质地改良食品(TMF)是改善吞咽困难患者吞咽安全性和效率的常用干预措施。食品的非标准化质地分类(NSTC)在世界范围内使用。然而,正如这项研究记录的那样,它可能会导致定义缺乏清晰度和混乱,这可能会损害患者的安全。国际吞咽困难饮食标准化倡议(IDDSI)框架提供了纹理测试的国际术语和标准化方法,可以解决此问题AIMS:为了记录NSTC和IDDSI的标准化纹理分类(STC)之间的差异,在送餐后30分钟内记录STC的变化,并探讨食物摄入与质地水平的关系。
在这项观察性研究中,数据来自24个长期护理部门,在为624名居民提供的五餐中,包括至少一份早餐,午餐和晚餐。要记录NSTC和STC之间的差异,LTC设施中使用的所有NSTC食物质地都被重新分类,以匹配食物离开厨房时的IDDSI质地水平(n=1276).要记录纹理中与时间相关的更改,将食物离开厨房后的STC质地与30分钟后的质地进行比较(n=1276)。最后,探索质地与消费之间的关系,使用对消费百分比结果和结果的主观评估,对单一食品消费(n=3820)进行了估计:在五餐服务的过程中,总共对1276种食品进行了分类(早餐至少各一种,午餐和晚餐)。发现NSTC和STC质地水平的统计显着差异表明,居民正在食用比TMF处方更难以食用的食物。此外,随着时间的推移,食物质地发生了显著变化,食物离开厨房后30分钟,质地水平显着增加。最后,与普通食物相比,质地较软的食物消费量更大;此外,早餐时食物消耗量最大,午餐时食物消耗量最低。
需要TMF的居民获得了比预期更硬的质地,需要复杂的吞咽能力,从而带来窒息风险。使用IDDSI提出的STC可以提高患者的安全性,口服摄入量和营养状况。在患者在服务后不立即食用食物的情况下,也应考虑与时间相关的变化。最后,午餐期间减少食物消耗可能会对整体营养素摄入量产生负面影响,特别是在午餐是一天的主餐的文化中。
尽管对STC的重要性达成了广泛的共识,机构护理提供者广泛使用NSTC。IDDSI框架为纹理测试提供国际术语和标准化方法。使用STC的临床重要性尚不清楚。本文对现有知识的补充这项研究发现,需要质地改良食物的居民正在食用比预期更具挑战性的食物质地。与30分钟后的质地相比,离开厨房时的食物质地存在差异。纯净的质地比普通的质地食物有更大的消耗。早餐时食物消耗量最高,在午餐时减少,这可能会对整体营养素摄入量产生负面影响。这项工作的潜在或实际临床意义是什么?准确的食物质地处方是提高患者安全性的第一步。然而,食物准备和处理也是非常重要的步骤,不要忽视。食物质地与时间相关的变化是显著的,在患者服务后不立即食用食物的情况下,应予以考虑。因为这些会危及患者的安全。
Texture-modified foods (TMF) is a common intervention for improving swallowing safety and efficiency for people with dysphagia. Non-standardized texture classification (NSTC) of foods is used worldwide. However, as this study documents, it can introduce a lack of clarity and confusion over definitions that can potentially harm patients\' safety. The International Dysphagia Diet Standardisation Initiative (
IDDSI) framework offers international terminology and standardized methods for texture testing that can address this issue AIMS: To document differences between NSTC and standardized texture classification (STC) of the
IDDSI, to document changes in the STC in the 30 min following meal delivery, and to explore the relationship between food intake and texture level.
In this observational study, data were collected from 24 long-term care departments during five meals served to 624 residents, including at least one breakfast, lunch and dinner. To document differences between NSTC and STC, all NSTC food textures used in the LTC facilities were reclassified to match the
IDDSI texture level at the time food left the kitchen (n = 1276). To document time-related changes in texture, the STC texture as food left the kitchen was compared with texture 30 min later (n = 1276). Finally, to explore the relationship between texture and consumption, estimates were made of single-item food consumption (n = 3820) using a subjective evaluation of consumption percentage OUTCOMES & RESULTS: A total of 1276 food items were classified over the course of five meal services (with at least one each from breakfast, lunch and dinner). Statistically significant differences in NSTC and STC texture levels were found that revealed that residents were consuming food that was more difficult to eat than intended by the TMF prescription. In addition, significant changes in food texture were found over time, with texture levels significantly increasing 30 min after food left the kitchen. Finally, greater consumption was found for softer textures in comparison with regular foods; moreover, food consumption was greatest during breakfast and lowest during lunch.
Residents requiring TMF received harder textures than intended which required complex swallowing ability, thus introducing a choking risk. Using the STC as proposed by the
IDDSI could improve patient safety, oral intake and nutritional status. Time-related changes should also be considered in circumstances where patients do not consume food soon after service. Lastly, reduced food consumption during lunch might negatively impact overall nutrient intake, particularly in cultures where lunch is the main meal of the day.
What is already known on the subject Despite widespread agreement on the importance of STC, institutional care providers widely use NSTC. The
IDDSI framework offers international terminology and standardized methods for texture testing. The clinical importance of using STC is not well understood. What this paper adds to existing knowledge This study found that residents who required texture-modified foods were eating food textures that were more challenging to swallow than intended. Differences were found in food texture between when it left the kitchen compared with texture 30 min later. Pureed texture had greater consumption than regular textured food. Food consumption was found to be the highest during breakfast, and reduced during lunch, which might negatively impact overall nutrient intake. What are the potential or actual clinical implications of this work? Accurate food texture prescription is the first step towards increasing patients\' safety. However, food preparation and handling are also very important steps, not to be disregarded. Time-related changes in food texture are remarkable and should be considered in circumstances where patients do not consume food soon after service, as these can compromise patients\' safety.