Challenges to assumptions regarding oral shear rate during oral processing and swallowing based on sensory testing with thickened liquids

From self-Assembly to healing: Engineering ultra-Small peptides into supramolecular hydrogels for controlled drug release

The aim of this study was the evaluation of suitability of novel mucoadhesive hydrogel platforms for the delivery of therapeutics useful for the management of disorders related to the gastrointestinal tract (GI). At this purpose, here we describe the preparation, the physicochemical characterization and drug delivery behaviour of novel hydrogels, based on self-assembling lipopeptides (MPD02-09), obtained by covalently conjugating lauric acid (LA) to SNA's peptide derivatives gotten by variously combining D- and L- amino acid residues. LA conjugation was aimed at improving the stability of the precursor peptides, obtaining amphiphilic structures, and triggering the hydrogels formation through the self-assembling. Budesonide (BUD), an anti-inflammatory drug, was selected as model because of its use in the treatment in GI disorders. Preliminary studies were performed to correlate the chemical structure of the conjugates with the key physicochemical properties of the materials for drug delivery. Two lipopeptides, MPD03 and MPD08, were found to form hydrogels (MPD03h and MPD08h, respectively) with characteristics suitable for drug delivery. These materials showed mucoadhesiveness of about 60 %. In vitro studies carried out with BUD loaded hydrogels showed about 70 % drug release within 6 h. Wound healing assessed in Caco-2 and HaCaT cells, showed reduction of cell-free area to values lower than 10 %. Taking together these results MPD03h and MPD08h have been shown to be excellent candidates for BUD delivery.

Effects of fluid shear stress on oral biofilm formation and composition and the transcriptional response of Streptococcus gordonii

Biofilms are subjected to many environmental pressures that can influence community structure and physiology. In the oral cavity, and many other environments, biofilms are exposed to forces generated by fluid flow; however, our understanding of how oral biofilms respond to these forces remains limited. In this study, we developed a linear rocker model of fluid flow to study the impact of shear forces on Streptococcus gordonii and dental plaque-derived multispecies biofilms. We observed that as shear forces increased, S. gordonii biofilm biomass decreased. Reduced biomass was largely independent of overall bacterial growth. Transcriptome analysis of S. gordonii biofilms exposed to moderate levels of shear stress uncovered numerous genes with differential expression under shear. We also evaluated an ex vivo plaque biofilm exposed to fluid shear forces. Like S. gordonii, the plaque biofilm displayed decreased biomass as shear forces increased. Examination of plaque community composition revealed decreased diversity and compositional changes in the plaque biofilm exposed to shear. These studies help to elucidate the impact of fluid shear on oral bacteria and may be extended to other bacterial biofilm systems.

Effect of bolus property on swallowing dynamics in patients with dysphagia

BACKGROUND

Modification of foods or liquids is commonly administered as part of dysphagia treatment. However, no consensus exists on the parameters for defining texture-modified food for patients with dysphagia.

OBJECTIVES

The aim of this study was to evaluate the effect of food/liquid material on swallowing physiology in patients with dysphagia and to discuss the optimal food choice for direct swallowing therapy.

MATERIALS AND METHODS

A total of 140 patients underwent a videofluoroscopic swallowing study using three test foods/liquids: 3 mL of mildly thick liquid (Thick liquid), jelly made of agar and polysaccharide (Jelly) and jelly made of pectin (Reset gel). Outcome measures of videofluoroscopic images, bolus transit time and hyoid movements were compared.

RESULTS

The frequency of chewing movements was highest for Jelly, followed by Reset gel and Thick liquid. While the probability of oral residue was the highest for Reset gel, pharyngeal residue after swallowing was high for Thick liquid as compared to Jelly and Reset gel. Oral transit time and pharyngeal transit time for Thick liquid were significantly smaller than that for Jelly and Reset gel. Pharyngeal delay time was significantly smaller for Thick liquid than that for Jelly and Reset gel. There was no difference in hyoid elevation time and hyoid movement time among the conditions.

CONCLUSION

Mildly thick liquid material may be optimal for patients with primarily oral motor function impairment and jelly, such as Reset gel, may be more suitable for patients with primarily pharyngeal motor function impairment or oral and pharyngeal coordinative motor function decline.

Microfluidic Rheology: An Innovative Method for Viscosity Measurement of Gels and Various Pharmaceuticals

Measuring the viscosity of pharmaceutical dosage forms is a crucial process. Viscosity provides information about the stability of the composition, the release rate of the drug, bioavailability, and, in the case of injectable drug formulations, even the force required for injection. However, measuring viscosity is a complex task with numerous challenges, especially for non-Newtonian materials, which include most pharmaceutical formulations, such as gels. Selecting the appropriate shear rate is critical. Since viscosity in many systems is highly temperature-dependent, stable temperature control is necessary during the measurement. Using microfluidics technology, it is now possible to perform rheological characterization and conduct fast and accurate measurements. Small sample volumes (even below 500 µL) are required, and viscosity determination can be carried out over a wide range of shear rates. Nevertheless, the pharmaceutical application of viscometers operating on the principle of microfluidics is not yet widespread. In our work, we compare the results of measurements taken with a microfluidic chip-based viscometer on different pharmaceutical forms (gels, solution) with those obtained using a traditional rotational viscometer, evaluating the relative advantages and disadvantages of the different methods. The microfluidics-based method enables time- and sample-efficient viscosity analysis of the examined pharmaceutical forms.

Oropharyngeal swallowing hydrodynamics of thin and mildly thick liquids in an anatomically accurate throat-epiglottis model

Understanding the mechanisms underlying dysphagia is crucial in devising effective, etiology-centered interventions. However, current clinical assessment and treatment of dysphagia are still more symptom-focused due to our limited understanding of the sophisticated symptom-etiology associations causing swallowing disorders. This study aimed to elucidate the mechanisms giving rise to penetration flows into the laryngeal vestibule that results in aspirations with varying symptoms. Methods: Anatomically accurate, transparent throat models were prepared with a 45° down flapped epiglottis to simulate the instant of laryngeal closure during swallowing. Fluid bolus dynamics were visualized with fluorescent dye from lateral, rear, front, and endoscopic directions to capture key hydrodynamic features leading to aspiration. Three influencing factors, fluid consistency, liquid dispensing site, and dispensing speed, were systemically evaluated on their roles in liquid aspirations. Results: Three aspiration mechanisms were identified, with liquid bolus entering the airway through (a) the interarytenoid notch (notch overflow), (b) cuneiform tubercle recesses (recess overflow), and (c) off-edge flow underneath the epiglottis (off-edge capillary flow). Of the three factors considered, liquid viscosity has the most significant impact on aspiration rate, followed by the liquid dispensing site and the dispensing speed. Water had one order of magnitude higher aspiration risks than 1% w/v methyl cellulose solution, a mildly thick liquid. Anterior dispensing had higher chances for aspiration than posterior oropharyngeal dispensing for both liquids and dispensing speeds considered. The effects of dispending speed varied. A lower speed increased aspiration for anterior-dispensed liquids due to increased off-edge capillary flows, while it significantly reduced aspiration for posterior-dispensed liquids due to reduced notch overflows. Visualizing swallowing hydrodynamics from multiple orientations facilitates detailed site-specific inspections of aspiration mechanisms.

Flaxseed oleosomes: Responsiveness to physicochemical stresses, tribological shear and storage

This study aimed to extract oleosomes (OLs) from flaxseeds and assess their response to environmental conditions during storage (pH and ionic strengths), shear and tribological stresses. Our hypothesis was that a shear-induced instability will enable OLs to exhibit favourable lubrication performance. During storage, OLs exhibited resistance to droplet aggregation for up to 6 weeks owing to the proteins (3.5-152.8 kDa molecular weights) stabilizing the OL droplets. However, presence of divalent (Ca2+) ions induced destabilization with marked increase in droplet size (p < 0.05). OLs demonstrated shear thinning behaviour, displaying an order of magnitude higher viscosity than flaxseed oil (FSO) at low shear rates (<10 s-1). Strikingly, OLs mirrored the frictional profile of FSO regardless of entrainment speeds, due to droplet coalescence, validating the hypothesis. Such kinetic stability with shear-induced coalescing feature of OLs hold strong potential for future plant-based food development, particularly in achieving desired mouthfeel characteristics.

Benchmarking of a microgel-reinforced hydrogel-based aqueous lubricant against commercial saliva substitutes

Xerostomia, the subjective sensation of 'dry mouth' affecting at least 1 in 10 adults, predominantly elders, increases life-threatening infections, adversely impacting nutritional status and quality of life. A patented, microgel-reinforced hydrogel-based aqueous lubricant, prepared using either dairy or plant-based proteins, has been demonstrated to offer substantially enhanced lubricity comparable to real human saliva in in vitro experiments. Herein, we present the benchmarking of in vitro lubrication performance of this aqueous lubricant, both in its dairy and vegan formulation against a range of widely available and employed commercial saliva substitutes, latter classified based on their shear rheology into "liquids", "viscous liquids" and "gels", and also had varying extensional properties. Strikingly, the fabricated dairy-based aqueous lubricant offers up to 41-99% more effective boundary lubrication against liquids and viscous liquids, irrespective of topography of the tested dry mouth-mimicking tribological surfaces. Such high lubricity of the fabricated lubricants might be attributed to their limited real-time desorption (7%) from a dry-mouth mimicking hydrophobic surface unlike the tested commercial products including gels (23-58% desorption). This comprehensive benchmarking study therefore paves the way for employing these microgel-based aqueous lubricant formulations as a novel topical platform for dry mouth therapy.

Correlating instrumental measurements and sensory perceptions of foods with different textural properties for people with impaired oral and swallowing capabilities - A review

The rising global life expectancy has underlined the necessity of designing novel and tasty food products, suitable for seniors and people with impaired oral and swallowing functions. For developing these products, texture should be optimised from rheological, colloidal, tribological, and masticatory points of view. The current review provides an overview of different studies based on shear rheological, tribological, and in vitro mastication properties of model or real food systems intended for the elderly and/or people with swallowing dysfunctions, with special emphasis on the relation between the instrumental measurements and sensory perceptions of foods. Several works demonstrated that instrumental data from shear rheological and tribological tests complement the sensory evaluations of foods, providing useful information when designing food commodities for specific populations. Conversely, only few works correlated the instrumental data obtained from artificial mouths and/or simulated masticators with the sensory attributes generated by trained assessors. Broaden knowledge of these topics will help in formulating and adapting foods with enhanced functionalities for people with impaired oral and swallowing capabilities. Shear rheology, soft oral tribology, and simulated mastication tests are crucial in designing safe- and easy-swallowing food products.

Effects of Continuous and Cycled Annealing on the Physicochemical Properties and Digestibility of Water Caltrop Starch

The effects of treatment time of continuous annealing (ANN) and cycle numbers of cycled ANN on the structural, physicochemical, and digestive properties of water caltrop starch were studied under 70% moisture at 65 °C. It was found that continuous and cycled ANN have no significant effects on the morphology of starch granules. However, the relative crystallinity and content of resistant starch increased pronouncedly, possibly due to crystalline perfection, which also led to the rise in gelatinization temperature and the narrowed gelatinization temperature range of starch. The treatment time in continuous ANN generally showed a pronounced effect on the rheological properties of water caltrop starch. During pasting, the breakdown viscosity and setback viscosity of all treatment decreased, implying that ANN modified starch was less susceptible to the condition in heating and continuous shearing, and less likely to cause short-term retrogradation. In contrast, peak viscosity decreased with increasing treatment time of continuous ANN, indicating crystalline perfection restricted the swelling of starch granules and viscosity development during pasting process, which was consistent with the results of steady and dynamic rheological evaluation. All ANN-modified samples showed pseudoplastic behavior with weak gel viscoelastic characteristic. Under a total annealing time of 96 h, the pasting and rheological properties of water caltrop starch were essentially less affected by annealing cycle numbers. However, multistage ANN showed stronger resistance to enzyme hydrolysis.

Characteristics of post-stroke dysphagia: A retrospective study based on FEES

OBJECTIVE

This study aims to examine the characteristics of dysphagia in stroke patients with different lesion sites and explore the factors that impact the duration of nasogastric tube after post-stroke dysphagia (PSD).

METHODS

Patients with PSD were screened for analysis. Stroke types and lesion sites were confirmed using MRI or CT scans. Included patients were categorized into two groups: supratentorial stroke group (including lobar and deep intracerebral stroke subgroups) and infratentorial stroke group (including brainstem and cerebellar stroke subgroups). Fiberoptic endoscopic evaluation of swallowing (FEES), Penetration-aspiration scale (PAS), Yale pharyngeal residue (PR) severity rating scale, Functional oral intake scale (FOIS), Murray secretion severity rating scale (MSS), laryngopharyngeal sensation, and vocal fold mobility were investigated to assess the swallowing function.

RESULTS

A total of 94 patients were included in the final analysis. Significant differences were found in PR scores (p < .001), PAS scores (p < .05), MSS scores (p < .05), and vocal fold mobility (p < .001) between infratentorial and supratentorial stroke groups. Moreover, lobar stroke showed significantly higher PR scores compared to the deep intracerebral stroke group (p < .05). Kaplan-Meier survival analysis indicated significant differences in the duration of nasogastric tube placement among the following groups: infratentorial versus supratentorial stroke, PAS ≤ 5 versus PAS > 5, PR ≥ 3 versus PR < 3, and normal vocal fold mobility versus vocal fold motion impairment group (p < .05).

CONCLUSIONS

The infratentorial stroke may lead to worse swallowing function as compared to a supratentorial stroke. Additionally, patients with infratentorial stroke, PAS > 5, PR ≥ 3, or vocal fold motion impairment may contribute to a longer duration of nasogastric tube placement.

Rheology, Texture and Swallowing Characteristics of a Texture-Modified Dysphagia Food Prepared Using Common Supplementary Materials

A dysphagia diet is a special eating plan. The development and design of dysphagia foods should consider both swallowing safety and food nutritional qualities. In this study, the effects of four food supplements, namely vitamins, minerals, salt and sugar, on swallowing characteristics, rheological and textural properties were investigated, and a sensory evaluation of dysphagia foods made with rice starch, perilla seed oil and whey isolate protein was carried out. The results showed that all the samples belonged to foods at level 4 (pureed) in The International Dysphagia Diet Standardization Initiative (IDDSI) framework, and exhibited shear thinning behavior, which is favorable for dysphagia patients. Rheological tests showed that the viscosity of a food bolus was increased with salt and sugar (SS), while it decreased with vitamins and minerals (VM) at shear rates of 50 s^-1. Both SS and VM strengthened the elastic gel system, and SS enhanced the storage modulus and loss modulus. VM increased the hardness, gumminess, chewiness and color richness, but left small residues on the spoon. SS provided better water-holding, chewiness and resilience by influencing the way molecules were connected, promoting swallowing safety. SS brought a better taste to the food bolus. Dysphagia foods with both VM and 0.5% SS had the best sensory evaluation score. This study may provide a theoretical foundation for the creation and design of new dysphagia nutritional food products.

Metabolomics and sensory evaluation of white asparagus ingredients in instant soups unveil important (off-)flavours

Split-stream processing of asparagus waste stream is a novel approach to produce spray-dried powder and fibre. Asparagus ingredients processed by this method and a commercial asparagus powder were compared by evaluating their flavour profile in a soup formulation. Professional sensory panel and untargeted metabolomics approaches using GC-MS and LC-MS were carried out. Unsupervised and supervised statistical analyses were performed to highlight discriminatory metabolites and correlate these to sensory attributes. The spray-dried powder scored higher on asparagus flavour compared to the commercial powder. The fibre negatively impacted the taste and mouthfeel of the soups. GC-O-MS confirmed the role of dimethyl sulphide, 2-methoxy-3-isopropyl pyrazine and 2-methoxy-3-isobutyl pyrazine in asparagus odour. Seven new volatile compounds are also proposed to contribute to asparagus flavour notes, most of which were more abundant in the spray-dried powder. This research demonstrates the feasibility of upcycling asparagus waste streams into flavour-rich ingredients with good sensorial properties.

Effect of processing and microstructural properties of chickpea-flours on in vitro digestion and appetite sensations

Nowadays, pulse flours are ingredients that are more and more used as substitutes in traditional staples (i.e., pasta, bread). In this study, cellular chickpea-flour was used as an ingredient to replace conventional raw-milled chickpea-flour in suspensions and semi-solid purees. The contribution of cellular integrity on in vitro macronutrient digestion and the subsequent effect on in vivo appetite sensations were investigated. Alternating the flour preparation sequence by interchanging hydrothermal treatment and mechanical disintegration (thermo-mechanical treatment) resulted in three chickpea-flours with distinct levels of cellular integrity, and thus nutrient accessibility. The study showed that cellular integrity in chickpea-flours was preserved upon secondary hydrothermal treatment and led to significant attenuation of in vitro macronutrient digestion as compared to conventional chickpea-flour. In a randomized crossover design, significant increase of mean in vivo subjective appetite sensations satiety and fullness along with decreases in hunger, desire to eat, and prospective food consumption were achieved when cellular integrity was kept without an effect on palatability and appearance of the purees (n = 22). In vitro digestion along with microstructural assessment confirmed the importance of cellular integrity for attenuating macronutrient digestion and thereby contributing to enhanced subjective satiety and fullness in pulses. Overall, this study highlights the promising potential of altarenating the flour preparation sequence resulting in macronutrient and energy-matched flours with different nutrient encapsulation which lead to different in vitro digestion kinetics and in vivo appetite sensations.

Modernising Orodispersible Film Characterisation to Improve Palatability and Acceptability Using a Toolbox of Techniques

Orodispersible films (ODFs) have been widely used in paediatric, geriatric and dysphagic patients due to ease of administration and precise and flexible dose adjustments. ODF fabrication has seen significant advancements with the move towards more technologically advanced production methods. The acceptability of ODFs is dependent upon film composition and process of formation, which affects disintegration, taste, texture and mouthfeel. There is currently a lack of testing to accurately assess ODFs for these important acceptability sensory perceptions. This study produced four ODFs formed of polyvinyl alcohol and sodium carboxymethylcellulose using 3D printing. These were assessed using three in vitro methods: Petri dish and oral cavity model (OCM) methods for disintegration and bio-tribology for disintegration and oral perception. Increasing polymer molecular weight (MW) exponentially increased disintegration time in the Petri dish and OCM methods. Higher MW films adhered to the OCM upper palate. Bio-tribology analysis showed that films of higher MW disintegrated quickest and had lower coefficient of friction, perhaps demonstrating good oral perception but also stickiness, with higher viscosity. These techniques, part of a toolbox, may enable formulators to design, test and reformulate ODFs that both disintegrate rapidly and may be better perceived when consumed, improving overall treatment acceptability.

Institutionalized elderly are able to detect small viscosity variations in thickened water with gum-based thickeners: should texture classifications be reviewed?

BACKGROUND

The prevalence of dysphagia is very high in institutionalized elderly. Knowledge of the rheological and sensory characteristics of the various thickeners in elderly is limited, although it has been seen that there are differences between the rheological behaviors of gum-based thickeners with different composition. Moreover, we have not found sensory studies of viscosity in institutionalized elderly. Our hypothesis was that viscosity ranges established by the scientific societies, such as the National Dysphagia Diet Task Force (NDD), seem to be very wide and individuals might be able to detect small differences within the same texture range. The objectives of our study were 1) comparing the rheological characteristics of two commercial gum-based thickeners with different composition, dissolved in water under standard conditions, and 2) perform a sensory analysis (with both adults and institutionalized elderly) to detect different viscosities within the same texture (nectar and honey).

METHODS

Two commercial thickeners based on gums (NC and RC) were studied analyzing their viscosity in water with different concentrations (shear rate: 50 s^- 1; temperature: 22-25 °C). A sensory analysis involving 26 elderly and 29 adult controls was carried out to evaluate whether differences within nectar and honey textures among gum-based thickeners could be distinguished.

RESULTS

As the shear rate increases, viscosity decreases (non-Newtonian and pseudoplastic behavior). At the same concentration, each thickener produces a different viscosity (p < 0.05). Institutionalized elderly detected viscosity differences in nectar range of 49.9 (2.5) mPa·s (p < 0.05) and 102.2 (4.7) mPa·s (p < 0.0001). They also detected viscosity differences in honey texture range of 134.6 (9.7) mPa·s (p < 0.05) y 199.3 (9.2) mPa·s (p < 0.0001). Their caregivers also detected viscosity differences in both viscosity ranges (p < 0.0001) and with greater intensity than the elderly in honey texture (p: 0.016).

CONCLUSIONS

Our results suggest that the accepted viscosity ranges by NDD for the different textures might be too wide because institutionalized elderly and their caregivers are able to discern small differences in viscosity in nectar and honey textures. Gum-based thickeners with different composition showed differences in viscosity capacity, so they are not interchangeable.

Predicting thickness perception of liquid food products from their non-Newtonian rheology

The "mouthfeel" of food products is a key factor in our perception of food quality and in our appreciation of food products. Extensive research has been performed on what determines mouthfeel, and how it can be linked to laboratory measurements and eventually predicted. This was mainly done on the basis of simple models that do not accurately take the rheology of the food products into account. Here, we show that the subjectively perceived "thickness" of liquid foods, or the force needed to make the sample flow or deform in the mouth, can be directly related to their non-Newtonian rheology. Measuring the shear-thinning rheology and modeling the squeeze flow between the tongue and the palate in the oral cavity allows to predict how a panel perceives soup "thickness". This is done for various liquid bouillons with viscosities ranging from that of water to low-viscous soups and for high-viscous xanthan gum solutions. Our findings show that our tongues, just like our eyes and ears, are logarithmic measuring instruments in agreement with the Weber-Fechner law that predicts a logarithmic relation between stimulus amplitude and perceived strength. Our results pave the way for more accurate prediction of mouthfeel characteristics of liquid food products.

Capsaicin burn increases thickness discrimination thresholds independently of chronic chili intake

The trigeminal nerve transduces both chemical irritation and textural sensations suggesting that perception in one may influence perception in the other. Little is known about how the oral burn of capsaicin may affect texture sensitivity. The aim of this study was to determine the effect of burning sensations on thickness discrimination thresholds in liquid foods assessed by consumers who vary in habitual spicy food intake. Forty-seven Caucasian participants (31 females and 16 males; mean age: 25.0 ± 5.7 yrs; mean BMI: 21.5 ± 2.6 kg/m²) were recruited in the Netherlands. Chili pepper intake frequency and preference for chili peppers and spicy foods were assessed using questionnaires. Perceived burn and disliking/liking of bouillon soups thickened with xanthan gum (concentrations ranging from 0.06 to 0.21 g/mL; viscosity at 50 s^-1 (η_50s-1) ranging from 11 to 48 mPas) containing varying amounts of capsaicin (0, 1, or 10 ppm) were determined using generalized scales (gLMS and gDOL). Estimates of thickness discrimination thresholds were determined using the 2-Alternative Forced Choice ascending staircase method. Capsaicin was applied in two ways: (i) capsaicin was added directly to the soups or (ii) a pre-rinse of a capsaicin solution was held in mouth before evaluating soups without capsaicin. As expected, frequent chili pepper consumers reported significantly lower burn intensity and higher hedonic ratings compared to infrequent consumers. Thickness discrimination thresholds (i.e., BET expressed as Δη_50s-1) increased significantly from 11.3 mPas at 0 ppm to 16.1 mPas at 1 ppm (42% increase) to 21.4 mPas at 10 ppm capsaicin (89% increase) on average across all participants. Similar modification of thickness discrimination thresholds were observed regardless of whether capsaicin was added to the soup or was applied as a pre-rinse. No significant differences in thickness discrimination thresholds were observed between infrequent and frequent chili consumers. We conclude that oral burn caused by capsaicin affects thickness discrimination independently of reported chili pepper intake. Also, we suggest the ability of capsaicin to alter thickness discrimination may be due to increased neural noise, attentional effects or cross-modal interactions.

Characterization of raft-forming alginate suspensions formed in HCl or model food systems at varying pH levels to better simulate gastric postprandial conditions

OBJECTIVE

Elucidate properties of raft-forming alginates in vitro with varying composition, a system in which the raft was formed (HCl solution; tomato soup; protein-rich beverage), and pH levels for a more accurate representation of postprandial gastric conditions.

SIGNIFICANCE

Knowledge of the impact of the food system and pH on properties of raft-forming alginates may aid in formulation optimization. Recommendations may be made on food that is consumed prior to their consumption to optimize efficacy as a therapeutic agent.

METHODS

Dispersions of sodium alginate, calcium carbonate, and sodium bicarbonate were prepared with levels similar to commercial formulations. Rafts were formed in HCl solution, tomato soup, and a protein-rich beverage at pH 1-4 to assess raft properties.

RESULTS

Significant differences (p < 0.05) in raft mass, strength, resilience, and ability to buffer acid were observed depending on the system in which the rafts were formed. The highest mass was obtained in tomato soup (48.5 ± 9.8 g) compared to the protein-rich beverage and HCl solution (32.5 ± 4.5 g and 23.4 ± 4.8 g, respectively) at pH 1. Rafts formed in the protein-rich beverage exhibited the highest strength. Rafts formed in both food systems had a greater ability to buffer added acid compared to rafts formed in HCl solution.

CONCLUSIONS

In vitro testing of raft forming alginates in HCl solution at low pH may not be sufficient to describe in vivo events, as a strong matrix effect was observed when rafts were formed in model meal systems at representative postprandial pH levels.

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.

Microwave treatment to modify textural properties of high protein gel applicable as dysphagia food

The study aimed to formulate a high protein base as a dysphagia food and investigate the possibility of textural modification by applying microwave treatments. The formulated mixture contained 41.7% pea protein (dry basis), which exhibited shear thinning behavior. The application of microwave processing at 300, 500, and 700 W for 60, 120, and 180 s showed that at a higher level of energy induction by microwave, the hardness of the sample gradually increased from a fluid gel to a soft solid and more rigid levels. Processing at 300 and 500 W in the tested range showed that textural properties (hardness, adhesiveness, cohesiveness, springiness, gumminess, and chewiness) of the sample could be modulated within the recommended criteria for dysphagia food, providing the possibility of individualization of food texture for dysphagia disorder. Two main causes of these textural changes could be water evaporation and protein denaturation, in which, regarding the ratio of water evaporation to the size of textural changes, protein denaturation was thought to have the main impact on the phenomena.

Physicochemical stability and gastrointestinal fate of β-carotene-loaded oil-in-water emulsions stabilized by whey protein isolate-low acyl gellan gum conjugates

This study aimed to examine the effect of whey protein isolate-low acyl gellan gum (WPI-GG) conjugate on the physicochemical properties and digestibility of β-carotene-loaded oil-in-water emulsions. The WPI-GG conjugate-stabilized emulsions had lower droplet sizes with more homogenous distribution, more negative surface charge, and higher interfacial protein concentration and viscosity, compared to those stabilized by WPI-GG mixture and WPI. The emulsion droplets coated by the conjugate were also generally more stable to environmental stresses (i.e., storage, pH changes, ionic strength, freeze-thaw cycles, and thermal treatment) along with higher β-carotene retention than other systems. The stability to droplet aggregation during in vitro digestion was remarkably increased for the conjugate-stabilized emulsion. However, the β-carotene bioaccessibility was significantly affected when the conjugate was used to stabilize the emulsions, likely due to the thick interfacial layer, high viscosity, and negative charge of the corresponding emulsions that could inhibit droplet digestion and mixed micelle formation.

Modulation of pharyngeal swallowing by bolus volume and viscosity

Oropharyngeal swallowing involves complex neuromodulation to accommodate changing bolus characteristics. The pressure events during deglutitive pharyngeal reconfiguration and bolus flow can be assessed quantitatively using high-resolution pharyngeal manometry with impedance. An 8-French solid-state unidirectional catheter (32 pressure sensors, 16 impedance segments) was used to acquire triplicate swallows of 3 to 20 ml across three viscosity levels using a Standardized Bolus Medium (SBMkit) product (Trisco, Pty. Ltd., Australia). An online platform (https://swallowgateway.com/; Flinders University, South Australia) was used to semiautomate swallow analysis. Fifty healthy adults (29 females, 21 males; mean age 46 yr; age range 19-78 yr old) were studied. Hypopharyngeal intrabolus pressure, upper esophageal sphincter (UES) maximum admittance, UES relaxation pressure, and UES relaxation time revealed the most significant modulation effects to bolus volume and viscosity. Pharyngeal contractility and UES postswallow pressures elevated as bolus volumes increased. Bolus viscosity augmented UES preopening pressure only. We describe the swallow modulatory effects with quantitative methods in line with a core outcome set of metrics and a unified analysis system for broad reference that contributes to diagnostic frameworks for oropharyngeal dysphagia.NEW & NOTEWORTHY The neuromodulation of the healthy oropharyngeal swallow response was described in relation to bolus volume and viscosity challenges, using intraluminal pressure and impedance topography methods. Among a wide range of physiological measures, those indicative of distension pressure, luminal opening, and flow timing were most significantly altered by bolus condition, and therefore can be considered to be potential markers of swallow neuromodulation. The study methods and associated findings inform a diagnostic framework for swallow assessment in patients with oropharyngeal dysphagia.

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.

Is IDDSI an Evidence-Based Framework? A Relevant Question for the Frail Older Population

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.

A Tutorial on Saliva's Role in Swallowing With a Focus on Sjögren's Syndrome

Purpose Saliva is integral to swallowing and necessary for oral health. Understanding saliva's origin and properties is important for swallowing assessment and management. Diseases such as Sjögren's syndrome (SS) can affect saliva negatively, often contributing to dysphagia. Our objectives are to (a) highlight saliva's fundamental role in swallowing, (b) provide a bibliometric overview of literature pertaining to SS pathophysiology and effects on saliva, (c) explore implications of salivary changes on swallowing and quality of life in SS and other populations, and (d) provide suggestions for systematic saliva assessment in practice. Method This tutorial reviews saliva production, composition, and involvement in swallowing within health and disease. Using rapid review methodology, we outline the effect of SS on saliva and describe SS etiology, diagnosis, and treatment. We discuss formal saliva assessments and a multidisciplinary approach. Results Saliva plays a vital role in swallowing, particularly lubrication, bolus formation, and oral health. SS affects the salivary glands altering salivary flow rate and composition. We identified 55 studies (N) measuring salivary changes, grouping them according to four strata demarcated by SS classification criteria updates. For some, xerostomia, dysphagia, and reduced life quality result. Formal saliva assessments include the Clinical Oral Dryness Score, Xerostomia Inventory, and Secretion Rating Scale. Multidisciplinary care is optimal for patients with salivary changes. Conclusion Understanding salivary changes in disease may enhance understanding of swallowing and inform dysphagia practice. Expanding swallowing assessments with formal saliva evaluations, and patient perspectives thereof, may aid in developing bespoke treatments, ultimately improving outcomes and quality of life. Supplemental Material https://doi.org/10.23641/asha.12456449.

Contributions of viscosity and friction properties to oral and haptic texture perception of iced coffees

Creaminess is affected by bulk properties (i.e. viscosity) and surfaces properties (i.e. friction). This study aimed (i) to assess contributions of viscosity and friction properties to creaminess, thickness and slipperiness perception; and (ii) to compare oral and haptic thickness and slipperiness perception of iced coffees. Three iced coffees differing in viscosity and friction properties were prepared: low viscosity - high friction (LV-HF); low viscosity - low friction (LV-LF) and high viscosity - low friction (HV-LF) iced coffee. Viscosity of iced coffees was adjusted by addition of maltodextrin, and viscosity of HV-LF was 2.5 times higher than that of LV-HF and LV-LF (10 vs. 4 mPa s at 100 s-1). Friction coefficients of LV-LF were reduced by addition of polyethylene glycol (PEG, Mw 6000), and were up to 25% lower than those of LV-HF. Forty-seven untrained panellists (18-27 years) performed two-alternative forced choice (2-AFC) and rank-rating tests to compare creaminess by oral assessment, and thickness and slipperiness by oral and haptic assessment. Results from 2-AFC and rank-rating congruently showed that HV-LF was creamier, thicker and more slippery than LV-HF and LV-LF, both orally and haptically. LV-LF was orally perceived as less creamy and less thick, but haptically as more slippery than LV-HF. Creaminess was more strongly correlated to thickness than to slipperiness. Oral and haptic evaluation of thickness was congruent, whereas differences between oral and haptic slipperiness evaluation were product-dependent. We conclude that increasing viscosity enhances creaminess, whereas increasing lubrication is not necessarily sufficient to increase creaminess in iced coffees.

The role of extensional rheology in the oral phase of swallowing: an in vitro study

Swallowing disorders deteriorate significantly the quality of life and can be life-threatening. Texture modification using shear thinning food thickeners has been proven to be effective in the management of dysphagia. Some studies have recently considered the positive role of cohesiveness, but there is still an insufficient understanding of the effect of the rheological properties of the liquid bolus on the dynamics of bolus transport, particularly when elasticity and extensional properties are combined with a shear thinning behaviour. This study combines steady shear, SAOS and capillary breakage extensional rheometry with an in vitro method to characterize the oral transport of viscoelastic liquids. Bolus velocity and bolus length were measured from exit in vitro experiments using image analysis and related to shear and extensional properties. A theory describing the bolus dynamics shows that the elastic and extensional properties do not influence significantly the oral transit dynamics. Conversely, in vitro results suggest that the extensional properties can affect the transition from the oral to the pharyngeal phase of swallowing, where thin, viscoelastic liquids lead to a fast transit, lower oral post-swallow residues and more compact bolus with a smoother surface, which may suggest a lower risk of fragmentation. This mechanistic explanation suggests that the benefit of the extensional properties of thin viscoelastic liquids in the management of dysphagia should be further evaluated in clinical trials.

Bolus rheology and ease of swallowing of particulated semi-solid foods as evaluated by an elderly panel

Preparation of a bolus is a complex process with both food comminution and degree of lubrication with saliva playing an important role in a safe swallow.

Experimental and Computational Investigation of the IDDSI Flow Test of Liquids Used in Dysphagia Management

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.

Cell Wall Polymer Composition and Spatial Distribution in Ripe Banana and Mango Fruit: Implications for Cell Adhesion and Texture Perception

Banana (Musa acuminata) and mango (Mangifera indica) are two of the most popular fruits eaten worldwide. They both soften during ripening but their textural attributes are markedly different. This study aimed to elucidate the molecular mechanism underpinning textural differences between banana and mango. We used a novel combination of methods at different scales to analyse the surface properties of fruit cells and the potential contribution of cells and cell wall components to oral processing and texture perception. The results indicated that cell separation occurred easily in both organs under mild mechanical stress. Banana cells showed distinctively elongated shapes with distinct distribution of pectin and hemicellulose epitopes at the cell surface. In contrast, mango had relatively spherical cells that ruptured during cell separation. Atomic force microscopy detected soft surfaces indicative of middle lamella remnants on banana cells, while mango cells had cleaner, smoother surfaces, suggesting absence of middle lamellae and more advanced cell wall disassembly. Comparison of solubilized polymers by cell wall glycome analysis showed abundance of mannan and feruylated xylan in separation exudate from banana but not mango, but comparable levels of pectin and arabinogalactan proteins. Bulk rheology experiments showed that both fruits had similar apparent viscosity and hence might be extrapolated to have similar "oral thickness" perception. On the other hand, oral tribology experiments showed significant differences in their frictional behavior at orally relevant speeds. The instrumental lubrication behavior can be interpreted as "smooth" mouthfeel for mango as compared to "astringent" or "dry" for banana in the later stages of oral processing. The results suggest that cell wall surface properties contribute to lubricating behavior associated with textural perception in the oral phase.

Reference Values for Healthy Swallowing Across the Range From Thin to Extremely Thick Liquids

Purpose Thickened liquids are frequently used as an intervention for dysphagia, but gaps persist in our understanding of variations in swallowing behavior based on incremental thickening of liquids. The goal of this study was to establish reference values for measures of bolus flow and swallowing physiology in healthy adults across the continuum from thin to extremely thick liquids. Method A sex-balanced sample of 38 healthy adults underwent videofluoroscopy and swallowed 20% weight-to-volume concentration barium prepared in thin and slightly, mildly, moderately, and extremely thick consistencies using a xanthan gum thickener. Participants took comfortable sips and swallowed without a cue; sip volume was measured based on presip and postsip cup weights. A standard operating procedure (the ASPEKT method: Analysis of Swallowing Physiology: Events, Kinematics and Timing) was used to analyze videofluoroscopy recordings. Results The results clarify that, for thin liquid sips (10-14 ml), a single swallow without clearing swallows is typical and is characterized by complete laryngeal vestibule closure, complete pharyngeal constriction, and minimal postswallow residue. Aspiration was not seen, and penetration was extremely rare. Bolus position at swallow onset was variable, extending as low as the pyriform sinuses in 37% of cases. With thicker liquids, no changes in event sequencing, laryngeal vestibule closure, pharyngeal constriction, or postswallow residue were seen. The odds of penetration were significantly reduced. A longer timing interval until onset of the hyoid burst movement was seen, with an associated higher bolus position at swallow onset. Other timing measures remained unaffected by changes in bolus consistency. Conclusion The results include new reference data for swallowing in healthy adults across the range from thin to extremely thick liquids.

Role of fluid cohesiveness in safe swallowing

In patients with dysphagia, it has been a practice to thicken fluid food to prevent aspiration-the transport of a bolus into the trachea instead of the oesophagus. In these patients, aspiration is a risk behaviour and is closely related to pneumonia (caused by the aspiration of oral bacteria into the lungs). Since excessive thickening of fluids can cause adverse effects, such as lowering the palatability of food, subsequent reduction of liquid intake, dehydration and malnutrition, identifying the optimum thickening level is vital. Thickening might not only increase fluid viscosity, but could also modify its cohesiveness, which is another key factor affecting aspiration. Even though cohesiveness is more of a concept than a well-defined measurable parameter, this property describes the degree of coherency provided by the internal structure of a material against its fractional breakup. In fluids, this concept is less explored than in solids, powders and granules, and during the last decade few scientists have tackled this topic. Although the role of cohesiveness in the swallowing of heterogeneous solid foods is briefly overviewed, the aim of the present paper is to introduce the concept of cohesiveness for a relatively homogeneous fluid bolus and its effect on swallowing. Cohesiveness is highly correlated with the extensibility and yield stress of the fluid, suggesting that a high cohesiveness could have an important role in preventing aspiration.