臺灣博碩士論文加值系統

咀嚼與吞嚥困難的發生可能肇因於神經性疾病、自身免疫失調、腫瘤、粘膜病變與老化等，是由於唾液腺和牙列參與咀嚼與食團形成，而顱神經和脊神經共同調節咀嚼與吞嚥相關之肌肉。咀嚼與吞嚥功能失調限制對食物選擇，造成營養素攝取不足、營養不良。為此，國際吞嚥困難飲食標準啟動計畫 (International Dysphagia Diet Standard Initiative, IDDSI) 將各國不同吞嚥困難飲食規格標準化，提供備餐分級依據。本研究評估國內六大類市售食品依IDDSI分級之現況，以瞭解市售食品之高齡友善程度。結果顯示多數市售食品質地偏硬、不均質或質地等級差異度高，可能使咀嚼與吞嚥困難者無法咀嚼至適合吞嚥大小或容易嗆咳。若使食品主體與配料之質地一致化，將更利於質地分級、消費者與照顧端之食品選擇。本研究亦參照IDDSI標準，規劃適合台灣飲食之質地調整菜單與備餐流程，以符合國人膳食營養素參考攝取量(DRIs)為基礎。餐次內容包含早、午、晚餐及點心，內容有主食、主菜、副菜與湯品，以IDDSI第5、6級為目標，透過IDDSI針筒、叉子與湯匙之檢測方式評估質地。結果發現製備餐食的過程中，蔬菜、粥、魚、肉類使用相同前處理後，切成不同尺寸或提高烹調壓力可達成分級標準；米飯類則須透過浸泡時間與米水比例調整製成。發展餐食製備程序及統一分級規格可方便團體膳食業者與照顧者製備餐食，利用統一分級方法檢測，有助未來產品與國際接軌。

Dysphagia could result from neuronal abnormalities, autoimmune disorders, neoplastic, mucosal lesions, aging and so on. Due to the salivary gland secretions and dentition are involved in mastication and formation of bolus and the muscles involved in swallowing are regulated by cranial and spinal nerves. As a result, a multi-professional expert panel meeting had launched the International Dysphagia Diet Standard Initiative (IDDSI) in order to unify the standard of food texture around the world in regard of dysphagia. The main purpose of this study was to evaluate the texture of commercial food products based on IDDSI standard. The results showed that most commercial foods products were harder in texture, heterogenous in ingredient contents which might cause swallowing difficultly or choking for individuals with dysphagia. The homogenization of texture for ingredients within foods and food products were suggested to food industry in order to produce food products friendly for dysphagic consumers and caregivers. The second purpose of this study was to establish standardized procedures for meals preparation based on IDDSI standards, the meals included breakfast, lunch, dinner and snacks with nutrient contents fulfilled Dietary Reference Intakes (DRIs) requirement, and with texture targeted at IDDSI levels 5 and 6 evaluated by fork pressure test and spoon tilt test. During preparation, criteria could be met by cutting into different sizes or adjusting cooking pressure for vegetables, porridge, fish, and meat. Rice, on the other hand, should adjusted soaking time and the ratio of rice to water in order to meet the criteria. The development of standardized procedures and specification could facilitate the preparation of meals for quantitative food service industry, caterers and caregivers by using simple methods to meet international standards.

摘要 I
第一章 前言 1
第二章 文獻回顧 2
第一節 咀嚼與吞嚥困難 2
一、 咀嚼與吞嚥困難定義 2
二、 造成咀嚼與吞嚥困難的相關因子 3
三、 咀嚼與吞嚥困難造成的風險及其盛行率 3
第二節 咀嚼、吞嚥困難因應飲食 5
一、 質地修飾飲食的發展 5
二、 國際吞嚥困難飲食標準化行動(IDDSI) 7
第三節 研究問題與目的 12
一、 研究問題 12
二、 研究目的 12
第三章 材料與方法 13
第一節 研究架構 13
第二節 研究流程 14
第三節 試驗材料 15
第四章 結果 28
第一節 依IDDSI質地分級規格評估市售食品質地 28
第二節 依IDDSI質地分級規格製備自製分級餐食 38
第三節 質地調整菜單設計 42
第五章 討論 51
第一節 依IDDSI質地分級規格評估市售食品質地 51
第二節 依IDDSI質地分級規格製備分級餐食 54
第三節 質地調整菜單設計 58
第六章 結論 60
第一節 研究結論 60
一、 依IDDSI質地分級規格評估市售食品質地 60
二、 依IDDSI質地分級規格製備分級餐食 60
三、 質地調整菜單設計 60
第二節 未來研究發展之方向與建議 61
參考文獻 62
附件 68

 

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