A Statistical Approach to Food Texture Determination in Dysphagia: Insights from Videoendoscopic Evaluation of Swallowing (VEES)

(Introduction)
Although various parameters have been proposed for VEES, few statistical studies have examined their relationship with food textures. This study aimed to identify and weight the factors influencing food texture selection through multiple regression analysis (MRA) based on VEES findings and overall health status. Additionally, we evaluated the predictive accuracy of the derived formula in determining appropriate food textures for dysphagia patients.

(Subjects)
A total of 488 hospitalized patients with dysphagia (332 males, 156 females; mean age: 77 years) who underwent VEES were included.

(Methods)
Food textures were scored on a 5-point scale. The following VEES parameters were evaluated and set as independent variables: (1) saliva retention in the pyriform sinus, (2) laryngeal reflex to tactile stimulation, (3) timing of the swallowing reflex with water intake, (4) pharyngeal clearance and laryngeal penetration/aspiration with blue-dyed water, laryngeal penetration/aspiration with (5)thickened liquid and (6)jelly, (7)vallecular clearance of jelly, and (8) pyriform sinus clearance of jelly. Consciousness level and serum albumin levels were included as additional variables. Food texture served as the dependent variable, and MRA was conducted. ROC analysis was performed to determine cutoff values for oral and semi-solid food intake feasibility.

(Results)
Five factors of VEES parameters— (1), (4), (5), (6), (7) —were identified as significant determinants of food texture selection as well as consciousness level and serum albumin level through MRA (adjR² = 0.49, Hyodo score*: R² = 0.27). The predictive formula improved sensitivity and specificity for oral and semi-solid food intake compared to the Hyodo score* alone.

(Conclusion)
When determining appropriate food texture using VEES, it is essential to evaluate saliva retention in the pyriform sinus, pharyngeal clearance and laryngeal penetration/aspiration with water, laryngeal penetration/aspiration with thickened liquid and jelly, and vallecular clearance of jelly. Additionally, assessing consciousness level and general condition related to nutritional status is crucial. The predictive formula derived from MRA in this study offers a reliable tool for food texture determination in dysphagia patients.
*Hyodo M, et al. Nihon Jibiinkoka Gakkai Kaiho 2010; 113: 670-678.