Objective: Texture-modified diets (TMDs) must comply with standardized texture classifications and ensure adequate nutrient content. However, the current practices and challenges in preparing TMDs in hospitals remain unclear. This study was conducted to investigate these issues.

　Methods: From April to June 2023, a web-based survey was sent to nutrition management departments across Japan. One representative from each consenting hospital responded. Responses were simply tallied, and outliers were excluded; the survey system was constructed, implemented, and tabulated by an independent third party, complying with the Personal Information Protection Act.

　Results: Responses were received from 905 hospitals (response rate 16.8%). TMDs were provided in 857 hospitals. Among these, 229/827 hospitals reported challenges in preparing TMDs, citing ‘cooks’skills’, ‘understanding of TMDs’, and ‘increased cooking time’ as main barriers. As a cooking indicator, 762/857 hospitals used the Japanese Dysphagia Diet of 2013 or 2021 by The Japanese Society of Dysphagia Rehabilitation (JDD Classification). Quality control for TMDs was predominantly ‘visual inspection before serving’ (707/857 hospitals). The median cost per meal was ¥764 for regular meals (inter-quartile range (IQR) 650–873) and ¥840 for TMDs (IQR: 700–1,000). Hospitals utilizing commercial products for TMDs numbered 599/857, with the primary reasons being ‘reduction in cooking time’ (502/599 hospitals), ‘consistent physical properties’ (433/857 hospitals), and ‘reduction in staffing costs’ (298/599 hospitals). The median nutritional value for TMDs ranged from 600–1,400 kcal and 20–60 g of protein per day, particularly low in code 1. The most common method to supplement insufficient nutrients was the use of oral nutritional supplements (672/741 hospitals). Test foods for videofluoroscopic swallowing study were provided by 456/857 hospitals, with costs often covered by the nutrition management department (311/456 hospitals).

　Conclusion: The results of this survey suggest that providing safe and nutritionally valuable meals requires enhanced knowledge and cooking skills for dysphagia diets, standardization of quality control methods, and appropriate reflection in medical fees.

　People who suffer from dysphagia (inability or refusal to swallow) sometimes use food thickeners to ease taking medicines. Upon immersion, food thickeners attach to the tablet surface and penetrate them. In doing so, the food thickeners sometimes cause disintegration delay or non-disintegration, which reduces the drug efficacy. Although xanthan- and guar-gum are often used as food thickeners, the effect of these thickeners on tablet disintegration is poorly understood. In this study, we compared the effects of xanthan- and guar-gum-based food thickeners on the disintegration of nine rapid disintegrating oral tablets. Of these, the disintegration time of two tablets differed between the two different food thickeners, with one tablet showing a longer time in the guar-gum-based thickener and the other showing a longer time in the xanthan-gum based thickener; however, the disintegration time of the remaining seven tablets was similar in both food thickeners. In conclusion, the results suggest that tablet disintegration delay may be related to both the food thickener type and tablet properties.

　The oral cavity, nasal cavity, and pharynx play important roles for resonance during speech production. When the soft palate, which coordinates the presence or absence of nasal resonance, does not function adequately, clear production of speech sounds becomes difficult. The movement of the soft palate is an important element in speech production, but its relation with the tongue position is not fully understood. Therefore, in this study, we investigated how the position of the tongue affects the function of the soft palate while maintaining the mandibular position constant, by measuring the association between nasal resonance and actual nasal emission of air during vowel phonation. Data obtained from 13 young healthy adult females (21.7±0.9 years old) were analyzed. The subjects were asked to vocalize the vowel /a/ three times under two conditions: maximum mouth-opening only (open-mouth condition), and maximum mouth-opening plus maximum tongue protrusion (open-tongue condition). Four measures (i.e., mean, min, max, and start) of the nasal cavity resonance rates as a percentage (the nasalance score, or N-score), were determined using the Nasometer II 6450. The results showed that nasal resonance was significantly greater in the open-tongue condition than in the open-mouth condition for the start value (r＝0.562, p＜0.05), but no significant differences were found for the other conditions. Regarding the correlation between nasal emission and nasal resonance rate, significant correlations were found for mean and max in the open-mouth condition, but no significant correlations were found in the other conditions. It was suggested that the nasal resonance rate was affected when the tongue position was changed while the mandible position was kept constant.

　Purpose: This study aimed to clarify the relationships of tongue pressure and masticatory performance with nutrient intake in Parkinson's disease patients.

　Subjects and Methods: The subjects were 10 Parkinson's disease patients (“PD group”) and 24 without PD (“control group”) in their 70s and 80s. A diet survey, tongue pressure measurements and masticatory performance measurements were conducted for both groups. The masticatory performance score method was used for the measurements.

　Results: The median age of the subjects was 72.5 years old in both groups. In the PD group, the Hoehn and Yahr stage was Yahr 1–3, and none of them had changed their diet. The median tongue pressure was 33.8 kPa in the PD group and 36.5 kPa in the control group, and the median masticatory performance score was 2 and 6 in the former and latter. respectively. The masticatory performance was significantly lower in the PD group than in the control group (p＝.046). No significant difference in nutrient intake was observed between the two groups. In the PD group, patients with a lower tongue pressure had a significantly higher intake of polyunsaturated fatty acid (r_s＝－.745, p ＝ .013) and those with a lower masticatory performance had a significantly higher intake of soluble dietary fiber (r_s＝－.790, p＝.006). In the control group, the tongue pressure and masticatory performance showed no significant relationship with nutrient intake.

　Discussion and Conclusion: In the PD group, patients with a lower tongue pressure and masticatory performance had a significantly higher intake of polyunsaturated fatty acid and soluble dietary fiber. The results are inconsistent with the tendency of elderly people in general, in which those with a lower tongue pressure and masticatory performance showed less nutrient intake. Polyunsaturated fatty acid and soluble dietary fiber are contained in large amounts in vegetables and seafood products, some of which require a high masticatory performance; however, none of the subjects with decreased tongue pressure and masticatory performance had changed their diet. This suggests there is a possibility that even Parkinson's disease patients with decreased tongue pressure and masticatory performance might eat food that requires mastication. Thus, it is considered that oral function and diet should be assessed from an early stage of Parkinson's disease.

　To extract issues of the Japanese Dysphagia Diet 2018 (JDD2018), which classifies texture modified diets for persons acquiring dysphagia in the developmental period, the status of utilization of the classification was surveyed. The scope of the questionnaire survey was 136 facilities and 75 national hospitals with wards for persons with severe motor and intellectual disabilities. The valid response rate was 34.6%. Few facilities were using the classification for meal services, nutrition and dietary counseling, or informationsharing with other facilities; even for meal services, which was the most utilized system, only 38.4% of the facilities were using it. More than half of the facilities that did not use this classification in their meal services used the Japanese Dysphagia Diet 2021 for midlife disorders (JDD2021). Although JDD2021 was indicated as the reason for not using the JDD2018 classification, it could not be clarified whether this was the result of a close examination of both classifications. It is possible that they did not actively consider introducing the JDD2018 classification. In order to encourage the use of this classification, it is important to reiterate the target and objectives, and promote its usefulness based on practical examples. In addition, it was also suggested that anxiety about the finished product, selection, cooking methods, etc. was a disincentive to introducing the system, and it was considered necessary to improve supplementary materials and training programs. Even if the system was used in meal services, few facilities used it for dietary and nutritional counseling and information-sharing with other facilities. It was inferred that there were few opportunities to share information because of the small number of transfers of food service recipients between facilities. Many of the nutritional challenges faced by meal recipients were inadequate energy, protein, and water intake due to insufficient oral intake and limited food intake, weight loss, and undernutrition. There was no difference in nutritional problems depending on usage of this classification, indicating that supplemental nutrition should be considered in conjunction with a texture modified diet for this category of patients.

　Introduction: A patient who developed aspiration pneumonia and fasted during hospitalization for COVID-19 infection underwent a videofluoroscopic examination (VF) of swallowing. VF showed that cervical vertebral body osteophytes had caused inversion of the epiglottis and obstruction of the passage of food mass through the fossa pellucida. In addition, when the patient was evaluated by videoendoscopic examination (VE) of swallowing, VE was achieved by postural adjustment and compensatory swallowing.

　Case: A man in his early 80s who had difficulty swallowing solid foods since before his illness was admitted to our hospital with COVID-19 and his condition stabilized with medication, but he developed aspiration pneumonia. He was admitted to our hospital for rehabilitation.

　Progress: Initially, the patient was fasting and VF was performed. At that time, cervical vertebral osteophytes (around C4–6) were observed, which inhibited inversion of the glottis, and the passage of the food mass through the pisiform fossa was also poor. We did not perform surgery, but started step-by-step feeding training. We also examined compensatory swallowing methods under VE, and were able to reduce the residual volume by performing an anterior tilt and chin down movement. Alternate swallowing of water without thickening was also used to safely reduce residual volume. Residuals could be self-sucked out. By combining anterior tilt, chin down, alternate swallowing with unthickened water, and self-extubation after swallowing, the patient was able to eat three normal meals orally and was discharged home.

　Introduction: In Japan, the incidence of sarcopenia is increasing because of the aging of dialysis patients. Although sarcopenia is related to dysphagia, there is no established evidence for treating sarcopenic dysphagia. Here, we report a case of possible sarcopenic dysphagia in an elderly dialysis patient with repeated aspiration pneumonia who achieved good results after repetitive peripheral magnetic stimulation (rPMS) of the suprahyoid muscle group.

　Case: The patient was an 87-year-old man who had started dialysis at the age of 81 due to chronic kidney disease resulting from chronic glomerulonephritis. The patient had been admitted to other hospitals multiple times due to aspiration pneumonia. While he was referred to our hospital for outpatient dialysis, his swallowing function assessment revealed that he aspirated with thin liquids but not with adjusted food. At the outpatient department, his tongue pressure was 21.1 kPa, cervical flexor strength was 8.1 N, and jaw-opening force was 53.6 N. He developed fever and cough 2 weeks after starting dialysis at our hospital and was admitted to our hospital because of a recurrence of aspiration pneumonia. His pneumonia improved with antibiotic treatment. The results of his skeletal muscle index, grip strength, and walking speed measurements indicated severe sarcopenia. During admission, a videofluoroscopic examination (VF) revealed poor laryngeal elevation, laryngeal invasion, and pharynx retention. Therefore, it was considered that he may have had sarcopenic dysphagia. Training, such as Shaker exercise, with sufficient frequency and intensity was difficult to implement; thus, we performed rPMS for 4 days a week for 8 weeks to increase the strength of the suprahyoid muscles. There were no adverse events due to rPMS, and the treatment could be performed as scheduled without pain. After 8 weeks of rehabilitation, muscle strength measurements revealed tongue pressure of 29.4 kPa, cervical flexor strength of 16.4 N, and jawopening force of 61.7 N. VF showed an increase in the bolus passing through the esophageal entrance, a reduced amount of bolus remaining in the pharynx, and an extended distance traveled by the hyoid bone.

　Discussion: rPMS performed on an elderly dialysis patient with possible sarcopenic dysphagia led to an increase in the strength of the suprahyoid muscles. Moreover, rPMS of the suprahyoid muscles is less painful, can be performed in a short time, and could be considered an effective training method for strengthening the suprahyoid muscles in elderly patients on dialysis.

　Swallowing function evaluation, swallowing guidance, swallowing training, and dietary guidance were continuously provided to two elderly patients with swallowing function decline through regular outpatient visits. Swallowing function was evaluated by measuring the Hyodo score through swallowing endoscopy. Swallowing guidance included postural adjustment and pacing during swallowing. For swallowing training, the subjects were instructed to perform laryngeal elevation training and respiratory function training before each meal. The training consisted of swallowing and forehead exercises, chin lifting exercises, and blowback exercises, 10 times each before each meal, 3 sets per day. Case 1 is a 79-year-old male. The patient’s Hyodo score at the initial examination was 8 points, and diffuse aspiration bronchitis was suspected. After 6 years of swallowing guidance and training, the Hyodo score improved to 5 points. Case 2 is a man in his late 70s. The patient’s Hyodo score at the initial examination was 6 points, and diffuse aspiration bronchitis was suspected. After 6 years of swallowing guidance and training, the Hyodo score improved to 5 points. Case 2 is a man in his late 70s. The patient’s Hyodo score at the initial examination was 6 points, and diffuse aspiration bronchitis was suspected. After 2 years of swallowing guidance and training, the Hyodo score improved to 4 points. Both cases underwent regular outpatient visits for swallowing function evaluation, swallowing guidance, and reconfirmation of home swallowing self-training. As a result, swallowing function improved in both cases, and hospitalization for aspiration pneumonia was avoided..