Nutritional Aspects of Dysphagia Management.
This chapter describes the nutritional aspects of dysphagia management by starting with the definition of these two conditions (dysphagia and malnutrition) that share three main clinical characteristics: (a) their prevalence is very high, (b) they can lead to severe complications, and (c) they are frequently underrecognized and neglected conditions. From an anatomical standpoint, dysphagia can result from oropharyngeal and/or esophageal causes; from a pathophysiological perspective, dysphagia can be caused by organic or structural diseases (either benign or malignant) or diseases causing impaired physiology (mainly motility and/or perception disorders). This chapter gathers up-to-date information on the screening and diagnosis of oropharyngeal dysphagia, the consequences of dysphagia (aspiration pneumonia, malnutrition, and dehydration), and on the nutritional management of dysphagic patients. Concerning this last topic, this chapter reviews the rheological aspects of swallowing and dysphagia (including shear and elongational flows) and its influence on the characteristics of the enteral nutrition for dysphagia management (solid/semisolid foods and thickened liquids; ready-to-use oral nutritional supplements and thickening powders), with special focus on the real characteristics of the bolus after mixing with human saliva.
I&D Centre Complex Formulations and Processing Technologies, Fresenius Kabi Deutschland GmbH, Bad Homburg, Germany. Electronic address: crispulo.gallegos-montes@fresenius-kabi.com.
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Gallegos
I&D Centre Complex Formulations and Processing Technologies, Fresenius Kabi Deutschland GmbH, Bad Homburg, Germany.
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Brito-de la Fuente
Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Barcelona, Spain.
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Clavé
Dysphagia Unit, Universitat de Barcelona, Hospital de Mataró, Mataró, Barcelona, Spain.
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Costa
I&D Centre Complex Formulations and Processing Technologies, Fresenius Kabi Deutschland GmbH, Bad Homburg, Germany.
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Assegehegn
D003680:Deglutition Disorders / Q000150:complications / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D003681:Dehydration / Q000209:etiology; D006801:Humans; D044342:Malnutrition / Q000209:etiology; D009747:Nutritional Physiological Phenomena; D011015:Pneumonia, Aspiration / Q000209:etiology
Aspiration pneumonia; Dehydration; Dysphagia; Enteral nutrition; Malnutrition; Oral nutritional supplements; Resistance to salivary α-amylase; Swallowing; Thickening powders; Viscous and elongational flows