Commercial thickeners used by patients with dysphagia: Rheological and structural behaviour in different food matrices

A near-infrared fluorescent probe for simultaneous detection of pH and viscosity

In this work, we developed a ratiometric fluorescent probe (NT) based on ICT framework in near-infrared (NIR) which could detect pH and viscosity simultaneously. Long emission wavelength in NIR could protect the probe from interference of background fluorescence and improve the accuracy of the test. Due to the presence of thiazole-salt, the probe possessed good water solubility and could respond immediately to pH in water system. The pH values measured by NT in the actual samples were not much different from that measured by the pH meter, therefore, NT could give excellent accuracy. NT realized the reversible detection of pH by protonation and deprotonation. NT was used successfully to detect the pH of actual water samples, human serum and meat, as well as the viscosity variation caused by thickeners. Additionally, NT could monitor the changes of pH and viscosity in living cells. Therefore, the novel probe exhibited potential application in the fields of the environment, human health and food safety evaluation.

Effects of dispersing media on the rheological and tribological properties of basil seed mucilage-based thickened liquids

The development of thickening powders for the management of dysphagia is imperative due to the rapid growth of aging population and prevalence of the dysphagia. One promising thickening agent that can be used to formulate dysphagia diets is basil seed mucilage (BSM). This work investigates the effects of dispersing media, including water, milk, skim milk, and apple juice, on the rheological and tribological properties of the BSM-thickened liquids. Shear rheology results revealed that the thickening ability of BSM in these media in ascending order is milk < skim milk ≈ apple juice < water. On the other hand, extensional rheology demonstrated that the longest filament breakup time was observed when BSM was dissolved in milk, followed by skim milk, water, and apple juice. Furthermore, tribological measurements showed varying lubrication behavior, depending on the BSM concentration and dispersing media. Dissolution of BSM in apple juice resulted in the most superior lubrication property compared with that in other dispersing media. Overall, this study provides insights on BSM's application as a novel gum-based thickening powder in a range of beverages and emphasizes how important it is for consumers to have clear guidance for the use of BSM in dysphagia management.

A FRET-based ratiometric fluorescent probe for sensing bisulfite/sulfite and viscosity and its applications in food, water samples and test strips

A FRET-based ratiometric dual-response fluorescent probe, CQI, constructed by combining quinolinium-indole as the acceptor and coumarin as the donor, was developed for sensing HSO3-/SO32- and viscosity. After the interaction of probe CQI with the analyte, we achieved a green channel for the response to HSO3-/SO32- and an orange channel for the response to viscosity. We comprehensively evaluated the ability of CQI to detect SO2 derivatives and viscosity using fluorescence spectroscopy. Probe CQI exhibited a large Stokes shift (196 nm), a high energy transfer efficiency (99.6 %) and a wide detection range (0-250 μM). The fluorescence intensity of the probe increased up to 14-fold with increasing viscosity, and CQI could detect the viscosity of food thickeners. More importantly, probe CQI could not only successfully monitor SO2 derivatives in various food and water samples, but also be prepared as bisulfite test strips.

Utilization of photo-luminescent technique toward viscosity detection in the liquid food system with triphenylamine-michaelitic acid molecular sensor

A noninvasive and effective viscosity inspection method is expected to ease the burden of continued increased health problems caused by liquid food safety. In this study, we proposed the viscosity of the liquid food micro-environment as a marker and further developed a versatile optical sensor, DPTMDD, for monitoring liquid food micro-environmental viscosity alterations. This sensor was strategically constructed by the triphenylamine-thiophene derivate and michaelitic acid, rotatable conjugate structure was utilized as the recognition site. The molecular sensor was synthesized in a one-step facile way, and DPTMDD displayed a longer emission wavelength (592 nm), low detection limit (1.419 cP), and larger Stokes shift (193.7 nm in glycerol and 177.8 nm in water) with narrower energy band, endowing the sensor with the capacity of achieving high signal-to-noise ratio imaging. Meanwhile, DPTMDD exhibits high adaptability, selectivity, sensitivity, and good photo-stability in various liquid foods, bright fluorescent signal (37.5-fold) of DPTMDD is specifically activated in the high viscosity media. Thickening efficiencies can be identified as well. More importantly, the viscosity fluctuations during the metamorphic stages of liquid foods are also screened through in situ monitoring. We expected that this unique strategy will reinvigorate the continued perfection of liquid food safety investigation systems.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13197-023-05699-y.

Green extract rosemary acid as a viscosity-sensitive molecular sensor in liquid systems

The liquid micro-environment plays a momentous role in the regulation of various activities, and the abnormal changes are often closely related to the deterioration phenomena in multiple beverages. The local viscosity fluctuation has long been regarded as a key indicator to reflect the micro-environmental status changes. Herein, we proposed a versatile optical sensor, rosmarinic acid (RA), one kind of green natural product extracted from rosemary, for monitoring liquid micro-environmental viscosity alterations. RA displays a larger Stokes shift (123.8 nm) with narrow-band energy and exhibits wide adaptability, high selectivity, good sensitivity, and excellent photostability in various commercial liquids. When in high viscous media, a bright fluorescent signal of RA is specifically activated, and a high signal-to-noise ratio signal was released (58-fold). With the assistance of the fluorescence analytical technique, we have successfully achieved tracking the viscosity fluctuations during the deterioration stage of liquids via an in situ and visualization method. Our study will spur additional research on the molecular tools extracted from natural products for liquid safety inspection, and a convenient and sustainable application pathway has been established.

Triphenylamine-Modified Cinnamaldehyde Derivate as a Molecular Sensor for Viscosity Detection in Liquids

Liquid safety is considered a serious public health problem; a convenient and effective viscosity determination method has been regarded as one of the powerful means to detect liquid safety. Herein, one kind of triphenylamine-modified cinnamaldehyde-based fluorescent sensor (3-(4'-(diphenylamino)-[1,1'-biphenyl]-4-yl)acrylaldehyde (DPABA)) has been developed for sensing viscosity fluctuations in a liquid system, where a cinnamaldehyde derivative was extracted from one kind of natural plant cinnamon and acted as an acceptor, which has been combined with a triphenylamine derivate via the Suzuki coupling reaction within one facile step. Twisted intramolecular charge transfer (TICT) was observed, and the rotation could be restricted in the high-viscosity microenvironment; thus, the fluorescent signal was released at 548 nm. Featured with a larger Stokes shift (223.8 nm in water, 145.0 nm in glycerol), high adaptability, sensitivity, selectivity, and good photostability, the capability of high signal-to-noise ratio sensing was achieved. Importantly, this sensor DPABA has achieved noninvasively identifying thickening efficiency investigation, and viscosity fluctuations during the liquid deterioration program have been screened as well. We believed that this unique strategy can accelerate intelligent molecular platforms toward liquid quality and safety inspection.

Rheological Issues on Oropharyngeal Dysphagia

There is an increasing proof of the relevance of rheology on the design of fluids for the diagnosis and management of dysphagia. In this sense, different authors have reported clinical evidence that support the conclusion that an increase in bolus viscosity reduces the risks of airway penetration during swallowing. However, this clinical evidence has not been associated yet to the definition of objective viscosity levels that may help to predict a safe swallowing process. In addition, more recent reports highlight the potential contribution of bolus extensional viscosity, as elongational flows also develops during the swallowing process. Based on this background, the aim of this review paper is to introduce the lecturer (experts in Dysphagia) into the relevance of Rheology for the diagnosis and management of oropharyngeal dysphagia (OD). In this sense, this paper starts with the definition of some basic concepts on Rheology, complemented by a more extended vision on the concepts of shear viscosity and elongational viscosity. This is followed by a short overview of shear and elongational rheometrical techniques relevant for the characterization of dysphagia-oriented fluids, and, finally, an in-depth analysis of the current knowledge concerning the role of shear and elongational viscosities in the diagnosis and management of OD (shear and elongational behaviors of different categories of dysphagia-oriented products and contrast fluids for dysphagia assessment, as well as the relevance of saliva influence on bolus rheological behavior during the swallowing process).

Sustainable natural chlorogenic acid as a functional molecular sensor toward viscosity detection in liquids

Liquids are perishable at ease during the long-term transportation and storage processes, non-invasive and in situ inspection method is urgent to be developed. In consideration of the important role of viscosity, one kind of sustainable natural product chlorogenic acid (CA) extracted from honeysuckle has been used as a versatile optical sensor for viscosity determination during the liquid spoilage process. The natural molecule was conducted by the O-diphenyl and carboxylic acid ester groups in coincidence, a typical twisted intramolecular charge transfer phenomenon was formed. This sensor features wide adaptability, high selectivity, good sensitivity, and excellent photo stability in various liquids. And CA displays a larger Stokes shift, high viscosity sensitive coefficient (0.62), and narrower energy band. The rotatable conjugate structure can be acted as the recognition site, and the bright fluorescent signal of CA is specifically activated when in the high viscous micro-environment. Inspired by this objective phenomenon, CA has been applied to detect the thickening efficiency of various food thickeners. More importantly, the viscosity fluctuations during the deterioration stage of liquids can be screened through non-invasive and in situ monitoring. We expected that more natural products can be developed as molecular tools for liquids safety investigation, and fluorescent analytical methods can be expanded toward interdisciplinary research.

Patients with dysphagia: How to supply nutrition through non-tube feeding

OBJECTIVE

Dysphagia has become one of the important factors that cause malnutrition in the whole age group. At present, tube feeding is still the mainstream means to solve the problem of dysphagia. However, tube feeding has physical and mental harm to people, and the ways of non-tube feeding are relatively diversified. The significance of the thickening mechanism described in some articles to solve the problem of dysphagia is not clear.

SETTING AND PARTICIPANTS

All patients with dysphagia worldwide, including oropharyngeal dysphagia (OD) and non-oropharyngeal dysphagia.

METHODS

We searched the literature in Pubmed, Web of Science and Cochrane Library and initially browsed the titles and abstracts. We reviewed the full text of the articles that met our topic, and the language of the article was limited to English.

RESULTS

We found that food thickening to a certain degree (350-1,750 cP) can reduce the complications of choking, aspiration, reflux, and other complications in patients with dysphagia, and reduce the social disorder, anxiety, and other psychological problems caused by catheterization and surgery. Significantly, food science engineers should invite clinicians to intervene in the development of specialty foods from different perspectives such as clinical pathophysiology and fluid mechanics.

CONCLUSION AND IMPLICATIONS

It is necessary to develop special foods for patients with dysphagia, which requires scientists from different disciplines to work together.

Characterization of Dysphagia Thickeners Using Texture Analysis-What Information Can Be Useful?

Besides shear viscosity, other texture parameters (adhesiveness or cohesiveness) might be relevant for safe swallowing in people suffering from oropharyngeal dysphagia. Shear viscosity is assessed through protocols developed using a viscometer or a rheometer. In contrast, protocols and instruments (capillary break-up rheometer) to assess adhesiveness and cohesiveness are less common and much less developed. Other equipment such as texture analyzers can provide useful information on food properties. Here, we aimed to explore different texture analyzer settings (type of test, probe, and protocol) to characterize four commercial dysphagia thickeners at the shear viscosity levels recommended by manufacturers. Among the tests used (extrusion or penetration) with the different probes (disc, cone and shape holder, sphere, or cylinder), cone extrusion provided information about adhesivity, disc extrusion about sample cohesiveness, and sphere about penetration and sample elasticity. The test speeds used influenced the results, but only one speed is needed as the different speeds provided the same fluid information; for easiness, it is proposed to use 1 mm/s. Comparing the texture analyzer results with viscosity values obtained at different shears, the texture analyzer parameters reflected information that differ from shear viscosity. This information could be relevant for the therapeutic effect of thickening products and food characterization.

Activatable molecular rotor based on bithiophene quinolinium toward viscosity detection in liquids

The development of non-invasive and effective viscosity inspection methods during the liquid deterioration process is urgently needed since viscosity is one of the most important physical parameters of liquids. Methods featuring rapid detection, high sensitivity, cheap equipment, and fast result output are greatly desired. In this study, a viscosity-sensitive molecular rotor (BTPEQ) with a large Stokes shift (187 nm), and long emission wavelength (648 nm) has been developed. The rotor is comprised of a bithiophene donor and quinolinium acceptor, and displays a typical twisted intramolecular-charge transfer (TICT) feature, with good photostability, selectivity, and universality in various commercial liquids. With the aid of BTPEQ, the thickening effects of liquid thickeners can be determined. More importantly, BTPEQ was explored to visualize the viscosity variations in liquids at different metamorphic stages, and it was found that the viscosity level in microenvironments is highly dependent on the liquid food metamorphic period. It is worth noting that this approach can facilitate the continued perfection of fluorescent analytical methods for food quality and safety inspection.

Effect of α-amylase and pH on the rheological properties of thickened liquids containing starch in in vitro conditions relevant to oral processing and swallowing

The objective of this study was to investigate quantitatively the impact of saliva on the rheological properties of thickened drinks (IDDSI Level 3) with different pH. Oral digestion was simulated and followed using a rheometer. An insalivation ratio measured from spitted boli, was used in the in vitro oral digestion experiments, comparing unstimulated human saliva to an artificial saliva. The initial viscosity of thickened water samples (pH 5.3 and 7.4) was reduced by 80% after only 5 s of in vitro oral digestion. A similar viscosity decay was observed with the artificial saliva. This decrease in viscosity was attributed to the breakdown of the starch granule structure by α-amylase and in a lesser extent to a dilution effect. In contrast, the rheological properties of thickened lemon drink (pH = 2.7) and thickened orange juice (pH = 4.0) were not influenced significantly by human salivary amylase. These results suggest that at these pH, starch-based thickened drinks can maintain their initial IDDSI level, despite a strong dilution with saliva, which could help in the management of dysphagia. Clinical trials should be performed to confirm this hypothesis. Only human salivary α-amylase should be used to study products between pH 3 and 5 to imitate the structural and rheological breakdown happening before swallowing, while α-amylase from Bacillus sp. could also be used outside this range. The method developed in this study can be used to quantify the impact of food oral processing and evaluate rheological properties relevant for swallowing in the presence of saliva. This article is protected by copyright. All rights reserved.

Instrumental and sensory techniques to characterize the texture of foods suitable for dysphagic people: A systematic review

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.

Dysphagia thickeners in context of use. Changes in thickened drinks’ viscosity and thixotropy with temperature and time of consumption

Dysphagia patients might need to thicken drinks. The viscosity of these thickened drinks varies among commercial thickeners and drinks compromising the ingesta safety. The aim of this study was to investigate how temperature and resting time affect the rheological properties of thickened drinks. Four commercial thickeners were used to thicken water, coffee, orange juice, and milk at two concentration levels used in dysphagia drinks (nectar and pudding). To study the effect of temperature, flow curves of thickened drinks at 10°C and 50°C were obtained and to study the effect of resting time, flow curves of thickened drinks at 25°C were obtained at different times (0, 30, and 60 min). All samples displayed shear‐thinning and time‐dependent behavior (thixotropy or antithixotropy). The effect of temperature on viscosity values and relative thixotropic area (RTA) depended on the thickener and the drink. Overall, apparent viscosity showed higher values at 50°C than 10°C, especially in thickeners containing starch and in drinks with higher soluble solids (milk and orange juice). This was attributed to the water absorption of pregelatinized starch granules favored by temperature. Antithixotropy was mainly observed at pudding concentration for the starch‐containing thickeners, and decreased with temperature. The effect of resting time on apparent viscosity and RTA depended also on the drink and thickener. Mostly, apparent viscosity values increased with resting time and antithixotropic behavior decreased. Both effects, increase in viscosity and decrease of antithixotropy with time, indicated that thickening action was being developed over the resting time.

Preparation and Performance of Thickened Liquids for Patients with Konjac Glucomannan-Mediated Dysphagia

The present study sought to characterize the rheological and thickening properties of Konjac glucomannan (KGM) and prepare thickening components for special medical purposes using KGM and maltodextrin as the primary raw materials and guar gum (GG), xanthan gum (XG), locust bean gum (LBG), and carrageenan (KC) as the supplemented materials. The formulation and preparation processes were optimized through single factor experiments taking sensory evaluation as an indicator. The results confirm that KGM had excellent thickening performance, reaching about 90 times its own mass. The optimal formulation process of the thickening components based on KGM was as follows: the mass concentration of the compound thickener (KGM/GG/XG/LBG/KC = 13:2:2:2:1) was 5.0–7.0 mg/mL; the maltodextrin concentration was 10.0 mg/mL; the brewing temperature of the thickening component was 60 °C with no restriction on consumption time. The rheology test results revealed that the thickening components had shear thinning characteristics, which could provide three different thickening effects of nectar-thick level (350 mPa·s), honey-thick level (1250 mPa·s), and pudding-thick level (1810 mPa·s) suitable for people with different degrees of chewing disorders. Overall, this study provides a theoretical basis and technical reference for KGM as a dietary nutrition support for patients with dysphagia.

Triphenylamine indanedione as an AIE-based molecular sensor with one-step facile synthesis toward viscosity detection of liquids

AIE-based triphenylamine indanedione molecular sensors were synthesized in a one-step facile manner and designed for viscosity detection in liquids.

3D Printing of Shiitake Mushroom Incorporated with Gums as Dysphagia Diet

With the speeding tendency of aging society, the population experienced dysphagia is increasing quickly. Desirable dysphagic diets should be safe, visually appealing and nutritious. 3D printing allows for creation of personalized nutritious foods with regular-like appearance. Shiitake mushroom, rich in protein and bioactive compounds, is suitable for elderly, but its hard texture was not friendly to the elderly with dysphagia. This study investigated the feasibility of production of dysphagic product using shiitake mushroom by 3D printing with various gums addition, including arabic gum (AG), xanthan gum (XG) and k-carrageenan gum (KG) at concentrations of 0.3%, 0.6% and 0.9% (w/w). Data suggested that XG and KG incorporation significantly increased inks’ mechanical strength by decreasing water mobility and promoting the formation of hydrogen bond, enabling 3D printed objects with great self-supporting capacity. The XG containing and KG-0.3% samples were categorized into level 5—minced and moist dysphagia diet within international dysphagia diet standardization initiative (IDDSI) framework. AG addition decreased mechanical strength and viscosity, hardness and self-supporting capacity of 3D printed constructions. AG-0.3% and AG-0.6% samples could not be classified as dysphagia diets based on IDDSI tests. This study provides useful information for dysphagia diet development with appealing appearance by 3D printing.

Physical, sensory, and simulated mastication properties of texture-modified Spanish sauce using different texturing agents

This study aims to evaluate the colour texture, flow, viscoelastic, sensory, and simulated mastication properties, in the presence and absence of artificial saliva, of texture-modified Spanish sauce at different temperatures (25 °C, 37 °C and/or 55 °C). Sauce texture was modified using five hydrocolloids (modified starch (MS), guar gum (GG), tara gum (TG), sodium carboxymethylcellulose (CMC), and chia seed mucilage (CSM) as an alternative texturing agent), achieving two well-differentiated consistencies: honey-like and pudding-like. The MS, GG, TG and CSM sauces showed greater consistency, firmness, stiffness, and resistance to flow than the CMC samples. Furthermore, the internal structure of CMC sauces was the most affected by temperature changes. The addition of saliva decreased the apparent viscosity, consistency, and adhesiveness of the sauces. Among the samples studied, the GG and CSM texture-modified sauces would be suitable for dysphagic patients because of their good elasticity, relatively high resistance to deformation and structural stability, as well as better resistance to salivary α-amylase action. However, CSM sauces obtained the lowest sensory attribute scores. This work opens the door to the use of CSM as a texturing agent and demonstrates the importance of considering not only the hydrocolloid type and consistency level, but also the administration temperature of dysphagia-oriented products. Selecting a suitable texturing agent is of great importance for safe and easy swallowing by dysphagic patients.

Food polysaccharides and roles of rheology and tribology in rational design of thickened liquids for oropharyngeal dysphagia: A review

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.

Exploring Tools for Designing Dysphagia-Friendly Foods: A Review

Dysphagia is a medical condition that affects normal swallowing. To prevent the risk of aspiration or choking, thickened fluids and texture-modified foods have been used for dysphagia management with the goal of slowing down the flow of liquids and protecting the airway. This article summarizes the available information about the rheological and textural parameters, the characterization of the most-used thickeners and the application of alternative texture modification technologies that are crucial to developing safe dishes for people who suffer from swallowing difficulties. Regarding rheological and textural measurements, fundamental and empirical methods are described.

Food Puree for Seniors: The Effects of XanFlax as a New Thickener on Physicochemical and Antioxidant Properties

With the increasing number of older adults, the elderly-friendly food market has been rapidly growing. The physicochemical and antioxidant properties of soymilk-based banana-blueberry-puree with and without flaxseed-based (XanFlax) and xanthan-gum-based (brand G) thickeners were compared as a potential senior food. Samples included a control, three treatments with XanFlax (1%, 3%, and 5%), and three treatments with brand G (1.35%, 2.7%, and 5.4%). The physicochemical (color, sugar, salinity, pH, viscosity, and hardness) and antioxidant properties [DPPH, ABTS, reducing power (RP), and total polyphenol content (TPC)] were compared. The chromaticity values (L*, a*, and b*) and pHs were similar among all treatments and the control, but the salinity of brand G showed statistical differences (p < 0.05). All samples met the Korean Industrial Standards for senior foods in terms of viscosity and hardness, while samples with brand G were harder and more viscous than those with XanFlax and the control (p < 0.001). XanFlax samples had greater ABTS radical scavenging activities than the control and brand G samples (p < 0.001). Although, the developed puree can be a possible senior food product without the addition of thickeners, XanFlax might be applied as a non-xanthan gum-based viscosity thickener with antioxidant functions for senior-friendly foods.

Texture-Modified Food for Dysphagic Patients: A Comprehensive Review

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.

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

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

Validating the textural characteristics of soft fish-based paste through International Dysphagia Diet Standardisation Initiative recommended tests

One in every twelve people worldwide suffers from dysphagia that affects the swallowing mechanism and some patients require a special texture-modified food for their sustenance. Fish is a great source of nutrients and proteins, however the commercially dysphagia diet made from fish is limited. This study investigated the textural characteristics of a soft fish paste produced from steamed grass carp fillet with different the water addition, grinding cycles and ratio of starch with the mixture of steamed fillet and water, following International Dysphagia Diet Standardisation Initiative (IDDSI) guidelines and other instruments. The water addition and particle size affected the physical properties, and the starch had a certain masking effect on fishy odor. The mixture of steamed fish fillets and water (91:9 wt/wt) was ground in a colloid mill for 3 cycles. The fish paste was then sterilized by adding sugar, salt, and starch in the mixture (ratios of 0.5:100, 0.5:100, and 0.6:100, wt/wt, respectively) and mixing well. The paste conformed to Level 4-pureed and extremely thick of IDDSI framework. The fish paste product had a light fishy odor that was acceptable to sensory specialists.

Influence of the particle size and hydrocolloid type on lipid digestion of thickened emulsions

Hydrocolloids are used as stabilizing agents in order to enhance the physical stability of emulsions during their storage. However, they can also play an important role in nutrient release and bioavailability. In this context, the aim of this research was to study the effect of the emulsion type and thickener type on the physical-structural changes and free fatty acid release during in vitro digestion. Oil-in-water emulsions were prepared with different particle sizes (CE: conventional emulsions and NE: nanoemulsions) and thickening agents (starch and xanthan gum). The experimental conditions of homogenization used allowed food emulsions to be obtained at the microscale and nanoscale, with particle sizes ranging among 3.2-3.4 μm and 78-107 nm for CE and NE, respectively. The addition of thickening agents (XG and ST) modified the physical properties of emulsions (particle size, zeta potential and stability) slightly, and thickened samples with similar viscosity were obtained. The kinetics of FFAs released during the in vitro intestinal digestion showed no significant differences (p > 0.05) in the digestion rate among samples; however, emulsion and thickener types decreased the final extent of free fatty acids, being more evident for those samples with starch. Xanthan gum kept the particle size of nanoemulsions stable during the oral and gastric phases, which promoted the release of FFAs during the intestinal phase. Therefore, xanthan gum could be used as a thickening agent of nanoemulsions exerting a minor impact on their lipid bioaccessibility.

Simultaneous X-ray Video-Fluoroscopy and Pulsed Ultrasound Velocimetry Analyses of the Pharyngeal Phase of Swallowing of Boluses with Different Rheological Properties

The Ultrasound Velocity Profiling (UVP) technique allows real-time, non-invasive flow mapping of a fluid along a 1D-measuring line. This study explores the possibility of using the UVP technique and X-ray video-fluoroscopy (XVF) to elucidate the deglutition process with the focus on bolus rheology. By positioning the UVP probe so that the pulsed ultrasonic beam passes behind the air-filled trachea, the bolus flow in the pharynx can be measured. Healthy subjects in a clinical study swallowed fluids with different rheological properties: Newtonian (constant shear viscosity and non-elastic); Boger (constant shear viscosity and elastic); and shear thinning (shear rate-dependent shear viscosity and elastic). The results from both the UVP and XVF reveal higher velocities for the shear thinning fluid, followed by the Boger and the Newtonian fluids, demonstrating that the UVP method has equivalent sensitivities for detecting the velocities of fluids with different rheological properties. The velocity of the contraction wave that clears the pharynx was measured in the UVP and found to be independent of bolus rheology. The results show that UVP not only assesses accurately the fluid velocity in a bolus flow, but it can also monitor the structural changes that take place in response to a bolus flow, with the added advantage of being a completely non-invasive technique that does not require the introduction of contrast media.

Tetranitrile-anthracene as a probe for fluorescence detection of viscosity in fluid drinks via aggregation-induced emission

An AIE-based fluorescent probe was developed for monitoring the viscosity change during the spoilage process of fluid drinks.

Assessment of the Food-Swallowing Process Using Bolus Visualisation and Manometry Simultaneously in a Device that Models Human Swallowing

The characteristics of the flows of boluses with different consistencies, i.e. different rheological properties, through the pharynx have not been fully elucidated. The results obtained using a novel in vitro device, the Gothenburg Throat, which allows simultaneous bolus flow visualisation and manometry assessments in the pharynx geometry, are presented, to explain the dependence of bolus flow on bolus consistency. Four different bolus consistencies of a commercial food thickener, 0.5, 1, 1.5 and 2 Pa s (at a shear rate of 50 s-1)-corresponding to a range from low honey-thick to pudding-thick consistencies on the National Dysphagia Diet (NDD) scale-were examined in the in vitro pharynx. The bolus velocities recorded in the simulator pharynx were in the range of 0.046-0.48 m/s, which is within the range reported in clinical studies. The corresponding wall shear rates associated with these velocities ranged from 13 s-1 (pudding consistency) to 209 s-1 (honey-thick consistency). The results of the in vitro manometry tests using different consistencies and bolus volumes were rather similar to those obtained in clinical studies. The in vitro device used in this study appears to be a valuable tool for pre-clinical analyses of thickened fluids. Furthermore, the results show that it is desirable to consider a broad range of shear rates when assessing the suitability of a certain consistency for swallowing.

Effect of sucrose on rheological properties of xanthan gum-locust bean gum mixtures

The effect of sucrose (0, 10, 20, 30, and 40%) on flow and dynamic rheological properties of xanthan gum (XG) mixed with locust bean gum (LBG) at different mixing ratios (100/0, 75/25, 50/50, and 0/100) were evaluated. The addition of sucrose significantly changed the flow behavior index (n), consistency index (K), storage modulus (G'), and loss modulus (G″) of XG, LBG, and XG-LBG mixtures. When XG and LBG were mixed, there was a synergistic effect on K and G' values, and 50XG/50LBG mixture exhibited stronger synergy than 75XG/25LBG mixtures. However, the addition of sucrose reduced the magnitude of the synergistic effects, indicating that the presence of sucrose in XG-LBG mixtures negatively affected the synergistic interaction between gum molecules. Sucrose may competitively inhibit the binding of gum polymers to water molecules. The rheological properties of XG, LBG, and XG-LBG mixtures were affected by the addition of sucrose in a concentration-dependent manner.

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?

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.