What Type of Food Can Older Adults Masticate?: Evaluation of Mastication Performance Using Color-Changeable Chewing Gum
Identifieur interne : 000C46 ( Pmc/Corpus ); précédent : 000C45; suivant : 000C47What Type of Food Can Older Adults Masticate?: Evaluation of Mastication Performance Using Color-Changeable Chewing Gum
Auteurs : Shinichi Wada ; Nobuyuki Kawate ; Masazumi MizumaSource :
- Dysphagia [ 0179-051X ] ; 2017.
Abstract
This study determines if older adults can masticate regular foods via a simple test conducted using a color-changeable chewing gum. Seventy-nine consecutive inpatients of our clinic receiving rehabilitation and general medicine were assessed for eligibility. The inclusion criterion was >65 years. Thirty patients consented to participate. The main outcome variable was the food bolus texture at the swallowing threshold for five regular foods. The main explanatory variable was the a* value of the color-changeable chewing gum after 120 s of chewing (a* represents the degree of color between red and green, and a positive a* value indicates red). The mean age ± standard deviation of the participants was 81.6 ± 8.6 years, and 40% were men. Participants being able to prepare the food with suitable texture for swallowing was positively associated with the a* values in boiled rice, ginger-fried pork loin, boiled fish-paste, and rice cracker (Crude OR 1.18, 1.15, 1.17, and 1.50;
Url:
DOI: 10.1007/s00455-017-9807-1
PubMed: 28474132
PubMed Central: 5608775
Links to Exploration step
PMC:5608775Le document en format XML
<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">What Type of Food Can Older Adults Masticate?: Evaluation of Mastication Performance Using Color-Changeable Chewing Gum</title><author><name sortKey="Wada, Shinichi" sort="Wada, Shinichi" uniqKey="Wada S" first="Shinichi" last="Wada">Shinichi Wada</name><affiliation><nlm:aff id="Aff1">Department of Rehabilitation Medicine, Moriyama Rehabilitation Clinic, 1-11-17 Nishi-Nakanobu, Shinagawa-ku, Tokyo, 142-0054 Japan</nlm:aff></affiliation><affiliation><nlm:aff id="Aff2"><institution-wrap><institution-id institution-id-type="ISNI">0000 0000 8864 3422</institution-id><institution-id institution-id-type="GRID">grid.410714.7</institution-id><institution>Department of Rehabilitation Medicine,</institution><institution>Showa University School of Medicine,</institution></institution-wrap>1-5-8 Hatanodai, Shinagawa-ku, Tokyo, Japan</nlm:aff></affiliation></author><author><name sortKey="Kawate, Nobuyuki" sort="Kawate, Nobuyuki" uniqKey="Kawate N" first="Nobuyuki" last="Kawate">Nobuyuki Kawate</name><affiliation><nlm:aff id="Aff2"><institution-wrap><institution-id institution-id-type="ISNI">0000 0000 8864 3422</institution-id><institution-id institution-id-type="GRID">grid.410714.7</institution-id><institution>Department of Rehabilitation Medicine,</institution><institution>Showa University School of Medicine,</institution></institution-wrap>1-5-8 Hatanodai, Shinagawa-ku, Tokyo, Japan</nlm:aff></affiliation></author><author><name sortKey="Mizuma, Masazumi" sort="Mizuma, Masazumi" uniqKey="Mizuma M" first="Masazumi" last="Mizuma">Masazumi Mizuma</name><affiliation><nlm:aff id="Aff2"><institution-wrap><institution-id institution-id-type="ISNI">0000 0000 8864 3422</institution-id><institution-id institution-id-type="GRID">grid.410714.7</institution-id><institution>Department of Rehabilitation Medicine,</institution><institution>Showa University School of Medicine,</institution></institution-wrap>1-5-8 Hatanodai, Shinagawa-ku, Tokyo, Japan</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">28474132</idno><idno type="pmc">5608775</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5608775</idno><idno type="RBID">PMC:5608775</idno><idno type="doi">10.1007/s00455-017-9807-1</idno><date when="2017">2017</date><idno type="wicri:Area/Pmc/Corpus">000C46</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000C46</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">What Type of Food Can Older Adults Masticate?: Evaluation of Mastication Performance Using Color-Changeable Chewing Gum</title><author><name sortKey="Wada, Shinichi" sort="Wada, Shinichi" uniqKey="Wada S" first="Shinichi" last="Wada">Shinichi Wada</name><affiliation><nlm:aff id="Aff1">Department of Rehabilitation Medicine, Moriyama Rehabilitation Clinic, 1-11-17 Nishi-Nakanobu, Shinagawa-ku, Tokyo, 142-0054 Japan</nlm:aff></affiliation><affiliation><nlm:aff id="Aff2"><institution-wrap><institution-id institution-id-type="ISNI">0000 0000 8864 3422</institution-id><institution-id institution-id-type="GRID">grid.410714.7</institution-id><institution>Department of Rehabilitation Medicine,</institution><institution>Showa University School of Medicine,</institution></institution-wrap>1-5-8 Hatanodai, Shinagawa-ku, Tokyo, Japan</nlm:aff></affiliation></author><author><name sortKey="Kawate, Nobuyuki" sort="Kawate, Nobuyuki" uniqKey="Kawate N" first="Nobuyuki" last="Kawate">Nobuyuki Kawate</name><affiliation><nlm:aff id="Aff2"><institution-wrap><institution-id institution-id-type="ISNI">0000 0000 8864 3422</institution-id><institution-id institution-id-type="GRID">grid.410714.7</institution-id><institution>Department of Rehabilitation Medicine,</institution><institution>Showa University School of Medicine,</institution></institution-wrap>1-5-8 Hatanodai, Shinagawa-ku, Tokyo, Japan</nlm:aff></affiliation></author><author><name sortKey="Mizuma, Masazumi" sort="Mizuma, Masazumi" uniqKey="Mizuma M" first="Masazumi" last="Mizuma">Masazumi Mizuma</name><affiliation><nlm:aff id="Aff2"><institution-wrap><institution-id institution-id-type="ISNI">0000 0000 8864 3422</institution-id><institution-id institution-id-type="GRID">grid.410714.7</institution-id><institution>Department of Rehabilitation Medicine,</institution><institution>Showa University School of Medicine,</institution></institution-wrap>1-5-8 Hatanodai, Shinagawa-ku, Tokyo, Japan</nlm:aff></affiliation></author></analytic><series><title level="j">Dysphagia</title><idno type="ISSN">0179-051X</idno><idno type="eISSN">1432-0460</idno><imprint><date when="2017">2017</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p id="Par4">This study determines if older adults can masticate regular foods via a simple test conducted using a color-changeable chewing gum. Seventy-nine consecutive inpatients of our clinic receiving rehabilitation and general medicine were assessed for eligibility. The inclusion criterion was >65 years. Thirty patients consented to participate. The main outcome variable was the food bolus texture at the swallowing threshold for five regular foods. The main explanatory variable was the a* value of the color-changeable chewing gum after 120 s of chewing (a* represents the degree of color between red and green, and a positive a* value indicates red). The mean age ± standard deviation of the participants was 81.6 ± 8.6 years, and 40% were men. Participants being able to prepare the food with suitable texture for swallowing was positively associated with the a* values in boiled rice, ginger-fried pork loin, boiled fish-paste, and rice cracker (Crude OR 1.18, 1.15, 1.17, and 1.50; <italic>P</italic> < 0.001, = 0.026, <0.001, and <0.001, respectively). The cut-off a* values had markedly high specificities (1.0) for boiled rice and boiled fish-paste and high sensitivities (0.86–0.94) for three foods, except boiled rice. We believe that mastication evaluation using the color-changeable chewing gum is not only useful but also extremely practical, even for older adults in a wide range of settings, including an individual’s home. This approach would lead to a reduction in unnecessary mechanically altered or pureed food for older adults who can eat pureed food and safely provide palatable food.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Barczi, Sr" uniqKey="Barczi S">SR Barczi</name></author><author><name sortKey="Sullivan, Pa" uniqKey="Sullivan P">PA Sullivan</name></author><author><name sortKey="Robbins, J" uniqKey="Robbins J">J Robbins</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kayser Jones, J" uniqKey="Kayser Jones J">J Kayser-Jones</name></author><author><name sortKey="Pengilly, K" uniqKey="Pengilly K">K Pengilly</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Cichero, Ja" uniqKey="Cichero J">JA Cichero</name></author><author><name sortKey="Steele, C" uniqKey="Steele C">C Steele</name></author><author><name sortKey="Duivestein, J" uniqKey="Duivestein J">J Duivestein</name></author><author><name sortKey="Clave, P" uniqKey="Clave P">P Clave</name></author><author><name sortKey="Chen, J" uniqKey="Chen J">J Chen</name></author><author><name sortKey="Kayashita, J" uniqKey="Kayashita J">J Kayashita</name></author><author><name sortKey="Dantas, R" uniqKey="Dantas R">R Dantas</name></author><author><name sortKey="Lecko, C" uniqKey="Lecko C">C Lecko</name></author><author><name sortKey="Speyer, R" uniqKey="Speyer R">R Speyer</name></author><author><name sortKey="Lam, P" uniqKey="Lam P">P Lam</name></author><author><name sortKey="Murray, J" uniqKey="Murray J">J Murray</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Okamoto, N" uniqKey="Okamoto N">N Okamoto</name></author><author><name sortKey="Tomioka, K" uniqKey="Tomioka K">K Tomioka</name></author><author><name sortKey="Saeki, K" uniqKey="Saeki K">K Saeki</name></author><author><name sortKey="Iwamoto, J" uniqKey="Iwamoto J">J Iwamoto</name></author><author><name sortKey="Morikawa, M" uniqKey="Morikawa M">M Morikawa</name></author><author><name sortKey="Harano, A" uniqKey="Harano A">A Harano</name></author><author><name sortKey="Kurumatani, N" uniqKey="Kurumatani N">N Kurumatani</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mchorney, Ca" uniqKey="Mchorney C">CA McHorney</name></author><author><name sortKey="Robbins, J" uniqKey="Robbins J">J Robbins</name></author><author><name sortKey="Lomax, K" uniqKey="Lomax K">K Lomax</name></author><author><name sortKey="Rosenbek, Jc" uniqKey="Rosenbek J">JC Rosenbek</name></author><author><name sortKey="Chignell, K" uniqKey="Chignell K">K Chignell</name></author><author><name sortKey="Kramer, Ae" uniqKey="Kramer A">AE Kramer</name></author><author><name sortKey="Bricker, De" uniqKey="Bricker D">DE Bricker</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Manly, Rs" uniqKey="Manly R">RS Manly</name></author><author><name sortKey="Braley, Lc" uniqKey="Braley L">LC Braley</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Olthoff, Lw" uniqKey="Olthoff L">LW Olthoff</name></author><author><name sortKey="Van Der Bilt, A" uniqKey="Van Der Bilt A">A van der Bilt</name></author><author><name sortKey="Bosman, F" uniqKey="Bosman F">F Bosman</name></author><author><name sortKey="Kleizen, Hh" uniqKey="Kleizen H">HH Kleizen</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Liedberg, B" uniqKey="Liedberg B">B Liedberg</name></author><author><name sortKey="Owall, B" uniqKey="Owall B">B Owall</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hayakawa, I" uniqKey="Hayakawa I">I Hayakawa</name></author><author><name sortKey="Watanabe, I" uniqKey="Watanabe I">I Watanabe</name></author><author><name sortKey="Hirano, S" uniqKey="Hirano S">S Hirano</name></author><author><name sortKey="Nagao, M" uniqKey="Nagao M">M Nagao</name></author><author><name sortKey="Seki, T" uniqKey="Seki T">T Seki</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Sato, S" uniqKey="Sato S">S Sato</name></author><author><name sortKey="Fueki, K" uniqKey="Fueki K">K Fueki</name></author><author><name sortKey="Sato, H" uniqKey="Sato H">H Sato</name></author><author><name sortKey="Sueda, S" uniqKey="Sueda S">S Sueda</name></author><author><name sortKey="Shiozaki, T" uniqKey="Shiozaki T">T Shiozaki</name></author><author><name sortKey="Kato, M" uniqKey="Kato M">M Kato</name></author><author><name sortKey="Ohyama, T" uniqKey="Ohyama T">T Ohyama</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Speksnijder, Cm" uniqKey="Speksnijder C">CM Speksnijder</name></author><author><name sortKey="Abbink, Jh" uniqKey="Abbink J">JH Abbink</name></author><author><name sortKey="Van Der Glas, Hw" uniqKey="Van Der Glas H">HW van der Glas</name></author><author><name sortKey="Janssen, Ng" uniqKey="Janssen N">NG Janssen</name></author><author><name sortKey="Van Der Bilt, A" uniqKey="Van Der Bilt A">A van der Bilt</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hirano, K" uniqKey="Hirano K">K Hirano</name></author><author><name sortKey="Takahashi, Y" uniqKey="Takahashi Y">Y Takahashi</name></author><author><name sortKey="Hirano, S" uniqKey="Hirano S">S Hirano</name></author><author><name sortKey="Hayakawa, I" uniqKey="Hayakawa I">I Hayakawa</name></author><author><name sortKey="Seki, T" uniqKey="Seki T">T Seki</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hama, Y" uniqKey="Hama Y">Y Hama</name></author><author><name sortKey="Kanazawa, M" uniqKey="Kanazawa M">M Kanazawa</name></author><author><name sortKey="Minakuchi, S" uniqKey="Minakuchi S">S Minakuchi</name></author><author><name sortKey="Uchida, T" uniqKey="Uchida T">T Uchida</name></author><author><name sortKey="Sasaki, Y" uniqKey="Sasaki Y">Y Sasaki</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hama, Y" uniqKey="Hama Y">Y Hama</name></author><author><name sortKey="Kanazawa, M" uniqKey="Kanazawa M">M Kanazawa</name></author><author><name sortKey="Minakuchi, S" uniqKey="Minakuchi S">S Minakuchi</name></author><author><name sortKey="Uchida, T" uniqKey="Uchida T">T Uchida</name></author><author><name sortKey="Sasaki, Y" uniqKey="Sasaki Y">Y Sasaki</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hirai, T" uniqKey="Hirai T">T Hirai</name></author><author><name sortKey="Anzai, T" uniqKey="Anzai T">T Anzai</name></author><author><name sortKey="Kaneda, K" uniqKey="Kaneda K">K Kaneda</name></author><author><name sortKey="Matai, N" uniqKey="Matai N">N Matai</name></author><author><name sortKey="Tanaka, O" uniqKey="Tanaka O">O Tanaka</name></author><author><name sortKey="Ikeda, Y" uniqKey="Ikeda Y">Y Ikeda</name></author><author><name sortKey="Uchida, T" uniqKey="Uchida T">T Uchida</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Rosenthal, Aj" uniqKey="Rosenthal A">AJ Rosenthal</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Pons, Mf" uniqKey="Pons M">MF Pons</name></author><author><name sortKey="Fiszman, Sm" uniqKey="Fiszman S">SM Fiszman</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Eichner, K" uniqKey="Eichner K">K Eichner</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Horiguchi, S" uniqKey="Horiguchi S">S Horiguchi</name></author><author><name sortKey="Suzuki, Y" uniqKey="Suzuki Y">Y Suzuki</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mann, Gd" uniqKey="Mann G">GD Mann</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hiltunen, K" uniqKey="Hiltunen K">K Hiltunen</name></author><author><name sortKey="Vehkalahti, M" uniqKey="Vehkalahti M">M Vehkalahti</name></author><author><name sortKey="Ainamo, A" uniqKey="Ainamo A">A Ainamo</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Palmer, Jb" uniqKey="Palmer J">JB Palmer</name></author><author><name sortKey="Rudin, Nj" uniqKey="Rudin N">NJ Rudin</name></author><author><name sortKey="Lara, G" uniqKey="Lara G">G Lara</name></author><author><name sortKey="Crompton, Aw" uniqKey="Crompton A">AW Crompton</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hiiemae, Km" uniqKey="Hiiemae K">KM Hiiemae</name></author><author><name sortKey="Palmer, Jb" uniqKey="Palmer J">JB Palmer</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Saitoh, E" uniqKey="Saitoh E">E Saitoh</name></author><author><name sortKey="Shibata, S" uniqKey="Shibata S">S Shibata</name></author><author><name sortKey="Matsuo, K" uniqKey="Matsuo K">K Matsuo</name></author><author><name sortKey="Baba, M" uniqKey="Baba M">M Baba</name></author><author><name sortKey="Fujii, W" uniqKey="Fujii W">W Fujii</name></author><author><name sortKey="Palmer, Jb" uniqKey="Palmer J">JB Palmer</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kagaya, H" uniqKey="Kagaya H">H Kagaya</name></author><author><name sortKey="Saitoh, E" uniqKey="Saitoh E">E Saitoh</name></author><author><name sortKey="Shibata, S" uniqKey="Shibata S">S Shibata</name></author><author><name sortKey="Onogi, K" uniqKey="Onogi K">K Onogi</name></author><author><name sortKey="Aoyagi, Y" uniqKey="Aoyagi Y">Y Aoyagi</name></author><author><name sortKey="Inamoto, Y" uniqKey="Inamoto Y">Y Inamoto</name></author><author><name sortKey="Ozeki, M" uniqKey="Ozeki M">M Ozeki</name></author><author><name sortKey="Ota, K" uniqKey="Ota K">K Ota</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Dysphagia</journal-id><journal-id journal-id-type="iso-abbrev">Dysphagia</journal-id><journal-title-group><journal-title>Dysphagia</journal-title></journal-title-group><issn pub-type="ppub">0179-051X</issn><issn pub-type="epub">1432-0460</issn><publisher><publisher-name>Springer US</publisher-name><publisher-loc>New York</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">28474132</article-id><article-id pub-id-type="pmc">5608775</article-id><article-id pub-id-type="publisher-id">9807</article-id><article-id pub-id-type="doi">10.1007/s00455-017-9807-1</article-id><article-categories><subj-group subj-group-type="heading"><subject>Original Article</subject></subj-group></article-categories><title-group><article-title>What Type of Food Can Older Adults Masticate?: Evaluation of Mastication Performance Using Color-Changeable Chewing Gum</article-title></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">http://orcid.org/0000-0001-5529-7591</contrib-id><name><surname>Wada</surname><given-names>Shinichi</given-names></name><address><phone>+81-3-6426-7318</phone><email>wada@aoi-med.org</email></address><xref ref-type="aff" rid="Aff1">1</xref><xref ref-type="aff" rid="Aff2">2</xref><bio><sec id="FPar1"><title>Shinichi Wada</title><p id="Par1">MD, MPH</p></sec></bio></contrib><contrib contrib-type="author"><name><surname>Kawate</surname><given-names>Nobuyuki</given-names></name><xref ref-type="aff" rid="Aff2">2</xref><bio><sec id="FPar2"><title>Nobuyuki Kawate</title><p id="Par2">MD, PhD</p></sec></bio></contrib><contrib contrib-type="author"><name><surname>Mizuma</surname><given-names>Masazumi</given-names></name><xref ref-type="aff" rid="Aff2">2</xref><bio><sec id="FPar3"><title>Masazumi Mizuma</title><p id="Par3">MD, PhD</p></sec></bio></contrib><aff id="Aff1"><label>1</label>Department of Rehabilitation Medicine, Moriyama Rehabilitation Clinic, 1-11-17 Nishi-Nakanobu, Shinagawa-ku, Tokyo, 142-0054 Japan</aff><aff id="Aff2"><label>2</label><institution-wrap><institution-id institution-id-type="ISNI">0000 0000 8864 3422</institution-id><institution-id institution-id-type="GRID">grid.410714.7</institution-id><institution>Department of Rehabilitation Medicine,</institution><institution>Showa University School of Medicine,</institution></institution-wrap>1-5-8 Hatanodai, Shinagawa-ku, Tokyo, Japan</aff></contrib-group><pub-date pub-type="epub"><day>4</day><month>5</month><year>2017</year></pub-date><pub-date pub-type="pmc-release"><day>4</day><month>5</month><year>2017</year></pub-date><pub-date pub-type="ppub"><year>2017</year></pub-date><volume>32</volume><issue>5</issue><fpage>636</fpage><lpage>643</lpage><history><date date-type="received"><day>12</day><month>1</month><year>2017</year></date><date date-type="accepted"><day>22</day><month>4</month><year>2017</year></date></history><permissions><copyright-statement>© The Author(s) 2017</copyright-statement><license license-type="OpenAccess"><license-p><bold>Open Access</bold>This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/4.0/">http://creativecommons.org/licenses/by/4.0/</ext-link>), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.</license-p></license></permissions><abstract id="Abs1"><p id="Par4">This study determines if older adults can masticate regular foods via a simple test conducted using a color-changeable chewing gum. Seventy-nine consecutive inpatients of our clinic receiving rehabilitation and general medicine were assessed for eligibility. The inclusion criterion was >65 years. Thirty patients consented to participate. The main outcome variable was the food bolus texture at the swallowing threshold for five regular foods. The main explanatory variable was the a* value of the color-changeable chewing gum after 120 s of chewing (a* represents the degree of color between red and green, and a positive a* value indicates red). The mean age ± standard deviation of the participants was 81.6 ± 8.6 years, and 40% were men. Participants being able to prepare the food with suitable texture for swallowing was positively associated with the a* values in boiled rice, ginger-fried pork loin, boiled fish-paste, and rice cracker (Crude OR 1.18, 1.15, 1.17, and 1.50; <italic>P</italic> < 0.001, = 0.026, <0.001, and <0.001, respectively). The cut-off a* values had markedly high specificities (1.0) for boiled rice and boiled fish-paste and high sensitivities (0.86–0.94) for three foods, except boiled rice. We believe that mastication evaluation using the color-changeable chewing gum is not only useful but also extremely practical, even for older adults in a wide range of settings, including an individual’s home. This approach would lead to a reduction in unnecessary mechanically altered or pureed food for older adults who can eat pureed food and safely provide palatable food.</p></abstract><kwd-group xml:lang="en"><title>Keywords</title><kwd>Deglutition</kwd><kwd>Masticatory performance</kwd><kwd>Food bolus</kwd><kwd>Color-changeable chewing gum</kwd></kwd-group><funding-group><award-group><funding-source><institution-wrap><institution-id institution-id-type="FundRef">http://dx.doi.org/10.13039/501100001691</institution-id><institution>Japan Society for the Promotion of Science</institution></institution-wrap></funding-source><award-id>KAKENHI Grant Number 24700559</award-id><principal-award-recipient><name><surname>Wada</surname><given-names>Shinichi</given-names></name></principal-award-recipient></award-group></funding-group><custom-meta-group><custom-meta><meta-name>issue-copyright-statement</meta-name><meta-value>© Springer Science+Business Media, LLC 2017</meta-value></custom-meta></custom-meta-group></article-meta></front><body><sec id="Sec1"><title>Introduction</title><p id="Par5">Although patients are sometimes unaware of the disorder, oropharyngeal dysphagia is a highly prevalent clinical condition as it affects 10–30% of adults aged 65 and above [<xref ref-type="bibr" rid="CR1">1</xref>] and more than 51% of institutionalized elderly patients [<xref ref-type="bibr" rid="CR2">2</xref>]. Conservative estimates suggest that 8% of the worldwide population experiences difficulty in consuming regular food and fluids because of dysphagia [<xref ref-type="bibr" rid="CR3">3</xref>]. Having fewer teeth inhibits masticatory ability, which disturbs smooth swallowing [<xref ref-type="bibr" rid="CR4">4</xref>].</p><p id="Par6">The process of chewing and swallowing food is very complex. The skill required to break down solid food, mix it with saliva, collect it into a cohesive bolus, and transport it to the posterior of the oral cavity for swallowing can be challenging to nearly impossible for individuals with oropharyngeal dysphagia. General clinicians and caregivers usually do not evaluate all these skills; as a result, unnecessary mechanically altered or pureed food might be provided for elderly patients, which might have a negative impact on their quality of life [<xref ref-type="bibr" rid="CR5">5</xref>]. Therefore, we need to more comprehensively, simply, and practically determine the types of food a person can eat.</p><p id="Par7">In previous studies, mastication performance has often been evaluated by measurement of an individual’s ability to grind or pulverize a test food by chewing. The degree of food breakdown is then determined by sieving [<xref ref-type="bibr" rid="CR6">6</xref>, <xref ref-type="bibr" rid="CR7">7</xref>]; however, it is not considered a simple and practical method. Another popular method evaluates an individual’s ability to mix and knead a food bolus. Also, a two-color chewing gum [<xref ref-type="bibr" rid="CR8">8</xref>, <xref ref-type="bibr" rid="CR9">9</xref>] and paraffin wax [<xref ref-type="bibr" rid="CR10">10</xref>, <xref ref-type="bibr" rid="CR11">11</xref>] have been used as test items to quantify mixing ability.</p><p id="Par8">The method using a color-changeable chewing gum demonstrates mastication performance based on mixing ability as well as the comminuting ability determined by the sieve test [<xref ref-type="bibr" rid="CR12">12</xref>]. Changes in the color values of a color-changeable chewing gum reliably reflected mastication performance of individuals with natural dentition and those with complete dentures [<xref ref-type="bibr" rid="CR13">13</xref>]. A color scale was developed for visual assessment of the gum to evaluate mastication performance [<xref ref-type="bibr" rid="CR14">14</xref>].</p><p id="Par9">Although these useful and practical scales require only a few minutes from the user to reach an objective evaluation, this evaluation cannot determine the types of food a person can eat. If we could determine the food type a person can masticate, through a simple test using a color-changeable chewing gum, then it would be useful not only in laboratories and specialized institutions but also in a wider range of settings, such as an individual’s home.</p><p id="Par10">This study aims to evaluate whether older adults can masticate regular foods via a simple test conducted using a color-changeable chewing gum. This approach may lead to reductions in unnecessary mechanically altered or pureed food for an older adult who can eat pureed food and to safely provide palatable food.</p><p id="Par11">We designed this study to assess the hypothesis that good mastication ability, evaluated using a color-changeable chewing gum, is associated with a suitable food bolus texture at the swallowing threshold.</p></sec><sec id="Sec2"><title>Methods</title><sec id="Sec3"><title>Setting</title><p id="Par12">The Moriyama Rehabilitation Clinic, located in a residential area in a special ward in Tokyo Metropolis, has 19 beds for inpatients and provides rehabilitation medicine and general medicine for inpatients and outpatients to the local community.</p></sec><sec id="Sec4"><title>Subjects</title><p id="Par13">All inpatients of our clinic were assessed for eligibility. The inclusion criterion was ≥65 years of age. Exclusion criteria included the inability to consume adequate food by oral ingestion, such as severe dysphasia, the inability to follow instructions, such as chewing and spitting out the gum, medical instability or other medical conditions that could confound the results, and patient refusal to participate. All participants or their representatives provided written informed consent.</p></sec></sec><sec id="Sec5"><title>Materials</title><sec id="Sec6"><title>Color-Changeable Chewing Gum and Color Measurement</title><p id="Par14">The color of the chewing gum (70 × 20 × 1 mm<sup>3</sup>; 3.0 g; Masticatory Performance Evaluating Gum XYLITOL, Lotte, Tokyo, Japan; Fig. <xref rid="Fig1" ref-type="fig">1</xref>) changes from yellowish-green to red when chewed. The gum base contains xylitol, citric acid, and red, yellow, and blue dyes, and it can be adjusted to not adhere to denture materials, which allow easy chewing, even by complete denture wearers who have reduced occlusal force. The red dye is pH-sensitive and changes color under neutral or alkaline conditions. Citric acid maintains a low internal pH of the yellowish-green gum before chewing. As chewing progresses, the gum color changes to red because the yellow and blue dyes seep into the saliva and the red color appears as a result of citric acid elution. Changes in the color values of the gum reflect the comprehensive abilities of mastication, such as dental occlusion, salivary secretion, and tongue movements during chewing [<xref ref-type="bibr" rid="CR12">12</xref>, <xref ref-type="bibr" rid="CR13">13</xref>].<fig id="Fig1"><label>Fig. 1</label><caption><p>The color-changeable chewing gum (70 × 20 × 1 mm<sup>3</sup>; 3.0 g). The gum changes color from <italic>yellowish-green</italic> (<italic>right side</italic>) to <italic>red</italic> (<italic>left side</italic>) after chewing. The <italic>red</italic> dye is pH-sensitive and changes color under neutral or alkaline conditions. Citric acid maintains a low internal pH of the <italic>yellowish</italic>-<italic>green</italic> gum before chewing. As chewing progresses, the gum changes to <italic>red</italic> because the <italic>yellow</italic> and <italic>blue</italic> dyes seep into the saliva and the <italic>red</italic> color appears as a result of citric acid elution. Changes in the color values of the gum reflect the comprehensive ability of mastication</p></caption><graphic xlink:href="455_2017_9807_Fig1_HTML" id="MO1"></graphic></fig></p><p id="Par15">Color was measured immediately after chewing for 120 s. The chewed gum was flattened to a thickness of 1.5 mm in polyvinylidene chloride films by compression between two glass plates and measured at five points using a colorimeter (CR-13; Konica-Minolta Sensing, Tokyo, Japan) positioned at the center and approximately 5 mm above, below, right, and left of center. Changes in color were visualized as three-dimensional coordinates organized along the L*, a*, and b* axes and evaluated using the CIELAB color system defined by the International Commission on Illumination, where a* represents the degree of color between red and green. Positive values for a* indicate red. The mean values of five points for each of a* were determined.</p></sec><sec id="Sec7"><title>Food Samples</title><p id="Par16">We selected five foods mainly from the 35 foods listed in a questionnaire for evaluating mastication function [<xref ref-type="bibr" rid="CR15">15</xref>]. The foods on the list were classified into five levels according to the degree of mastication difficulty. Foods in the lower level of the list were easier to masticate. In this study, we selected one food from the three middle levels of the list (boiled fish-paste: level two, rice cracker: level three, and fried pork: level four) and our staple foods (boiled rice and sliced white bread). The specific foods in our study were boiled rice (Sato no Gohan; a pack of 200 g prepared rice; the type of rice was Koshihikari, Sato Foods Industries, Niigata, Japan), sliced white bread (Pasco Chojuku; 20 mm in thickness, Shikishima Baking, Aichi, Japan), ginger-fried pork loin (Seven Premium, Seven & i Holdings, Tokyo, Japan), boiled fish-paste (Yuzuki mini red 95 g, Yuzuki, Fukushima, Japan), and rice cracker (Teshioya flavored with stock and salt, Kameda Seika, Niigata, Japan).</p></sec><sec id="Sec8"><title>Measurements of Food Bolus Texture at the Swallowing Threshold</title><p id="Par17">Participants were instructed to masticate a mouthful of food in their usual manner and spit out the food bolus immediately before swallow onset. The test foods were administered in the order of boiled rice, sliced white bread, ginger-fried pork loin, boiled fish-paste, and rice cracker. The weight of a mouthful of food before mastication, mastication frequency, mastication time, and the texture of the food bolus spewed were measured. The food texture properties of hardness, cohesiveness, and adherence were measured by the texture profile analysis method determined by the Japanese Ministry of Health, Labour and Welfare. We used a texture analysis instrument (The TA.XT plus Texture Analyser, Stable Micro Systems, Surrey, UK) equipped with a cylindrical plunger (ø 20 mm), a cylindrical cup (int. ø 40 mm), and a 50-N load cell. The bolus underwent two successive compression cycles performed at a constant displacement rate of 10 mm/s. A compression ratio of 67% deformation (the bolus was filled 15 mm in height and the clearance was 5 mm) was chosen. The hardness was determined by the first peak height in the load–time curve, and the adhesiveness was determined by the negative force area for the first bite representing the work required to pull the plunger away from the sample. The cohesiveness was determined by the ratio of the positive force area of the second compression to that of the first compression [<xref ref-type="bibr" rid="CR16">16</xref>, <xref ref-type="bibr" rid="CR17">17</xref>].</p><p id="Par18">Japanese dysphagia diet level two is defined as a rough-surface jelly food with protein, and it is equivalent to the dysphagia pureed designation of the National Dysphagia Diet in the USA [<xref ref-type="bibr" rid="CR3">3</xref>] as well as level three in the texture-modified food pyramid of Japan. The lower levels in the texture-modified food pyramid are easier to swallow. Levels zero to three in the texture-modified food pyramid are defined as a texture that satisfies three criteria: (1) under 15,000 N/m<sup>2</sup> in hardness, (2) under 1000 J/m<sup>2</sup> in adhesiveness, and (3) between 0.2 and 0.9 in cohesiveness. If the food bolus texture was within the zero to three levels, we regarded it as suitable for swallowing.</p></sec><sec id="Sec9"><title>Other Measurements</title><p id="Par19">Occlusal contact status was recorded by the Eichner index [<xref ref-type="bibr" rid="CR18">18</xref>], where class A has a maximum of four supporting zones (minimum of one tooth contact between the antagonist jaws in the premolar and molar region on each side), class B has one to three supporting zones, and class C has no supporting zones. The Eichner index was recorded for variations in supporting zones with and without removable prostheses.</p><p id="Par20">We also performed the repetitive saliva swallowing test, the water swallowing test (3-mL-modified) [<xref ref-type="bibr" rid="CR19">19</xref>], and the Mann assessment of swallowing ability (MASA) test [<xref ref-type="bibr" rid="CR20">20</xref>] as only reference.</p></sec><sec id="Sec10"><title>Design</title><p id="Par21">This was a cross-sectional study. The main outcome variable was the food bolus texture at the swallowing threshold, which was represented as suitable mastication for swallowing (level zero to three) or poor mastication (above level three) based on the texture-modified food pyramid. The main explanatory variable was the a* value of the color-changeable chewing gum after 120 s of chewing. Our hypothesis was that a high a* value is associated with a suitable food bolus texture at the swallowing threshold.</p></sec><sec id="Sec11"><title>Sample Size</title><p id="Par22">We assumed that the mean a* value after 120 s of chewing was 25 in participants who had suitable mastication abilities and 12 in those with poor mastication abilities, and that the standard deviation (SD) of the a* values was 10 (in a previous study, the SD of a* values was approximately five in dentate people) [<xref ref-type="bibr" rid="CR12">12</xref>]. The level of significance was set at <italic>P</italic> < 0.05, and the desired statistical power of the trial was set at 0.8. We considered that the expected effect size was at least one. With the sample sizes of both groups equal, the required sample size was 17. We assumed unequal sizes and determined that the required sample size for this study was 30.</p></sec><sec id="Sec12"><title>Statistical Analysis</title><p id="Par23">Univariate logistic regression analyses were performed to calculate odds ratios (ORs) and 95% confidence intervals and to examine the relationship between suitable preparations for swallowing and each explanatory variable. After the univariate analyses, the a* values (main explanatory variable), age (spontaneous, because it is known to be associated with mastication abilities), and the significant variables were tested in a multivariate logistic regression analysis. We set the cut-off as the a* values that were nearest to the point (sensitivity: 1, 1-specificity: 0) on the receiver–operating characteristic curves in order to increase both sensitivity and specificity.</p><p id="Par24">JMP version 9.0.2 (SAS institute Inc., Cary, NC) was used for all analyses; <italic>P</italic> < 0.05 was considered statistically significant.</p></sec></sec><sec id="Sec13"><title>Results</title><sec id="Sec14"><title>Participants</title><p id="Par25">Seventy-nine consecutive inpatients of our clinic were assessed for eligibility from December 2014 to August 2015, 12 of which were younger than 65 years. Among the 67 patients, we excluded four patients who had tube feeding or total parenteral nutrition and 17 patients who were medically unstable or not able to follow our instructions because of dementia or aphasia. Of the remaining 46 eligible patients, 30 were willing to participate.</p></sec><sec id="Sec15"><title>Characteristics</title><p id="Par26">Table <xref rid="Tab1" ref-type="table">1</xref> shows the demographic and clinical characteristics of the participants. The mean age ± SD of the participants was 81.6 ± 8.6 years, and 12 participants (40%) were men. Rehabilitation for bone and joint disease or cerebrovascular disease accounted for 80% of the admissions. The Functional Independence Measure indicated that the average participant’s motor function was moderate assistance or minimal contact assistance, but their average cognitive function was modified independence.<table-wrap id="Tab1"><label>Table 1</label><caption><p>Participant characteristics</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="left">Characteristic</th><th align="left">Values are mean ± SD (median) or <italic>n</italic> (%)</th></tr></thead><tbody><tr><td align="left">Age (years)</td><td char="±" align="left">81.6 ± 8.6</td></tr><tr><td align="left">Sex (male)</td><td align="left">12 (40%)</td></tr><tr><td align="left">Reason for admission: rehabilitation for cerebrovascular disease</td><td align="left">9 (30%)</td></tr><tr><td align="left">Reason for admission: rehabilitation for bone and joint disease</td><td align="left">15 (50%)</td></tr><tr><td align="left">Functional independence measure (FIM) at admission (median)</td><td char="±" align="left">77.5 ± 26.6 (80.5)</td></tr><tr><td align="left">The motor subscale of FIM at admission (median)</td><td char="±" align="left">49.7 ± 20.7 (55)</td></tr><tr><td align="left">The cognition subscale of FIM at admission (median)</td><td char="±" align="left">27.8 ± 7.8 (31.5)</td></tr><tr><td align="left">Repetitive saliva swallowing test</td><td char="±" align="left">2.8 ± 1.6 (3)</td></tr><tr><td align="left">MASA<sup>a</sup></td><td char="±" align="left">190.5 ± 9.6 (194.5)</td></tr><tr><td align="left">The a* values of the color-changeable chewing gum after 120 s of chewing</td><td char="±" align="left">21.6 ± 11.6 (median: 27.8, maximum: 32.8, minimum: −9.9)</td></tr><tr><td align="left">Mastication frequency of the gum over 120 s</td><td char="±" align="left">150 ± 34 (median: 156, maximum: 214, minimum: 40)</td></tr><tr><td align="left" colspan="2">The water swallowing test (3 mL modified)<sup>b</sup></td></tr><tr><td align="left"> #5</td><td align="left">27 (90%)</td></tr><tr><td align="left"> #4</td><td align="left">1 (3%)</td></tr><tr><td align="left"> #3</td><td align="left">2 (7%)</td></tr><tr><td align="left" colspan="2">Eichner index (supporting zones without removable prostheses)<sup>c</sup></td></tr><tr><td align="left"> A</td><td align="left">10 (33%)</td></tr><tr><td align="left"> B</td><td align="left">7 (23%)</td></tr><tr><td align="left"> C</td><td align="left">13 (43%)</td></tr><tr><td align="left" colspan="2">Eichner index (supporting zones with removable prostheses)<sup>c</sup></td></tr><tr><td align="left"> A</td><td align="left">23 (77%)</td></tr><tr><td align="left"> B</td><td align="left">6 (20%)</td></tr><tr><td align="left"> C</td><td align="left">1 (3%)</td></tr></tbody></table><table-wrap-foot><p><sup>a</sup>Total score of The Mann Assessment of Swallowing Ability</p><p><sup>b</sup>Criteria #3: Swallowed 3 mL of cold water successfully, but with choking and/or wet hoarseness. Criteria #4: Swallowed 3 mL of cold water successfully without choking or wet hoarseness. Criteria #5: Criteria #4, plus, 2 successful swallowing within 30 s</p><p><sup>c</sup>Class A: maximum of four supporting zones (minimum of one tooth contact between the antagonist jaws in the premolar and molar region on each side). Class B: one to three supporting zones. Class C: no supporting zone</p></table-wrap-foot></table-wrap></p><p id="Par27">Without removable prostheses, more participants were classified as Eichner class C, which has no supporting zone, than any other class. However, including occlusal supporting zones of the removable dentures, the percentages were 77% in Eichner class A, which has a maximum of four supporting zones, and 3% in class C. The mean total score ± SD of MASA was 190.5 ± 9.6. Dysphagia is unlikely if the total score of MASA is more than 178 [<xref ref-type="bibr" rid="CR20">20</xref>].</p></sec><sec id="Sec16"><title>Food Bolus at the Swallowing Threshold</title><p id="Par28">Table <xref rid="Tab2" ref-type="table">2</xref> shows the number and percentage of persons able to prepare the food with suitable texture for swallowing and the means and SDs for the weight of a mouthful of food, mastication frequency, and mastication time for each food. The percentage for suitable preparation for swallowing was around 65% for boiled rice, boiled fish-paste, and rice cracker. However, two foods had low percentages for suitable preparation for swallowing: sliced white bread due to high adhesiveness and ginger-fried pork loin due to high hardness. One participant for boiled fish-paste and six participants for rice cracker did not masticate because of their fatigue.<table-wrap id="Tab2"><label>Table 2</label><caption><p>Food bolus at the swallowing threshold</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="left"></th><th align="left">Suitable preparation for swallowing (<italic>n</italic>, %)<sup>a</sup></th><th align="left">Weight of a mouthful of food (g)</th><th align="left">Mastication frequency (times)</th><th align="left">Mastication time (s)</th></tr></thead><tbody><tr><td align="left">Boiled rice</td><td align="left">21, 70%</td><td char="±" align="char">10.4 ± 1.3</td><td char="±" align="char">64.0 ± 28.6</td><td char="±" align="char">42.5 ± 13.2</td></tr><tr><td align="left">Sliced white bread</td><td align="left">4, 13%</td><td char="±" align="char">4.7 ± 0.7</td><td char="±" align="char">59.0 ± 20.9</td><td char="±" align="char">40.8 ± 13.4</td></tr><tr><td align="left">Ginger-fried pork loin</td><td align="left">7, 23%</td><td char="±" align="char">3.8 ± 0.6</td><td char="±" align="char">53.1 ± 20.0</td><td char="±" align="char">34.8 ± 15.3</td></tr><tr><td align="left">Boiled fish-paste</td><td align="left">17, 59%<sup>b</sup></td><td char="±" align="char">7.7 ± 1.2</td><td char="±" align="char">65.8 ± 29.1</td><td char="±" align="char">36.5 ± 15.1</td></tr><tr><td align="left">Rice cracker</td><td align="left">16, 67%<sup>b</sup></td><td char="±" align="char">2.9 ± 1.8</td><td char="±" align="char">51.1 ± 15.5</td><td char="±" align="char">35.6 ± 12.0</td></tr></tbody></table><table-wrap-foot><p>Values are mean ± SD or <italic>n</italic></p><p><sup>a</sup>The suitable food bolus for swallowing was defined as texture that meets three criteria: under 15,000 N/m<sup>2</sup> in hardness, under 1000 J/m<sup>2</sup> in adhesiveness, and between 0.2 and 0.9 in cohesiveness</p><p><sup>b</sup>One patient for boiled fish-paste and six patients for rice cracker did not masticate because of their fatigue</p></table-wrap-foot></table-wrap></p><p id="Par29">The associations between suitable preparation for swallowing each food and several variables, based on univariate and multivariate logistic regression analyses, are provided in Table <xref rid="Tab3" ref-type="table">3</xref>. Suitable preparation of the food for swallowing was positively associated with the a* values in boiled rice, ginger-fried pork loin, boiled fish-paste, and rice cracker (Crude OR 1.18, 1.15, 1.17, and 1.50; <italic>P</italic> < 0.001, = 0.026, <0.001, and <0.001, respectively). The higher a* value not only meant that a person’s mastication was better but also that their preparation for swallowing was better. Age was not significantly associated with suitable swallowing preparation for any of the foods.<table-wrap id="Tab3"><label>Table 3</label><caption><p>Results of univariate and multivariate logistic regression analysis for the associations between suitable preparation for swallowing each food and several variables</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="2">Explanatory variables</th><th align="left" colspan="4">Boiled rice</th></tr><tr><th align="left">Crude odds ratios (95% confidence interval)</th><th align="left"><italic>P</italic> value</th><th align="left">Adjusted odds ratios (95% confidence interval)</th><th align="left"><italic>P</italic> value</th></tr></thead><tbody><tr><td align="left">The a* values of the color-changeable chewing gum after 120 s of chewing</td><td align="left">1.18 (1.07–1.36)</td><td char="." align="char"><0.001*</td><td align="left">1.14 (1.02–1.32)</td><td align="left">0.012*</td></tr><tr><td align="left">Mastication frequency of each food</td><td align="left">1.05 (1.01–1.12)</td><td char="." align="char">0.014*</td><td align="left">1.03 (0.99–1.11)</td><td align="left">0.195</td></tr><tr><td align="left">Age (years)</td><td align="left">0.97 (0.88–1.07)</td><td char="." align="char">0.587</td><td align="left">0.99 (0.85–1.16)</td><td align="left">0.893</td></tr><tr><td align="left">Total score of the mann assessment of swallowing ability</td><td align="left">1.00 (0.92–1.09)</td><td char="." align="char">0.906</td><td align="left">Excluded</td><td align="left"></td></tr><tr><td align="left">Good occlusal contact status: Eichner index class A without removable good occlusal contact status: Eichner index class A without removable prostheses (No = reference)</td><td align="left">6.00 (0.63–57.0)</td><td char="." align="char">0.204</td><td align="left">Excluded</td><td align="left"></td></tr></tbody></table><table frame="hsides" rules="groups"><thead><tr><th align="left" colspan="4">Sliced white bread</th><th align="left" colspan="4">Ginger-fried pork loin</th></tr><tr><th align="left">Crude odds ratios (95% confidence interval)</th><th align="left"><italic>P</italic> value</th><th align="left">Adjusted odds ratios (95% confidence interval)</th><th align="left"><italic>P</italic> value</th><th align="left">Crude odds ratios (95% confidence interval)</th><th align="left"><italic>P</italic> value</th><th align="left">Adjusted odds ratios (95% confidence interval)</th><th align="left"><italic>P</italic> value</th></tr></thead><tbody><tr><td align="left">1.10 (0.97–1.43)</td><td align="left">0.164</td><td align="left">1.10 (0.97–1.43)</td><td align="left">0.164</td><td align="left">1.15 (1.01–1.45)</td><td align="left">0.026</td><td align="left">1.10 (0.98–1.39)</td><td align="left">0.123</td></tr><tr><td align="left">0.99 (0.93–1.04)</td><td align="left">0.570</td><td align="left">Excluded</td><td align="left"></td><td align="left">1.03 (0.99–1.08)</td><td align="left">0.168</td><td align="left">Excluded</td><td align="left"></td></tr><tr><td align="left">1.05 (0.92–1.21)</td><td align="left">0.461</td><td align="left">0.95 (0.82–1.08)</td><td align="left">0.462</td><td align="left">1.05 (0.95–1.19)</td><td align="left">0.317</td><td align="left">0.97 (0.85–1.08)</td><td align="left">0.534</td></tr><tr><td align="left">1.07 (0.97–1.18)</td><td align="left">0.187</td><td align="left">Excluded</td><td align="left"></td><td align="left">1.00 (0.90–1.09)</td><td align="left">0.972</td><td align="left">Excluded</td><td align="left"></td></tr><tr><td align="left">8.14 (0.72–91.9)</td><td align="left">0.095</td><td align="left">Excluded</td><td align="left"></td><td align="left">9.00 (1.32–61.1)</td><td align="left">0.026</td><td align="left">4.79 (0.61–47.8)</td><td align="left">0.137</td></tr></tbody></table><table frame="hsides" rules="groups"><thead><tr><th align="left" colspan="4">Boiled fish-paste</th><th align="left" colspan="4">Rice cracker</th></tr><tr><th align="left">Crude odds ratios (95% confidence interval)</th><th align="left"><italic>P</italic> value</th><th align="left">Adjusted odds ratios (95% confidence interval)</th><th align="left"><italic>P</italic> value</th><th align="left">Crude odds ratios (95% confidence interval)</th><th align="left"><italic>P</italic> value</th><th align="left">Adjusted odds ratios (95% confidence interval)</th><th align="left"><italic>P</italic> value</th></tr></thead><tbody><tr><td align="left">1.17 (1.06–1.35)</td><td char="." align="char"><0.001</td><td align="left">1.14(1.02–1.34)</td><td char="." align="char">0.023</td><td align="left">1.50 (1.17–2.81)</td><td char="." align="char"><0.001</td><td align="left">1.62 (1.18-4.02)</td><td char="." align="char"><0.001</td></tr><tr><td align="left">1.04 (1.0006–1.09)</td><td char="." align="char">0.046</td><td align="left">1.04 (0.99–1.11)</td><td char="." align="char">0.125</td><td align="left">0.98 (0.85–1.08)</td><td char="." align="char">0.647</td><td align="left">Excluded</td><td char="." align="char"></td></tr><tr><td align="left">1.02 (0.93–1.12)</td><td char="." align="char">0.703</td><td align="left">0.95 (0.81–1.13)</td><td char="." align="char">0.577</td><td align="left">0.97 (0.87–1.07)</td><td char="." align="char">0.533</td><td align="left">1.11 (0.82–1.66)</td><td char="." align="char">0.497</td></tr><tr><td align="left">0.95 (0.86–1.03)</td><td char="." align="char">0.235</td><td align="left">Excluded</td><td char="." align="char"></td><td align="left">0.92 (0.05–1.01)</td><td char="." align="char">0.082</td><td align="left">Excluded</td><td char="." align="char"></td></tr><tr><td align="left">9.78 (1.02–93.5)</td><td char="." align="char">0.043</td><td align="left">4.07 (0.23–346.4)</td><td char="." align="char">0.359</td><td align="left">5.44 (0.54–55.2)</td><td char="." align="char">0.189</td><td align="left">Excluded</td><td char="." align="char"></td></tr></tbody></table><table-wrap-foot><p>Odds ratios of the a* values were per frequency</p><p>Outcome variable: suitable preparation for swallowing each food</p><p>After the univariate analyses, the a* values (main explanatory variable), age (spontaneous), and the significant variables were tested in a multivariate logistic regression analysis</p></table-wrap-foot></table-wrap></p></sec><sec id="Sec17"><title>Cut-off a* Values of the Color-Changeable Chewing Gum after 120 s of Chewing</title><p id="Par30">The cut-off a* values of each food, except sliced white bread, are given in Table <xref rid="Tab4" ref-type="table">4</xref>. The specificities of the cut-off a* values were markedly high (1.0) for boiled rice and boiled fish-paste. Thus, their positive predictive values were indirectly high. The sensitivities of the cut-off a* values were high (0.86–0.94) for ginger-fried pork loin, boiled fish-paste, and rice cracker. Thus, their negative predictive values were indirectly high.<table-wrap id="Tab4"><label>Table 4</label><caption><p>Cut-off a* values of the color-changeable chewing gum after 120 s of chewing</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="left"></th><th align="left">Cut-off a* values</th><th align="left">Sensitivity</th><th align="left">Specificity</th></tr></thead><tbody><tr><td align="left">Boiled rice</td><td char="." align="char">27.8</td><td char="." align="char">0.76</td><td char="." align="char">1.00</td></tr><tr><td align="left">Ginger-fried pork loin</td><td char="." align="char">28.7</td><td char="." align="char">0.86</td><td char="." align="char">0.65</td></tr><tr><td align="left">Boiled fish-paste</td><td char="." align="char">21.2</td><td char="." align="char">0.94</td><td char="." align="char">1.00</td></tr><tr><td align="left">Rice cracker</td><td char="." align="char">21.2</td><td char="." align="char">0.88</td><td char="." align="char">0.75</td></tr></tbody></table></table-wrap></p></sec></sec><sec id="Sec18"><title>Discussion</title><p id="Par31">Although many previous studies have evaluated mastication ability [<xref ref-type="bibr" rid="CR6">6</xref>–<xref ref-type="bibr" rid="CR14">14</xref>], the regular foods a person can prepare suitably for swallowing, based on mastication evaluation, remain unknown. This study shows that it can be clearly determined, via mastication evaluation using a color-changeable chewing gum, whether older adults can masticate and prepare regular foods suitably for swallowing. The high a* values were significantly associated with a high percentage of participants able to prepare food with suitable texture for swallowing for four of the five foods. For cut-off a* values, there were markedly high specificities (i.e., high positive predictive values) for boiled rice and boiled fish-paste and high sensitivities (i.e., high negative predictive values) for ginger-fried pork loin, boiled fish-paste, and rice cracker.</p><p id="Par32">Thus, we believe that mastication evaluation using a color-changeable chewing gum is not only useful but also extremely practical, even for older adults. Mastication evaluation using a color-changeable chewing gum requires only a few minutes to achieve an objective evaluation and is used not only in laboratories and specialized institutions but also in a wider range of settings, such as an individual’s home. The gum color is more easily measured using a visual color scale than using a colorimeter [<xref ref-type="bibr" rid="CR14">14</xref>].</p><p id="Par33">Our results would be applicable to older adults with modified dependence in motion at home or in nursing facilities. We consider that food bolus texture at the swallowing threshold likely reflects real-life behavior and is more clinically relevant than a fixed mastication frequency. Occlusal status of the participants was consistent with an older adult population based on the Eichner index [<xref ref-type="bibr" rid="CR21">21</xref>]. Reasons for admission of our inpatients were mainly rehabilitation after an acute phase of disease; thus, the general condition of our patients was stable. Activities of daily living for most of the participants were modified dependence in motion and modified independence in cognition.</p><p id="Par34">The measurement of a food bolus has limitations; however, we consider these limitations to be minimal. There were missing values for the food bolus texture for two foods because several participants had low endurance. There is a possibility that the entire food bolus was not spit out and measured due to stage II transport [<xref ref-type="bibr" rid="CR22">22</xref>, <xref ref-type="bibr" rid="CR23">23</xref>]. However, masticated solid food rarely enters the hypopharynx before swallow onset [<xref ref-type="bibr" rid="CR24">24</xref>]. Moreover, if the food bolus texture in the oral cavity is suitable for swallowing, then that in the pharynx at the swallowing threshold would be suitable too [<xref ref-type="bibr" rid="CR25">25</xref>].</p><p id="Par35">Instrumental texture profile analysis is a good tool to assess textural parameters of semisolid foods [<xref ref-type="bibr" rid="CR17">17</xref>]. If mastication is not suitable for swallowing preparation, then the food bolus would not be semisolid and cannot be measured by instrumental texture profile analysis. However, it was not a problem for this study because the main outcome variable here was the food bolus texture at the swallowing threshold, represented as suitable mastication for swallowing (binary variable).</p><p id="Par36">For four of the five foods, the a* values of the color-changeable chewing gum after 120 s of chewing were significantly associated with suitable preparation of the food for swallowing. For sliced white bread, however, the a* values were not significantly associated with suitable preparation of the food for swallowing. Many participants’ texture of sliced white bread was not regarded as suitable for swallowing preparation because adhesion was too high (over 1000 J/m<sup>2</sup>), despite suitable hardness and cohesiveness. Adhesion might be changed by selecting different types of bread.</p><p id="Par37">We regarded the texture that satisfies three criteria (in hardness, adhesiveness, and cohesiveness; see methods) as suitable for swallowing. These criteria have limitations. The criteria were not based on the results of scientific verification experiments; however, they were based on the observational studies that determine the texture-modified food pyramid according to the texture measurement of several levels of real texture modified food in a hospital in Japan.</p><p id="Par38">In conclusion, this simple mastication evaluation would determine if persons can masticate and suitably prepare regular foods. This approach would lead to a reduction in unnecessary mechanically altered or pureed food for older adults who can eat pureed food and safely provide palatable food, which may have a positive impact on their quality of life.</p></sec></body><back><fn-group><fn><p>An erratum to this article is available at <ext-link ext-link-type="uri" xlink:href="https://doi.org/10.1007/s00455-017-9823-1">https://doi.org/10.1007/s00455-017-9823-1</ext-link>.</p></fn></fn-group><ack><title>Acknowledgements</title><p>This work was supported by JSPS KAKENHI Grant Number 24700559. Daisuke Yamaguchi and Rie Shibuya, speech-language hearing therapists, contributed to the acquisition and interpretation of data.</p><sec id="d29e1484"><title>Funding</title><p>The funding sources for this study had no influence in the design, methods, subject recruitment, data collections, analysis or preparation of this paper.</p></sec></ack><notes notes-type="COI-statement"><title>Compliance with Ethical Standards</title><sec id="d29e1492"><title>Conflict of interest</title><p>The authors have no financial or any other personal conflicts to delcare.</p></sec></notes><ref-list id="Bib1"><title>References</title><ref id="CR1"><label>1.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Barczi</surname><given-names>SR</given-names></name><name><surname>Sullivan</surname><given-names>PA</given-names></name><name><surname>Robbins</surname><given-names>J</given-names></name></person-group><article-title>How should dysphagia care of older adults differ? Establishing optimal practice patterns</article-title><source>Semin Speech Lang</source><year>2000</year><volume>21</volume><issue>4</issue><fpage>347</fpage><lpage>361</lpage><pub-id pub-id-type="doi">10.1055/s-2000-8387</pub-id><pub-id pub-id-type="pmid">11085258</pub-id></element-citation></ref><ref id="CR2"><label>2.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Kayser-Jones</surname><given-names>J</given-names></name><name><surname>Pengilly</surname><given-names>K</given-names></name></person-group><article-title>Dysphagia among nursing home residents</article-title><source>Geriatr Nurs</source><year>1999</year><volume>20</volume><issue>2</issue><fpage>77</fpage><lpage>82</lpage><pub-id pub-id-type="doi">10.1053/gn.1999.v20.97011</pub-id><pub-id pub-id-type="pmid">10382421</pub-id></element-citation></ref><ref id="CR3"><label>3.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Cichero</surname><given-names>JA</given-names></name><name><surname>Steele</surname><given-names>C</given-names></name><name><surname>Duivestein</surname><given-names>J</given-names></name><name><surname>Clave</surname><given-names>P</given-names></name><name><surname>Chen</surname><given-names>J</given-names></name><name><surname>Kayashita</surname><given-names>J</given-names></name><name><surname>Dantas</surname><given-names>R</given-names></name><name><surname>Lecko</surname><given-names>C</given-names></name><name><surname>Speyer</surname><given-names>R</given-names></name><name><surname>Lam</surname><given-names>P</given-names></name><name><surname>Murray</surname><given-names>J</given-names></name></person-group><article-title>The need for international terminology and definitions for texture-modified foods and thickened liquids used in dysphagia management: foundations of a global initiative</article-title><source>Curr Phys Med Rehabil Rep</source><year>2013</year><volume>1</volume><fpage>280</fpage><lpage>291</lpage><pub-id pub-id-type="doi">10.1007/s40141-013-0024-z</pub-id><pub-id pub-id-type="pmid">24392282</pub-id></element-citation></ref><ref id="CR4"><label>4.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Okamoto</surname><given-names>N</given-names></name><name><surname>Tomioka</surname><given-names>K</given-names></name><name><surname>Saeki</surname><given-names>K</given-names></name><name><surname>Iwamoto</surname><given-names>J</given-names></name><name><surname>Morikawa</surname><given-names>M</given-names></name><name><surname>Harano</surname><given-names>A</given-names></name><name><surname>Kurumatani</surname><given-names>N</given-names></name></person-group><article-title>Relationship between swallowing problems and tooth loss in community-dwelling independent elderly adults: the Fujiwara-kyo study</article-title><source>J Am Geriatr Soc</source><year>2012</year><volume>60</volume><issue>5</issue><fpage>849</fpage><lpage>853</lpage><pub-id pub-id-type="doi">10.1111/j.1532-5415.2012.03935.x</pub-id><pub-id pub-id-type="pmid">22469311</pub-id></element-citation></ref><ref id="CR5"><label>5.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>McHorney</surname><given-names>CA</given-names></name><name><surname>Robbins</surname><given-names>J</given-names></name><name><surname>Lomax</surname><given-names>K</given-names></name><name><surname>Rosenbek</surname><given-names>JC</given-names></name><name><surname>Chignell</surname><given-names>K</given-names></name><name><surname>Kramer</surname><given-names>AE</given-names></name><name><surname>Bricker</surname><given-names>DE</given-names></name></person-group><article-title>The SWAL-QOL and SWAL-CARE outcomes tool for oropharyngeal dysphagia in adults: III. Documentation of reliability and validity</article-title><source>Dysphagia</source><year>2002</year><volume>17</volume><issue>2</issue><fpage>97</fpage><lpage>114</lpage><pub-id pub-id-type="doi">10.1007/s00455-001-0109-1</pub-id><pub-id pub-id-type="pmid">11956835</pub-id></element-citation></ref><ref id="CR6"><label>6.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Manly</surname><given-names>RS</given-names></name><name><surname>Braley</surname><given-names>LC</given-names></name></person-group><article-title>Masticatory performance and efficiency</article-title><source>J Dent Res</source><year>1950</year><volume>29</volume><issue>4</issue><fpage>448</fpage><lpage>462</lpage><pub-id pub-id-type="doi">10.1177/00220345500290040701</pub-id><pub-id pub-id-type="pmid">15436916</pub-id></element-citation></ref><ref id="CR7"><label>7.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Olthoff</surname><given-names>LW</given-names></name><name><surname>van der Bilt</surname><given-names>A</given-names></name><name><surname>Bosman</surname><given-names>F</given-names></name><name><surname>Kleizen</surname><given-names>HH</given-names></name></person-group><article-title>Distribution of particle sizes in food comminuted by human mastication</article-title><source>Arch Oral Biol</source><year>1984</year><volume>29</volume><issue>11</issue><fpage>899</fpage><lpage>903</lpage><pub-id pub-id-type="doi">10.1016/0003-9969(84)90089-X</pub-id><pub-id pub-id-type="pmid">6596036</pub-id></element-citation></ref><ref id="CR8"><label>8.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Liedberg</surname><given-names>B</given-names></name><name><surname>Owall</surname><given-names>B</given-names></name></person-group><article-title>Oral bolus kneading and shaping measured with chewing gum</article-title><source>Dysphagia</source><year>1995</year><volume>10</volume><issue>2</issue><fpage>101</fpage><lpage>106</lpage><pub-id pub-id-type="doi">10.1007/BF00440079</pub-id><pub-id pub-id-type="pmid">7600850</pub-id></element-citation></ref><ref id="CR9"><label>9.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Hayakawa</surname><given-names>I</given-names></name><name><surname>Watanabe</surname><given-names>I</given-names></name><name><surname>Hirano</surname><given-names>S</given-names></name><name><surname>Nagao</surname><given-names>M</given-names></name><name><surname>Seki</surname><given-names>T</given-names></name></person-group><article-title>A simple method for evaluating masticatory performance using a color-changeable chewing gum</article-title><source>Int J Prosthodont</source><year>1998</year><volume>11</volume><issue>2</issue><fpage>173</fpage><lpage>176</lpage><pub-id pub-id-type="pmid">9709608</pub-id></element-citation></ref><ref id="CR10"><label>10.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Sato</surname><given-names>S</given-names></name><name><surname>Fueki</surname><given-names>K</given-names></name><name><surname>Sato</surname><given-names>H</given-names></name><name><surname>Sueda</surname><given-names>S</given-names></name><name><surname>Shiozaki</surname><given-names>T</given-names></name><name><surname>Kato</surname><given-names>M</given-names></name><name><surname>Ohyama</surname><given-names>T</given-names></name></person-group><article-title>Validity and reliability of a newly developed method for evaluating masticatory function using discriminant analysis</article-title><source>J Oral Rehabil</source><year>2003</year><volume>30</volume><issue>2</issue><fpage>146</fpage><lpage>151</lpage><pub-id pub-id-type="doi">10.1046/j.1365-2842.2003.01050.x</pub-id><pub-id pub-id-type="pmid">12535140</pub-id></element-citation></ref><ref id="CR11"><label>11.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Speksnijder</surname><given-names>CM</given-names></name><name><surname>Abbink</surname><given-names>JH</given-names></name><name><surname>van der Glas</surname><given-names>HW</given-names></name><name><surname>Janssen</surname><given-names>NG</given-names></name><name><surname>van der Bilt</surname><given-names>A</given-names></name></person-group><article-title>Mixing ability test compared with a comminution test in persons with normal and compromised masticatory performance</article-title><source>Eur J Oral Sci</source><year>2009</year><volume>117</volume><issue>5</issue><fpage>580</fpage><lpage>586</lpage><pub-id pub-id-type="doi">10.1111/j.1600-0722.2009.00675.x</pub-id><pub-id pub-id-type="pmid">19758256</pub-id></element-citation></ref><ref id="CR12"><label>12.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Hirano</surname><given-names>K</given-names></name><name><surname>Takahashi</surname><given-names>Y</given-names></name><name><surname>Hirano</surname><given-names>S</given-names></name><name><surname>Hayakawa</surname><given-names>I</given-names></name><name><surname>Seki</surname><given-names>T</given-names></name></person-group><article-title>A study on measurement of masticatory ability using a color-changeable chewing gum with a new coloring reaction</article-title><source>J Jpn Prosthodontics</source><year>2002</year><volume>46</volume><fpage>103</fpage><lpage>109</lpage><pub-id pub-id-type="doi">10.2186/jjps.46.103</pub-id></element-citation></ref><ref id="CR13"><label>13.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Hama</surname><given-names>Y</given-names></name><name><surname>Kanazawa</surname><given-names>M</given-names></name><name><surname>Minakuchi</surname><given-names>S</given-names></name><name><surname>Uchida</surname><given-names>T</given-names></name><name><surname>Sasaki</surname><given-names>Y</given-names></name></person-group><article-title>Properties of a color-changeable chewing gum used to evaluate masticatory performance</article-title><source>J Prosthodont Res</source><year>2014</year><volume>58</volume><issue>2</issue><fpage>102</fpage><lpage>106</lpage><pub-id pub-id-type="doi">10.1016/j.jpor.2013.12.005</pub-id><pub-id pub-id-type="pmid">24461959</pub-id></element-citation></ref><ref id="CR14"><label>14.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Hama</surname><given-names>Y</given-names></name><name><surname>Kanazawa</surname><given-names>M</given-names></name><name><surname>Minakuchi</surname><given-names>S</given-names></name><name><surname>Uchida</surname><given-names>T</given-names></name><name><surname>Sasaki</surname><given-names>Y</given-names></name></person-group><article-title>Reliability and validity of a quantitative color scale to evaluate masticatory performance using color-changeable chewing gum</article-title><source>J Med Dent Sci</source><year>2014</year><volume>61</volume><issue>1</issue><fpage>1</fpage><lpage>6</lpage><pub-id pub-id-type="pmid">24658959</pub-id></element-citation></ref><ref id="CR15"><label>15.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Hirai</surname><given-names>T</given-names></name><name><surname>Anzai</surname><given-names>T</given-names></name><name><surname>Kaneda</surname><given-names>K</given-names></name><name><surname>Matai</surname><given-names>N</given-names></name><name><surname>Tanaka</surname><given-names>O</given-names></name><name><surname>Ikeda</surname><given-names>Y</given-names></name><name><surname>Uchida</surname><given-names>T</given-names></name></person-group><article-title>Evaluation method for masticatory function of complete denture wearers – by questionnaire with 35 foods listings</article-title><source>J Jpn Prosthodont Soc</source><year>1988</year><volume>32</volume><fpage>1261</fpage><lpage>1267</lpage><pub-id pub-id-type="doi">10.2186/jjps.32.1261</pub-id></element-citation></ref><ref id="CR16"><label>16.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Rosenthal</surname><given-names>AJ</given-names></name></person-group><article-title>Texture profile analysis – How important are the parameters?</article-title><source>J Texture Stud</source><year>2010</year><volume>41</volume><fpage>672</fpage><lpage>684</lpage><pub-id pub-id-type="doi">10.1111/j.1745-4603.2010.00248.x</pub-id></element-citation></ref><ref id="CR17"><label>17.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Pons</surname><given-names>MF</given-names></name><name><surname>Fiszman</surname><given-names>SM</given-names></name></person-group><article-title>Instrumental texture profile analysis with particular reference to gelled systems</article-title><source>J Texture Stud</source><year>1996</year><volume>27</volume><fpage>597</fpage><lpage>624</lpage><pub-id pub-id-type="doi">10.1111/j.1745-4603.1996.tb00996.x</pub-id></element-citation></ref><ref id="CR18"><label>18.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Eichner</surname><given-names>K</given-names></name></person-group><article-title>Renewed examination of the group classification of partially edentulous arches by Eichner and application advices for studies on morbidity statistics</article-title><source>Stomatol DDR</source><year>1990</year><volume>40</volume><issue>8</issue><fpage>321</fpage><lpage>325</lpage><pub-id pub-id-type="pmid">2270610</pub-id></element-citation></ref><ref id="CR19"><label>19.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Horiguchi</surname><given-names>S</given-names></name><name><surname>Suzuki</surname><given-names>Y</given-names></name></person-group><article-title>Screening Tests in Evaluating Swallowing Function</article-title><source>JMAJ</source><year>2011</year><volume>54</volume><issue>1</issue><fpage>31</fpage><lpage>34</lpage></element-citation></ref><ref id="CR20"><label>20.</label><element-citation publication-type="book"><person-group person-group-type="author"><name><surname>Mann</surname><given-names>GD</given-names></name></person-group><source>The Mann Assessment of Swallowing Ability</source><year>2001</year><publisher-loc>Clifton Park</publisher-loc><publisher-name>Singular Thomas Learning</publisher-name></element-citation></ref><ref id="CR21"><label>21.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Hiltunen</surname><given-names>K</given-names></name><name><surname>Vehkalahti</surname><given-names>M</given-names></name><name><surname>Ainamo</surname><given-names>A</given-names></name></person-group><article-title>Occlusal imbalance and temporomandibular disorders in the elderly</article-title><source>Acta Odontol Scand</source><year>1997</year><volume>55</volume><issue>3</issue><fpage>137</fpage><lpage>141</lpage><pub-id pub-id-type="doi">10.3109/00016359709115406</pub-id><pub-id pub-id-type="pmid">9226422</pub-id></element-citation></ref><ref id="CR22"><label>22.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Palmer</surname><given-names>JB</given-names></name><name><surname>Rudin</surname><given-names>NJ</given-names></name><name><surname>Lara</surname><given-names>G</given-names></name><name><surname>Crompton</surname><given-names>AW</given-names></name></person-group><article-title>Coordination of mastication and swallowing</article-title><source>Dysphagia</source><year>1992</year><volume>7</volume><issue>4</issue><fpage>187</fpage><lpage>200</lpage><pub-id pub-id-type="doi">10.1007/BF02493469</pub-id><pub-id pub-id-type="pmid">1308667</pub-id></element-citation></ref><ref id="CR23"><label>23.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Hiiemae</surname><given-names>KM</given-names></name><name><surname>Palmer</surname><given-names>JB</given-names></name></person-group><article-title>Food transport and bolus formation during complete feeding sequences on foods of different initial consistency</article-title><source>Dysphagia</source><year>1999</year><volume>14</volume><issue>1</issue><fpage>31</fpage><lpage>42</lpage><pub-id pub-id-type="doi">10.1007/PL00009582</pub-id><pub-id pub-id-type="pmid">9828272</pub-id></element-citation></ref><ref id="CR24"><label>24.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Saitoh</surname><given-names>E</given-names></name><name><surname>Shibata</surname><given-names>S</given-names></name><name><surname>Matsuo</surname><given-names>K</given-names></name><name><surname>Baba</surname><given-names>M</given-names></name><name><surname>Fujii</surname><given-names>W</given-names></name><name><surname>Palmer</surname><given-names>JB</given-names></name></person-group><article-title>Chewing and food consistency: effects on bolus transport and swallow initiation</article-title><source>Dysphagia</source><year>2007</year><volume>22</volume><issue>2</issue><fpage>100</fpage><lpage>107</lpage><pub-id pub-id-type="doi">10.1007/s00455-006-9060-5</pub-id><pub-id pub-id-type="pmid">17347905</pub-id></element-citation></ref><ref id="CR25"><label>25.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Kagaya</surname><given-names>H</given-names></name><name><surname>Saitoh</surname><given-names>E</given-names></name><name><surname>Shibata</surname><given-names>S</given-names></name><name><surname>Onogi</surname><given-names>K</given-names></name><name><surname>Aoyagi</surname><given-names>Y</given-names></name><name><surname>Inamoto</surname><given-names>Y</given-names></name><name><surname>Ozeki</surname><given-names>M</given-names></name><name><surname>Ota</surname><given-names>K</given-names></name></person-group><article-title>Delayed Pharyngeal Response in CHEW-SWALLOW Does Not Increase Risk of Aspiration in Individuals with Stroke</article-title><source>J Am Geriatr Soc</source><year>2015</year><volume>63</volume><issue>8</issue><fpage>1698</fpage><lpage>1699</lpage><pub-id pub-id-type="doi">10.1111/jgs.13570</pub-id><pub-id pub-id-type="pmid">26289691</pub-id></element-citation></ref></ref-list></back></pmc></record>Pour manipuler ce document sous Unix (Dilib)
EXPLOR_STEP=$WICRI_ROOT/Wicri/Santé/explor/EdenteV2/Data/Pmc/Corpus
HfdSelect -h $EXPLOR_STEP/biblio.hfd -nk 000C46 | SxmlIndent | more
Ou
HfdSelect -h $EXPLOR_AREA/Data/Pmc/Corpus/biblio.hfd -nk 000C46 | SxmlIndent | more
Pour mettre un lien sur cette page dans le réseau Wicri
{{Explor lien
|wiki= Wicri/Santé
|area= EdenteV2
|flux= Pmc
|étape= Corpus
|type= RBID
|clé= PMC:5608775
|texte= What Type of Food Can Older Adults Masticate?: Evaluation of Mastication Performance Using Color-Changeable Chewing Gum
}}
Pour générer des pages wiki
HfdIndexSelect -h $EXPLOR_AREA/Data/Pmc/Corpus/RBID.i -Sk "pubmed:28474132" \
| HfdSelect -Kh $EXPLOR_AREA/Data/Pmc/Corpus/biblio.hfd \
| NlmPubMed2Wicri -a EdenteV2
| This area was generated with Dilib version V0.6.32. |  |