嚥下調整食の国際コンセンサス

嚥下調整食の用語や定義に関する国際コンセンサスに向けた現状の論文を紹介します。日本からは栢下淳先生が参加しています。

Julie A. Y. Cichero, et al. The Need for International Terminology and Definitions for Texture-Modified Foods and Thickened Liquids Used in Dysphagia Management: Foundations of a Global Initiative. Current Physical Medicine and Rehabilitation Reports, doi: 10.1007/s40141-013-0024-z

下記のHPで全文見ることができますので、嚥下調整食に関心のある方はぜひ読んでください。

http://link.springer.com/content/pdf/10.1007%2Fs40141-013-0024-z.pdf

嚥下調整食は国内では日本摂食・嚥下リハ学会が基準化に向けて活動していますが、国際的にはInternational Dysphagia Diet Standardisation Initiative (IDDSI)が活動しそうです。

http://www.iddsi.org/

特筆すべきは日本の嚥下調整食が最も進んでいるようであることが、本文中に明記されていることです。これは栢下先生のお力が非常に大きいと思います。以下、論文からの引用です。

The Japanese Society of Dysphagia Rehabilitation
(JSDR) appears to be the most advanced in providing
measurable specifications for both liquids and foods. The
JSDR is also in the process of converting rheological
measures for liquids expressed in mPa s to line-spread
measure values (cm) [41]. The Japanese system of identifying
texture-modified foods is very advanced, incorporating
energy content (kcal), protein (g) and measures of
hardness, adhesiveness and cohesiveness for each food
level. Measures are also differentiated on whether the food
is served cold (15 C) or warm (45 C). With extremely
texture-modified foods, Japanese clinicians also determine
whether pure´e or jelly textures are safer or easier to
swallow. The Japanese system also includes a recommendation
for 30–40 % weight/volume for barium sulfate to be
added to foods/liquids to ensure substances are radiopaque
for videofluoroscopy examination. Addition rates of locally
available thickening agents (gels, powder thickener, agar)
per 100 ml liquid barium are also available.

以上、引用です。日本の嚥下調整食の基準がそのまま国際基準になるかどうかはわかりませんが、最も進んでいる日本抜きで話が進むようではとても困るのでよかったです。最初に示した表3、表4にも日本のトロミ、嚥下食ピラミッドの基準が明記されています。

ただ、文献を見ると日本からのものは46論文中、2つしかなさそうです。他人事ではありませんが、日本での取り組みを英語できちんと発信していかなければいけないと改めて実感しました。

Abstract
 Conservative estimates suggest that dysphagia
(difficulty swallowing) affects approximately 8 % of the
world’s population. Dysphagia is associated with malnutrition,
dehydration, chest infection and potentially death.
While promising treatments are being developed to
improve function, the modification of food texture and
liquid thickness has become a cornerstone of dysphagia
management. Foods are chopped, mashed or pure´ed to
compensate for chewing difficulties or fatigue, improve
swallowing safety and avoid asphyxiation. Liquids are
typically thickened to slow their speed of transit through
the oral and pharyngeal phases of swallowing, to avoid
aspiration of material into the airway and improve transit to
the esophagus. Food texture and liquid modification for
dysphagia management occurs throughout the world.
However, the names, the number of levels of modification
and characteristics vary within and across countries. Multiple
labels increase the risk to patient safety. National
standardization of terminology and definitions has been
promoted as a means to improve patient safety and interprofessional
communication. This article documents the
need for international standardized terminology and definitions
for texture-modified foods and liquids for individuals
with dysphagia. Furthermore, it documents the
research plan and foundations of a global initiative dedicated
to this purpose.