Role of fluid cohesiveness in safe swallowing

Understanding the oral processing of solid foods: Insights from food structure

Understanding the relationship between the structure of solid foods and their oral processing is paramount for enhancing features such as texture and taste and for improving health-related factors such as management of body weight or dysphagia. This paper discusses the main aspects of the oral processing of solid foods across different categories: (1) oral physiology related to chewing, (2) in-mouth food transformation, (3) texture perception, and (4) taste perception, and emphasis is placed on unveiling the underlying mechanisms of how food structure influences the oral processing of solid foods; this is exemplified by comparing the chewing behaviors for a number of representative solid foods. It highlights that modification of the texture/taste of food based on food structure design opens up the possibility for the development of food products that can be applied in the management of health.

Influence of thickening agents on rheological properties and sensory attributes of dysphagic diet

Dysphagia is the difficulty during the progression of the bolus from the mouth to the stomach. Modifying the texture of the food is a fundamental factor for safe swallowing in patients with dysphagia since inadequate consistency can result in complications. To personalize and develop diets for dysphagia, understanding, and controlling the rheological and sensory properties of thickeners is useful. This review examines the different types of thickeners used to modify the texture of foods, as well as their influence on rheological properties and sensory attributes to efficiently manage the diet in dysphagia. The study discusses characteristics such as: hardness, viscosity, viscoelasticity, as well as sensory attributes related to rheology. The thickeners xanthan gum, methylcellulose, carboxymethylcellulose, guar gum, linseed, and chia, carboxymethylated curdlan, and konjac glucomannan were reviewed in this work. Sensory evaluations of different foods have already been carried out on some products such as: meats, carrots, soups, pates, and timbales with their modified textures. The sensory attributes measured among hydrocolloids are strongly correlated with rheological parameters. Dysphagic diets should have less hardness and adherence, but with adequate cohesiveness to facilitate chewing, swallowing to protect from aspiration and reduction of residues in the oropharynx. The use of a single type of thickener may not be ideal, their mixtures and synergistic effect can improve the viscous and elastic characteristics of foods, to obtain safe food to swallow and to improve the sensory interest of dysphagic patients. Personalized recommendations with follow-up on swallowing approaches, respecting patient's individuality, explaining thickening agents' differences would be pertinent.

Molar mass effect in food and health

It is demanded to supply foods with good quality for all the humans. With the advent of aging society, palatable and healthy foods are required to improve the quality of life and reduce the burden of finance for medical expenditure. Food hydrocolloids can contribute to this demand by versatile functions such as thickening, gelling, stabilising, and emulsifying, controlling texture and flavour release in food processing. Molar mass effects on viscosity and diffusion in liquid foods, and on mechanical and other physical properties of solid and semi-solid foods and films are overviewed. In these functions, the molar mass is one of the key factors, and therefore, the effects of molar mass on various health problems related to noncommunicable diseases or symptoms such as cancer, hyperlipidemia, hyperglycemia, constipation, high blood pressure, knee pain, osteoporosis, cystic fibrosis and dysphagia are described. Understanding these problems only from the viewpoint of molar mass is limited since other structural characteristics, conformation, branching, blockiness in copolymers such as pectin and alginate, degree of substitution as well as the position of the substituents are sometimes the determining factor rather than the molar mass. Nevertheless, comparison of different behaviours and functions in different polymers from the viewpoint of molar mass is expected to be useful to find a common characteristics, which may be helpful to understand the mechanism in other problems.

Thickened liquids: do they still have a place in the dysphagia toolkit?

PURPOSE OF REVIEW

The use of commercially or naturally thickened liquids is a well-established treatment for patients with dysphagia to fluids, the aim of which is to improve swallow safety by minimizing risk of aspiration. Although the most recent systematic reviews conclude that this treatment lacks evidential support and leads to patient-reported worsening health and quality of life, thickened liquids continue to be used with patients with dysphagia across clinical settings. This review briefly summarizes the evidence and considers potential reasons for the apparent mismatch between the evidence and clinical practice.

RECENT FINDINGS

Continuing practice with thickened liquids is influenced by a range of factors, including gaps in clinical knowledge, inadequate patient involvement, a culture of common practice and a reliance on invalid surrogate studies or research lacking a credible association between thickened liquids and clinically meaningful endpoints.

SUMMARY

While awaiting further research, clinical decision-making about thickened liquids can be improved by considering the evidence of clinically meaningful endpoints, promoting shared decision-making with patients and underpinning practice with knowledge about the complex relationship between dysphagia, aspiration and pneumonia.

Texture and texture assessment of thickened fluids and texture-modified food for dysphagia management

Thickened fluids and texture-modified foods are commonly used in the medical management of individuals who suffer from swallowing difficulty (known as dysphagia). However, how to reliably assess texture properties of such food systems is still a big challenge both to industry and to academic researchers. This article aims to identify key physical parameters that are important for objective assessment of such properties by reviewing the significance of rheological or textural properties of thickened fluids and texture-modified foods for swallowing. Literature reviews have identified that dominating textural properties in relation to swallowing could be very different for thickened fluids and for texture-modified foods. Important parameters of thickened fluids are generally related with the flow of the bolus in the pharyngeal stage, while important parameters of texture-modified foods are generally related with the bolus preparation in the oral stage as well as the bolus flow in the pharyngeal stage. This review helps to identify key textural parameters of thickened fluids and texture-modified foods in relation to eating and swallowing and to develop objective measuring techniques for quality control of thickened fluids and texture-modified foods for dysphagia management.

Roughness-Induced Friction on Liquid Foams

Complex liquids flow is known to be drastically affected by the roughness condition at the interfaces. We combined stresses measurements and observations of the flow during the motion of different rough surfaces in dry liquid foams. We visually show that three distinct friction regimes exist: slippage, stick-slip motion, and anchored soap films. Our stress measurements are validated for slippage and anchored regimes based on existing models, and we propose a leverage rule to describe the stresses during the stick-slip regime. We find that the occurrence of the stick-slip or anchored regimes is controlled by the roughness factor, defined as the ratio between the size of the surface asperities and the radius of curvature of the Plateau borders.

The Importance of Extensional Rheology in Bolus Control during Swallowing

Thickened fluids are commonly used in the medical management of individuals who suffer swallowing difficulty (known as dysphagia). Previous studies have shown that the rheological properties of a liquid affect the flow behavior of the bolus in swallowing, such as pharyngeal transit time. While there is no doubt that shear rheology is a highly important factor for bolus flow, it is suspected that extensional properties of a liquid bolus also plays an important role in swallowing, due to elongation of the bolus as it flows through the oropharynx. Our aim in this work was to observe the effect of extensional viscosity on pharyngeal transit time and elongation of the bolus during swallowing. Eight samples of thickened liquid barium that were shear-controlled, but varied in extensional viscosity and two samples that were extensional-controlled, but varied in shear viscosity were swallowed by eight healthy individuals. Data were collected under lateral view of videofluoroscopy swallow study (VFSS); measures of pharyngeal transit time and the ratio of the length to the width of the bolus on the frame of Upper Esophageal Sphincter (UES) opening were taken from the VFSS recordings. It was observed that the pharyngeal transit time generally increases when the fluids are thickened to higher IDDSI consistency. Additionally, higher extensional viscosity fluids reduced the elongation of the bolus during swallowing, thus potentially reducing the risk of post-swallow residue due to bolus breakage. This study confirmed the relevance of the extensional viscosity of the bolus in swallowing.

Shape up! How shape, size and addition of condiments influence eating behavior towards vegetables

Practical approaches to increase consumption of healthy foods such as vegetables are needed. Controlling eating rate is a promising strategy, since faster eating rates have been related to higher food intake. Food properties can be modified to influence eating rates, but little is known about the impact of vegetable dimensions and condiment additions on eating rates of vegetables. This study determined the influence of shape, size and condiment properties on eating behavior towards carrots. Eating behavior (mastication time, number of chews, chewing frequency, eating rate) was determined for carrots with same total weight but different shapes (cube, julienne), and varying in size, number of pieces and aspect ratio. Carrots presented in one large cube required the lowest mastication effort (shortest mastication time, fewest chews) among all pre-cut carrots. Carrot cubes required less mastication effort leading to higher eating rates than carrots julienne. To investigate the effect of condiment addition on eating behavior towards carrots, mayonnaises varying in fat content and viscosity were combined with carrots, and mastication behavior and bolus properties were determined. Mayonnaises, in particular those with high fat content or low viscosity, contributed to faster bolus formation of carrots. Carrots were swallowed with less particles of larger sizes when mayonnaises were added. These results indicate that a specific particle size is not a prerequisite to induce swallowing, and that other bolus properties such as lubrication or cohesiveness trigger the urge to swallow. We conclude that eating behavior towards carrots can be controlled by relatively small changes in both carrot and condiment properties. To increase carrot intake by increasing eating rate, we suggest to avoid cutting of carrots or to add condiments, which could be an effective strategy to increase vegetable consumption or to decrease mastication effort to target the elderly population.

Characterizing the Dynamic Textural Properties of Hydrocolloids in Pureed Foods-A Comparison Between TDS and TCATA

Pureed foods, a compensatory diet for dysphagia, require the incorporation of hydrocolloids in order to be swallowed safely. The effect of hydrocolloid addition on textural dynamics of pureed foods has not yet been investigated. Starch and xanthan were added to levels that allowed products to meet the criteria of the International Dysphagia Diet Standardization Initiative. Nine pureed carrot matrices made with two concentrations of starch, xanthan, and their blends were characterized for textural evolution using two dynamic sensory techniques: Temporal Dominance of Sensations (TDS) and Temporal Check-All-That-Apply (TCATA). Each test, with four replications, was conducted with 16 panelists. Results indicate that purees were divided into two groups based on sensory responses--grainy and smooth were the primary differentiating attributes for these two groups. Grainy was associated with starch-added samples, while samples with xanthan (alone and in blends) were smooth and slippery. For both groups, thickness was perceived during the first half of processing, adhesiveness in the second half of oral processing, and mouthcoating was perceived toward the end of processing. A comparison of results from these tests showed that both TDS and TCATA gave similar information about texture dynamics and product differentiation of pureed foods.