2020 Volume 24 Issue 2 Pages 130-142
Objective: Since the publication of the Japanese Dysphagia Diet 2013 (JDD2013), standardization of the dysphagia diet criteria has been progressing in Japan. Because texture-modified diets are described not with physical property values but with words, their interpretation differs among people, especially for Codes 3 and 4 of JDD2013. Further development of JDD2013 depends on the establishment of a physical method of measuring dysphagia diets with multiple ingredients. In this study, the hardness of dysphagia diets prepared based on Code 4 of JDD2013 was measured, and the reference value of the hardness of Code 4 was determined.
Methods: Samples consisted of 199 ingredients from the soft diet (not eligible for JDD2013) and 156 ingredients from the dysphagia diet (eligible for Code 4 in JDD2013). Both diets were lunches served in a nursing home in Kyoto City for 27 days. A speech-hearing therapist, registered dietitian, and licensed cook at the nursing home considered if the dysphagia diets were appropriate for JDD2013. The mastication ability of most individuals who consumed the dysphagia diet (Code 4) had been declining. One ingredient was placed on the stage using a creepmeter (RE2-3305C, Yamaden Co., Ltd.) and a 5-mm-diameter cylindrical plunger was plunged into the sample. Samples were kept at 20±2℃using a 20-N load cell, and the plunging rate was 1 mm/s. Hardness was calculated from the highest point among the distortion factor of 0–90%. Each measurement was repeated five times, and the average was calculated.
Results: Of 156 ingredients in dysphagia diets (Code 4), the hardness of 150 was lower than 200 kPa. Of 199 ingredients of soft diets, 81 had a hardness of ≥ 200 kPa. The difference between the dysphagia diets (Code 4) and the soft diets was evaluated by the measurement method of this study. Ingredients from the commercial Universal Design Food (crushed with gums) were measured for comparison. Though the hardness of carrot and potato was less than 200 kPa, mushroom and meat had a hardness of ≥ 200 kPa.
Conclusions: This measurement method could be a new evaluation method of Code 4 of JDD2013.
