In infants and children with feeding and swallowing issues, modifying solid foods to form a liquid or puree is used to ensure adequate growth and nutrition. However, the behavioral and neurophysiological effects of prolonged use of this intervention during critical periods of postnatal oral skill development have not been systematically examined, although substantial anecdotal evidence suggests that it negatively impacts downstream feeding motor and coordination skills, possibly due to immature sensorimotor development. Using an established animal model for infant and juvenile feeding physiology, we leverage X-ray reconstruction of moving morphology to compare feeding behavior and kinematics between 12-week-old pigs reared on solid chow (control) and an age- and sex-matched cohort raised on the same chow softened to a liquid. When feeding on two novel foods, almond and apple, maintenance on a soft diet decreases gape cycle duration, resulting in a higher chewing frequency. When feeding on almonds, pigs in this group spent less time ingesting foods compared to controls, and chewing cycles were characterized by less jaw rotation about a dorsoventral axis (yaw) necessary for food reduction. There was also a reduced tendency to alternate chewing side with every chew during almond chewing, a behavioral pattern typical of pigs. These more pronounced impacts on behavior and kinematics during feeding on almonds, a tougher and stiffer food than apples, suggest that food properties mediate the behavioral and physiological impacts of early texture modification and that the ability to adapt to different food properties may be underdeveloped. In contrast, the limited effects of food texture modification on apple chewing indicate that such intervention/treatment does not alter feeding behavior of less challenging foods. Observed differences cannot be attributed to morphology because texture modification over the treatment period had limited impact on craniodental growth. Short-term impacts of soft-texture modification during postweaning development on feeding dynamics should be considered as potential negative outcomes of this treatment strategy.

A dysphagia diet is a special eating plan. The development and design of dysphagia foods should consider both swallowing safety and food nutritional qualities. In this study, the effects of four food supplements, namely vitamins, minerals, salt and sugar, on swallowing characteristics, rheological and textural properties were investigated, and a sensory evaluation of dysphagia foods made with rice starch, perilla seed oil and whey isolate protein was carried out. The results showed that all the samples belonged to foods at level 4 (pureed) in The International Dysphagia Diet Standardization Initiative (IDDSI) framework, and exhibited shear thinning behavior, which is favorable for dysphagia patients. Rheological tests showed that the viscosity of a food bolus was increased with salt and sugar (SS), while it decreased with vitamins and minerals (VM) at shear rates of 50 s-1. Both SS and VM strengthened the elastic gel system, and SS enhanced the storage modulus and loss modulus. VM increased the hardness, gumminess, chewiness and color richness, but left small residues on the spoon. SS provided better water-holding, chewiness and resilience by influencing the way molecules were connected, promoting swallowing safety. SS brought a better taste to the food bolus. Dysphagia foods with both VM and 0.5% SS had the best sensory evaluation score. This study may provide a theoretical foundation for the creation and design of new dysphagia nutritional food products.

UNASSIGNED: The International Dysphagia Diet Standardization Initiative (IDDSI) has created global standardized definitions for texture-modified diets (TMDs) and thickened liquids to improve the safety and care for individuals with swallowing difficulties. The IDDSI framework guides health care facilities, such as aged care, to provide food to at-risk patients.
UNASSIGNED: This study aims to design, deliver, and evaluate a tailored intervention to facilitate IDDSI implementation in aged care.
UNASSIGNED: Five aged care facilities received tailored interventions, which were guided by the Expert Recommendation for Implementing Change process and used the corresponding barriers identified in the previous study: 1) tailored material, delivery, and planning; 2) opinion leaders and professional input; 3) strategies to attract and involve staff; and 4) reflections and evaluations. Meal compliance against IDDSI standards and staff knowledge acquisition were the primary outcomes evaluating the impact of the intervention. Written consent was obtained from facility managers. Staff trainings were delivered by a dietitian, accompanied with electronic and printed materials. An audit was conducted on all items listed on the TMD daily menu (lunch, dinner, and midmeals). TMD IDDSI audits and staff self-administered surveys were conducted before and 6 mo after the intervention.
UNASSIGNED: Audits of 68 and 79 TMD meals/items were conducted pre- and postintervention, respectively. Significant improvement in meal compliance was found in all 3 levels of TMDs, including soft and bite-sized (50%; P = 0.0001), minced and moist (44%; P = 0.0024), and puréed (42%; P = 0.0024). The overall IDDSI compliance increased by 46% postintervention (P < 0.0001). Staff achieved higher scores in both dysphagia and IDDSI knowledge sections (P < 0.0001).
UNASSIGNED: Tailored interventions facilitated IDDSI implementation in aged care evidenced by increased TMD compliance and staff knowledge, which remained at 6 mo postintervention.

With the speeding tendency of aging society, the population experienced dysphagia is increasing quickly. Desirable dysphagic diets should be safe, visually appealing and nutritious. 3D printing allows for creation of personalized nutritious foods with regular-like appearance. Shiitake mushroom, rich in protein and bioactive compounds, is suitable for elderly, but its hard texture was not friendly to the elderly with dysphagia. This study investigated the feasibility of production of dysphagic product using shiitake mushroom by 3D printing with various gums addition, including arabic gum (AG), xanthan gum (XG) and k-carrageenan gum (KG) at concentrations of 0.3%, 0.6% and 0.9% (w/w). Data suggested that XG and KG incorporation significantly increased inks\' mechanical strength by decreasing water mobility and promoting the formation of hydrogen bond, enabling 3D printed objects with great self-supporting capacity. The XG containing and KG-0.3% samples were categorized into level 5-minced and moist dysphagia diet within international dysphagia diet standardization initiative (IDDSI) framework. AG addition decreased mechanical strength and viscosity, hardness and self-supporting capacity of 3D printed constructions. AG-0.3% and AG-0.6% samples could not be classified as dysphagia diets based on IDDSI tests. This study provides useful information for dysphagia diet development with appealing appearance by 3D printing.

Commercial cold beverages thickened with a xanthan gum (XG)-based food thickener were examined at different thickness levels by using the simple, cost-effective syringe flow test (SFT) developed by the International Dysphagia Diet Standardization Initiative (IDDSI). We prepared cold thickened beverage (CTB) samples with different thickener concentrations and measured them by extrapolating the viscosity range (51-350 mPa·s) for nectar-like consistency. CTBs were also measured via the line-spread test (LST), and the flow distance value (cm) by LST and the volume remaining (mL) in the syringe by SFT was correlated with the apparent viscosity (ηa,50). Plots comparing ηa,50 with SFT or LST values showed good exponential relationships between the measurements. The SFT showed a better relationship (R2 = 0.928) than LST (R2 = 0.825), indicating that the former can predict the viscosity better in the range for nectar-like consistency. In particular, the SFT showed a significant difference (R2 = 0.964) compared to the LST (R2 = 0.709) for thickened protein-based beverages. These results suggest that the SFT using the IDDSI methodology is a more suitable instrument than the LST for accurately evaluating the viscosity of XG-based CTBs with nectar-like consistency.

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

Children with dysphagia, or swallowing disorder, are at an increased risk for developing respiratory compromise, failure to thrive, and aversion. Thickened liquids can be recommended for children with dysphagia, if shown to be effective on instrumental examination and if strategies/interventions with thin liquids are not successful. Thickened liquids have many benefits, including creating a more cohesive bolus, slowing oropharyngeal transit time, and reducing aspiration. However, preparing thickened liquids with commercially available thickeners can result in poor compliance due to concerns regarding taste, texture, accessibility, cost, thickness variability, and potential negative impact of these substances on a child\'s immature digestive tract. The purpose of this study was to determine if liquids could be successfully thickened with widely available, commercial pureed foods, and to assess how these mixtures compare to starch and gum based thickening agents. The International Dysphagia Diet Standardisation Initiative (IDDSI) flow test was performed for each sample of puree thickened liquids, gum based thickened water, and cornstarch based thickened water. In addition, rheology testing was performed on each category of the samples to measure viscosity at various shear rates and temperatures, and to assess the presence of yield stress. Results revealed that liquids thickened with smooth textured purees were comparable to commercial starch and gum based thickeners, and may be offered as a viable alternative.

To delay impacts of aging, optimal nutritional status is essential. Several factors can reduce food intake, such as isolation, income, and cognitive/physical decline. Additionally, chewing and swallowing difficulties, or dysphagia, often disrupt the ability to consume life-long favorite dishes. Food and liquids could require modification of texture or consistency to ensure a comfortable or safe swallow. The food industry, foodservices facilities, and caregivers need quality control benchmarks to provide adequate nourishment and meet these new feeding challenges. The International Dysphagia Diet Standardisation Initiative (IDDSI) is proposing the IDDSI framework and testing methods to describe food used in nutritional care plans to circumvent dysphagia and improve communication among caregivers. This systematic review assesses the validity and reliability of the IDDSI testing methods using the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN). Two publications presented content validity whereas 19 publications looked at construct validity or reliability for the IDDSI testing methods. One study was conducted in older adults presenting dysphagia. This review concludes that there is insufficient evidence to recommend the IDDSI testing methods. Further research, conducted with robust methodological design and reporting, is needed to develop and assess nutritious adapted food for frail older populations.

Transitional foods are under-utilized in the adult population as they may provide an opportunity to optimize eating pleasure and nutrition for individuals on a modified texture diet. Yet, little is known about the behavioral properties of transitional foods and no research to date has explored the dissolution of known transitional foods in adults. This study aimed to understand the extent of dissolution of five transitional snacks items in relationship to time, tongue pressure, and amount of saliva. Thirty individuals ages 50 to 88 participated in this study (10 with diagnosed xerostomia). The foods tested included shrimp chips, Baby Mum Mums, the EAT bar, and the Savorease cracker with and without dip. Each test food was placed in the mouth for 5 s or 12 s with or without tongue pressure and then expectorated. Benchtop preparation via the International Dysphagia Diet Standardisation Initiative (IDDSI) protocol was also completed. An IDDSI fork pressure test was then performed on all samples. Significant differences between snacks were found in degree of dissolution, with Savorease crackers dissolving more consistently than all others and Baby Mum Mums dissolving least frequently than all others. Tongue pressure positively influenced the dissolution of some foods, particularly those with decreased rates of dissolution. Differences also existed between testing conditions. Overall, there was a wide variability in degree and speed of dissolution across different transitional foods and testing methods. These findings support the need for individual testing to explore post-oral processing consistency when determining the clinical utility of transitional foods.

This study aimed to evaluate an existing liquid-thickening guideline provided by a major manufacturer of thickener in Hong Kong and to provide directions for the implementation of the IDDSI framework. Fifteen participants who are naïve to liquid thickening were required to prepare thickened liquids samples from three drink bases (i.e., Milk-tea, Chinese tea, and Herbal tea) at two target consistency levels (i.e., mildly and medium/moderately thick) based on two guidelines (i.e., the manufacturer\'s guideline and an IDDSI-driven guideline). Viscosities of the samples were measured rheologically to reflect liquid consistency. The manufacturer\'s guideline resulted in distinguishable viscosities at the two consistency levels (F(1, 35.464) = 113.764, p < 0.001, ηp2 = 0.802), as well as different viscosities in different drink bases (F(1.267, 35.464 = 92.951, p < 0.001, ηp2 = 0.769). Comparison between the manufacturer\'s and the IDDSI-driven guideline showed that the later resulted in more viscous liquid samples in all drink bases and at both consistency levels. The difference between the two guidelines was statistically significant (F(1,28) = 35.137, p < 0.001, ηp2 = 0.557). Following only the manufacturer\'s guideline when thickening non-water beverages may lead to discrepancy between the resultant and prescribed consistencies. Thus, it should be considered inadequate to ensure swallowing safety. The effect of drink base should be emphasized to patients and caregivers, and pre-serving tests should be introduced. Despite similar classifications and terminologies used between the current local framework and the IDDSI framework, measures should be taken to avoid potential confusions and associated threats to swallowing safety.