Our ability to eat can be affected by old age, as well as by certain pathologies such as dysphagia. This swallowing disorder, which can affect the whole population, mainly concerns the elderly (notably, 30 to 70% of elderly people in French residential care homes: EPHADs[1]) and people with disabilities. To meet the needs of these individuals, it is necessary to adapt their diet to their pathologies. This involves adjusting portions, flavors and foods, as well as using appropriate textures.

Dysphagia: from causes to consequences

Dysphagia is a swallowing disorder characterized by the difficulty or impossibility of swallowing food and drink. It has a variety of causes and can have serious consequences if left unchecked and untreated.

A disorder with diverse origins [1]

Dysphagia can be a consequence of aging, resulting from the loss of muscular and cerebral capacity for swallowing.

However, it can also be the consequence of a pathology. There are three types of pathology associated with dysphagia: neurological disorders (e.g., Parkinson’s disease, acute stroke), ENT disorders (such as ENT inflammations and cancer), and muscular disorders (dystrophy i.e., degeneration of an organ).

A disease with physical and psychological consequences [2]

The consequences of dysphagia are numerous and are exacerbated by the consumption of unsuitable food. They are both physical and psychosocial.

Firstly, reduced swallowing capacity leads to discomfort and even pain when eating. In fact, food that can no longer be reduced to a homogeneous food bolus (in order to circulate smoothly from the mouth to the stomach via the esophagus), risks passing into the respiratory tract. This is known as a “false route” and can subsequently lead to pain, coughing, infection and even suffocation. This can also lead to mealtimes becoming less enjoyable for the individual affected, coupled with anxiety about what is normally a trivial, even pleasurable, part of everyday life. As a result, some people suffering from dysphagia eat less, leading to social isolation, loss of autonomy and weight loss.

In the most severe cases, there is an increased risk of complications such as asphyxia, pneumonia, dehydration and undernutrition. In fact, people with dysphagia are 4.8 times more likely to suffer from undernutrition[3] than those without the condition. What’s more, this discrepancy between nutrient intake and the body’s needs can lead to other pathologies such as osteoporosis or sarcopenia. The latter can also be a cause of dysphagia, since loss of muscle mass in the oral area can induce or aggravate a swallowing disorder.

What solutions are there for dysphagia sufferers ?

To avoid the symptoms mentioned above, it is necessary to improve conditions during meals. This requires the establishment of a good environment and eating practices adapted to dysphagia sufferers.

The main lever for action is food. Dysphagic people need to be offered adapted dishes, for example by choosing textures compatible with their swallowing abilities.

There are other important levers to consider. Indeed, given the diversity of consequences, the environmental parameters surrounding the dysphagic person come into play. These include good oral hygiene, adapting one’s posture at the table, eating in a pleasant, calm environment, and adapting the portions and timing of meals (small quantities taken over long periods of time are preferable, so that the person suffering from dysphagia has sufficient time to eat).

Adapted textures to meet the needs of people with dysphagia

According to one study, among the elderly population, 50% of dysphagic people consume modified textures, compared with 30% of non-dysphagic individuals. The aim is therefore to detect cases of dysphagia as early as possible, in order to develop access to adapted textures for those who need them. On the other hand, if the use of modified textures is not justified, it is recommended to continue with a conventional diet for as long as possible, so as not to weaken chewing abilities.[4]

Adapting this diet involves adapting the foods chosen as well as their textures, which must be compatible with the person’s ability to chew and swallow. Fibrous, small and dry foods should be avoided. To facilitate swallowing, it is possible to ensure the cohesion and lubrication/gelling of dishes, by adding food additives or certain ingredients.

In addition, the International Dysphagia Diet Standardization Initiative (IDDSI) can be used as a reference for adapting textures. This classification defines a universal terminology for modified textures used in the treatment of dysphagia sufferers. It consists of 8 levels of modified textures, ranging from liquids to “normal” foods.

Textures adapted for people with dysphagia have several positive impacts. Firstly, the homogeneity of the texture and the appearance of the dish are two parameters that promote meal acceptance.[4] Adapted textures should be used, without offering only blended foods, so that consumers can visually identify what they are eating. In addition, maintaining a certain degree of texture preserves and stimulates the senses, and thus promotes longer autonomy. The palatability of the product is also important in order to preserve eating pleasure.

Secondly, adapted textures help to address undernutrition. On the one hand, by maintaining eating pleasure, they help to keep dysphagic people interested in food. Secondly, dishes with adapted textures can be enriched with products that are naturally rich in nutrients, or with essential ingredients/nutrients.

The use of dairy products in adapted textures

To address undernutrition in dysphagic people, dairy ingredients are often used first and foremost to naturally enrich dishes. However, they also possess highly versatile properties that can be exploited in adapted textures.

Firstly, dairy proteins have emulsifying and texturizing properties. For example, micellar caseins retain a fluid texture during heat treatment and can coagulate under the effect of acidification. At Lactalis Ingredients, for instance, we offer Pronativ® – Native Micellar Casein, ideal for the formulation of low-viscosity, high-protein-density oral nutritional supplements (ONS), and Pronativ^® – Native Whey Protein. The latter can be used at acidic pH, enabling it to be incorporated into new ONS formats such as clear fruit drinks or hyper-protein gels. In addition to ONS, these two proteins can be added to a wide range of products with textures adapted to the elderly, such as cream desserts, to improve their smoothness, for example. Pronativ^® Native Serum Protein also possesses foaming properties that improve the texture, creaminess and organoleptic quality of the final product. To find out more about the challenges of texture in formulation, click here.

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Sources:

[1] C. Capet, O. Delaunay, F. Idrissi, I. Landrin, N. Kadri, Troubles de la déglutition de la personne âgée : bien connaître les facteurs de risque pour une prise en charge précoce, NPG Neurologie – Psychiatrie – Gériatrie,Volume 7, Issue 40,2007,Pages 15-23, ISSN 1627-4830)
[2] K.Vach, Sarcopenic Dysphagia, Malnutrition, and Oral Frailty in Elderly: A Comprehensive Review, 2022
[3] SALEEDAENG, P. KORWANICH, N. MUANGPAISAN, W. « et col. » Effect of dysphagia on the older adults’ nutritional status and meal pattern. Journal of Primary Care & Community Health, 2023, 14, doi: 10.1177/21501319231158280
[4] G.Merino, Dishes adapted to dysphagia : sensory characteristics and their relationship to hedonic acceptance, 2021