Impact of Oral and Swallowing Function on the Feeding Status of Older Adults in Nursing Homes.

BACKGROUND: To date, there have been few guidelines proposed for adjustment of the food consistency, particularly to match the oral function of older adults, which will guide clinicians and caregivers in appropriately modifying food. OBJECTIVE: We investigated how oral, swallowing, and cognitive conditions of older adults who required daily nursing care in a nursing home were associated with different dietary food consistencies. METHODS: Clinical examinations to record dentition status, swallowing, and cognitive functions were performed, and the feeding status, including the food consistencies and need for assistance at lunchtime, was evaluated in 37 older residents in nursing homes. The swallowing function was assessed by performing a modified water-swallowing test, and food swallowing was tested using pudding and rice crackers. The χ2 test was used to determine the relationships among the parameters. RESULTS: No participants were able to take cooked rice, nor regular and soft side dishes. There was no significant relationship between dentition status and feeding status. Of the participants, 95% ate pudding without any problems and 49% ate rice crackers without any signs of swallowing difficulty such as coughing or stopping chewing. There was a significant relationship between the food test score using a rice cracker and the level of food consistencies, and between the same test score and the level of mealtime assistance, whereby the better the score of the food test using a rice cracker, the better was the level of food consistencies including use of a thickening agent and the better was the level of mealtime assistance. CONCLUSION: The results strongly suggest that the food test using a rice cracker was associated with the level of food consistency and mealtime assistance for older adults in nursing homes.

Fostering infant food texture acceptance: A pilot intervention promoting food texture introduction between 8 and 15 months.

Healthy infant feeding practices form the basis of healthy eating behaviour later in life. The effect of providing parents with recommendations on textured food introduction between 8 and 15 months on children's experience with and acceptance of textured foods was studied. Sixty parent/child dyads were randomly assigned to a control group (CG) receiving current French recommendations and an intervention group (IG) receiving a brochure with supplementary advice, tips and monthly counselling on food texture introduction. After the intervention, parents completed self-report measures about the introduction of 188 food items, including purees, soft/small pieces, hard/large pieces and double textures. Children's acceptance of eight textured foods was assessed in a laboratory setting. Parents in the IG introduced more soft/small food pieces (P = 0.004) but not more complex textures (P = 0.15). There was no group difference in children acceptance for any of the textured foods offered in the laboratory. Independent of their study group, children's exposure to texture was associated with birth order, self-feeding with fingers, low gagging frequency and seldom use of commercial baby foods. Higher acceptance was associated with higher exposure to food pieces but not to pureed foods (either smooth or rough) and with children's eating behavioural traits (high food enjoyment, high food responsiveness and low food fussiness). This pilot intervention demonstrated that providing information can be effective in promoting the introduction of small and soft food pieces, but the most effective way to influence the introduction of more challenging textures (hard pieces and double texture) is uncertain. Further research should focus on the identification of barriers to complex texture introduction and on how building on this knowledge for a population-based public health intervention.

Oral Health Status and Nutritional Habits as Predictors for Developing Alzheimer's Disease.

OBJECTIVE: Poor oral health, mainly tooth loss, has been suggested to pose a risk factor for Alzheimer's disease (AD). The nature of this relationship can be explained by mastication deficit and nutritional status. Also, the influence of nutritional parameters on cognitive impairment has been documented. The aim of this study was to investigate whether poor dental status and nutrition habits can be potential separate or associated risk factors for development of the AD. METHODS: The study sample included 116 patients with AD and 63 controls. Sociodemographic variables were investigated as factors potentially associated with AD. Dental examination included recording the number of natural teeth, presence of fixed or removable dentures, and the number of functional tooth units (FTUs). Nutritional status analysis included qualitative nutrition information, body mass index, serum albumin level, food consistency, and need for assistance in feeding. Regression analysis was used to investigate the predictors for development of AD. RESULTS: Variables with significant differences between groups, which were analyzed by using the binary regression analysis, were marital status, residence, number of total FTUs (no matter whether the contacts were between natural teeth or dentures), eating meat/fish and fruits/vegetables, food consistency, and serum albumin level. Logistic regression analysis showed that being single/widowed/divorced, eating more meat/fish or fruit/vegetable, eating blended/mashed/liquid food, having low levels of serum albumin, and having less FTUs were significant predictors for developing dementia. CONCLUSION: Having fewer occlusal contacts, consumption of soft food, and lower serum albumin levels can be considered as associated risk factors for AD.

The cost-effectiveness of food consistency modification with xanthan gum-based Nutilis Clear® in patients with post-stroke dysphagia in Poland.

BACKGROUND: Dysphagia is a well-known stroke complication characterised by difficulty in swallowing. It may affect the majority of stroke patients and increases mortality and morbidity, due to aspiration pneumonia and malnutrition. Food thickening may help patients to feed themselves, and its effectiveness was demonstrated. However, the cost-effectiveness studies are lacking. We evaluate the cost-utility of xanthan gum-based consistency modification therapy (Nutilis Clear®) in adult post-stroke patients from the public payer perspective in Poland. METHODS: Routine clinical practice was used as a comparator, as no alternative specific treatment for dysphagia is available. To verify the robustness of the results against the modelling approach, we built two models: a static (a fixed simple-equations model, 8-week time horizon of dysphagia) and a dynamic one (Markov model, with a possible dysphagia resolution over a 1-year horizon). In both models, the treatment costs, health state utilities, and clinical events (i.e. aspiration, aspiration pneumonia, death) were included. Parameters were estimated jointly for both models, except for the duration of dysphagia and the risk of aspiration pneumonia (specific to the time horizon). We only assumed Nutilis Clear® to prevent aspirations, without affecting dysphagia duration. RESULTS: The average cost of one quality-adjusted life year (i.e. the incremental cost-utility ratios, ICURs) amounted to 21,387 PLN (€1 ≈ 4.5 PLN), and 20,977 PLN in static and dynamic model, respectively; far below the cost-effectiveness threshold in Poland (147,024 PLN). The one-way, scenario, and probabilistic sensitivity analysis confirmed these findings. CONCLUSIONS: Nutilis Clear® is highly cost-effective in Poland from the public payer perspective. Our approach can be used in other countries to study the cost-effectiveness of food thickening in stroke patients.

Consistency of supplied food and dentition status of the elderly in residential care homes.

BACKGROUND: The association between oral health and malnutrition has been investigated in detail. The nutrition of elderly subjects in residential care homes is determined by caregivers, dietitians or nutritionists and managed by changing the consistency of their supplied food. However, few reports have described the relationship between oral condition and supplied food consistency. The objective of this study was to determine dentition status and care levels that correlate with supplied food consistency among elderly residents of care facilities. In addition, we estimated the care level at which ordinary food consistency can be supplied by caregivers who cannot diagnose dental status. METHOD: Several factors, including dentition, wearing removable dentures, meals categorized as ordinary or processed (sliced, mashed, or liquefied), and care levels according to the Japanese standardized care-needs certification system were investigated in 276 elderly residents (male, n = 56; female, n = 220; mean age, 87.68 ± 5.94 years) of 12 fee-based care facilities. RESULTS: The results of this study showed that care levels were significantly correlated with the consistency of the food supplied to the residents. When supplied food consistency was categorized as ordinary or processed, the number of remaining teeth and the number of tooth contact pairs, either natural or artificial, were statistically significant. From logistic regression analysis, it was determined that the numbers of tooth contact pairs were statistically significant among residents requiring high levels of care. CONCLUSION: The number of tooth contact pairs, either natural or artificial, was one of the contributing factors for deciding supplied food consistency among elderly residents of care facilities. Elderly residents requiring less than care level 3 should have ordinary meals.

Effects of the masticatory demand on the rat mandibular development.

The influence of masticatory loading stimulus on mandibular development is not fully clear. In this paper, experimental alterations in the daily muscle use, caused by a changed diet consistency, were continuously monitored, while adaptations in bone and cartilage were examined. It is hypothesised that decreased muscular loading will result in a decrease in the growth factor expression and mandible growth. Fourteen 21-day-old Wistar strain male rats were randomly divided into two groups and fed on either a hard or soft diet for 14 weeks. An implanted radio-telemetric device recorded continuously muscle activity of the superficial masseter muscle. Chondroblast proliferation in the condylar cartilage was identified by insulin-like growth factor-1 receptor (IGF-1r) immunostaining. Furthermore, an X-ray was taken for cephalometric analysis. In the soft-diet group, the duty time of the superficial masseter muscle at higher activity levels was significantly lower than that in the hard-diet group. This decrease in muscular loading of the jaw system was accompanied by: a significant reduction in (i) articular cartilage thickness, (ii) expression of IGF-1r immunopositive cells and (iii) mandible ramus height. In conclusion, a decrease in masticatory demand during the growth period leads to insufficient mandibular development.

Functions of the temporomandibular system in extracranial chronic pain conditions: modulatory effects on nocifensive behavior in an animal model.

OBJECTIVE: Mastication may be able to activate endogenous pain inhibitory mechanisms and therefore lead to modulation of nociceptive processing. The purpose of this study was to examine the possible effect of food consistency on noxious input from the spinal system. METHODS: Three groups of adult male Sprague-Dawley rats were given an injection of complete Freund adjuvant in a hind paw 10 days after eating soft or hard food (one group received a saline injection-the control group [C]; the other group (D) received no injection). Nocifensive behavior was assessed with the use of the hot plate and tail flick assays at 1, 3, 6, and 12 hours and at 6.5 days after injection for groups A/B, and c-Fos activity was assessed in the brain after testing. Groups C/D had hot plate testing at 1 hour and 6.5 days. The data were analyzed by general linear modeling and 1-way analysis of variance. RESULTS: There was a small increase in the hot plate percent maximum possible effect (MPE) from -45.7 to -61.1 in group A over the length of the experiment, but a very small decrease for group B over the same period (-33.5 to -28.8). For the saline control group, there was a small increase toward 0 %MPE over the same time frame (-15.0 to 1.7). The %MPE differences were significant between groups A and C (P < .0005), but not significant between the other groups (F = 13.34, df = 2, P = .001, observed power = 99%). Using the pooled results (all time points), the differences between all groups were significant (P < .0005). There were no significant differences in the tail flick test. c-Fos was mainly observed in the raphe pallidus area with significant differences between groups A and B at 3 and 6 hours after injection of CFA (P = .027 and .022, respectively). CONCLUSIONS: The results of this study indicate that food consistency (hardness) influences nocifensive behavior in this animal model via a descending pathway operating at the supraspinal level.

The effect of a soft diet on molar dentin formation during the occlusal establishment period.

OBJECTIVE: This study intends to investigate the effect of a soft food diet on molar dentin formation during the occlusal establishment period. It can provide dietary guidance for infants to strengthen their dental structure. DESIGN: 60 BALB/c mice were used to obtain mandibles during lactation (P0.5, P7.5, P15.5, P21.5) and occlusal establishment (P27.5, P33.5, P60.5). The mice were randomly divided into soft or hard diet groups after weaning at day 21.5. Hematoxylin-eosin and aniline blue staining were used to observe the morphology and number of odontoblasts and the amount of molar dentin formation. Immunohistochemistry was performed to observe the proliferation and apoptosis of odontoblasts. The in vivo fluorescence double-labeling was applied to evaluate the rate of molar dentin formation. RESULTS: The soft diet group had poorer periodontal membrane development but more cervical dentin deposition. Alterations in morphology and the number of odontoblasts showed a stronger correlation with age rather than food hardness. There are no significant differences in proliferative and apoptotic behavior of dentin-forming cells between the two groups. Rather, it affected the rate of dentin deposition. The rate of dentin deposition was high in the soft diet group from P21.5 to P27.5, but it was surpassed by the hard diet group within P27.5-P33.5, and the difference between the two groups disappeared at P33.5-P60.5. CONCLUSIONS: A soft diet promotes molar early cervical dentin formation. This advantage is caused by an enhanced odontoblast secretion rate rather than affecting the morphology, number, proliferation, or apoptosis of odontoblasts.

Impact of Diet Consistency on the Mandibular Morphology: A Systematic Review of Studies on Rat Models.

Apart from genetics, environmental factors, such as food consistency, may affect craniofacial morphology and development. The present systematic review aims to systematically investigate and appraise the available evidence regarding the effect of diet consistency on the anatomical structures of the basal bone of the rat mandible. The search was performed without restrictions in five databases (PubMed, Scopus, Web of Science, ProQuest Dissertations and Theses Global, including grey literature) and hand searching through January 2022. A total of 14,904 references were initially identified, and 16 articles were finally included in the systematic review. Rats that consumed hard diets were found to exhibit an increase inbigonial width, corpus height, condylar depth, condylar base inclination, condylar process inclination, mandibular plane inclination, height and length of angular process, mandibular body height, depth of antegonial notch, growth rate in the gonial angle, angular process convexity and height of condylar process. It was also noted that mandibular depth, mandibular height, ramus angle and angle between the angular process and mandibular plane were decreased in rats that were fed with a hard diet. On the other hand, there were conflicting results about the growth of mandibular length and width, corpus length, mandibular body length, ramus height, condylar length and width, gonial angle and height of coronoid process. From the abovementioned results, it can be concluded that food consistency may affect the morphology of anatomical structures and the overall growth and development of rat mandibles in various ways.

Effects of dietary consistency on the occlusal changes in nonhuman mammals: A systematic review.

OBJECTIVES: This systematic review aimed to assess whether hard or soft foods interfere with the pattern of occlusal changes in nonhuman mammals. DESIGN: The electronic databases PubMed, Scopus, Web of Science, Cochrane Library, LILACS, OpenGrey and Google Scholar were examined. Only studies investigating the effects of dietary consistency on the occlusal characteristics in animal models were included. The risk of bias was performed based on the SYRCLE's tool, which assigned a low, high or uncertain assessment to each domain. RESULTS: After the removal of duplicates, a total of 8,977 articles remained. From those, 19 studies met the eligibility criteria. Although a great methodological heterogeneity was observed, the results of the included studies as a whole points to homogeneity in the findings obtained on rats, pigs, and monkeys. The increase in the masticatory load was associated with larger dental arch dimensions. Dental wear and dento-alveolar changes were more evident with an increase of diet consistency. Baseline characteristics, blinding of outcome assessors, other sources of bias, incomplete outcome data, and selective outcome reporting were best assessed, denoting a lower risk of bias. In sequence generation and allocation concealment, insufficient details were provided to improve the classification. Random housing and outcome assessment and blinding of researchers were poorly evaluated. CONCLUSION: Considering the limited evidence obtained from these findings, it seems that food consistency may interfere with the development of occlusal patterns and arch dimensions among growing animals. The findings suggest an environmental effect, even if minimal, on the occlusal characteristics.

Impact of the Consistency of Food Substances on Health and Related Factors of Residents in Welfare Facilities for Seniors in Japan.

The aim of this study is to determine the effect of food consistency on health and related factors among residents in welfare facilities for seniors (n = 227; mean age, 86.2 ± 8.0 years; 78.9% female). Residents who ate regular food had a lower incidence of fever during the 3-month period (p < 0.001) and consumed more calories (1325.97 ± 220.2 kcal) than those who ate chopped (1125.0 ± 256.8 kcal), paste (1122.0 ± 288.5 kcal), and gastric tube food (812.5 ± 150.7 kcal) (p < 0.001). Modifying a resident's food by making it softer and finer did not reduce the incidence of choking. Logistic regression analysis (backward elimination method) revealed four factors related to eating regular food: vitality index, appetite, number of remaining teeth, and choking frequency. Causal relationships were not obtained because this was a cross-sectional study. The findings of this study suggest that a regular consistency of food positively influences the health of older individuals.

Which swallowing difficulty of food consistency is best predictor for oropharyngeal dysphagia risk in older person?

PURPOSE: The present study aimed to investigate which swallowing difficulty of food consistency in participants over 65 years of age who did not have any disease that might affect swallowing functions, and which symptoms were most likely related to oropharyngeal dysphagia (OD). METHODS: The cross-sectional and multicenter study was conducted at 12 hospitals including 883 participants aged ≥65 years who were fed orally and who were admitted to the physical medicine and rehabilitation outpatient clinics between September 2017 and December 2018. Demographic characteristics were recorded. Katz Daily Living Activities Index (KDLAI), swallowing-related quality of life scale (Swal-QoL) and 10-item Eating Assessment Tool (EAT-10) were used. The participants were asked the "yes" or "no" questions including swallowing difficulty of various types of food consistency with the face-to-face interview. RESULTS: Participants were divided into two groups as normal swallowing (EAT-10 < 3 group) (n = 639) and OD risk groups (EAT-10 ≥ 3 group) (n = 244) according to the EAT-10 scores. While there was no difference related to number of teeth and KDLAI scores between groups (p = 0.327 and p = 0.221, respectively), the significant difference was found between groups in terms of yes/no questions and Swal-QoL scores (p < 0.05). Receiver operating characteristic analysis revealed that eating difficulty of mixed content food provided maximum sensitivity (99%) and eating/drinking difficulty of thick liquid had maximum specificity (77%). The higher area under curve was in eating/drinking difficulty of thick liquid (0.891), and higher positive likelihood ratio (LR) was eating/drinking difficulty of thick liquid (4.26) as well as lower negative LR was eating difficulty of mixed content food (0.01). The higher diagnostic odds ratio was eating difficulty of mixed content food (367.0), and the higher posttest probability was eating/drinking difficulty of thick liquid (0.211). CONCLUSION: While eating difficulty of hard solid food is the most common symptom in healthy participants over 65 years of age, the eating difficulty of thick liquids is the highest predictive value related to oropharyngeal dysphagia risk. Also, the eating difficulty of mixed content food had the highest diagnostic ratio.

Early impacts of modified food consistency on oromotor outcomes in mouse models of Down syndrome.

Down syndrome (DS) in humans is associated with differences of the central nervous system and oromotor development. DS also increases risks for pediatric feeding challenges, which sometimes involve the use of altered food consistencies. Therefore, experimental food consistency paradigms are of interest to oromotor investigations in mouse models of Down syndrome (DS). The present work reports impacts of an altered food consistency paradigm on the Ts65Dn and Dp(16)1Yey mouse models of DS, and sibling control mice. At weaning, Ts65Dn, Dp(16)1Yey and respective controls were assigned to receive either a hard food or a soft food (eight experimental groups, n = 8-10 per group). Two weeks later, mice were assessed for mastication speeds and then euthanized for muscle analysis. Soft food conditions were associated with significantly smaller weight gain (p = .003), significantly less volitional water intake through licking (p = .0001), and significant reductions in size of anterior digastric myofibers positive for myosin heavy chain isoform (MyHC) 2b (p = .049). Genotype was associated with significant differences in weight gain (p = .004), significant differences in mastication rate (p = .001), significant differences in a measure of anterior digastric muscle size (p = .03), and significant reductions in size of anterior digastric myofibers positive for MyHC 2a (p = .04). In multiple measures, the Ts65Dn model of DS was more affected than other genotype groups. Findings indicate a soft food consistency condition in mice is associated with significant reductions in weight gain and oromotor activity, and may impact digastric muscle. This suggests extended periods of food consistency modifications may have impacts that extend beyond their immediate roles in facilitating deglutition.

Effects of age and viscosity on food transport and breathing-swallowing coordination during eating of two-phase food in nursing home residents.

AIM: When eating food that contains both liquid and solid phases, the liquid component frequently enters the hypopharynx before swallowing and can increase the risk of aspiration. Thus, we examined whether the initial viscosity of mixed consistency food could alter pre-swallow food transport and breathing-swallowing coordination in older adults. METHODS: Fiberoptic endoscopy was recorded while 18 healthy young adults and 19 older adults ate 5 g of steamed rice combined with 3 mL of blue-dye water. Liquid viscosity was set at three levels by the addition of a thickening agent (0 wt%, thin; 2 wt%, thicker; 4 wt%, higher-viscosity, respectively). We measured the timing of swallow initiation and its corresponding respiratory phase for each participant. RESULTS: For thin mixed consistency food, whereas the timing of swallow initiation was comparable between young and older participants, swallowing was initiated during inspiration significantly more often in older participants (31.6 %) than in young participants (5.6 %). In contrast, the timing of swallow initiation was delayed in older participants for thicker and higher-viscosity foods, although swallowing was commonly initiated during expiration in both groups. CONCLUSIONS: In older adults, we observed that swallow initiation function was preserved for thin mixed consistency samples, but breathing-swallowing coupling was diminished. For higher-viscosity foods, swallow initiation was delayed in this group, but breathing-swallowing coordination was not disturbed, probably as a result of the slow bolus flow into the hypopharynx. Thus, it appears the initial viscosity of mixed consistency food profoundly affects food transport before swallowing as well as breathing-swallowing coordination in nursing home residents. Geriatr Gerontol Int 2017; 17: 2171-2177.

Impact of wear and diet on molar row geometry and topography in the house mouse.

OBJECTIVES: Dental evolution affects the geometry of the tooth, but the adaptive relevance of these changes is related to tooth sharpness, complexity, and relief (topography). On a set of laboratory mice, we assessed how wear related to age and food consistency affected molar geometry and topography. DESIGN: Three groups of laboratory inbred mice (C57BL/6J strain) were considered: Four week old mice close to weaning, six month old mice fed on regular rodent pellets, and six month old mice fed on rodent pellets that were powdered and served as jelly. Their upper and lower molar rows were imaged in 3D. The geometry of the surfaces was quantified using a template describing the whole surface of the rows. Topographic indices were estimated on the same surfaces. RESULTS: The geometry of the molar rows was heavily affected by age-related wear. Food consistency affected mostly the upper molar row, which was more worn and less helical in soft food eaters. Tooth sharpness and relief decreased with age-related wear. Tooth relief was lower in soft food eaters, but only on the upper molar row. Tooth complexity was insensitive to wear. CONCLUSION: The primary factor affecting tooth geometry and topography is age-related wear, as wear erodes the molar surfaces. Tooth complexity, however, appears to be insensitive to wear, making this index relevant for comparison of tooth morphology among wild mice of unknown age. Soft food eaters displayed more worn teeth, with less helical molar row occlusal surface, possibly because behavior and jaw morphology were disturbed due to this unusual food resource.

The influence of food consistency on chewing rate and muscular work.

Food properties influence the parameters of the masticatory process, such as jaw movement, muscle activity and chewing rate. Firm foods will require more muscle activity than softer foods. However, the influence of food hardness on chewing rate is ambiguous as both slower and higher chewing rates have been reported for harder foods. Rheological characteristics of the food, such as plasticity and elasticity, may help to explain differences in chewing rate. The aim of our study was to determine the influence of food properties on chewing rate and muscular work in five phases of a chewing sequence. Eighty-four participants chewed on five foods, which strongly differed in consistency. Chewing gum was used as a reference food. The phase in the chewing sequence had a large significant effect on cycle duration for the five foods. A significant decrease in cycle duration at the beginning of chewing was followed by an increase in later phases, leading to U-shaped curves. Food type had a small effect on the average cycle duration. However, large significant differences in cycle duration were observed between the foods at the beginning of a chewing sequence. In that phase, the firm foods were chewed much slower than the soft foods. Muscular work was significantly influenced by both chewing phase and food type.