Dysphagia-a swallowing disorder involving the oral cavity, pharynx and esophagus, or gastro-oesophageal junction-is a source of malnutrition risks in vulnerable segments of the population.
Its significant prevalence, and additional risks (ex. ab ingestis pneumonia, chronic lung disease, choking) with impact on overall health deserve further study.
1) Dysphagia, causes and symptoms
The causes oforopharyngeal dysphagia (OD) are numerous. Neurological diseases (stroke, Parkinson’s, Alzheimer’s, dementia, multiple sclerosis, ALS), muscular dystrophy, tumors and surgery, spinal cord injury, chronic obstructive pulmonary disease, etc. Swallowing disorders also recur in aging and increase with age. (1)
Symptoms in turn range from painful swallowing (odinophagia), the sensation of food stuck in the throat or chest or behind the chest, salivation (reduced or overabundant), reflux, frequent heartburn, reflux of acid or food down the throat, weight loss, coughing or nausea during swallowing, and contraction of food. To the point of being unable to eat certain foods and/or swallow.
2) Prevalence and management of dysphagia
The prevalence of dysphagia is high and increasing. IDDSI(International Dysphagia Diet Standardization) reports a generic-inevitably rough estimate of 590 million people, or about 8 percent of the global population.
The most recent meta-analyses (Rivelsrud et al., 2023) report 36.55 percent of patients in hospitals, 42.5 percent in rehabilitation centers, and 50.2 percent in nursing homes and sheltered housing. (2)
Intervention strategies for dysphagia include swallowing exercises and swallowing compensation, with the help of speech therapists, as well as patient and caregiver education. And the change in the consistency of the bolus, that is, solid and liquid foods. (3)
3) Risks of malnutrition, diet for dysphagia.
The risks of malnutrition and dehydration associated with dysphagia can rapidly compromise the health status of vulnerable populations. Also because swallowing disorders can result in reduced pleasure and disinterest, embarrassment, and/or isolation in relation to eating or drinking. Periodic monitoring and early diagnosis are therefore essential, particularly among the elderly, the fastest-growing segment of the population in the Old World. (4)
The recommended diet for dysphagia is based on moist, soft foods that are easy to chew and move around in the mouth. So as to reduce the risk of food and fluids ending up in the respiratory tract (trachea) instead of the digestive system, through the esophagus. It therefore refers to a ‘mechanical soft diet’(Dysphagia Mechanical Soft Diet), which must include the broadest group of foods to provide all the necessary nutrients. And that is why homogenized foods formulated for infants are often used, even for adults.
4) Food for people with dysphagia, rules and standards
Dysphagia foods , depending on the case, may fall under reg. EU 609/2013(Food for Specific Groups, FSG) and in Commission Delegated Regulation EU 2016/128(food for special medical purposes), which defines general composition and labeling requirements for food for special medical purposes.
The scientific committee of IDDSI(International Dysphagia Diet Standardization) met in 2013 with the goal of developing terminology and related international standards for diets and products for people with dysphagia in all age groups, in varied cultural and care settings. The standards define:
- 8 consistency levels of the foods in question, from 0 to 4 for beverages and 3 to 7 for solid foods,
- the useful concepts to easily transfer essential news to patients, caregivers and health care providers.
5) Interim Conclusions
Swallowing difficulties and their associated risks are a widespread social problem that is often underestimated outside of hospital, rehabilitation and inpatient settings. It is important to consider the characteristics of various foods and beverages to ensure adequate and balanced nutrition.
Research and innovation must come today focused on the organoleptic as well as nutritional properties of these foods. To return patients with dysphasia to the pleasure of foods and prevent the risks of their rejection, also taking into account cultural and gastronomic traditions that cannot be exhausted in homogenized foods and ‘baby food’.
Dario Dongo
Notes
(1) Samy A. Azer, Ashok Kumar Kanugula, Ravi K. Kshirsagar. (2023). Dysphagy. https://www.ncbi.nlm.nih.gov/books/NBK559174/#_NBK559174_pubdet_ StatPearls Publishing. Treasure Island (FL)
See also Marta Strinati. Nutrition of the elderly to prevent and cure. GIFT (Great Italian Food Trade). 2.4.22
(2) Rivelsrud, M.C., Hartelius, L., Bergström, L. et al. Prevalence of Oropharyngeal Dysphagia in Adults in Different Healthcare Settings: A Systematic Review and Meta-analyses. Dysphagia 38, 76-121 (2023). https://doi.org/10.1007/s00455-022-10465-x
(3) Magda Rizzardi. Managing dysphagia at home, for family members and caregivers. https://www.asl4.liguria.it/wp-content/uploads/2019/09/disfagia.pdf ASL 4 Liguria
(4) See footnote 1 in Paola Palestini, Dario Dongo. Coronavirus and infections, how to strengthen the defenses of the over-65s with a good diet. GIFT (Great Italian Food Trade). 15.3.20
Dario Dongo, lawyer and journalist, PhD in international food law, founder of WIISE (FARE - GIFT - Food Times) and Égalité.
