1
|
Jones D, Allsopp K, Burden S. Getting the consistency right in thickened liquids using Viscgo Sticks: A validation study. J Hum Nutr Diet 2024; 37:464-473. [PMID: 38017710 DOI: 10.1111/jhn.13268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 11/17/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND Dysphagia is a condition whereby a person's ability to swallow, eat and drink is impacted. One strategy to manage dysphagia and aid safe swallowing is the modification of food and drink, including using thickening agents to thicken drinks. Drinks are thickened to levels appropriate to a person's swallowing abilities and the underutilised 'syringe flow test' is currently the recommended method for checking thickness levels. Viscgo Sticks were developed as a practical alternative to the flow test. METHODS This is a real-world validation study designed to determine validity and reliability of Viscgo Sticks. Independent researchers and healthcare professionals tested Viscgo Sticks (Viscgo Limited) against the flow test in three levels of thickened drinks. Researchers also conducted tests with different thickening agents and different drink types: water, milk, orange juice and hot tea. RESULTS The intra- and inter-rater reliability of Viscgo Sticks was moderate to almost perfect (κ = 0.45-0.98) within and between researchers and substantial (κ = 0.66-0.67) within and between healthcare professionals. When tested by researchers and healthcare professionals against the flow test, Viscgo Sticks correctly classified 83.33%-100% of thickened drinks with high accuracy (area under curve = 0.70-1.00). CONCLUSIONS A simple and reliable tool like Viscgo Sticks, which can verify a prescribed thickness level of liquid, is invaluable in healthcare settings where day-to-day drink preparation occurs. Overall, Viscgo Sticks provide a reliable and valid means to test thickened drinks in clinical practice with a few exceptions identified.
Collapse
Affiliation(s)
- Debra Jones
- The University of Manchester, School of Health Sciences, Manchester, UK
| | - Karen Allsopp
- The University of Manchester, School of Health Sciences, Manchester, UK
| | - Sorrel Burden
- The University of Manchester, School of Health Sciences, Manchester, UK
- Northern Care Alliance NHS Foundation Trust, Salford Care Organisation, Salford, UK
| |
Collapse
|
2
|
Alqallaf A, Cates DW, Render KP, Patel KA. Sodium Phenylbutyrate and Taurursodiol: A New Therapeutic Option for the Treatment of Amyotrophic Lateral Sclerosis. Ann Pharmacother 2024; 58:165-173. [PMID: 37269231 DOI: 10.1177/10600280231172802] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Abstract
OBJECTIVE To review the safety and efficacy of sodium phenylbutyrate and taurursodiol (SP + T) in slowing progression of amyotrophic lateral sclerosis (ALS) compared with pre-existing therapies. DATA SOURCES A PubMed (from January 1, 2009, to April 13, 2023) and ClinicalTrials.gov search conducted using sodium phenylbutyrate, taurursodiol, AMX0035, riluzole, and edaravone. Additional articles were identified by hand from references. DATA SELECTION AND DATA EXTRACTION This included English-language articles evaluating SP + T efficacy or safety in humans for decreasing neuronal death and slowing the progression of ALS. DATA SYNTHESIS In one phase II clinical trial that encompassed an open-label extension phase, disease severity, assessed by the rate of decline in overall score on the Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised with higher scores indicating more functional ability, was -1.24 points per month with active drug and -1.66 points per month with placebo (difference, 0.42 points per month; 95% CI, 0.03-0.81; P = 0.03). Post hoc analysis found survival benefit of median 4.8 months with active medication compared with placebo. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE IN COMPARISON WITH EXISTING DRUGS SP + T is a new US Food and Drug Administration-approved oral suspension for the treatment of ALS. Patients who received active medication through the phase II trial showed decreased rates of disease progression. Overall, SP + T could be considered a potential agent for the treatment of ALS which has a high unmet need. CONCLUSION SP + T is an option for the treatment of ALS; however, additional data regarding efficacy in phase III trials with long-term safety profile considerations, as well as trials to compare current therapy with SP + T, are needed.
Collapse
|
3
|
Katherine Sofia TO, Sotelo-Díaz LI, Caez-Ramírez GR. Mechanical and rheological categorization of food patterns suitable for older adults with swallowing limitation. INTERNATIONAL JOURNAL OF FOOD PROPERTIES 2022. [DOI: 10.1080/10942912.2022.2140811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | - Luz Indira Sotelo-Díaz
- Research group in food and process management and service, EICEA, Universidad de La Sabana, Chia, Colombia
| | - Gabriela R Caez-Ramírez
- Research Group in Procesos Agroindustriales, Engineering Faculty, Universidad de la Sabana, Chía, Colombia
| |
Collapse
|
4
|
Vergara J, Teixeira HS, de Souza CM, Ataide JA, de Souza Ferraz F, Mazzola PG, Mourão LF. Flow test by the International Dysphagia Diet Standardization Initiative reveals distinct viscosity parameters of three thickening agents. JOURNAL OF FOOD SCIENCE AND TECHNOLOGY 2022; 59:3627-3633. [PMID: 35875213 PMCID: PMC9304459 DOI: 10.1007/s13197-022-05369-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Revised: 10/13/2021] [Accepted: 01/10/2022] [Indexed: 06/15/2023]
Abstract
The International Dysphagia Diet Standardization Initiative (IDDSI) flow test is useful for the global standardization of food consistencies of dysphagia patients. In clinical practice, different compositions of food thickeners are commonly used, directly influencing viscosity parameters and swallowing physiology. We aimed to compare the IDDSI thickness levels, remaining volume in the syringe (RVS), and viscosity parameters of three different food thickeners. As a secondary objective, we compared the cost of preparing 100 mL of thickened drinks using the studied thickeners. Thickeners A (xanthan gum), B (corn starch, tara gum, xanthan gum, and guar gum), and C (corn starch) were prepared in increasing concentrations from 1 to 7 g/100 mL and were assayed in quintuplicate using the IDDSI flow test. Thickeners A, B, and C presented statistically different results for the IDDSI levels, RVS, and viscosity parameters at all concentrations. Thickener A reached higher levels in the IDDSI framework, RVS, and viscosity parameters compared with thickeners B and C. A large range of RVS was observed at different concentrations for thickener B compared with C. Regarding viscosity, thickeners B and C, with corn starch in their composition, showed exponential behavior as concentrations increased, while thickener A presented a linear trend. The thickener composition was significantly influenced by IDDSI classification, RVS, and viscosity parameters. The study shows that xanthan gum thickeners present less variability in IDDSI, RVS, and viscosity compared with starch-based thickeners.
Collapse
Affiliation(s)
- José Vergara
- Department of Surgery, University of Campinas, R. Tessália Vieira de Camargo, 126, Campinas, SP 13083-887 Brazil
| | - Heloisa Sant’Ana Teixeira
- Speech-Language Pathology and Audiology Sciences, University of Campinas, R. Tessalia Vieira de Camargo, 126, Campinas, SP 13083-887 Brazil
| | - Cinthia Madeira de Souza
- School of Medical Sciences, University of Campinas, Av. Tessalia Vieira de Camargo, 126, Campinas, SP 13083-887 Brazil
| | - Janaina Artem Ataide
- Faculty of Pharmaceutical Sciences, University of Campinas, R. Cândido Portinari, 200, Campinas, SP 13083-871 Brazil
| | | | - Priscila Gava Mazzola
- Faculty of Pharmaceutical Sciences, University of Campinas, R. Cândido Portinari, 200, Campinas, SP 13083-871 Brazil
| | - Lucia Figueiredo Mourão
- Speech-Language Pathology and Audiology Sciences, University of Campinas, R. Tessalia Vieira de Camargo, 126, Campinas, SP 13083-887 Brazil
| |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
Kumai Y, Suzuki I, Tousen Y, Kondo T, Kayashita J, Chiba T, Furusho T, Takebayashi J. Reliability in viscosity measurement of thickening agents for dysphagia management: are results obtained by cone‐and‐plate rheometers reproducible between laboratories? J Texture Stud 2022; 53:315-322. [DOI: 10.1111/jtxs.12672] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 01/31/2022] [Accepted: 02/24/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Yasuhito Kumai
- National Institute of Health and Nutrition National Institutes of Biomedical Innovation, Health and Nutrition Tokyo Japan
| | - Ippei Suzuki
- National Institute of Health and Nutrition National Institutes of Biomedical Innovation, Health and Nutrition Tokyo Japan
| | - Yuko Tousen
- National Institute of Health and Nutrition National Institutes of Biomedical Innovation, Health and Nutrition Tokyo Japan
| | - Takashi Kondo
- National Institute of Health and Nutrition National Institutes of Biomedical Innovation, Health and Nutrition Tokyo Japan
| | - Jun Kayashita
- Department of Health Sciences Prefectural University of Hiroshima Hiroshima Japan
| | - Tsuyoshi Chiba
- National Institute of Health and Nutrition National Institutes of Biomedical Innovation, Health and Nutrition Tokyo Japan
| | - Tadasu Furusho
- Department of International Food and Agricultural Science Tokyo University of Agriculture Tokyo Japan
| | - Jun Takebayashi
- National Institute of Health and Nutrition National Institutes of Biomedical Innovation, Health and Nutrition Tokyo Japan
| |
Collapse
|
7
|
On the assessment of shear and extensional rheology of thickened liquids from commercial gum-based thickeners used in dysphagia management. J FOOD ENG 2022. [DOI: 10.1016/j.jfoodeng.2021.110820] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
|
8
|
Wong LY, Ng ML, Tong ETS. How Accurate Are the Consistency Labels Used in Hong Kong? An Objective Study of the Consistency of Thickened Liquids Using International Dysphagia Diet Standardisation Initiative and Consistometric Measurements. Folia Phoniatr Logop 2021; 74:167-175. [PMID: 34348310 DOI: 10.1159/000518480] [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: 11/11/2020] [Accepted: 07/13/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES The present study objectively examined the consistency (thickness) of labels that are used in Hong Kong for the population with dysphagia using an International Dysphagia Diet Standardisation Initiative (IDDSI) flow test and Bostwick consistometric measurements. METHODS Liquids were prepared by thickening water to achieve 4 consistency labels (slightly thick, mildly thick, medium thick, and extra thick) according to manufacturer's instructions, employing 2 types of thickening products that are used in Hong Kong, i.e., starch based and gum based. For each consistency label prepared using each thickening product, the IDDSI flow test and consistometric measurements were obtained and compared. RESULTS The results showed that the actual thickness of liquids was highly dependent on the type of thickener (starch based vs. gum based) used. Thickened liquids prepared using the starch-based thickener were generally thinner than the actual value at a lower concentration. CONCLUSION Though prepared strictly following the manufacturer's instructions, the thickened liquids fail to faithfully correlate with the standardized norms established according to the IDDSI framework and the objective consistometric measurement using a Bostwick consistometer. Therefore, caution must be exercised when administering a thickened diet following the manufacturer's instructions for patients with dysphagia.
Collapse
Affiliation(s)
- Long Yat Wong
- Speech Science Laboratory, Faculty of Education, University of Hong Kong, Hong Kong, China
| | - Manwa L Ng
- Speech Science Laboratory, Faculty of Education, University of Hong Kong, Hong Kong, China
| | - Eric T S Tong
- Hong Kong Sheng Kung Hui Welfare Council, Hong Kong, China
| |
Collapse
|
9
|
Methacanon P, Gamonpilas C, Kongjaroen A, Buathongjan C. Food polysaccharides and roles of rheology and tribology in rational design of thickened liquids for oropharyngeal dysphagia: A review. Compr Rev Food Sci Food Saf 2021; 20:4101-4119. [PMID: 34146451 DOI: 10.1111/1541-4337.12791] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 05/21/2021] [Accepted: 05/25/2021] [Indexed: 01/02/2023]
Abstract
In today's market environment, an aging society is recognized as one of the megatrends in the world. The demographic change in the world population age structure has driven a huge demand in healthcare products as well as services that include the technological innovation for the health and wellness of the elderly. Dysphagia or swallowing difficulty is a common problem in the elderly as many changes in swallowing function come with aging. The presence of a strong relationship between swallowing ability, nutritional status, and health outcomes in the elderly leads to the importance of dysphagia management in the population group. Modification of solid food and/or liquid is a mainstay of compensatory intervention for dysphagia patients. In this regard, texture-modified foods are generally provided to reduce risks associated with choking, while thickened liquids are recommended for mitigating risks associated with aspiration. In this review, we discuss thickened liquids and other issues including the importance of their rheological and tribological properties for oropharyngeal dysphagia management in the elderly. The review focuses on both commercial thickeners that are either based on modified starch or xanthan gum and other potential polysaccharide alternatives, which have been documented in the literature in order to help researchers develop or improve the characteristic properties of thickened liquids required for safe swallowing. Furthermore, some research gaps and future perspectives, particularly from the nutrition aspect related to the interaction between thickeners and other food ingredients, are suggested as such interaction may considerably control the rate of nutrient absorption and release within our body.
Collapse
Affiliation(s)
- Pawadee Methacanon
- Advanced Polymer Technology Research Group, National Metal and Materials Technology Center (MTEC), NSTDA, Klong Luang, Pathumthani, Thailand
| | - Chaiwut Gamonpilas
- Advanced Polymer Technology Research Group, National Metal and Materials Technology Center (MTEC), NSTDA, Klong Luang, Pathumthani, Thailand
| | - Akapong Kongjaroen
- Advanced Polymer Technology Research Group, National Metal and Materials Technology Center (MTEC), NSTDA, Klong Luang, Pathumthani, Thailand
| | - Chonchanok Buathongjan
- Advanced Polymer Technology Research Group, National Metal and Materials Technology Center (MTEC), NSTDA, Klong Luang, Pathumthani, Thailand
| |
Collapse
|
10
|
Maieves HA, Teixeira GL. Assessment of tomato-based thick fluid diet for patients with dysphagia using a simple and cheap test. J Texture Stud 2021; 52:647-655. [PMID: 34101187 DOI: 10.1111/jtxs.12617] [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: 12/31/2020] [Revised: 05/28/2021] [Accepted: 06/01/2021] [Indexed: 11/26/2022]
Abstract
Swallowing difficulty, also known as dysphagia, is a health condition that can be managed by different approaches, such as changing the viscosity of fluid foods with thickener agents. Tomato-based beverages such as "gazpacho" and "salmorejo" are common foods much appreciated by the populations that adopt a Mediterranean diet, mainly in Spain. These beverages usually present a low viscosity, challenging to include in diets for dysphagia patients. Thus, this work aimed at evaluating the flow properties of tomato-based beverages with or without the addition of thickener agents (based on maltodextrin or gum) using a simple and cheap method proposed by the International Dysphagia Diet Standardization Initiative (IDDSI) to verify the suitability of using those products in a diet of patients with dysphagia. The study also evaluated the differences in using BD-type syringes on the test. Results indicated that the type of thickener significantly (p < .05) affects the samples' flow properties, enhancing their rheological behavior. The type of syringe can also affect the results, as they present different Luer slip tips. The results revealed that tomato-based beverages may have their properties improved simply by using low amounts of thickener agents (1.2-3.0 g 200 ml-1 ) and that the IDDSI test can be an alternative, cheap and straightforward method for evaluating these types of foods in hospital environments. Including tomato-based beverages in the diet of patients with dysphagia may present many benefits as these products have a rich nutritional composition (fiber) in addition to biocompounds such as lycopene and phenolic compounds.
Collapse
Affiliation(s)
- Helayne Aparecida Maieves
- Faculty of Nutrition, Federal University of Pelotas, Pelotas, Brazil.,Dpto. Nutrición y Ciencia de los Alimentos, Facultad de Farmacia, Universidad Complutense de Madrid, Madrid, Spain
| | - Gerson Lopes Teixeira
- Department of Food Science and Technology, Federal University of Santa Catarina, Florianópolis, Brazil
| |
Collapse
|
11
|
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.
Collapse
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
| |
Collapse
|
12
|
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.
Collapse
|
13
|
Hadde EK, Chen J. Texture and texture assessment of thickened fluids and texture-modified food for dysphagia management. J Texture Stud 2020; 52:4-15. [PMID: 33155674 DOI: 10.1111/jtxs.12567] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 10/26/2020] [Accepted: 11/02/2020] [Indexed: 12/19/2022]
Abstract
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.
Collapse
Affiliation(s)
- Enrico K Hadde
- Lab of Food Oral Processing, School of Food Science and Biotechnology, Zhejiang Gongshang University, Zhejiang, Hangzhou, China
| | - Jianshe Chen
- Lab of Food Oral Processing, School of Food Science and Biotechnology, Zhejiang Gongshang University, Zhejiang, Hangzhou, China
| |
Collapse
|
14
|
Is IDDSI an Evidence-Based Framework? A Relevant Question for the Frail Older Population. Geriatrics (Basel) 2020; 5:geriatrics5040082. [PMID: 33096747 PMCID: PMC7709687 DOI: 10.3390/geriatrics5040082] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/14/2020] [Accepted: 10/15/2020] [Indexed: 02/07/2023] Open
Abstract
To delay impacts of aging, optimal nutritional status is essential. Several factors can reduce food intake, such as isolation, income, and cognitive/physical decline. Additionally, chewing and swallowing difficulties, or dysphagia, often disrupt the ability to consume life-long favorite dishes. Food and liquids could require modification of texture or consistency to ensure a comfortable or safe swallow. The food industry, foodservices facilities, and caregivers need quality control benchmarks to provide adequate nourishment and meet these new feeding challenges. The International Dysphagia Diet Standardisation Initiative (IDDSI) is proposing the IDDSI framework and testing methods to describe food used in nutritional care plans to circumvent dysphagia and improve communication among caregivers. This systematic review assesses the validity and reliability of the IDDSI testing methods using the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN). Two publications presented content validity whereas 19 publications looked at construct validity or reliability for the IDDSI testing methods. One study was conducted in older adults presenting dysphagia. This review concludes that there is insufficient evidence to recommend the IDDSI testing methods. Further research, conducted with robust methodological design and reporting, is needed to develop and assess nutritious adapted food for frail older populations.
Collapse
|
15
|
Riluzole Oral Suspension for the Treatment of Amyotrophic Lateral Sclerosis: Texture and Compatibility with Food Thickeners Evaluation. J 2020. [DOI: 10.3390/j3030021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Riluzole 5 mg/mL oral suspension is the only licensed liquid medicine to treat Amyotrophic Lateral Sclerosis (ALS) orally. As more than 80% of ALS patients develop dysphagia, an oral liquid formulation provides an important therapeutic option. The Riluzole 5 mg/mL oral suspension is administered by means of the graduated oral dosing syringe included in the medicine package. Its concentration (5 mg/mL) is consistent with a small and easy to measure volume (10 mL) to deliver the prescribed 50-mg dose twice daily. This work had a dual objective. The first was to evaluate the texture of the Riluzole 5 mg/mL oral suspension according to the International Dysphagia Diet Standardisation Initiative (IDDSI) flow test. Results of this experiment indicated that Riluzole 5 mg/mL oral suspension would basically fall under the “mildly thick” IDDSI descriptors. This is an important feature because thick fluids facilitate a safer swallow in patients with dysphagia. As a second objective, we evaluated for scientific purposes the compatibility of Riluzole 5 mg/mL oral suspension with some of the most common food thickeners available on the market. Intimate mixtures of the Riluzole 5 mg/mL oral suspension with thickeners were evaluated for appearance, pH, Riluzole assay and Riluzole related substances immediately after preparation and after two hours at room temperature. Riluzole 5 mg/mL oral suspension resulted to be compatible with all the marketed thickeners tested.
Collapse
|
16
|
Hanson B, Jamshidi R, Redfearn A, Begley R, Steele CM. Experimental and Computational Investigation of the IDDSI Flow Test of Liquids Used in Dysphagia Management. Ann Biomed Eng 2019; 47:2296-2307. [PMID: 31218485 PMCID: PMC6838027 DOI: 10.1007/s10439-019-02308-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 06/11/2019] [Indexed: 11/26/2022]
Abstract
The International Dysphagia Diet Standardisation Initiative (IDDSI) flow test, using a standard 10-mL syringe, is being adopted in many countries for clinical measurement of the consistency of drinks. The working hypothesis is that thickening drinks to retard flow can be advantageous for individuals who struggle to cope with thin drinks. This study assesses how the IDDSI test relates to rheology and clinical knowledge of physiological flows during swallowing. With no pre-existing analytical solution for internal flow through the syringe, a computational model was designed, incorporating rheometry data from a variety of Newtonian and non-Newtonian liquids. The computational model was validated experimentally across the range of liquids but the technique showed limitations in simulating dripping and cohesiveness. Gum-based liquids which were strongly shear-thinning (0.12 < n < 0.25) showed plug-flow characteristics with 90% of the shear occurring in only 22% of the radial dimension. Shear rates were maximal at the nozzle outlet (> 60 times higher than the barrel) and reached 7400/s for the thinnest gum-based liquid. Shear rheology data alone was unable to describe the flow of these drinks. The flow conditions in the test varied according to the type and consistency of liquid, relating to the desired clinical effect.
Collapse
Affiliation(s)
- Ben Hanson
- UCL Mechanical Engineering, Torrington Place, London, WC1E 7JE, UK.
| | - Rashid Jamshidi
- UCL Chemical Engineering, Torrington Place, London, WC1E 7JE, UK
| | - Andrew Redfearn
- UCL Mechanical Engineering, Torrington Place, London, WC1E 7JE, UK
| | - Ryan Begley
- UCL Mechanical Engineering, Torrington Place, London, WC1E 7JE, UK
| | - Catriona M Steele
- Toronto Rehabilitation Institute - University Health Network, 550 University Avenue, #12-101, Toronto, ON, M5G 2A2, Canada
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, 500 University Avenue, Suite 160, Toronto, ON, Canada
| |
Collapse
|