Dysphagia – a swallowing disorder involving the oral cavity, pharynx and oesophagus, i.e. the gastroesophageal junction – is a source of malnutrition risks in vulnerable sections of the population.
Its significant prevalence, and additional risks (e.g. pneumonia ab ingestis, chronic lung disease, suffocation) with impact on general health deserve further study.
1) Dysphagia, causes and symptoms
The causes of oropharyngeal dysphagia (oropharyngeal dysphagia, OD) are numerous. Neurological diseases (stroke, Parkinson's, Alzheimer's, dementia, multiple sclerosis, ALS), muscular dystrophy, tumors and surgeries, spinal cord injuries, chronic obstructive pulmonary disease, etc. Swallowing disorders also occur in aging and increase with age. (1)
Symptoms These vary from painful swallowing (odynophagia), the sensation of food stuck in the throat or in the chest or behind the chest, salivation (reduced or profuse), reflux, frequent heartburn, reflux of acid or food in the throat, loss of weight, cough or nausea when swallowing and contracting food. Up to the inability to eat certain foods and/or to swallow.
2) Prevalence and management of dysphagia
The prevalence of dysphagia is high and growing. IDDSI (International Dysphagia Diet Standardization) reports a generic estimate – inevitably approximate – of 590 million people, equal to about 8% of the global population.
The meta-analyses more recent (Rivelsrud et al., 2023) refer to 36,55% of patients in hospitals, 42,5% in rehabilitation centers, 50,2% in nursing homes and protected residences. (2)
intervention strategies for dysphagia include swallowing and swallowing compensation exercises, with the help of speech therapists, as well as the education of patients and caregiver. And the modification of the consistency of the bolus, i.e. of solid and liquid foods. (3)
3) Risks of malnutrition, diet for dysphagia
The risks of malnutrition and dehydration associated with dysphagia can quickly compromise the health conditions of vulnerable population groups. Also because swallowing disorders can cause decreased pleasure and disinterest, embarrassment and / or isolation in relation to eating or drinking. Periodic monitoring and early diagnosis are therefore essential, especially among the elderly, the fastest growing segment of the population in the Old Continent. (4)
The diet Recommended for dysphagia is moist, soft foods that are easy to chew and move around in the mouth. So as to reduce the risk that food and liquids end up in the respiratory tract (trachea) rather than in the digestive system, through the esophagus. It therefore refers to a 'soft mechanical diet' (Dysphagia Mechanical Soft Diet), which must include the largest group of foods to provide all necessary nutrients. And it is for this reason that homogenized foods formulated for infants are often used, even for adults.
4) Foods for people with dysphagia, rules and standards
Foods for dysphagia, depending on the case, they can fall under the discipline of reg. EU 609/2013 (Food for specific groups, FSG) and in Commission Delegated Regulation EU 2016/128 (food for special medical purposes), which defines the general requirements for the composition and labeling of foods intended for special medical purposes.
The scientific commission by IDDSI (International Dysphagia Diet Standardization) met in 2013 with the aim of developing terminology and related international standards for diets and products intended for people with dysphagia in all age groups, in various cultural and care contexts. The standards define:
- 8 levels of consistency of the foods in question, from 0 to 4 for drinks and from 3 to 7 for solid foods,
- concepts useful for easily transferring essential information to patients, i caregiver and healthcare professionals.
5) Provisional conclusions
Swallowing difficulties and the associated risks represent a widespread social problem, often underestimated outside the hospital, rehabilitation and shelter contexts. It is important to consider the characteristics of various foods and beverages to ensure adequate and balanced nutrition.
Research and innovation today must be focused on the organoleptic, as well as nutritional, properties of these foods. To restore the pleasure of foods to patients with dysphasia and prevent the risks of refusing them, also taking into account the cultural and gastronomic traditions that cannot be exhausted in homogenized and 'push'.
(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 for the elderly to prevent and cure. GIFT (Great Italian Food Trade). 2.4.22
(2) Rivelsrud, MC, 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 note 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