病院における摂食･嚥下機能に対応した食事のﾃｸｽﾁｬｰ

佐世保市内の病院で提供されている摂食･嚥下機能に対応した食事(嚥下調整食)について､ﾃｸｽﾁｬｰ測定により数値化して客観的ﾃﾞｰﾀに基づいた食品条件を把握することを目的に､ﾃｸｽﾁｬｰ測定値からみた食事形態の現状を検討した｡嚥下調整食は､同じ食種であっても硬さ､凝集性､付着性の範囲が広く､食事形態には差があった｡病院における提供の目安とﾃｸｽﾁｬｰ測定値からみた UDF の区分や嚥下食ﾋﾟﾗﾐｯﾄﾞのﾚﾍﾞﾙを比較した結果､UDF の区分4の｢かまなくてよい｣を目安に提供している食事には､測定値からみた区分が3の｢舌でつぶせる｣に該当するものもあり､また､嚥下食ﾋﾟﾗﾐｯﾄﾞのﾚﾍﾞﾙ1･2･3の｢嚥下食｣を目安に提供している食事には､測定値からみたﾚﾍﾞﾙが4の｢移行食｣に該当するものもあった｡We analyzed objective data from texture measurements of food for the dysphagia diet provided in a hospital at the Sasebo city, to examine and understand the current food style in this hospital. Dysphagia diets vary in food style (hardness, cohesiveness, and adhesiveness) even when the same kind of food is provided. We compared the classified UDFs with the levels of the standard dysphagia diets provided at hospitals. We found that some foods in Class 4 (i.e., "Do not need to chew") provided in accordance with the standard regulations, actually belonged to Class 3 (i.e., "can crush with the tongue") based on our texture measurements. Moreover, among the classes of food provided under the "dysphagia diet" standard at levels 1, 2, and 3 of the dysphagia diet pyramid, several foods belonged to level 4 of the "transition diet" standard

食事内容の工夫が咀嚼回数および食事時間や咀嚼行動に対する意識に及ぼす影響

調理法を工夫して食事内容を変えた2種類の被験食において咀嚼回数や食事時間がどのように変化するかを調べた｡また､咀嚼行動に対する意識についてｱﾝｹｰﾄ調査を行い､咀嚼力､咀嚼回数および食事時間との関連性について検討した｡被験食Aに比し､被験食Bは有意にかたい食事内容であった｡咀嚼回数は被験食AとBともに個人差があり､その差はかたい食事内容になるように工夫したBの方が顕著であった｡被験食Aの咀嚼回数と被験食Bの咀嚼回数との間に正の相関を認めた(r=0.799, p<0.01)｡また､被験食Bにおける咀嚼回数と食事時間との間に正の相関を認めた(r=0.727,p<0.01)｡咀嚼力が高い人ほど被験食Aにおける｢自分の一口量｣が多くなり､被験食Bであっても｢噛みごたえ｣をあまり感じていなかった｡We examined how mastication count and meal duration varied with two kinds of test meals that differed in terms of their specifically devised dietary constituents using a cooking method. We also conducted a questionnaire survey to understand the awareness surrounding mastication behavior and examined the relationship between mastication force, mastication frequency, and meal duration. In comparison with test meal A, test meal B contained harder constituents. Mastication frequency was notably different from person to person between test meal A and test meal B owing to the harder constituents in test meal B. A positive correlation existed in terms of mastication count between test meal A and test meal B (r=0.799, p<0.01) . Furthermore, a positive correlation was observed between mastication count and meal duration (r=0.727, p<0.01) for test meal B. The higher the mastication force, the more amount of food per mouthful. Moreover, the chewy feeling was found to be less even in test meal B

摂食･嚥下機能に対応した食事に関するｱﾝｹｰﾄ調査

嚥下調整食の提供を取り巻く現状を把握することで､よりよい嚥下調整食の提供に向けた情報の交換･伝達を行うための基礎資料を得ることを目的に､摂食･嚥下機能に対応した食事に関するｱﾝｹｰﾄ調査を行った｡摂食･嚥下等の判定方法について､病院では嚥下造影検査と嚥下内視鏡検査が多かったが､施設では､水飲みﾃｽﾄ､体調の確認など日頃より行える判定方法が採られていた｡摂食･嚥下訓練の実施頻度や訓練によって改善がみられた患者または利用者の割合は､病院･施設で様々であった｡また､摂食･嚥下障害の原因は､病院では加齢が最も多く､次いで脳血管疾患であった｡一方､施設では認知症が最も多かった｡佐世保市内の病院で提供されている嚥下調整食の種類は､1病院あたり平均10種類､1施設あたり平均6種類であった｡また､一般的に用いられている名称以外に病院･施設独自に細分化した名称をつけているところも複数あった｡To understand the present situation for serving the dysphagia diets and gain the basic knowledge and materials for sharing the information necessary to improve the situation, we carried out a questionnaire-based survey of the foods, regarding eating and swallowing function. While videofluoroscopic and endoscopic examinations of swallowing and endoscopic examination were mostly employed at hospitals, easily administered methods such as the water drinking test and physical examination were adopted at welfare facilities for the elderly. The percentage of patients who showed improvement by the implementation of and training in the eating and swallowing exercise varied among hospitals and facilities. In the hospitals, aging was found to be the most prominent cause of difficulty in swallowing, followed by cerebrovascular diseases. On the contrary, in the facilities, dementia was the most frequent cause. On an average, hospitals provided 10 kinds of dysphagia diets, whereas facilities provided 6 kinds of diets, in Sasebo city. Moreover, several hospitals / facilities employed sub-divided names other than the ones generally used

咀嚼能力低下者に対する食事のテクスチャーからみた食品選択と調理法

本研究では、既存のレシピに基づいて調理した介護食について、テクスチャーを測定後、ユニバーサルデザインフード（UDF）に基づいて分類し、調理上の工夫と食品テクスチャーの調整の現状分析を行った。さらに UDF の「容易にかめる」であったものは、UDF の「歯ぐきでつぶせる」「舌でつぶせる」「かまなくてよい」介護食への展開を検討し、咀嚼能力低下者が摂取できる食品の制約を軽減する調理上の工夫を食品テクスチャーから調べた。①食塊を形成しやすくする②かみ切りやすくする③食品の水分含量を保持・増加するという工夫により UDF の「歯ぐきでつぶせる」「舌でつぶせる」「かまなくてよい」にかたさを調整することができ、咀嚼能力低下者の食生活の維持、向上に寄与することが示唆された

Sphingosine 1-Phosphate (S1P) in the Peritoneal Fluid Skews M2 Macrophage and Contributes to the Development of Endometriosis

Sphingosine 1-phosphate (S1P), an inflammatory mediator, is abundantly contained in red blood cells and platelets. We hypothesized that the S1P concentration in the peritoneal cavity would increase especially during the menstrual phase due to the reflux of menstrual blood, and investigated the S1P concentration in the human peritoneal fluid (PF) from 14 non-endometriosis and 19 endometriosis patients. Although the relatively small number of samples requires caution in interpreting the results, S1P concentration in the PF during the menstrual phase was predominantly increased compared to the non-menstrual phase, regardless of the presence or absence of endometriosis. During the non-menstrual phase, patients with endometriosis showed a significant increase in S1P concentration compared to controls. In vitro experiments using human intra-peritoneal macrophages (MΦ) showed that S1P stimulation biased them toward an M2MΦ-dominant condition and increased the expression of IL-6 and COX-2. An in vivo study showed that administration of S1P increased the size of the endometriotic-like lesion in a mouse model of endometriosis

歯の状態がｱﾝｹｰﾄ調査および色変わりﾁｭｰｲﾝｸﾞｶﾞﾑを用いた高齢者の咀嚼能力に及ぼす影響

高齢者の栄養障害の要因の一つに口腔状態や摂食の問題があり､食物摂取に直接影響するのは咀嚼能力の低下である｡咀嚼能力を簡便にかつ客観的に測定するために､咀嚼の進行に伴い色が変わるﾁｭｰｲﾝｶﾞﾑが開発されたが､この色変わりﾁｭｰｲﾝｶﾞﾑ(ｶﾞﾑ)を用いて高齢者の咀嚼能力を測定した報告は未だ少ない｡本研究では高齢者の咀嚼能力の実情を知るため､ｱﾝｹｰﾄ調査とｶﾞﾑを用いた咀嚼能力の測定を行い､食品の咀嚼の難易と咀嚼能力との関連性について検討を行うこととした｡対象者は､活動力の高い在宅の高齢者65名とした｡ｱﾝｹｰﾄは年齢､歯の状態､かみ合わせ評価度､また19食品について摂食可能かを尋ね､普通に食べられる食品の割合を示す咀嚼機能ｽｺｱを集計した｡咀嚼後のｶﾞﾑの色は､色彩色差計にて咀嚼能力の程度を示す a* 値を測定した｡活動力の高い在宅者では､｢義歯群｣が53.8%を占めており､｢欠損歯あり｣はいなかった｡｢義歯群｣間では､かみ合わせ評価度､咀嚼機能ｽｺｱおよび a* 値はいずれも個人差が大きく､顕著な差は認められなかった｡咀嚼の難易の程度が高い食品ほど､かみにくいため義歯依存性はより高くなっており､食べられないと答えた食品の数は､義歯の装着部位が多くなると増える傾向にあった｡As one of the factors of nutritional disorders among the elderly, they have problems in their oral cavity conditions or eating. It is a decreased mastication ability that directly influences on their food intake. Although a chewing gum which changes its color according to the progression of mastication has been developed to briefly and objectively measure the mastication ability, still a few studies has been reported to measure the mastication ability of the elderly using this color-changeable chewing gum. In this study, we planed to measure the mastication ability of the elderly by using a questionnaire survey and the gum to know the actual condition of their mastication ability and then to conduct a study on the relationship between the difficulty of food mastication and the mastication ability. Regarding study subjects, we incorporated 65 elderly subjects who consisted of highly active home inhabitants. In the questionnaire survey, we inquired about their age, teeth conditions, assessment score levels of teeth occlusion,and eating availabilities for 19 kinds of foods and we then aggregated mastication function scores which showed the ratio of the foods that they could ordinarily eat. Regarding the color of the chewing gum after mastication, we measured values of a* which showed the degree of the mastication ability with a color difference meter. Among the highly active home inhabitants,“a group of subjects with some dentures”accounted for 53.8% and a“group of subjects with some lost teeth”in a“group of subjects with only natural teeth”was not present. In the mean while, among the“other groups of subjects with some dentures”, no significant difference was noted, because each the assessment score levels of teeth occlusion, the mastication function scores and values of a* had great differences between individuals. When the number of wearing areas of dentures increases, the numbers of foods for which the study subjects answered that they could not eat tended to increase, because a food with a higher difficulty of food mastication required higher degree of dependence on dentures due to more difficult mastication

高齢者の年代､歯の状態および居住形態が咀嚼能力に及ぼす影響

高齢者の年代､歯の状態および居住形態が咀嚼能力にいかなる影響を及ぼすのかを明らかにすることを目的として研究を行った｡咀嚼能力は､ｱﾝｹｰﾄ調査によるかみ合わせ評価度および咀嚼機能ｽｺｱと､色変わりﾁｭｰｲﾝｶﾞﾑを用いた a* 値から検討した｡その結果､年代が増すと咀嚼機能ｽｺｱおよび a* 値はともに低下した｡義歯の装着部分が増すと､また欠損歯を有すると咀嚼機能ｽｺｱおよび a* 値はいずれも低値を示した｡活動力の高い在宅の高齢者の咀嚼機能ｽｺｱおよび a* 値に比し､施設入所および通所の高齢者のそれらの値はともに低かった｡このことから､加齢､義歯数の増加､欠損歯を有することや日頃やわらかいものを食べることの多い食習慣はいずれも咀嚼能力の低下の要因となることが示唆された｡An investigation was made with the elderly to clarify what kinds of influence do teeth status and living style have on the chewing ability. The chewing ability was estimated based on the scores of teeth occlusion and chewing function evaluated through a questionnaire survey, and a* value determined using color-changeable chewing gum. Results of the present survey demonstrated that the scores of chewing function and a* value were both decreased with aging. When an area wearing a denture is increased or a missing teeth is present, the scores of both chewing function and a* value were lowered. The scores of chewing function and a* value were higher for the in-home elderly whose daily activity is high than the elderly living in care service facility or usually visiting it. These findings suggest that aging, an increase of the number of denture / the presence of missing teeth and eating habits to take soft foods might cause a lowering of chewing ability for the elderly

大量調理機器を用いた湿式加熱が野菜類の性状に与える影響

食品に適した大量調理機器を選択し、最適な調理条件を設定することで、嗜好・品質特性を高め、給食の調理における効率化および標準化に繋げる基礎資料を得ることを目的とした。大量調理機器は、鍋、スチコン、バリオを用い、湿式加熱による食品の調理特性を検討した。スチコンが最も加熱時間を要した。スチコン加熱は、湿式加熱のうち蒸気による凝縮熱伝導と熱風蒸し操作であるため、食材の表面から内部へ温度の上昇は緩慢となり、均一な加熱となることで野菜の糖度は高かった。バリオ加熱は、加熱初期の温度上昇が早く、デンプンの糊化が急速に進み、じゃがいもではビタミンＣが失われにくかったが、にんじんでは高温で加熱される時間が長くなりビタミンＣの分解が進んだ

高齢者施設入所者および通所者における歯の状態からみた咀嚼能力

ｹｱﾊｳｽ入所者､ﾃﾞｲｻｰﾋﾞｽ通所者および介護老人福祉施設入所者を対象に､主観的な咀嚼評価としてかみ合わせ評価度および咀嚼機能ｽｺｱをｱﾝｹｰﾄ調査により､客観的な咀嚼能力の評価を色変わりﾁｭｰｲﾝｸﾞｶﾞﾑにより測定し､高齢者の咀嚼能力の実情について検討を行った｡(1)ｱﾝｹｰﾄ調査では､｢義歯群｣間に有意差を認めなかった｡また｢自歯群｣の｢自歯欠損あり｣の評価は個人差が顕著であった｡それに比し､｢自歯群｣の｢自歯欠損なし｣の評価が最も高く個人差は小さかった｡(2)咀嚼能力 a* 値の平均値について､｢義歯群｣では､｢一部｣と｢上下全部｣との間に有意差を認め(p<0.05)､｢上下全部｣の a* 値が低かった｡また｢自歯群｣の｢自歯欠損なし｣の a* 値に比し､｢義歯群｣の｢上全部と一部｣および｢上下全部｣の a* 値はともに有意に低く(p<0.05および p<0.01)､義歯の装着部分が多いと a* 値は低下した｡一方｢自歯群｣では､｢自歯欠損あり｣の a* 値は｢自歯欠損なし｣の a* 値に比し有意に低く(p<0.05)､欠損歯を有すると a* 値は低下した｡A questionnaire survey on food mastication ability and measurement of its mastication ability using color-changeable chewing gum were made with elderly people to clarify actual status of elderly\u27s mastication ability. Elderly persons living in nursing care homes, those receiving day care service as an outpatient and those living in long term care welfare facilities for the elderly were used as the subjects. The results were as follows. (1)There was no significant difference in the degree of dental occlusion among denture-wearing groups. In the own-teeth groups, there were marked individual differences in dental occlusion among persons having some defected teeth. Whereas the degree of dental occlusion was highest in the own-teeth group with no defected own teeth and their individual differences were smallest in the group. (2)In the denture-wearing group, the mean value of mastication ability(a*)was significantly different(p<0.05)between person group whose upper and lower jaws were partly occupied with dentures and that whose jaws were all occupied with dentures, and the value was lower in the latter group than the former. When compared with persons having no defected teeth in the own-teeth group, either of value a* for persons whose upper and lower jaws were all occupied by dentures and that for persons whose upper jaw and a part of lower one were occupied with dentures was significantly lower(p<0.05 and p<0.01). This indicated that the value a* was decreased as an increase in denture-occupied area. On the other hand, the value a* was significantly lower(p<0.05)in persons having some defected teeth than those with no defected ones in the own-teeth group, indicating that the value a* was decreased by the presence of defected teeth