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Aii S, Fujishima I, Shigematsu T, Ohno T, Kunieda K, Yamawaki M. Sliced Jelly Whole Swallowing Reduces Deglutition Risk: A Novel Feeding Method for Patients with Dysphagia. Dysphagia 2024:10.1007/s00455-024-10674-6. [PMID: 38568345 DOI: 10.1007/s00455-024-10674-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 01/18/2024] [Indexed: 04/24/2024]
Abstract
Texture modification in the form of gels or jellies is used for patients with dysphagia. For over 20 years, our group has been using gelatin jellies, a type of gel, as a starting diet for patients with dysphagia. Gelatin jellies are served in a small-sliced form and swallowed whole. In sliced jelly whole swallowing (SJWS), sliced gelatin jelly (SGJ) passes through the pharynx in one lump without collapsing. This study aimed to examine the usefulness of SJWS. We analyzed the images of videofluoroscopic swallowing studies performed using the normalized residue ratio scale (NRRSv: vallecula, NRRSp: pyriform sinus), the penetration-aspiration scale (PAS), and pharyngeal transit time (PTT) in 50 patients with dysphagia and compared the results in a prospective study. SJWS had significantly less residue in both NRRSv and NRRSp than in moderately thickened liquid swallowing. No significant differences in PAS scores were found between SGJ and moderately thickened liquid. Additionally, no significant differences in PTT scores were noted between the two. This study demonstrated the usefulness of SJWS in improving swallowing safety in patients with dysphagia. Further studies are needed to evaluate the reproducibility of the test, the comparison of SGJ with other thickened liquids, and the safety of SJWS for different diseases.
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Affiliation(s)
- Seijiro Aii
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, 1-6-1 Wagokita, Chuo-Ku, Hamamatsu City, Shizuoka, 433-8511, Japan.
- Department of Medical Education Research and Development, Graduate School of Medicine and Dentistry, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Ichiro Fujishima
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, 1-6-1 Wagokita, Chuo-Ku, Hamamatsu City, Shizuoka, 433-8511, Japan
| | - Takashi Shigematsu
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, 1-6-1 Wagokita, Chuo-Ku, Hamamatsu City, Shizuoka, 433-8511, Japan
| | - Tomohisa Ohno
- Department of Dentistry, Hamamatsu City Rehabilitation Hospital, Hamamatsu City, Shizuoka, Japan
| | - Kenjiro Kunieda
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, 1-6-1 Wagokita, Chuo-Ku, Hamamatsu City, Shizuoka, 433-8511, Japan
- Department of Neurology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Masanaga Yamawaki
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, 1-6-1 Wagokita, Chuo-Ku, Hamamatsu City, Shizuoka, 433-8511, Japan
- Department of Medical Education Research and Development, Graduate School of Medicine and Dentistry, Tokyo Medical and Dental University, Tokyo, Japan
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2
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Bak J, Kim SE, Won D, Yoo B. Effect of Setting Time on Viscosity Stability of Xanthan Gum- and Starch-Based Thickened Beverages for Patients with Dysphagia: Comparison of IDDSI Syringe Flow Test and Line-Spread Test. Prev Nutr Food Sci 2024; 29:87-92. [PMID: 38576878 PMCID: PMC10987383 DOI: 10.3746/pnf.2024.29.1.87] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 12/05/2023] [Accepted: 12/14/2023] [Indexed: 04/06/2024] Open
Abstract
Because the viscosity of thickened beverages prepared with thickeners gradually changes before consumption, achieving their desired viscosity is important for managing dysphagia. This study aimed to investigate the viscosity changes of thickened beverages (water, orange juice, and milk) prepared with xanthan gum (XG)- and starch-based commercial thickeners over time using the syringe flow test (SFT) and line-spread test (LST). The LST values of beverages stabilized more quickly (≤1.5 h) than the SFT values (2.0∼3.5 h) at level 2 (mildly thick), whereas the opposite finding was observed at level 3 (moderately thick). After stabilization in a water system, SFT and LST yielded similar results. However, the SFT values of orange juice and milk thickened with XG-based thickener exceeded the reference values at level 2 and gradually increased at level 3. These results may be attributed to particulates interrupting fluid flow from the small tip of the syringe and the high friction force caused by the contact between the thickened sample and the syringe surface. The results suggest that the LST method is more reliable than the SFT method in clearly distinguishing between levels 2 and 3 of thickened beverages and demonstrate that the viscosity measurements of thickened beverages over time after preparation were strongly influenced by the measurement tools used for predicting the thickness level.
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Affiliation(s)
- Juneha Bak
- Department of Food Science and Biotechnology, Dongguk University-Seoul, Gyeonggi 10326, Korea
| | - Seung-Eon Kim
- Department of Food Science and Biotechnology, Dongguk University-Seoul, Gyeonggi 10326, Korea
| | - Damhee Won
- Department of Food Science and Biotechnology, Dongguk University-Seoul, Gyeonggi 10326, Korea
| | - Byoungseung Yoo
- Department of Food Science and Biotechnology, Dongguk University-Seoul, Gyeonggi 10326, Korea
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3
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Mintel M, Lee J, Teoman B, Potanin A. Visual assessment and rheological characterization of shape retention of products on a surface. J Texture Stud 2023; 54:626-632. [PMID: 37318150 DOI: 10.1111/jtxs.12783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/24/2023] [Accepted: 05/28/2023] [Indexed: 06/16/2023]
Abstract
A device to measure the height loss of a sample extruded from a syringe on a surface is described thus emulating toothpaste extrusion from a tube with the goal to predict shape retention of the extruded ribbon. Correlations with rheological tests are considered with a special focus on experiments more likely to be implementable in an industrial environment. In agreement with previous studies, the instantaneous viscosity maximum measured in a stress ramp test is a good predictor of ribbon height loss. Up- and down-shear flow curves of the thixotropic loop were fitted with a generalized Casson equation and the correlations of the fitting parameters with the height loss were also considered. Yield stress extracted from the up-shear flow curve as well as the shape of the curve is found to define the ribbon height loss as well as the degree of thixotropy which may be quantified by the width of the loop or simply as the ratio of viscosities at low shear rate.
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Affiliation(s)
- Mark Mintel
- Colgate-Palmolive Company, Piscataway, New Jersey, USA
| | - Jonghun Lee
- Colgate-Palmolive Company, Piscataway, New Jersey, USA
| | - Baran Teoman
- Colgate-Palmolive Company, Piscataway, New Jersey, USA
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4
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Yasuda T, Shimokasa K. Improved system for measuring rheological properties of thickened liquid using an inclined parallel plate and optical sensor. J Texture Stud 2023; 54:510-520. [PMID: 37144497 DOI: 10.1111/jtxs.12758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 04/06/2023] [Accepted: 04/08/2023] [Indexed: 05/06/2023]
Abstract
The purpose of this study was to improve the method of using an inclined parallel plate (IPP) in directly estimating the yield stressτ iy and evaluating the properties of a thickened liquid. The flow curve of the relationship between the shear rate and shear stress of a liquid thickened with a xanthan gum agent was predicted using the Herschel-Bulkley fluid model ( τ = τ y + k γ ˙ n - 1 ). We supposed that the yield stressτ y and the result of a line spread test (LST) indicate the deformation state and the flow state of shear stress ( k γ ˙ n - 1 ), respectively.τ iy , the yield stressτ ry estimated adopting a rotational viscometer and LST, was investigated for three liquids thickened with xanthan gum at four concentrations (C) at intervals of 0.5 wt% within the range 0.5-2.0 wt%. Linear plots of the relations of C versusτ iy andτ ry and the LST show that with an increase in C , the resistance force (τ ry andτ iy ) increases until flow starts, after which viscosity increases. We suggest that yield stressτ iy estimated with the IPP method effectively indicates the rheological properties of thickened liquids.
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Affiliation(s)
- Toshitaka Yasuda
- Department of Electronic Engineering, Tokyo National College of Technology, Hachioji, Japan
| | - Kenji Shimokasa
- Course of System Engineering, Division of Industrial Technology, Tsukuba University of Technology, Tsukuba, Japan
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5
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Ibañez FC, Merino G, Marín-Arroyo MR, Beriain MJ. Instrumental and sensory techniques to characterize the texture of foods suitable for dysphagic people: A systematic review. Compr Rev Food Sci Food Saf 2022; 21:2738-2771. [PMID: 35481665 DOI: 10.1111/1541-4337.12957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 03/14/2022] [Accepted: 03/18/2022] [Indexed: 11/29/2022]
Abstract
The interest to characterize texture-modified foods (TMFs) intended for people with oropharyngeal dysphagia (OD) has grown significantly since 2011. Several instrumental and sensory techniques have been applied in the analysis of these foods. The objective of the present systematic review was to identify the most appropriate techniques, especially for the food industry and clinical setting. The search was carried out in three online databases according to the "Preferred Reporting Items for Systematic Reviews and Meta-Analyses" (PRISMA). Across the multiple trials reviewed, Texture Profile Analysis and the Uniaxial Compression Test were most used as the instrumental technique for solid foods, and the Back Extrusion Test for fluid and semisolid foods. All trials used descriptive analysis as the sensory technique. However, the experimental conditions of the trials lacked standardization. Consequently, the results of the trials were not comparable. To properly characterize the texture of TMFs intended for OD by each technique, an international consensus is needed to establish standardized experimental conditions. Methods based on these techniques should also be validated by collaborative studies to verify repeatability, replicability, and reproducibility.
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Affiliation(s)
- Francisco C Ibañez
- Institute for Sustainability and Food Chain Innovation, Universidad Pública de Navarra, Pamplona, Spain
| | - Gorka Merino
- Institute for Sustainability and Food Chain Innovation, Universidad Pública de Navarra, Pamplona, Spain
| | | | - María José Beriain
- Institute for Sustainability and Food Chain Innovation, Universidad Pública de Navarra, Pamplona, Spain
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6
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Sei H, Yasuda K, Asayama R, Tanaka K, Oba S, Shidahara M, Hato N. Development of a simple evaluation instrument for liquid thickness measurement. J Texture Stud 2022; 53:81-85. [PMID: 34994993 DOI: 10.1111/jtxs.12660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 11/03/2021] [Accepted: 12/28/2021] [Indexed: 11/27/2022]
Abstract
Simple methods, such as the line spread test (LST), are often used to evaluate thickened liquids in clinical settings. Although it is desirable for these simple methods to be rapid, even the LST requires approximately 1 min to complete the evaluation. Herein, we aimed to shorten this time by developing a new simple instrument for evaluating thickened liquids considering the fluid engineering perspective with improved funnel design and evaluation methods. A thickened liquid was prepared with a xanthan gum-based thickening agent and water. Samples with viscosities of approximately 50, 150, 300, and 500 mPa∙s were prepared. For evaluation, 30 ml of the sample was injected manually with the outlet closed. The outlet was then opened to allow the liquid to fall as soon as the evaluation began. The time taken for the water surface of the liquid to move 50 mm from the starting point to the target point was measured eight times using a stopwatch, and the average was taken as the evaluation time. The instrument took 2.22-3.29 s, 3.29-9.16 s, and 9.16-23.14 s to classify mildly thick, moderately thick, and extremely thick samples, respectively. This method enabled extremely thick samples to be evaluated in 23 s, which is 27 s less than the time taken by the conventional funnel method. Verification results showed that this developed evaluation instrument for thickened liquids could perform classification according to the criteria of the Japanese Dysphagia Diet 2013. We aim to improve its design for clinical use in the future.
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Affiliation(s)
- Hirofumi Sei
- Department of Otolaryngology, School of Medicine, Ehime University, Toon-City Shitsukawa, Ehime, Japan
| | - Kazunori Yasuda
- Department of Mechanical Engineering, Graduate School of Science and Engineering, Ehime University, Toon-City Shitsukawa, Ehime, Japan
| | - Rie Asayama
- Department of Otolaryngology, School of Medicine, Ehime University, Toon-City Shitsukawa, Ehime, Japan
| | - Kaori Tanaka
- Department of Otolaryngology, School of Medicine, Ehime University, Toon-City Shitsukawa, Ehime, Japan
| | - Shiori Oba
- Department of Community Health System Nursing, Ehime University Graduate School of Medicine, Toon-City Shitsukawa, Ehime, Japan
| | - Mutsumi Shidahara
- Department of Otolaryngology, School of Medicine, Ehime University, Toon-City Shitsukawa, Ehime, Japan
| | - Naohito Hato
- Department of Otolaryngology, School of Medicine, Ehime University, Toon-City Shitsukawa, Ehime, Japan
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7
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Yasuda T. Improvement of simplified inclined plane test for evaluation of thickened liquids by using optical sensor. J Texture Stud 2021; 53:86-92. [PMID: 34535896 DOI: 10.1111/jtxs.12632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 08/06/2021] [Accepted: 09/13/2021] [Indexed: 11/30/2022]
Abstract
The thickening management index for food for dysphagia is important in enabling recognition of the rheological properties of thickened liquids, including their static and dynamic properties. One of the static properties of these liquids is the yield stress. An improvement to the simplified inclined plane test is proposed here that involves use of an automatic system for measurement of the displacements of thickened liquids on an inclined plate. The aim of this study is to investigate the relationship between the displacements of the thickened liquids and the variable thickener concentrations using an optical sensor. To measure the displacement of each thickened liquid on a clear inclined plate, an optical sensor that has a 12-mm-long light receiving surface is selected to form a one-dimensional position-sensitive detector (1D-PSD) under the clear inclined plate. The relationship between the angle of inclination of the plate θ at which the maximum voltage occurred in the 1D-PSD and five thickener (xanthan gum) concentrations c, ranging from 1.0 to 3.0 wt% in steps of 0.5 wt%, was investigated. It was confirmed that an approximately linear plot was obtained under the condition that θ = 8.24 c + 0.18, with the correlation R = .99 (for n = 7). This result indicated that the optical sensor composed of the 1D-PSD can measure the displacements of thickened liquids with various thickener concentrations on the clear inclined plate automatically.
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Affiliation(s)
- Toshitaka Yasuda
- Department of Electronic Engineering, Tokyo National College of Technology, Tokyo, Japan
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8
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Schubert DW. Simple Model for the Spreading of Inks in Bioprinting—Revealing Relevant Scaling Laws—Part I Theory. MACROMOL THEOR SIMUL 2021. [DOI: 10.1002/mats.202100032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Dirk W. Schubert
- Faculty of Engineering, Department of Materials Science, Institute of Polymer Materials Friedrich‐Alexander University Erlangen‐Nürnberg (FAU) Martensstraße 7 Erlangen 91058 Germany
- Bavarian Polymer Institute Key Lab Advanced Fiber Technology Dr.‐Mack‐Straße 77 Fürth 90762 Germany
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9
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Relationship between Syringe Flow Measurements and Viscosity of Nectar-Thick Beverages for Dysphagia Management. Foods 2021; 10:foods10091981. [PMID: 34574091 PMCID: PMC8465823 DOI: 10.3390/foods10091981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 08/20/2021] [Accepted: 08/21/2021] [Indexed: 11/17/2022] Open
Abstract
Commercial cold beverages thickened with a xanthan gum (XG)-based food thickener were examined at different thickness levels by using the simple, cost-effective syringe flow test (SFT) developed by the International Dysphagia Diet Standardization Initiative (IDDSI). We prepared cold thickened beverage (CTB) samples with different thickener concentrations and measured them by extrapolating the viscosity range (51–350 mPa·s) for nectar-like consistency. CTBs were also measured via the line-spread test (LST), and the flow distance value (cm) by LST and the volume remaining (mL) in the syringe by SFT was correlated with the apparent viscosity (ηa,50). Plots comparing ηa,50 with SFT or LST values showed good exponential relationships between the measurements. The SFT showed a better relationship (R2 = 0.928) than LST (R2 = 0.825), indicating that the former can predict the viscosity better in the range for nectar-like consistency. In particular, the SFT showed a significant difference (R2 = 0.964) compared to the LST (R2 = 0.709) for thickened protein-based beverages. These results suggest that the SFT using the IDDSI methodology is a more suitable instrument than the LST for accurately evaluating the viscosity of XG-based CTBs with nectar-like consistency.
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10
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Kang W, Chung J, Lee J, Jung KI, Yoo WK, Ohn SH. The influence of pharyngeal width on post-stroke laryngeal aspiration. NeuroRehabilitation 2021; 49:435-444. [PMID: 34308916 DOI: 10.3233/nre-210120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Laryngeal penetration, which is a less serious form of aspiration, should be considered in patients with stroke to ensure early detection of risk of laryngeal aspiration and prevention of pneumonia. OBJECTIVE As a follow-up to a previous study that demonstrated the association of pharyngeal width to laryngeal aspiration, the present study sought to determine whether the pharyngeal width was related to not only laryngeal aspiration but also laryngeal penetration in patients with deglutition disorder following stroke. METHODS The pharyngeal width on the roentgenogram was measured and compared based on the severity of aspiration. Moreover, the optimal cut-off points were determined for predicting the penetration and aspiration so that the difference between the penetration and the aspiration could be elucidated. RESULTS The pharyngeal width of the patients was wider than the controls. The increase of the pharyngeal width by aspiration severity was more evident in the patients with chronic and right cerebral stroke. The optimal cut-off point of the pharyngeal width was approximately 1 mm lesser for the prediction of penetration than for aspiration. CONCLUSIONS The pharyngeal width could be an ancillary method for detecting penetration and aspiration in stroke patients.
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Affiliation(s)
- Wonil Kang
- Department of Physical Medicine and Rehabilitation, Hallym University Sacred Heart Hospital, Hallym University Collegeof Medicine, Gwanpyeong-ro Beon-gil Dongan-gu Anyang Gyeonggi-do Republic of Korea
| | - Jane Chung
- Department of Physical Medicine and Rehabilitation, Hallym University Sacred Heart Hospital, Hallym University Collegeof Medicine, Gwanpyeong-ro Beon-gil Dongan-gu Anyang Gyeonggi-do Republic of Korea
| | - Jeongeun Lee
- Department of Physical Medicine and Rehabilitation, Hallym University Sacred Heart Hospital, Hallym University Collegeof Medicine, Gwanpyeong-ro Beon-gil Dongan-gu Anyang Gyeonggi-do Republic of Korea
| | - Kwang-Ik Jung
- Department of Physical Medicine and Rehabilitation, Hallym University Sacred Heart Hospital, Hallym University Collegeof Medicine, Gwanpyeong-ro Beon-gil Dongan-gu Anyang Gyeonggi-do Republic of Korea
| | - Woo-Kyoung Yoo
- Department of Physical Medicine and Rehabilitation, Hallym University Sacred Heart Hospital, Hallym University Collegeof Medicine, Gwanpyeong-ro Beon-gil Dongan-gu Anyang Gyeonggi-do Republic of Korea
| | - Suk Hoon Ohn
- Department of Physical Medicine and Rehabilitation, Hallym University Sacred Heart Hospital, Hallym University Collegeof Medicine, Gwanpyeong-ro Beon-gil Dongan-gu Anyang Gyeonggi-do Republic of Korea
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11
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Poursani P, Razavi SM, Norouzi A. Numerical investigation of a two-phase system on swallowing behavior in dysphagia: A case study on cress seed gum–xanthan gum thickened liquids. FOOD AND BIOPRODUCTS PROCESSING 2021. [DOI: 10.1016/j.fbp.2021.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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12
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Chen W, Hadde EK, Chen J. Development of a ball back extrusion technique for texture analysis of fluid food. J Texture Stud 2021; 52:461-469. [PMID: 34050528 DOI: 10.1111/jtxs.12613] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 05/04/2021] [Indexed: 11/30/2022]
Abstract
Textural properties of a food not only influence consumers' sensory preference of the product but also more importantly influence the strategy of food oral manipulation. Availability of reliable instrumental techniques has always been sought by food industry for proper assessment of food texture both in lab and online quality control. In this work a set of ball back extrusion (BBE) geometries with various ball/cup diameters (38/40, 35/40, 31.5/40, 24.5/28, all in mm) have been assessed as a fixture of a standard texture analyzer for flowability and consistency test of fluid foods. The feasibility of the new design has been tested against plate back extrusion (PBE), a current standard, for a set of fluid food materials (3 near Newtonians and 2 non-Newtonians). Pressing force and apparent maximum stress were used to quantify the flowability of fluid materials. It was observed that both techniques were able to reflect the rheological nature of the samples and were able to distinguish flowability for both Newtonian and Non-Newtonian fluids. However, the new design shows advantages against the plate back extrusion with much improved stability. Results show that BBE could replace the conventional plate-back extrusion to evaluate the flow properties of fluid foods in an industrial environment. The geometries of 35/40 or 24.5/28 ball/cup diameters (aspect ratio 0.875) were shown to give most satisfactory performance. The device is specifically suitable for texture classification of fluid foods for dysphagia management.
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Affiliation(s)
- Wei Chen
- Lab of Food Oral Processing, School of Food Science and Biotechnology, Zhejiang Gongshang University, Hangzhou, Zhejiang, China
| | - Enrico K Hadde
- Lab of Food Oral Processing, School of Food Science and Biotechnology, Zhejiang Gongshang University, Hangzhou, Zhejiang, China
| | - Jianshe Chen
- Lab of Food Oral Processing, School of Food Science and Biotechnology, Zhejiang Gongshang University, Hangzhou, Zhejiang, China
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13
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Raheem D, Carrascosa C, Ramos F, Saraiva A, Raposo A. Texture-Modified Food for Dysphagic Patients: A Comprehensive Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:5125. [PMID: 34066024 PMCID: PMC8150365 DOI: 10.3390/ijerph18105125] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/30/2021] [Accepted: 05/08/2021] [Indexed: 12/16/2022]
Abstract
Food texture is a major food quality parameter. The physicochemical properties of food changes when processed in households or industries, resulting in modified textures. A better understanding of these properties is important for the sensory and textural characteristics of foods that target consumers of all ages, from children to the elderly, especially when food product development is considered for dysphagia. Texture modifications in foods suitable for dysphagic patients will grow as the numbers of elderly citizens increase. Dysphagia management should ensure that texture-modified (TM) food is nutritious and easy to swallow. This review addresses how texture and rheology can be assessed in the food industry by placing particular emphasis on dysphagia. It also discusses how the structure of TM food depends not only on food ingredients, such as hydrocolloids, emulsifiers, and thickening and gelling agents, but also on the applied processing methods, including microencapsulation, microgels as delivery systems, and 3D printing. In addition, we address how to modify texture for individuals with dysphagia in all age groups, and highlight different strategies to develop appropriate food products for dysphagic patients.
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Affiliation(s)
- Dele Raheem
- Northern Institute for Environmental and Minority Law (NIEM), Arctic Centre, University of Lapland, 96101 Rovaniemi, Finland;
| | - Conrado Carrascosa
- Department of Animal Pathology and Production, Bromatology and Food Technology, Faculty of Veterinary, Universidad de Las Palmas de Gran Canaria, Trasmontaña s/n, 35413 Arucas, Spain;
| | - Fernando Ramos
- Pharmacy Faculty, University of Coimbra, Azinhaga de Santa Comba, 3000-548 Coimbra, Portugal;
- REQUIMTE/LAQV, R. D. Manuel II, Apartado 55142, 4051-401 Porto, Portugal
| | - Ariana Saraiva
- Department of Animal Pathology and Production, Bromatology and Food Technology, Faculty of Veterinary, Universidad de Las Palmas de Gran Canaria, Trasmontaña s/n, 35413 Arucas, Spain;
| | - António Raposo
- CBIOS (Research Center for Biosciences and Health Technologies), Universidade Lusófona de Humanidades e Tecnologias, Campo Grande 376, 1749-024 Lisboa, Portugal
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14
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Gosa MM, Choquette CK. Effect of commercially available thickening agents on ready-to-feed infant formulas. J Texture Stud 2021; 52:612-622. [PMID: 33843078 DOI: 10.1111/jtxs.12600] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 02/12/2021] [Accepted: 03/30/2021] [Indexed: 11/27/2022]
Abstract
Because of the importance of providing the appropriate fluid consistency for effective management of swallowing problems (dysphagia) in infants, this project sought to determine the effect of three commercially available thickening agents on the resulting thickened consistencies of commonly prescribed, ready-to-feed infant formulas. Nine ready-to-feed infant formulas were thickened with three different thickening agents to nectar and honey consistencies following manufacturer's instructions and their resulting thickness was measured via line spread test (LST). The nine formulas with nothing added to them (thin liquids) and the 27 target-nectar and 27 target-honey samples together created 63 unique samples for comparison. A series of one-way analysis of variance analyses were conducted to determine if the resulting thickness (as measured by LST values) for target categories of nectar and honey consistencies was significantly influenced by the type of thickening agent used. The achieved thickness of the formula samples as measured by LST values was statistically significantly different for the three different types of thickening agents used to achieve a target nectar consistency, F (2, 24) = 15.55, p < .001, η p 2 = .709. Additionally, the achieved thickness of the formula samples was statistically significantly different for the three different types of thickening agents used to achieve a target honey consistency, F (2, 24) = 16.18, p < .001, η p 2 = .709. The results of this study reveal that the choice of thickening agent impacts the resulting thickness of ready-to-feed infant formula.
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Affiliation(s)
- Memorie M Gosa
- The University of Alabama, Department of Communicative Disorders, Tuscaloosa, Alabama, USA.,LeBonheur Children's Hospital, Rehabilitation Department, Memphis, Tennessee, USA.,Druid City Hospital, Neonatal Intensive Care Unit, Tuscaloosa, Alabama, USA
| | - Chloe K Choquette
- The University of Alabama, Department of Communicative Disorders, Tuscaloosa, Alabama, USA
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Cuomo F, Angelicola M, De Arcangelis E, Lopez F, Messia MC, Marconi E. Rheological and Nutritional Assessment of Dysphagia-Oriented New Food Preparations. Foods 2021; 10:foods10030663. [PMID: 33808873 PMCID: PMC8003745 DOI: 10.3390/foods10030663] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 03/16/2021] [Accepted: 03/17/2021] [Indexed: 11/22/2022] Open
Abstract
Dysphagia that involves difficulty swallowing food and liquids is a symptom of different diseases. In some cases, patients who experience this symptom should be fed with modified consistency foods. Dysphagia is often accompanied by malnutrition and dehydration and an interesting approach to dealing with these conditions is to provide patients with nutrient-rich foods. In this study, two new food formulations for dysphagia patients are proposed: a cereal-based protein meal and a vegetable cream. The nutritional and rheological characteristics of the two innovative preparations were assessed and compared with those of commercial products. The proposed protein meal formulations meet the criteria for the “high protein” claim and the vegetable cream meets those of the “source of fiber” claim. The rheological investigation revealed that the flow properties of the innovative formulations were comparable to those of the commercial ones. Based on these preliminary outcomes, this investigation represents an interesting perspective potentially valuable to enlarge the offer of possibilities for people suffering from swallowing disorders.
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Yasuda T, Shimokasa K. A proposed method of evaluating the yield stress of a thickened liquid using a simplified inclined plane test. J Texture Stud 2021; 53:307-314. [PMID: 33580713 DOI: 10.1111/jtxs.12590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 01/27/2021] [Accepted: 02/01/2021] [Indexed: 11/30/2022]
Abstract
Managing the thickening index of food is important for dysphagia and helps in recognizing the static and dynamic rheological properties of the thickening agent. One dynamic property is the viscosity under a shear rate of 50 s-1 , and one static property is the yield stress at a shear rate of 0 s-1 . The purpose of this study is to design a simplified inclined plane test to identify the yield stress of a thickened liquid by observing flow behavior on an inclined plate. The yield angle (stress) is defined as the inclination angle of the plate just before the thickened liquid flows. The concentrations (yield stresses, yield angles) of a thickening agent containing xanthan gum are 1.0 (1.2, 3°), 1.5 (5.6, 13°), 2.0 (7.5, 26°), 2.5 (12.5, 26°), and 3.0 (19.1, 42°) wt% (Pa, degrees). We measured the time course of the displacement of the downstream edge (DDE) of the thickened liquid on the inclined plate. The discrete inclination angles were in the range of 0° to 42°. The DDE after 10 s was more than 4.5 mm for all concentrations of the thickening agent at an inclination greater than the yield angle of the plate. We confirmed that the yield angle identifies the yield stress for the thickened liquid via the DDE using the simplified inclined plane test with discrete inclination angles.
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Affiliation(s)
- Toshitaka Yasuda
- Department of Electronic Engineering, Tokyo National College of Technology, Tokyo, Japan
| | - Kenji Shimokasa
- Course of System Engineering, Division of Industrial Technology, Tsukuba University of Technology, Ibaraki, Japan
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Baek S, Jung IH, Lee HY, Song J, Cha E, Jung KI, Yoo WK, Ohn SH. Changes in Pharyngeal Width Over Time as an Indicator of Dysphagia in Stroke Patients. Ann Rehabil Med 2020; 44:203-209. [PMID: 32475096 PMCID: PMC7349039 DOI: 10.5535/arm.19140] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 10/17/2019] [Indexed: 12/11/2022] Open
Abstract
Objective To verify the pharyngeal width at rest as a measurement that could be used to assess changes in the degree of dysphagia over time in stroke patients. Methods In a cohort of stroke patients, we performed serial measurements of the pharyngeal width at the midpoints of the second (C2) and third (C3) cervical vertebral bodies using lateral neck X-rays while the patients were at rest. The JOSCYL width, a parameter named after the first initial of each developers’ surname and defined as the average value of the upper and lower pharyngeal widths, was used to formulate the JOSCYL scale, which was calculated as the JOSCYL width × 100/neck circumference. All patients also underwent serial videofluoroscopic swallowing studies (VFSSs). The Spearman correlation analysis was used to detect correlations between the serial VFSS results, JOSCYL widths, and JOSCYL scale values. Results Over time, we observed significant positive and negative correlations of change in the JOSCYL width and scale with changes in the Penetration-Aspiration Scale and the Dysphagia Outcome and Severity Scale scores, respectively. Conclusion The JOSCYL width and JOSCYL scale clearly reflected changes in dysphagia in stroke patients over time. These parameters may provide an easier method for evaluating whether post-stroke dysphagia has been alleviated.
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Affiliation(s)
- Seungki Baek
- Department of Physical Medicine and Rehabilitation, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Il Hwan Jung
- Department of Physical Medicine and Rehabilitation, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Ho Young Lee
- Department of Physical Medicine and Rehabilitation, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Jimin Song
- Department of Physical Medicine and Rehabilitation, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Eunsil Cha
- Department of Physical Medicine and Rehabilitation, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Kwang-Ik Jung
- Department of Physical Medicine and Rehabilitation, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Woo-Kyoung Yoo
- Department of Physical Medicine and Rehabilitation, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Suk Hoon Ohn
- Department of Physical Medicine and Rehabilitation, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
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19
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Lee HY, Jung IH, Cha E, Song J, Jung KI, Yoo WK, Ohn SH. Predictive Value of Pharyngeal Width at Rest (JOSCYL Width) for Aspiration in Elderly People. Ann Rehabil Med 2019; 43:187-194. [PMID: 31072085 PMCID: PMC6509575 DOI: 10.5535/arm.2019.43.2.187] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 10/10/2018] [Indexed: 11/25/2022] Open
Abstract
Objective To develop a new tool for aspiration risk prediction based on pharyngeal width at rest in older adults with symptoms of aspiration. Methods Lateral cervical spine roentgenograms were obtained from 33 older adult patients who complained of dysphagia and from 33 healthy, age-matched controls. Pharyngeal width at rest was measured at two points. We named the average of these two pharyngeal widths ‘JOSCYL Width’, calculated ‘JOSCYL Scale’, and compared these parameters between dysphagia and control groups. Correlations of individual JOSCYL Width and JOSCYL Scale, with Penetration Aspiration Scale (PAS) and Dysphagia Outcome and Severity Scale (DOSS) scores were analyzed for the dysphagia group. To determine optimal cutoff points for predicting aspiration, a receiver operating characteristic curve analysis was performed on JOSCYL Width and JOSCYL Scale. Results Both JOSCYL Width and JOSCYL Scale of the dysphagia group were larger than those of the control group (p<0.001). The correlation between JOSCYL Width and severity of dysphagia was significant for the dysphagia group (PAS p=0.007; DOSS p=0.012). The correlation between JOSCYL Scale and the severity of dysphagia was also significant for the dysphagia group (PAS p=0.009; DOSS p=0.011). Optimal cutoffs for JOSCYL Width and JOSCYL Scale for predicting aspiration were 20.0 mm and 5.9, respectively. Conclusion JOSCYL Width and JOSCYL Scale can be new indicators for predicting aspiration in older adults. They are both precise and easy to use.
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Affiliation(s)
- Ho Young Lee
- Department of Physical Medicine and Rehabilitation, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Il Hwan Jung
- Department of Physical Medicine and Rehabilitation, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Eunsil Cha
- Department of Physical Medicine and Rehabilitation, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Jimin Song
- Department of Physical Medicine and Rehabilitation, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Kwang-Ik Jung
- Department of Physical Medicine and Rehabilitation, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Woo-Kyoung Yoo
- Department of Physical Medicine and Rehabilitation, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Suk Hoon Ohn
- Department of Physical Medicine and Rehabilitation, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
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20
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Barbon CEA, Steele CM. Thickened Liquids for Dysphagia Management: a Current Review of the Measurement of Liquid Flow. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2018; 6:220-226. [PMID: 32149018 PMCID: PMC7059648 DOI: 10.1007/s40141-018-0197-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE OF REVIEW The use of thickened liquids has become one of the most common management strategies for individuals with dysphagia. The purpose of this paper is to review methods that can be used to measure the flow characteristics of liquids used in dysphagia management. We describe the measurement of apparent viscosity, measures of extensional flow, slump tests (specifically the line-spread test and Bostwick consistometry), gravity flow tests, and subjective methods. RECENT FINDINGS We discuss the relationship between different approaches to measuring flow, the 2002 American National Dysphagia Diet and the 2017 International Dysphagia Diet Standardisation Initiative (IDDSI) framework. A comparison of test results across four methods is provided. SUMMARY A consistent approach is needed for the measurement of flow for thickened liquids used in dysphagia management. This review highlights differences that can be expected across different flow testing methodologies. Adherence to a common method and measurement definitions will promote patient safety and facilitate future research regarding the effectiveness of texture modification as an intervention for dysphagia.
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Affiliation(s)
- Carly E. A. Barbon
- Swallowing Rehabilitation Research Laboratory, Toronto Rehabilitation Institute - University Health Network, 550 University Avenue, 12th floor, Toronto, ON M5G 2A2, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Catriona M. Steele
- Swallowing Rehabilitation Research Laboratory, Toronto Rehabilitation Institute - University Health Network, 550 University Avenue, 12th floor, Toronto, ON M5G 2A2, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
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21
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Côté C, Germain I, Dufresne T, Gagnon C. Comparison of two methods to categorize thickened liquids for dysphagia management in a clinical care setting context: The Bostwick consistometer and the IDDSI Flow Test. Are we talking about the same concept? J Texture Stud 2018; 50:95-103. [PMID: 30370530 DOI: 10.1111/jtxs.12377] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 10/09/2018] [Accepted: 10/25/2018] [Indexed: 11/28/2022]
Abstract
The Bostwick consistometer and the International Dysphagia Diet Standardization Initiative (IDDSI) Flow Test are both proposed methods to measure and categorize thickened liquids for dysphagia management. The objectives were to: (a) compare the Bostwick consistometer reference values used in clinical settings and the IDDSI reference values of thickened liquids suggested for nutrition care plans in the management of dysphagia when measuring commercially available preprepared thickened liquids; (b) explore the relationship between the two methods; (c) assess the interchangeability; (d) document the intra-rater reliability. Preprepared thickened liquids (n = 32) were measured twice with the Bostwick consistometer and 3 times with the IDDSI Flow Test, using a rigorous methodology. A registered dietitian nutritionist and a registered nutrition and dietetic technician performed the measurements. The Pearson's correlation coefficient was calculated to explore the relationship between the two methods. Using a linear regression equation, back-calculations of the IDDSI Flow Test values were done, based on the experimental Bostwick results. Interchangeability was assessed by documenting the level of agreement between the results with a Bland and Altman graphical analysis. Intraclass correlation coefficients calculation and a Bland and Altman graphical analysis were performed to assess reliability. The strong correlation (r = -.93, p < .001) between the IDDSI Flow Test and the Bostwick consistometer measurements suggests that they measure flow rate in a similar manner, but not exactly the same, as confirmed with the Bland and Altman graphical analysis. Thus, they produced results that are not interchangeable. However, both tests show excellent intra-rater reliability (ICC ≥ 0.99) when using a rigorous methodology. PRACTICAL APPLICATIONS: Thickened liquids are used to manage oropharyngeal dysphagia. Clinicians need to provide quality assurance/quality control (QA/QC) support in the selection or production of thickened liquids as well as staff training or patient education regarding these products. Methods and classification have been proposed to measure and categorize thickened liquids for dysphagia management, such as the line spread test, the Bostwick consistometer method, and the IDDSI Flow Test. Although empirical, these methods are more accessible to clinicians than viscometer or rheometer assessments. Clinicians need to understand the limitations of these techniques as neither appear to capture the full extent of consistency for potential beverages available on the market or produced in-house. In this article, we compare the Bostwick consistometer and the IDDSI Flow Test methods and classifications and propose a standard operating procedure in order to maximize the quality of results. We point out the large variations in consistency levels of commercial preprepared thickened liquids in light of the absence of evidence of clinical outcomes associated with either proposed methods or consistency classifications.
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Affiliation(s)
- Claudia Côté
- Centre de recherche Charles-Le-Moyne - Saguenay-Lac-Saint-Jean sur les innovations en santé (CR-CSIS), Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, Québec, Canada.,Groupe de recherche interdisciplinaire sur les maladies neuromusculaires (GRIMN), Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-St-Jean/Neuromuscular Clinic, Jonquière, Québec, Canada
| | - Isabelle Germain
- Association des nutritionnistes experts en dysphagie, Montréal, Québec, Canada
| | | | - Cynthia Gagnon
- Centre de recherche Charles-Le-Moyne - Saguenay-Lac-Saint-Jean sur les innovations en santé (CR-CSIS), Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, Québec, Canada.,Groupe de recherche interdisciplinaire sur les maladies neuromusculaires (GRIMN), Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-St-Jean/Neuromuscular Clinic, Jonquière, Québec, Canada
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22
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Kim YH, Jeong GY, Yoo B. Comparative study of IDDSI flow test and line-spread test of thickened water prepared with different dysphagia thickeners. J Texture Stud 2018; 49:653-658. [PMID: 30187484 DOI: 10.1111/jtxs.12360] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 07/01/2018] [Accepted: 08/23/2018] [Indexed: 11/28/2022]
Abstract
The flow behaviors of thickened water samples prepared with six commercial instant thickeners (A-F) were investigated at different thickness levels using the inexpensive, simple, and visual clinical tools, such as a line-spread test (LST) and a syringe flow test developed by the International Dysphagia Diet Standardization Initiative (IDDSI). Both the flow distance value measured by the LST and the volume remaining in syringe by IDDSI flow test were compared with the apparent viscosity (ηa,50 ) values measured with a sophisticated computer-controlled rheometer. The ηa,50 values of thickened water samples increased as thickener concentration increased, whereas the flow distance (cm; LST) or remaining volume (ml; IDDSI flow test) were decreased. Plots comparing ηa,50 values to LST flow distances and IDDSI volumes revealed exponential relationships (R2 = 0.926 for the LST and R2 = 0.898 for IDDSI test) between the two measurements. Such lower determination coefficient (R2 ) values (0.898) by IDDSI flow test seems to be due to the stickiness characteristics of starch component in starch-based thickeners (E and F), indicating that the syringe flow test is not suitable for starch-based thickeners. However, the thickened water samples prepared only with xanthan gum (XG)-based thickeners (A-D) showed strong relationships (R2 = 0.972 for the LST and R2 = 0.939 for IDDSI test). These results suggest that the LST is a more reliable method than the IDDSI test for evaluating the correct and desirable viscosity for the dysphagia diet, and that the IDDSI test provides a means to predict the rheometer-measured viscosity of water thickened with only XG-based thickeners. PRACTICAL APPLICATIONS: The effective management of dysphagia requires the thickened fluids prepared with the correct and desirable viscosity. In terms of clinical practice, it is very important to observe the comparison of LST with IDDSI flow test to determine a suitable method for estimating the correct viscosity of thickened fluids. Our results showed good relationships between the rheometer-measured viscosity and flow values measured by the LST and IDDSI test methods for the thickened water samples prepared with different foods thickeners. The IDDSI flow test may be useful as a clinical training tool for preparing thickened fluids with only XG-based thickeners to a target level of viscosity. These results presented in this study will provide clinicians, caregivers, and patients with valuable information for IDDSI flow test as an inexpensive and simple method for measuring the correct viscosity.
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Affiliation(s)
- Yong-Hwan Kim
- Department of Food Science and Biotechnology, Dongguk University - Seoul, Goyang, Gyeonggi, South Korea
| | - Geon Young Jeong
- Department of Food Science and Biotechnology, Dongguk University - Seoul, Goyang, Gyeonggi, South Korea
| | - Byoungseung Yoo
- Department of Food Science and Biotechnology, Dongguk University - Seoul, Goyang, Gyeonggi, South Korea
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23
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Howard MM, Nissenson PM, Meeks L, Rosario ER. Use of Textured Thin Liquids in Patients With Dysphagia. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2018; 27:827-835. [PMID: 29710346 DOI: 10.1044/2018_ajslp-16-0140] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 01/26/2018] [Indexed: 06/08/2023]
Abstract
PURPOSE The goals of this article are to explore the use of textured thin liquids for dysphagic patients who require thickened liquids and to illustrate their impact on hydration and patient satisfaction. METHOD A retrospective evaluation of textured thin liquids was completed using patient data looking at laboratory values relevant to the detection of dehydration (blood urea nitrogen, creatinine, sodium) and patient satisfaction (using a clinician-generated questionnaire) on different modified liquid textures. In addition, the viscosity for all liquids was tested using a rheometer. RESULTS Measurements show that the viscosity of the textured thin liquids examined in this pilot study are significantly lower than the viscosity of nectar-thick liquids and fall within the "thin" category as defined by the National Dysphagia Diet guidelines. Patients on honey- and nectar-thick liquids had laboratory values signifying dehydration, whereas those receiving the textured thin liquid consistency were within the normal range for all laboratory values. Importantly, when consuming textured thin liquids, patients reported significant improvement in their satisfaction related to their thirst. CONCLUSION The results of this pilot study highlight the consequences of common thickened liquid dietary recommendations and of the potentially beneficial clinical application of textured thin liquids for patients with dysphagia as well as the need for future prospective research.
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Affiliation(s)
| | - Paul M Nissenson
- Department of Mechanical Engineering, California State Polytechnic University, Pomona
| | - Lauren Meeks
- Casa Colina Hospital and Centers for Healthcare, Pomona, CA
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Mertz Garcia J, Chambers E, Cook K. Visualizing the Consistency of Thickened Liquids With Simple Tools: Implications for Clinical Practice. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2018; 27:270-277. [PMID: 29255849 DOI: 10.1044/2017_ajslp-16-0160] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 07/19/2017] [Indexed: 06/07/2023]
Abstract
PURPOSE Accurate texture modifications to thin liquids are a critical aspect of patients' nutritional health and well-being. This study explored the use of 3 tools (2 distance- and 1 time-measuring devices) to characterize texture-modified liquids. The objectives were to use the tools to measure modified liquids, to determine if measurements differentiated nectar and honey levels of modification, and to compare measurements with other published reports. METHOD We measured the flow distance of 33 prethickened water samples in centimeters (cm) using a line spread apparatus and a Bostwick Consistometer (Christison Particle Technologies). We selected a Zahn viscosity cup to measure the stream time of each prethickened liquid in seconds. RESULTS The 2 distance-measuring devices (line spread and Bostwick Consistometer) showed that thinner (nectar-thick) modifications spread or flowed a farther distance in comparison to thicker (honey-like) modifications. Testing with the line spread indicated that an average spread distance of 4.5 cm differentiated nectar-thick and honey-like consistencies. A flow distance of greater than 15 cm differentiated nectar from honey consistency measured with a Bostwick Consistometer. We were not successful in using the Zahn viscosity cup to determine the stream time of modified liquids. CONCLUSIONS Two of the tools provided objective information about levels of liquid modification, which has implications for day-to-day preparation. Measurement tools that are accurate and easy to use have the potential to provide quick and dependable feedback to verify a prescribed level of liquid modification. Further efforts are needed to standardize the application of simple measurement tools in the management of patients who consume thickened liquids.
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Affiliation(s)
- Jane Mertz Garcia
- Communication Sciences & Disorders, School of Family Studies and Human Services, Kansas State University, Manhattan
| | - Edgar Chambers
- Department of Food, Nutrition, Dietetics and Health, Kansas State University, Manhattan
| | - Kelsey Cook
- Communication Sciences & Disorders, School of Family Studies and Human Services, Kansas State University, Manhattan
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Watanabe E, Yamagata Y, Fujitani J, Fujishima I, Takahashi K, Uyama R, Ogoshi H, Kojo A, Maeda H, Ueda K, Kayashita J. The Criteria of Thickened Liquid for Dysphagia Management in Japan. Dysphagia 2017; 33:26-32. [PMID: 28856459 DOI: 10.1007/s00455-017-9827-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 07/27/2017] [Indexed: 11/28/2022]
Abstract
In Japan, the viscosity of thickened liquids is different among hospitals and nursing homes. In order to standardize viscosity of thickened liquids, the dysphagia diet committee of the Japanese Society of Dysphagia Rehabilitation developed the Japanese Dysphagia Diet 2013 (JDD2013). To decide on a definition of thickened liquids, the committee reviewed categories from other countries. Especially, the criteria of the USA and Australia were used as references. The definition had three levels: mildly thick, moderately thick, and extremely thick. Then a sensory evaluation by health care workers was carried out to decide the viscosity range of each level, and a draft document was made. After collecting public comments, follow-up experiments using thickened water with thickeners using xanthan gum were performed, and the JDD2013 (Thickened Liquid) was determined. The JDD2013 (Thickened Liquid) evaluated the drinking properties, visual properties, and viscosity values of each level. The shear rate of 50 s-1 was adopted to measure the viscosity with a cone and plate type viscometer to duplicate the measurement criteria used by the USA. We also set the values of the JDD2013 with the Line Spread Test to promote the use of guidelines in clinical practice. We believe the JDD2013 standards help hospitals and other settings that care for people with dysphagia to use the same thickness level and the same labels. In the future, the JDD2013 levels will be compared with new international guidelines to help with international understanding of the JDD2013 levels.
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Affiliation(s)
- Emi Watanabe
- Department of Molecular Nutrition, Institution of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Yoshie Yamagata
- Department of Health Sciences, Prefectural University of Hiroshima, 1-1-71 Ujina-Higashi, Minami-ku, Hiroshima, 734-8558, Japan
| | - Junko Fujitani
- Department of Rehabilitation Medicine, National Center for Global Health and Medicine, Tokyo, Japan
| | - Ichiro Fujishima
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, Shizuoka, Japan
| | - Koji Takahashi
- Division of Oral Rehabilitation Medicine, Department of Special Needs Dentistry, School of Dentistry, Showa University, Tokyo, Japan
| | - Risa Uyama
- Department of Biochemistry School of Dentistry, Showa University, Tokyo, Japan
| | - Hiro Ogoshi
- Faculty of Human Sciences and Design, Japan Women's University, Tokyo, Japan
| | - Akiko Kojo
- Division of Medical Nutrition, Faculty of Healthcare, Tokyo Healthcare University, Tokyo, Japan
| | - Hiroshi Maeda
- Department of Rehabilitation Medicine, Seirei Yokohama General Hospital, Kanagawa, Japan
| | - Koichiro Ueda
- Department of Dysphasia Rehabilitation, Nihon University of Dentistry, Tokyo, Japan
| | - Jun Kayashita
- Department of Health Sciences, Prefectural University of Hiroshima, 1-1-71 Ujina-Higashi, Minami-ku, Hiroshima, 734-8558, Japan.
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Watanabe E, Yamagata Y, Kogirima M, Miyamoto KI, Kayashita J. Development of a simple and objective evaluation method for thickened liquids using funnels. J Texture Stud 2017; 48:198-204. [PMID: 28573730 DOI: 10.1111/jtxs.12235] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 10/16/2016] [Accepted: 10/23/2016] [Indexed: 11/26/2022]
Abstract
Some patients with dysphagia are prone to aspiration of low-viscosity liquids. Thickened liquids are often used in attempts to prevent aspiration. The patients should be given thickened liquids with suitable thickness, and the thickness should be constant at all time. While rotational and cone-and-plate viscometers are used for the evaluation of thickened liquids, they are high-precision and expensive equipment. To control the thickness of liquids, a simple and objective evaluation method is thus necessary. We developed a method to evaluate thickened liquids using funnels, and verified the appropriateness of this method. We measured the outflow times of five thickened liquids through funnels. One of the thickened liquids was a commercially available nutritional supplement, another was made with a thickening agent that contained guar gum, and all others were made with a thickening agent that contained xanthan gum. Four funnels with different stem sizes were tested. We found that the outflow time of thickened liquids through a funnel depended on their viscosities at a shear rate between 10 and 50 s-1 , when the average inner diameter of the stem was in the range of 5.3-9.0 mm, and the volume of the liquid poured into the funnel was 30 mL. The correlation coefficient between the value of the sensory evaluation and the outflow time of the funnel with an average stem ID of 5.3 mm was 0.946. Therefore, this method may be useful in hospital and nursing home kitchens for evaluating thickened liquids. PRACTICAL APPLICATIONS The findings of this study will help develop a new method for the evaluation of thickened liquids. Funnels made from polypropylene, which are inexpensive and light, were used in this method. The process for measuring the outflow time of thickened liquids through a funnel is simple, and we can obtain quantitative data that are objective. Even though line spread test (LST) is well known as a simple measurement method, nutritional supplements and liquids thickened using a thickening agent containing guar gum have not been evaluated accurately. The funnel method was found to have a stronger correlation with sensory evaluation compared to LST. This method is useful in hospital and nursing home kitchens for evaluating thickened liquids.
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Affiliation(s)
- Emi Watanabe
- Department of Molecular Nutrition, Institution of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan.,Department of Food Science and Nutrition, Doshisha Women's College, Imadegawa Teramachi, Kamigyo-ku, Kyoto, 602-0893, Japan
| | - Yoshie Yamagata
- Department of Health Sciences, Prefectural University of Hiroshima, 1-1-71 Ujina-Higashi, Minami-ku, Hiroshima, 734-8558, Japan
| | - Miho Kogirima
- Department of Food Science and Nutrition, Doshisha Women's College, Imadegawa Teramachi, Kamigyo-ku, Kyoto, 602-0893, Japan
| | - Ken-Ichi Miyamoto
- Department of Molecular Nutrition, Institution of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan
| | - Jun Kayashita
- Department of Health Sciences, Prefectural University of Hiroshima, 1-1-71 Ujina-Higashi, Minami-ku, Hiroshima, 734-8558, Japan
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Abstract
BACKGROUND Unlike adult populations, who primarily depend on liquids for hydration alone, infants rely on liquids to provide them with hydration and nutrition. Speech-language pathologists working within pediatric medical settings often identify dysphagia in patients and subsequently recommend thickened liquids to reduce aspiration risk. Caregivers frequently report difficulty attempting to prepare infant formula to the prescribed thickness. MATERIALS AND METHODS This study was designed to determine (1) the relationship between consistencies in modified barium swallow studies and thickened infant formulas and (2) the effects of time and temperature on the resulting thickness of infant formula. Prepackaged barium consistencies and 1 standard infant formula that was thickened with rice cereal and with 2 commercially available thickening agents were studied. Thickness was determined via a line spread test after various time and temperature conditions were met. RESULTS There were significant differences between the thickened formula and barium test consistencies. Formula thickened with rice cereal separated over time into thin liquid and solid residue. Formula thickened with a starch-based thickening agent was thicker than the desired consistency immediately after mixing, and it continued to thicken over time. The data from this project suggest that nectar-thick and honey-thick infant formulas undergo significant changes in flow rates within 30 minutes of preparation or if refrigerated and then reheated after 3 hours. CONCLUSIONS Additional empirical evidence is warranted to determine the most reliable methods and safest products for thickening infant formula when necessary for effective dysphagia management.
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Affiliation(s)
- Memorie M Gosa
- 1 The University of Alabama, Tuscaloosa, Alabama, USA.,2 LeBonheur Children's Hospital, Memphis, Tennessee, USA
| | - Pamela Dodrill
- 3 Brigham & Women's Hospital, Boston, Massachusetts, USA
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Zargaraan A, Saghafi Z, Hasandokht Firouz M, Fadavi G, Ghorbani Gorji S, Mohammadifar MA. Effect of Rheological Properties on Sensory Acceptance of Two-Model Dysphagia-Oriented Food Products. J Texture Stud 2015. [DOI: 10.1111/jtxs.12131] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Azizollaah Zargaraan
- Office of the Vice President for Research; National Nutrition and Food Technology Research Institute; Shahid Beheshti University of Medical Science; Tehran Iran
| | - Zahra Saghafi
- Department of Food Science and Technology; National Nutrition and Food Technology Research Institute; Faculty of Nutrition Sciences and Food Technology; Shahid Beheshti University of Medical Sciences; PO Box 19395-4741 Tehran Iran
| | - Mahtab Hasandokht Firouz
- Department of Food Science and Technology; National Nutrition and Food Technology Research Institute; Faculty of Nutrition Sciences and Food Technology; Shahid Beheshti University of Medical Sciences; PO Box 19395-4741 Tehran Iran
| | - Ghasem Fadavi
- Department of Food and Agriculture Research; Institute of Standard and Industrial Research of Iran (ISIRI); Karaj Iran
| | - Sara Ghorbani Gorji
- School of Agriculture and Food Sciences; University of Queensland; St. Lucia Queensland Australia
| | - Mohammad Amin Mohammadifar
- Department of Food Science and Technology; National Nutrition and Food Technology Research Institute; Faculty of Nutrition Sciences and Food Technology; Shahid Beheshti University of Medical Sciences; PO Box 19395-4741 Tehran Iran
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Kim SG, Yoo W, Yoo B. Relationship between Apparent Viscosity and Line-Spread Test Measurement of Thickened Fruit Juices Prepared with a Xanthan Gum-based Thickener. Prev Nutr Food Sci 2014; 19:242-5. [PMID: 25320723 PMCID: PMC4195631 DOI: 10.3746/pnf.2014.19.3.242] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 07/03/2014] [Indexed: 11/24/2022] Open
Abstract
The flow behaviors of three thickened fruit juices (orange, apple, and grape juice) prepared with a commercial instant xanthan gum (XG)-based thickener that is marketed in Korea were investigated at different thickener concentrations (1.0%, 1.5%, 2.0%, 2.5%, 3.0%, and 3.5%) and setting times (5 and 30 min) using a rheometer and a line-spread measurement method. The flow distance values measured by the line-spread test (LST) were compared with the apparent viscosity (ηa,50) values measured with a sophisticated computer-controlled rheometer. The ηa,50 values of the juices increased as thickener concentration increased, whereas their flow distances decreased. The ηa,50 values at the 30-min setting time were much higher than those at the 5-min setting time, indicating that the setting time before serving or consuming thickened juices can affect viscosity values. Plots comparing ηa,50 values to LST flow distances revealed strong exponential relationships between the two measures (R2=0.989 and R2=0.987 for the 5- and 30-min setting times, respectively). These results indicate that the LST can be a suitable instrument for evaluating the viscosity of thickened fruit juices prepared with different XG-based thickener concentrations and setting times for the dysphagia diet.
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Affiliation(s)
- Sung-Gun Kim
- Department of Food Science and Technology, Dongguk University, Seoul 100-715, Korea
| | | | - Byoungseung Yoo
- Department of Food Science and Technology, Dongguk University, Seoul 100-715, Korea
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30
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Coorey R, Tjoe A, Jayasena V. Gelling Properties of Chia Seed and Flour. J Food Sci 2014; 79:E859-66. [DOI: 10.1111/1750-3841.12444] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 02/28/2014] [Indexed: 12/01/2022]
Affiliation(s)
- Ranil Coorey
- School of Public Health and Curtin Health Innovation Research Inst.; Curtin Univ.; GPO Box U1987 Perth Western Australia 6845 Australia
| | - Audrey Tjoe
- School of Public Health and Curtin Health Innovation Research Inst.; Curtin Univ.; GPO Box U1987 Perth Western Australia 6845 Australia
| | - Vijay Jayasena
- School of Public Health and Curtin Health Innovation Research Inst.; Curtin Univ.; GPO Box U1987 Perth Western Australia 6845 Australia
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Park JH, Kim HG, Oh BM, Lee MW, Hwang IK, Lee SU, Han TR. Comparison of different gum-based thickeners using a viscometer and line spread test: a preliminary study. Ann Rehabil Med 2014; 38:94-100. [PMID: 24639932 PMCID: PMC3953370 DOI: 10.5535/arm.2014.38.1.94] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 09/17/2013] [Indexed: 11/05/2022] Open
Abstract
Objective To compare fluid thickeners composed of starch polysaccharide (STA), guar gum-based polysaccharide (GUA), and xanthan gum-based polysaccharide (XAN) with the use of a viscometer and a line spread test (LST) under various measurement conditions. Methods The viscosity of thickened fluid with various concentrations (range, GUA 1%-4%, XAN 1%-6%, STA 1%-7%, at intervals of 1%) was measured with a rotational viscometer with various shear rates (1.29 s-1, 5.16 s-1, 51.6 s-1, and 103 s-1) at a temperature of 35℃, representing body temperature. The viscosity of STA showed time dependent alteration. So STA was excluded. Viscosities of GUA and XAN (range of concentration, GUA 1%-3%, XAN 1%-6%, at intervals of 1%) were measured at a room temperature of 20℃. LST was conducted to compare GUA and XAN (concentration, 1.5%, 2.0%, and 3.0%) at temperatures of 20℃ and 35℃. Results The viscosities of 1% GUA and XAN were similar. However, viscosity differences between GUA and XAN were gradually larger as concentration increased. The shear thinning effect, the inverse relationship between the viscosity and the shear rate, was more predominant in XAN than in GUA. The results of LST were not substantially different from GUA and XAN, in spite of the difference in viscosity. However manufacturers' instructions do not demonstrate the rheological properties of thickeners. Conclusion The viscosities of thickened fluid were different when the measurement conditions changed. Any single measurement might not be sufficient to determine comparable viscosity with different thickeners. Clinical decision for the use of a specific thickener seems to necessitate cautious consideration of results from a viscometer, LST, and an expert's opinion.
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Affiliation(s)
- Jae Hyeon Park
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Ho-Geun Kim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Min-Woo Lee
- Department of Food and Nutrition, College of Human Ecology, Seoul National University, Seoul, Korea
| | - In-Kyeong Hwang
- Department of Food and Nutrition, College of Human Ecology, Seoul National University, Seoul, Korea
| | - Shi-Uk Lee
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Tai Ryoon Han
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea
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Zargaraan A, Rastmanesh R, Fadavi G, Zayeri F, Mohammadifar MA. Rheological aspects of dysphagia-oriented food products: A mini review. FOOD SCIENCE AND HUMAN WELLNESS 2013. [DOI: 10.1016/j.fshw.2013.11.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Lund AM, Garcia JM, Chambers E. Line spread as a visual clinical tool for thickened liquids. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2013; 22:566-571. [PMID: 23813193 DOI: 10.1044/1058-0360(2013/12-0044)] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
PURPOSE Preparing modified liquids to a target level of consistency is critical to patients' nutritional care. This study examined the relationship of line spread (i.e., the distance a liquid flows) to viscometer measurements for a variety of product/liquid combinations and determined if flow distance visually differentiated nectar-thick versus honey-like consistency. METHOD Combinations of 4 thickening products (3 starch-based and 1 gum-based thickener) prepared with 6 serving-temperature liquids that had various levels of fat, fiber, and added nutrients were tested. A total of 32 product/liquid combinations tested within the target range of 80-800 centipoise (cP). Measurements were recorded using line spread and a Brookfield RVDV-II+ viscometer. RESULTS Nectar-thick and honey-like consistencies significantly differed in their degree of line spread. Using our line spread apparatus, a value of 4.5 cm differentiated between nectar-thick and honey-like consistencies. There was an inverse correlation (-.75) between viscometer data and line spread results. That is, high viscosity values represented samples with less flow distance (line spread), and low viscosity values represented samples with more flow distance. CONCLUSION Line spread appears to be a quick, objective, and visual method that might be used to help patients and their caregivers achieve more accurate and consistent thickened liquid preparation.
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Suiter DM, Gosa MM, Leder SB. Intraoral Dwell Time Results in Increased Bolus Temperature and Decreased Bolus Viscosity for Thickened Liquids. TOP CLIN NUTR 2013. [DOI: 10.1097/tin.0b013e31827df962] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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36
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Pharyngeal dysphagia in inflammatory muscle diseases resulting from impaired suprahyoid musculature. Dysphagia 2011; 27:408-17. [PMID: 22207246 DOI: 10.1007/s00455-011-9384-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2010] [Accepted: 12/09/2011] [Indexed: 10/14/2022]
Abstract
Dysphagia has previously been reported in the inflammatory myopathies (IMs): inclusion body myositis (IBM), dermatomyositis (DM), and polymyositis (PM). Patients report coughing, choking, and bolus sticking in the pharynx. Myotomy has been the treatment of choice, with variable success reported. We sought to determine underlying causes of dysphagia in IM patients using instrumental evaluation. Eighteen subjects participated in the study: four with DM, six with PM, and eight with IBM. They underwent simultaneous videofluoroscopy and manometry, yielding 214 swallows for analysis regarding function of the upper esophageal sphincter (UES), swallow initiation, hyolaryngeal excursion, and pharyngeal residue. Penetration and aspiration were also recorded. UES failed to relax in two participants. High incidence of pharyngeal dysphagia was noted; 72% of participants demonstrated abnormalities, including delayed swallow initiation (24%), decreased hyolaryngeal excursion (22%), pyriform residue (17%), and penetration (22%). Dysphagia in IM patients appears to be more due to impaired muscle contraction and reduced hyolaryngeal excursion than the often held belief of failed UES relaxation. The distinction between mechanisms causing patients' dysphagia should be examined, particularly if CP myotomy is being considered as it may be contraindicated for patients with normal UES relaxation. More studies investigating IM patients pre- and post-myotomy are needed.
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Dysphagia in Inflammatory Myopathy: Self-report, Incidence, and Prevalence. Dysphagia 2011; 27:64-9. [DOI: 10.1007/s00455-011-9338-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2010] [Accepted: 02/24/2011] [Indexed: 11/26/2022]
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Wendin K, Ekman S, Bülow M, Ekberg O, Johansson D, Rothenberg E, Stading M. Objective and quantitative definitions of modified food textures based on sensory and rheological methodology. Food Nutr Res 2010; 54:5134. [PMID: 20592965 PMCID: PMC2894641 DOI: 10.3402/fnr.v54i0.5134] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2010] [Revised: 05/07/2010] [Accepted: 05/26/2010] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Patients who suffer from chewing and swallowing disorders, i.e. dysphagia, may have difficulties ingesting normal food and liquids. In these patients a texture modified diet may enable that the patient maintain adequate nutrition. However, there is no generally accepted definition of 'texture' that includes measurements describing different food textures. OBJECTIVE Objectively define and quantify categories of texture-modified food by conducting rheological measurements and sensory analyses. A further objective was to facilitate the communication and recommendations of appropriate food textures for patients with dysphagia. DESIGN About 15 food samples varying in texture qualities were characterized by descriptive sensory and rheological measurements. RESULTS Soups were perceived as homogenous; thickened soups were perceived as being easier to swallow, more melting and creamy compared with soups without thickener. Viscosity differed between the two types of soups. Texture descriptors for pâtés were characterized by high chewing resistance, firmness, and having larger particles compared with timbales and jellied products. Jellied products were perceived as wobbly, creamy, and easier to swallow. Concerning the rheological measurements, all solid products were more elastic than viscous (G'>G''), belonging to different G' intervals: jellied products (low G') and timbales together with pâtés (higher G'). CONCLUSION By combining sensory and rheological measurements, a system of objective, quantitative, and well-defined food textures was developed that characterizes the different texture categories.
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Affiliation(s)
- Karin Wendin
- SIK - The Swedish Institute for Food and Biotechnology, Göteborg, Sweden
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Stuart S, Motz JM. Viscosity in infant dysphagia management: comparison of viscosity of thickened liquids used in assessment and thickened liquids used in treatment. Dysphagia 2009; 24:412-22. [PMID: 19472005 DOI: 10.1007/s00455-009-9219-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2008] [Accepted: 03/17/2009] [Indexed: 11/26/2022]
Abstract
The purpose of this study was to investigate comparability of viscosity of liquids used in assessment and treatment of infants with dysphagia. Goals of this study were as follows: (1) Establish baseline viscosity values for (a) the commercial barium assessment liquids of varying thicknesses and (b) clinically typical infant formula thickened with varied thickeners. (2) Compare the baseline viscosities of the various liquids for correlation of values. We attempted to mimic real-world situations and recreate clinical assessment and treatment conditions. We also identified and made every effort to control typical clinical variables, e.g., mixer and mixing procedure, brand of product, and temperature of liquid. The method of measurement was based on rheologic principles and used a Brookfield Engineering LVDV II + Pro Cone/Plate Viscometer at spindle and speed combinations to maximize shear rates consistent with swallowing. Statistically, there was no comparability between barium and formula mixtures, regardless of thickener utilized. The implications of these findings and the need to develop a standardized means of thickening formula to a viscosity comparable to the assessment materials are discussed.
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Affiliation(s)
- Sheela Stuart
- Department of Hearing and Speech, Children's National Medical Center, Washington, DC 20010, USA
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Strowd L, Kyzima J, Pillsbury D, Valley T, Rubin B. Dysphagia Dietary Guidelines and the Rheology of Nutritional Feeds and Barium Test Feeds. Chest 2008; 133:1397-1401. [DOI: 10.1378/chest.08-0255] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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