BMI improvement overtime by an unpaired Student's t test, Mann-Whitney U test or Chi square test, as appropriate. Dysphagia was diagnosed in more than 96.0% of subjects; 22.1% (n = 59) of dysphagic subjects were also malnourished. Dysphagia was treated exclusively by nutrition therapy, prevalently by individualized texture-modified diets (77.4%). For the classification of diet texture, the IDDSI framework was used. The follow-up visit was attended by 63.7% (n = 102) of subjects. Aspiration pneumonia was registered only in one patient (less than 1%), and BMI improved in 13 of 19 malnourished subjects (68.4%). The improvement of nutritional status was primarily reached in subjects whose energy intake was increased and texture of solids modified, in younger subjects, and in those taking less drugs and not reporting any weight loss before the first assessment. The nutritional management of dysphagia must guarantee both an adequate consistency and energy-protein intake. Evaluations and outcomes should be described with universal scales, in order to allow for comparison between studies and contribute to the collection of a critical mass of evidence on the efficacy of texture-modified diets in the management of dysphagia and its complications.

Characterizing Canadian long-term care home consumed foods and their inflammatory potential: a secondary analysis

BackgroundNutrient dense food that supports health is a goal of food service in long-term care (LTC). The objective of this work was to characterize the “healthfulness” of foods in Canadian LTC and inflammatory potential of the LTC diet and how this varied by key covariates. Here, we define foods to have higher “healthfulness” if the are in accordance with the evidence-based 2019 Canada’s Food Guide, or with comparatively lower inflammatory potential.MethodsWe conducted a secondary analysis of the Making the Most of Mealtimes dataset (32 LTC homes; four provinces). A novel computational algorithm categorized food items from 3-day weighed food records into 68 expert-informed categories and Canada’s Food Guide (CFG) food groups. The dietary inflammatory potential of these food sources was assessed using the Dietary Inflammatory Index (DII). Comparisons were made by sex, diet texture, and nutritional status.ResultsConsumption patterns using expert-informed categories indicated no single protein or vegetable source was among the top 5 most commonly consumed foods. In terms of CFG’s groups, protein food sources (i.e., foods with a high protein content) represented the highest proportion of daily calorie intake (33.4%; animal-based: 31.6%, plant-based: 1.8%), followed by other foods (31.3%) including juice (9.8%), grains (25.0%; refined: 15.0%, whole: 10.0%), and vegetables/fruits (10.3%; plain: 4.9%, with additions: 5.4%). The overall DII score (mean, IQR) was positive (0.93, 0.23 to 1.75) indicating foods consumed tend towards a pro-inflammatory response. DII was significantly associated with sex (female higher; p<0.0001), and diet (minced higher; p=0.036).Conclusions“Healthfulness” of Canadian LTC menus may be enhanced by lowering inflammatory potential to support chronic disease management through further shifts from refined to whole grains, incorporating more plant-based proteins, and moving towards serving plain vegetables and fruits. However, there are multiple layers of complexities to consider when optimising foods aligned with the CFG, and shifting to foods with anti-inflammatory potential for enhanced health benefits, while balancing nutrition and ensuring sufficient food and fluid intake to prevent or treat malnutrition.

The Benefits of a Transdisciplinary Trach Team in Inpatient Rehabilitation

<h3>Research Objectives</h3> Investigation of benefits of a transdisciplinary trach team in an inpatient rehabilitation environment via exploratory research design focusing on knowledge translation and enhanced patient experience. <h3>Design</h3> Following establishment of a transdisciplinary trach team, including representatives from nursing, respiratory care and speech therapy, we developed a qualitative study to track outcomes. Targeted diet progression via IDDSI and trach size/type, speaking valve trials, capping trials and decannulation. <h3>Setting</h3> Inpatient rehabilitation hospital. <h3>Participants</h3> Patients admitted with tracheostomy. <h3>Interventions</h3> Holding twice weekly walking rounds, at patient bedside. Discussions during rounds resulting in changes to patient status are reflected on in room signage as well as charted in the medical record. <h3>Main Outcome Measures</h3> The apriori hypothesis of this study was the transdisciplinary trach team leads to increased communication between team members and therefore fewer days to diet upgrade and decannulation. A team member tracks number of days each patient remains with a trach, use of speaking valve, and diet progression. The IDDSI scale has strong consensual validity as a measure of the patient's diet texture. <h3>Results</h3> For this qualitative study, data for first 12 weeks showed: Participation in average of 3.5 rounds 7 patients (60%) admitted on diets below "regular" diet of IDDSI 7/0 progressed to IDDSI 5/0 or higher 10 patients progressed to decannulation (80%) <h3>Conclusions</h3> The role of the transdisciplinary trach team is cited as beneficial to the tracheostomized patient's outcomes especially considering the potential for these patients to have complex needs . In this qualitative study, a common theme among the population was advancement of diet and progression toward decannulation. This information was gathered through analysis of data documented in patients' medical record and tracked via spreadsheet. The data support the hypothesis that a trach team enhances patient outcomes. Considerations for further qualitative investigation include use of PROMs to explore experience of all stakeholders regarding in-person rounds and interviews to determine the individual's perceptions of the team rounds. Additionally utilizing analysis software to manage our data could only enhance the analysis of our data. <h3>Author(s) Disclosures</h3> None.

Solid state fermentation improves the quality of soy-cassava diet

Abstract Cassava is used as a staple food in many developing countries despite its low nutrient density. Fortification of cassava diets is needed for the prevention of malnutrition and achievement of food security. Cassava-soybean complementary foods were formulated from natural and solid state fermented cassava complemented with soybean. The proximate composition, physicochemical properties, nutritional quality, and sensory properties of the samples were determined (Table 2). The moisture content (7.51%) and ash (3.81%) content of the solid state fermented (SSF) cassava flour complemented with un-defatted soybean flour was significantly higher (P &lt; 0.05) than of the other samples. Solid state fermentation (SSF) led to the highest reduction in viscosity (from 2,855 to 2,052 cPs). Average weight gain and protein efficiency ratio (PER) of experimental animals fed SSF cassava were the highest. The colour and aroma of SSF diets and that of fermented cassava samples were similar (P &gt; 0.05). The texture of diets from SSF cassava were inferior (P &lt; 0.05) to the other samples. Solid state fermentation of cassava with Rhizopus oligosporus and supplementation with soybean can be used to produce a complementary food that is nutrient dense and nutritionally adequate, although the texture of the product might need to be improved.

Differences in the use of food textures in oropharyngeal dysphagia according to the place of living.

Modifying solid/liquid foods is the main treatment in oropharyngeal dysphagia (OD). Commercial Thickener (CT) for treatment is subsidized by health system and is delivered to patient's place of living, once is managed by our hospital Nutrition-Dietetics Unit (NDU). To describe the patterns of texture for foods/liquids follow in patients with OD who are treated with CT. Cohort prospective study. Randomized patients from NDU-database followed throughout 2018 (4 calls-interviews/year). Variables; age, diagnostic, gender, residence type: Home(H)/Nursing Home(NH), thickener manager (patient, family member or caregiver), education, days with commercial thickener (CT), thickener regimen established by Volume/Viscosity test: nectar (N), honey (HY), pudding (P), type of diets; measured by FOIS scale and texture; pureed (PD); soft (SD); mixed (P&S/D); regular (RD), risk foods consumption (RFC), complete diet intake (CI), changes in; diets, intake and RFC. Analysed 204 patients, aged 85 years; (IQR: 78-90), from which 57.8% were women. Residence: 43.6% H/56.4% NH. Days with CT median 380 days (IQR: 153-682). A proper viscosity guideline was indicated in 168 patients: N 37.3%, HY 20.6% and P 24.5%. In 36 patients (17.5%) there were no indications, 75% of them coming from primary care. Despite this, 184 patients (90%) referred a concrete indication; N 35.8%, HY 26% and P 28.4%. The concordance between indicated and referred viscosity was significantly higher at H (Kappa 0.798) compared to NH (Kappa 0.428), p<0.0001. FOIS: 65.7% followed the total oral diet of a single consistency. Diet textures: PD 66.7%, SD 2.9%, P&S/D 21.1%, RD 9.3%. Difference in PD given in NH 86.1% vs H 41.6%, p<0.001. Under N viscosity different diet distributions, PD 28.6%H vs 71% NH, p<0.05. CI in 66.7% with no difference among NH/H. RFC similar but higher consumption of jellies at NH, p<0.001. According to this study the place of living determines a better approach to OD treatment. Viscosity and diet texture are more restricted in NH with worse compliance of indicated regimens. Increasing variety in diets and reassessment of OD treatment is desirable.

Masseter Muscle Thickness Measured by Ultrasound as a Possible Link with Sarcopenia, Malnutrition and Dependence in Nursing Homes.

Sarcopenia is a progressive and generalized loss of skeletal muscle mass and strength. It is frequently associated with malnutrition and dependence in nursing homes. Masticatory muscle strength could be the link between sarcopenia, malnutrition and dependence. We aimed to study the relation between sarcopenia, malnutrition and dependence with masseter muscle thickness measured by ultrasound. A cross-sectional study was realized, with 464 patients from 3 public nursing homes in Zaragoza (Spain). The diagnosis of sarcopenia was assessed according to the European Working Group on Sarcopenia in Older People 2 criteria, malnutrition by the Mini Nutritional Assessment (MNA) and the Global Leadership Initiative on Malnutrition (GLIM) criteria and functional capacity by the Barhel Index and the texture diet. Masseter muscle thickness (MMT) was measured by ultrasound. The median age was 84.7 years, and 70% of the participants were women. Sarcopenia was confirmed in 39.2% of patients, malnutrition in 26.5% (risk 47.8%), total dependence in 37.9% and diet texture was modified in 44.6%. By logistic regression, once the model was adjusted for age, sex, Barthel index and texture diet, our analyses indicated that each 1 mm decrease in MMT increased the risk of sarcopenia by ~57% (OR: 0.43), the risk of malnutrition by MNA by ~63% (OR: 0.37) and the risk of malnutrition by GLIM by ~34% (OR: 0.66). We found that MMT was reduced in sarcopenic, malnourished and dependent patients, and it could be the common point of a vicious cycle between sarcopenia and malnutrition. Further studies are needed to establish causality.

GAMBARAN SISA MAKANAN PASIEN DI RSUD PETALA BUMI PROVINSI RIAU

Background : The high amount of leftover food is a serious problem that must be addressed immediately because the food served in the hospital has taken into account the quantity and quality according to the patient's needs. This also indicates that nutrition services are not achieved. The purpose of this study was to describe the leftover in Petala Bumi Hospital, Riau Province by classifying based on meal time, treatment class, food texture and type of diet. Research Methods : The study used cross sectional design. The population of this study were all patients in room 1 stclass, 2nd class and 3rd class with a total sample of 8 people using purposive sampling method. The leftover was measured using a 6-point Comstock scale for 3 days including breakfast, lunch, dinner, morning and evening snacks. Research Result : The results showed that leftover was mostly found in animal side dishes of the lunch menu (87,5%), blenderized food in first class (100%0, and low-salt and high-fiber diets (100%). Conclusion : The most leftovers are in blenderized foods and low-salt and high-fiber diets.

A Mouse Model Suggests How an Industrialized Diet Alters Jaw Form

Food texture affects jaw form by creating biomechanical stress during chewing. Chewing prompts remodelling via increased bone cell activities, including cell signalling, differentiation, proliferation, and matrix secretion. Vitamin D may influence jaw form via regulation of these bone cell activities. Modern, post-Industrialized human diets are characterized by soft textured food with low levels of vitamin D, but how these two factors affect mandible shape and size is unclear. Via a mouse model and specialized diets, we tested the effects of dietary texture and vitamin D on mandibular form. We hypothesized that vitamin D intake is: 1) imperative for normal mandibular form, and; 2) a greater influence on mandibular form than diet texture. C57BL/6J mice weaned at 7 weeks were raised on a soft or hard diet with vitamin D (n=40; n=48), or on a soft diet without vitamin D (n=39). Post-sacrifice, adult mice were scanned with a Skyscan1172 micro-CT system and landmarked using Amira software. Landmark datasets underwent Generalized Procrustes Analysis followed by Principal Component Analysis (PCA) in Morphologika. Mice fed soft diets had shorter mandibles with diminutive alveolar bone, gentler masseteric crests, a wider angle between dentary bones, and larger bicondylar breadth. Diet groups occupied distinct but overlapping regions of shape space, with diet texture accounting for 30.8% (PC1) of total shape variance. Presence/absence of vitamin D accounted for 13.8% (PC2) of total shape variance between soft diet groups. Mice fed a soft diet with vitamin D had mandibles with more flaring angular processes, more robust masseteric crests, and elevated alveolar bone. Our results indicate that vitamin D influenced dentary bone shape less than diet texture did, and that diet had a greater role in mandibular bone remodelling, including increased variation at muscle attachment sites. Future work will explore whether vitamin D also influences muscle form and function.

Effect of diet texture on morphology and surface of mandibular condyle in Senescence-Accelerated Mouse P8 (SAMP8)

Effect of diet texture on morphology and surface of mandibular condyle in Senescence-Accelerated Mouse P8 (SAMP8)

Prevalence and risk factors of dysphagia among nursing home residents in eastern China: a cross-sectional study.

BackgroundDysphagia is a common health care problem and poses significant risks including mortality and hospitalization. China has many unsolved long-term care problems, as it is a developing country with the largest ageing population in the world. The present study aimed to identify the prevalence and risk factors of dysphagia among nursing home residents in China to direct caregivers towards preventative and corrective actions.MethodsData were collected from 18 public or private nursing homes in 9 districts of Nanjing, China. A total of 775 older adults (aged 60 ~ 105 years old; 60.6% female) were recruited. Each participant underwent a standardized face-to-face interview by at least 2 investigators. The presence of risk of dysphagia was assessed using the Chinese version of the EAT-10 scale. The Barthel Index (BI) was used to evaluate functional status. Additionally, demographic and health-related characteristics were collected from the participants and their medical files. Univariate analyses were first used to find out candidate risk factors, followed by binary logistic regression analyses to determine reliable impact factors after adjusting for confounders.ResultsOut of 775 older adults, the prevalence of dysphagia risk was calculated to be 31.1%. A total of 85.0% of the older adults reported at least one chronic disease, and diseases with the highest prevalence were hypertension (49.5%), stroke (40.4%), diabetes (25.5%) and dementia (18.2%). Approximately 11.9% of participants received tube feeding. The mean BI score was 56.2 (SD = 38.3). Risk factors for dysphagia were texture of diet (OR = 2.978, p ≤ 0.01), BI level (OR = 1.418, p ≤ 0.01), history of aspiration, pneumonia and heart attack (OR = 22.962, 4.909, 3.804, respectively, p ≤ 0.01), types of oral medication (OR = 1.723, p ≤ 0.05) and Parkinson disease (OR = 2.566, p ≤ 0.05).ConclusionsA serious risk of dysphagia was observed among Chinese nursing home residents. Overall, nursing home residents were moderately dependent, according to the BI level. The risk for dysphagia increased with thinner diet texture, worse functional status, history of aspiration, pneumonia and heart attack, more oral medications and Parkinson disease. The findings of our study may serve to urge nursing home staff to pay more attention to the swallowing function of all residents and to take more actions in advance to prevent or reduce dysphagia.

Acoustic activity of Litopenaeus vannamei fed pelleted and extruded diets

Passive acoustics monitoring (PAM) is an exceptional tool to analyze the feeding behavior of shrimp, as they emit a “click” sound by the mandibular occlusion. Hence, acoustic demand-feeding systems based on the click signals energy have been applied to improve feeding management in shrimp farming. These acoustic signals may be affected by the texture properties of the foods pellets, which are modified by the manufacturing process. The aim of the present study was to evaluate the acoustic activity of Litopenaeus vannamei fed pelleted and extruded diets. Two commercial diets were used, manufactured by extrusion and pelleting processing with similar formulation (36% crude protein) and pellet diameter. Acoustic evaluation was performed with these diets offered “as is” dry and previously soaked in water for one and two hours in a 2 × 3 factorial arrangement. The pellet hardness and moisture content were also measured. The acoustic trial was performed using omnidirectional hydrophones inside acoustic foam anechoic chambers. Three fastened shrimp (10 g) were placed inside acoustic chambers and audio recordings started (30 min) when food (0.5 g) was offered. The texture of diets was closely related to the acoustic intensity (Root Mean Square Amplitude - RMS) produced by L. vannamei during the feeding activity. The greater hardness of the extruded diet resulted in higher RMS than pelleted food when offered dry, which could be an advantage for the sound detection of feeding activity. The lower RMS observed when both diets were soaked suggests that softer texture pellets can be eventually ingested without the need of mandibles occlusion, and consequently without clicking sound emission. Additionally, unusual clicks train signals were first reported when shrimp fed soaked diets, probably due to mandibles rubbing. The relationship between textural properties and acoustical responses of foods should gain more attention, especially considering the potential applications on automatic acoustic feedback systems in shrimp farming.

Posterior occluding pairs of teeth or dentures and 1-year mortality in nursing home residents in Japan.

Associations between tooth loss and mortality have been reported in older individuals. However, limited information is available regarding the association between occlusion and mortality in nursing home residents. We investigated the association between posterior occluding pairs (POPs) of teeth or dentures and 1-year mortality in nursing home residents. The subjects of this study were residents from four nursing homes in Aichi prefecture, Japan, who were capable of eating and were enrolled in baseline examinations. We examined the number of present teeth and POPs (0-8 pairs), defined as pairs of occluding natural, restored or fixed prosthetic post-canine teeth. Then, we defined prosthetic POPs (0-8 pairs) as pairs of occluding natural, restored or fixed prosthetic post-canine teeth and removable dentures. Nutritional status, activities of daily living, cognitive function and comorbid conditions were assessed. One year later, we followed up the subjects. Ultimately, we analysed 173 elderly people (mean age±SD: 87.1±8.6years; the survival group: N=145, the deceased group: N=28). In univariate analyses, mortality was significantly associated with age, peripheral vascular disease, nutritional status, diet texture and POPs. In multivariate logistic regression analysis, subjects who had 0 prosthetic POPs had significantly higher odds of a high mortality, compared with 8 prosthetic POPs. Lack of properly occluding posterior teeth, whether remaining teeth or dentures, is associated with 1-year mortality. (228 words/250).

Prevalence of dysphagia in a regional hospital setting: Acute care hospital and a geriatric sociosanitary care hospital: A cross-sectional study

Oropharyngeal Dysphagia (OD) is a symptom commonly found in hospitalized patients and related to a vast array of clinical diagnosis and to high morbidity and mortality that is becoming very important to identify. Our aim was to assess the prevalence of OD in our hospital setting. Cross-sectional randomized study to determine the prevalence of dysphagia in an acute care hospital (ACH) and long term care hospital (LTCH). Multiquestionnaire test performed to assess dysphagia with the bedside validated volume-viscosity swallow test (V-VST test), in those with the validated swallowing ability test, eating assessment tool (EAT-10)>3. Variables; sex, age (>65y), diagnosis, mininutritional assessment (MNA), previous diagnosis of dysphagia (including any recommendations given before), EAT-10, V-VST, presence of dysphagia, type of diet prescribed (basal or therapeutic), use of thickener and diet texture (pureed with liquids allowed, pureed without liquids, soft diet, normal). N=200 patients (100 in each centre). 49% male; Age=81.1 [65-101] years; Diagnostics: medical 70%/surgery 30%. Dysphagia analysis: 42% patients showed an EAT-10>3 so the V-VST test was done in these patients resulting in global prevalence of 28.5% (95% CI: 22.7-35.1). Among centres no significant differences were observed: ACH 30% (95% CI: 14-34) and LTCH 27% (95% CI: 19-36). Highlighting a greater concentration of dysphagia in Orthogeriatric and Neurological patients in the LTCH than in ACH (Pneumology, Internal Medicine and Cardiology). MNA analysis: 27% normal 44% risk 29% malnutrition. Malnutrition present in 50.9% of patients diagnosed with dysphagia, 44% in those at risc (EAT-10+) and 27.6% in those without risc or dysphagia (p=0.020). From the novo patients, 75.4% did not have adequate complete adapted treatment (diet and thickener). Only 13.3% had their thickener prescribed. In those with history of dysphagia 37% had an inappropriate treatment. Prevalence of OD matches with what is described in the literature. There is a high proportion of infradiagnostic and overall inadequate treatment, more than a third of patients do not have their diet adapted correctly. It is important to identify this symptom to treat it properly and to raise awareness among sanitary professionals for best adaptation of treatment.

Biting force and tongue muscle strength as useful indicators for eating and swallowing capability assessment among elderly patients

Weakened capability of eating and swallowing is common among elderly population, affecting negatively on their health and well-being. This work measured occlusal force and tongue muscle strength of elderly patients and then assessed whether correlations existed between oral physiological properties and the eating and swallowing capability. A total of 26 elderly patients with potential swallow disorder were recruited in this work. Participants’ denture status and daily diet texture were determined by a pre-questionnaire analysis. Their swallowing capability was assessed and rated by water drinking test. Maximum tongue pressure, incisor occlusal force and hand gripping force were measured for each subject. It was observed that participating subjects have on average a significantly lower biting force and maximum tongue pressure than that of normal adults. The swallowing grades assessed by water drinking test showed significant correlations with both the biting force (r=−0.498, P<0.05) and the tongue muscle strength (r=−0.544, P<0.05). The biting force of dysphagia participants correlates significantly with dental conditions (P<0.05). The observed correlation between tongue pressure and diet texture indicates that tongue muscle strength could be used as a reliable indicator of the eating and swallowing capability for elderly people.

Dietary Intake and Associated Factors in Long-Term Care Homes in Southeast Spain.

Diet is a key modifiable factor in the management of malnutrition and age-related diseases such as sarcopenia, an important issue in long-term care homes. The objectives of this study were to evaluate the dietary intake of residents, define dietary patterns, and analyze their association with sex, diet texture, nutritional status, and the presence of sarcopenia. Intake was assessed by the precise weighing method, dietary patterns were defined a posteriori by cluster analysis, and nutritional status and sarcopenia were evaluated by applying the MNA-SF test and EWGSOP algorithm, respectively. A regular diet was consumed by 63% of participants; 56% were at risk of malnutrition and 63% were diagnosed with sarcopenia. Intake of potassium, magnesium, zinc, iodine, vitamin D, E, folic acid, and fiber was low in >80% of participants. Protein intake was <1 g/kg/day in 56% of participants and <25 g/meal in 100%. Two dietary patterns were identified, but neither fully met recommendations. The risk of a poorer diet was higher in females and residents with sarcopenia and was lower in those consuming regular diets. In conclusion, action is required to improve the inadequate nutritional intake of long-term care residents.

Right meal, right patient, first time

Lean is the application of a set of principles to identify and eliminate waste, and to deliver to the customer what they want, when they want it.1 Dysphagia is a swallowing disorder whose management includes altering the texture of diet and / or altering the consistency of fluids.2