Older adults are at a very high risk of dysphagia, compared to other populations. Estimates suggest that 40-60% of older adults in assisted living facilities, and 15-22% of older adults in the general population , are affected by dysphagia. The likely cause for the high risk in older adults is the impact ageing has on the swallowing process.
Dysphagia is a condition where an individual has difficulty swallowing, or moving the food and liquid from the back of the mouth to the stomach . It is generally an issue with either the throat or the oesophagus.
There are many factors that can lead to the development of dysphagia. Many dysphagia patients are older adults, babies, or people with nervous system disorders.
The most common causes are:
A healthy person’s nerves and muscles act together during the swallowing process. The person will voluntarily move the food/liquid towards the back of the mouth. Then the body will reflexively close the airway, move the food/liquid into the oesophagus, and then move it down to the stomach using the muscles of the oesophagus.
However, ageing affects nerve conduction, muscle strength and mass, which can then increase the risk of dysphagia.
Dysphagia may occur in elderly people due to structural or motor issues such as:
Older adults are at a higher risk of suffering from malnutrition due to dysphagia .
Dysphagia leads to an altered or decreased intake of food. This potentially reduces the amount of nutrition consumed, and increases the risk of malnutrition .
Malnutrition is the state of insufficient nutrients in the diet. It can be insufficient calories, macro-nutrients such as protein, or micro-nutrients such as vitamins and minerals.
To manage malnutrition in older adults with dysphagia, the food and liquid consumption needs to be optimised for their needs. This may include adding nutritional supplements; providing fortified or nutrient-dense options; and, ensuring foods and liquids are at the individual’s required level of texture-modification . By utilising one or more of these options, the risk of malnutrition can be significantly lowered and improve one’s quality of life.
It is essential to manage the condition in any patient, but older populations are of particular concern. This is where nutrition management is a key strategy to ensure the well-being of older adults.
Protein in a nutshell, is a nitrogen-containing macronutrient made up of smaller individual chemical chains known as amino acids.
Dietary protein has many vital roles and functions in the body including the growth, repair and maintenance of our cells, bone, skin and tissue, which is particularly important as we age.
Protein is delivered to us from an array of animal and plant-based forms from all food groups. Examples include egg, chicken, beef, nuts, fish, tofu, legumes (such as chickpeas or kidney beans) and some cereal-based products. Despite this, it is important to recognise that not all dietary proteins (or supplements) are created equal.
Protein quality often trumps protein quantity regarding its overall impact on our health, as the prevalence of protein deficiency among the general population in Australia is quite rare. However, if present, the main symptoms of protein deficiency are sarcopenia (muscle atrophy or wastage), oedema (excess fluid build-up such as swelling of the feet or ankles) and anaemia .
As we get older our protein requirement increases, yet consumption often declines. This can be due to a lack of appetite, loss of taste or smell, a decline in interest in food or cooking, poor dentition or reduced mobility . In such circumstances the quality of the protein and the food matrix in which it is consumed are very important considerations in the maintenance of an individual’s good health.
Protein quality can be simply defined by how well or how poorly a given protein can perform its metabolic function in the body. This is underpinned by the digestibility and quantitative supply of essential amino acids for providing proteins in the correct ratios for human consumption [3,4].
There are 20 ‘metabolically essential’ amino acids required for protein synthesis and for sustaining our body’s nitrogen equilibrium. However, only nine of these; histidine, leucine, isoleucine, lysine, methionine, phenylalanine, threonine, tryptophan and valine, need to be obtained from the diet, otherwise known as ‘indispensable’ or essential amino acids (EAAs). The other amino acids are conditionally essential (especially in times of illness or stress) or non-essential because they can be self-synthesised in the body.
However, in order to sustain protein quality integrity, all essential amino acids must be present in the diet. Complete protein sources contain all EAAs and are therefore considered ‘high quality’, whereas ‘low quality’ protein sources are incomplete proteins as they do not contain all EAAs.
Examples of high quality protein sources include:
Examples of low quality protein sources include:
Therefore, for individuals to appropriately meet both their minimum and/or additional dietary protein requirements, it is recommended to consume high quality proteins or a combination of at least two or more low/insufficient protein sources to adequately attain all EAAs through the formation of complementary proteins. The American Dietetic Association in 2003 concluded that complementary proteins do not all need to be consumed during the same meal and can be spread throughout the day to meet protein needs while also ensuring adequate nitrogen retention .
It is also worth considering the many benefits of consuming enough high-quality protein sources to meet our needs. Eating meals containing high quality protein can help increase satiety levels more than carbohydrate or fat sources; this can assist in reducing overall energy consumption and the desire to consume extra snacks. Adopting a moderately higher protein diet can also help to maintain and grow lean muscle mass and reduce body fat .
There are a range of different methods currently used to determine protein quality.
The most common is referred to as the ‘Biological Value’ (BV) protein scoring system. BV expresses the body’s nitrogen utilisation as a percentage (nitrogen retention for tissue formation is divided by the nitrogen absorption from food).
The Protein Digestibility Corrected Amino Acid Score (PDCAAS) is an internationally standardised system which assesses protein quality via combining estimates of protein digestibility with an age-related amino acid profile pattern, also factoring in bodily protein excretion [6,7].
DIAAS, or the Digestible Indispensable Amino Acid Score, DIAAS uses a mathematic equation to calculate the “individual indispensable amino acids in the dietary protein relative to human reference amino acid requirement pattern” . Dietary proteins are ranked according their score, to indicate dietary protein quality. This is beneficial when looking for foods with higher scores to complement less nutritious proteins.
Acquiring a deeper understanding of the importance of both protein and protein quality can lead to better food choices to support our physiological health and general wellbeing.
Age-related muscle loss is one of greatest health issues for older adults. Up to a third of people over 50 experience sarcopenia – the age-related loss of muscle mass and strength. This can lead to many other health complications. However, it can also be prevented and managed with just a few simple interventions.
Sufficient muscle mass is essential for health and wellbeing at any age. One of the key roles of muscle is utilisation of carbohydrates for energy production. More muscle mass means more is used for energy, instead of being stored as fat.
Muscle mass can protect against conditions such as diabetes, cardiovascular disease, premature ageing and poor cognitive function. Unfortunately, many older adults experience sarcopenia, which increases the risk of illness and injury.
When people are inactive for any reason, muscle can waste away. This is known as muscle atrophy or muscle loss.
One of the most common causes of muscle loss is ageing. There are multiple factors that cause age-related muscle loss. It’s believed that a reduction of testosterone and growth hormone combined with an increase in pro-inflammatory cytokines play a big role (1).
There are other causes of muscle loss aside from ageing. Significant injuries, malnutrition, stroke, long-term steroid use and general inactivity can all lead to atrophied muscles. Conditions that restrict movement can also contribute.
Unfortunately, muscle loss can have a significant impact on health and wellbeing.
Muscle loss can negatively impact on health in a number of ways. By losing muscle mass, people are likely to gain body fat instead. This is due to the reduced carbohydrate usage by the muscles, leading to more energy being stored as fat.
People may also experience stiffer joints with muscle loss. This will make it harder for them to move around, which contributes further to muscle loss and fat gain.
This may lead to other health conditions and complications, including cardiovascular disease, diabetes and arthritis. Many of these can become serious or even fatal if left untreated. It is essential to intervene in the early stages of muscle loss, to slow or even reverse the process.
It’s possible to halt and even reverse muscle loss through simple interventions. By using the right nutrition and exercise, muscles can grow and regain strength.
One of the most important interventions is to consume sufficient protein to meet dietary needs. Research suggests that eating similar quantities at each meal is more effective than a large intake in one meal (2).
Keeping physically active is essential for maintaining muscle mass. Even small, regular movement can help in those with limited movement. Research has demonstrated that even 15 minutes of cardiovascular exercise can stimulate muscle growth (3).
Ideally, resistance exercise is included so that muscle strength can be restored. One study demonstrated that just 3 resistance-training sessions per week for 12 weeks could increase muscle strength (4).
These interventions are inexpensive but highly effective in preventing and reversing age-related muscle loss.
Sarcopenia and muscle loss can cause many health issues. However, simple interventions such as nutrition and exercise provide a safe, easy and effective way to prevent and reverse muscle loss.
Posted by ProPortion Foods Blog on Sep 11, 2017 in 3D Food
Technology has helped to address many health-related challenges. Now a new technology, 3D printing, is being used to print foods. These foods can make eating much easier and more nutritious for those with swallowing disorders. In fact, 3D printed food may be the future of personalised nutrition.
It might sound like science fiction but 3D foods are created using a 3D model file from a computer. This file is then used to create thinly sliced layers that make up an object – in this case, food.
It allows food to be prepared in an automated manner. The most common food printer is a deposition printer, where layers made of raw materials are deposited. Any ingredient that can pass through a hollow needle can be used in 3D food.
This new technology shows promise when it comes to health and personalised nutrition.
3D foods have great potential to be used as therapeutic foods in healthcare, particularly for those with dysphagia.
Dysphagia is a medical term used to describe difficulty swallowing. It affects up to 8% of the world’s population (1). For those affected, consuming food can be stressful and even dangerous but 3D foods make it easier and safer by creating appropriate textures.
There are also potential benefits for those who are malnourished. 3D foods can often retain more nutrition than traditional pureed food, and can be fortified with additional nutrients, such as vitamins and minerals. This allows people with poor appetite to consume more nutrition, supporting their recovery and wellbeing.
One of the most exciting benefits of 3D food is the appearance and resulting impact on consumption. People with dysphagia often have poor appetite, as soft textured food has an unappealing appearance.
But 3D food technology has made soft textured food far more appealing. This can lead to improved compliance and consumption of food. With more nutrition consumed, people with dysphagia can reduce their risk of malnutrition and problematic weight loss.
It might seem like 3D food would be a limited menu. But here are just some of the foods that a 3D printer can create:
These delicious foods are far more appealing than conventional soft foods that those with dysphagia are typically offered. They also retain more nutrients and flavour.
Printed food is only in its infancy right now. It’s predicted that in the future, 3D food printing will be done at home.
The first at-home 3D food to be created may be chocolate. A Dutch company has designed an industrial 3D food printer that can print chocolate. They expect to follow this with a household appliance in the near future.
If this trend continues, one day, every household may have a 3D food printer. This has the potential to improve the nutritional status of anyone with deficiencies.
In the future, 3D food may be the key to personalising nutrition for those with health conditions. The possibilities for using 3D food to optimise well-being and nutrition are endless.
Cichero, Julie AY, et al. “Development of international terminology and definitions for texture-modified foods and thickened fluids used in dysphagia management: The IDDSI Framework.” Dysphagia 32.2 (2017): 293-314.