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.

Effects of single ingestion of rice cracker and cooked rice with high resistant starch on postprandial glucose and insulin responses in healthy adults: two randomized, single-blind, cross-over trials.

Rice with double mutation of starch synthase IIIa and branching enzyme IIb (ss3a/be2b) has much higher amounts of apparent amylose and resistant starch (RS) than usual varieties. In this study, we conducted two randomized, single-blind, crossover trials to investigate the effect of single ingestion of two processed foods composed of ss3a/be2b mutant rice on postprandial blood glucose and insulin response in healthy adults, compared to those of usual cultivar. In trial 1, of ingestion of rice crackers, the incremental area under the curves of glucose (IAUCglc) and insulin (IAUCins) in RS group was significantly lower than in the control group. In trial 2, of the ingestion of cooked rice, IAUCglc in the RS group was significantly lower than in the control group. These results showed that the ss3a/be2b-mutant rice cracker and cooked rice having high RS can attenuate postprandial blood glucose and insulin response.

Effect of heat-moisture treated brown rice crackers on postprandial flow-mediated dilation in adults with mild endothelial dysfunction.

Background: Endothelial dysfunction is an early pathophysiological feature and independent predictor of a poor prognosis in most forms of cardiovascular disease. We evaluated the effect of brown rice crackers (BR-C) on endothelial function. Methods: Effect of heat-moisture treated (HMT) -BR-C on postprandial flow-mediated dilation (FMD) in adults with mild endothelial dysfunction was compared with that of BR-C and white rice crackers (WR-C) in 12 adults with mild endothelial dysfunction (less than 7.0% of FMD) by a randomized, single-blind, three-treatment three-period crossover trial (UMIN 000034898). Since we considered that the FMD increase was associated with the treatment of HMT-BR-C, we examined the effect of three possible factors: postprandial glucose levels, polyphenol content, and polyphenol release from the food matrix. Results: Mean pre-intake baseline FMD values of HMT-BR-C, BR-C, and WR-C were 4.9%, 5.1%, and 4.9%, respectively, and those values 1 h post-intake were 6.3%, 5.1%, and 4.8%, respectively. There was no difference in intergroup comparisons of FMD using Dunnett's multiple comparison test. There was a significant increase in FMD only in HMT-BR-C in intragroup comparisons (P = 0.042 by paired-t test). In comparison with BR-C, no significant difference was noted in the postprandial glucose level nor in the content of total polyphenols and ferulic acid derivatives in HMT-BR-C. However, the 70% ethanol extracted from HMT-BR-C contained a significantly larger amount of free and bound ferulic acids than from BR-C. Conclusion: HMT-BR-C intake increased the postprandial FMD response.

Age-related changes in functional adaptation to bolus characteristics during chewing.

We investigated how the physical properties of food affect chewing kinematics, and examined the effects of aging on behavior. Twenty young and 21 older volunteers were asked to freely chew rice crackers and spit the food out at their average chewing duration. We compared chewing characteristics among the conditions (age × rice cracker), and examined the area of rectified masseter and suprahyoid electromyographic bursts per chewing cycle. We also evaluated temporal changes in those values. In addition, the bolus properties at the end of chewing were compared. The harder/larger the rice cracker, the longer the chewing duration and the greater the number of chewing cycles. These values also increased with age. Chewing cycle time was not affected by age and rice cracker properties, except in one condition: for the rice cracker with the lowest hardness and density, the chewing cycle time was longer than for the other rice crackers. Chewing cycle time decreased at the middle stage of chewing, followed by an increase, with increasing suprahyoid electromyographic activity at the late stage. The physical properties of the bolus at the end of chewing did not differ between age groups, and depended on the initial properties. The water absorption rate of the bolus was significantly greater for the rice cracker with the lowest hardness and density compared with other rice crackers. The results demonstrated that not only hardness, but also other factors, such as density, significantly affected chewing behaviors.

Effects of rheological properties of rice dough during manufacture of rice cracker on the quality of the end product.

Influence of the viscoelastic properties of rice dough on the mechanical properties and the microstructure of rice crackers was experimentally investigated to predict and control the quality of the rice cracker in the early stage of the lengthy manufacturing process. Various rice doughs steamed for 5, 30, or 60 min and kneaded for 5, 10, or 15 min were examined. Longer steaming and kneading resulted in lower G' and G″ and higher tan δ, specific volume of the rice crackers, decreased nonuniform and deficient network, and thinner cell wall in rice cracker sections. There was a high correlation between tan δ of rice dough and specific volume of the rice cracker samples (R2 > 0.79). The hardness of the rice crackers increased with extending the kneading time for 5 and 30 min as the tan δ increased, while those of the rice crackers made from the rice doughs steamed for 60 min decreased inversely. These results indicated that qualities of rice crackers can be predicted and quantified by measuring viscoelasticity of actual rice doughs during the process. PRACTICAL APPLICATIONS: Improved methods to control quality of end product in manufacturing process and to develop new products with unique textures are desired. We established the new method to quantify the rice dough and this method has already been used for confirming equivalency or improvement of rice dough during manufacture of rice crackers when instrument or condition have changed.

A new evaluation of masticatory ability in patients with dysphagia: The Saku-Saku Test.

OBJECTIVE: In the elderly and patients with dysphagia, masticatory problems often cause aspiration or choking. Although simple methods to predict aspiration and silent aspiration exist, methods for evaluating the masticatory function of patients with dysphagia are lacking. Accordingly, we developed a simple test to assess the chewing and swallowing ability of patients with dysphagia. METHODS: One hundred and five patients with dysphagia were included. We used the Saku-Saku Test (SST), in which patients were asked to eat a rice cracker, and evaluated the quality of mandibular rotation during mastication. We studied the participants' ability to grind, aggregate, and swallow using videoendoscopic evaluation (VE) and investigated its association with mandibular rotation. RESULTS: The SST showed good reliability between two examiners, with a kappa coefficient of 0.80. 92.4% of the patients ate the rice cracker without aspiration. The SST showed a high sensitivity of 73.3% and specificity of 93.3% for the degree of grinding. The degree of food bolus aggregation had a sensitivity of 45.0% and specificity of 90.6%, and aspiration had a sensitivity of 25.0% and specificity of 84.5%, both of which showed high specificity. CONCLUSIONS: The results of this study suggested that the SST might be simple and useful for identifying patients with dysphagia who are able to masticate, even if they do not eat foods that need chewing and could be used before starting these patients on foods that need chewing.