Effect of addition of human saliva on steady and viscoelastic rheological properties of some commercial dysphagia-oriented products

Carboxymethylcellulose-induced depletion attraction to stabilize high internal phase Pickering emulsions for the elderly: 3D printing and β-carotene delivery

In this study, a carboxymethylcellulose (CMC) induced depletion attraction was developed to stabilize high internal phase Pickering emulsions (HIPPEs) as age-friendly 3D printing inks. The results demonstrated that depletion force induced the adsorption of yolk particles at the droplet interface and the formation of osmotic droplet clusters, thereby increasing the stability of HIPPEs. In addition, the rheological properties and nutrient delivery properties of HIPPEs could be adjusted by the mass ratio of yolk/CMC. The HIPPEs stabilized at yolk/CMC mass ratio 20:7.5 showed optimal printability, viscoelastic, structural recovery, and swallowability. HIPPEs have been applied to 3D printing, International Dysphagia Dietary Standardization Initiative (IDDSI) test, and in vitro digestive simulation in the elderly, indicating their attractive appearance, safe swallowability, and enhanced bioaccessibility of β-carotene. Our work provides new ideas for developing age-friendly foods with plasticity and nutrient delivery capacity by depletion attraction stabilizing HIPPEs.

Relationship between rheological properties, sensory perception, and overall acceptability of thickened liquids for dysphagia in young and old healthy individuals

This study investigated the relationship between rheological properties, sensory perception, and overall acceptability in healthy young and old groups for dysphagia thickened liquids. Unflavored (UTL) and flavored (FTLP) thickened liquids were prepared using tap water or pomegranate juice at 10 different viscosity levels. The rheological properties were then evaluated via syringe flow test and line spread test (LST). When the apparent viscosity levels of UTL and FTLP were similar, the syringe test and LST results were also similar, indicating consistent flow behavior. Sensory perception evaluations showed that the young group better distinguished viscosity differences between stages compared to the old group. Regarding overall acceptability, the old group preferred samples with higher apparent viscosity than the young group. Principal component analysis and k-means cluster analysis were used to explore correlations between variables and classify thickened liquids into four groups. This can serve the foundation for standardized texture grades of dysphagia thickened liquids, considering rheological characteristics and sensory profiles.

Pinching dynamics, extensional rheology, and stringiness of saliva substitutes

Saliva substitutes are human-made formulations extensively used in medicine, food, and pharmaceutical research to emulate human saliva's biochemical, tribological, and rheological properties. Even though extensional flows involving saliva are commonly encountered in situations such as swallowing, coughing, sneezing, licking, drooling, gleeking, and blowing spit bubbles, rheological evaluations of saliva and its substitutes in most studies rely on measured values of shear viscosity. Natural saliva possesses stringiness or spinnbarkeit, governed by extensional rheology response, which cannot be evaluated or anticipated from the knowledge of shear rheology response. In this contribution, we comprehensively examine the rheology of twelve commercially available saliva substitutes using torsional rheometry for rate-dependent shear viscosity and dripping-onto-substrate (DoS) protocols for extensional rheology characterization. Even though most formulations are marketed as having suitable rheology, only three displayed measurable viscoelasticity and strain-hardening. Still, these too, failed to emulate the viscosity reduction with the shear rate observed for saliva or match perceived stringiness. Finally, we explore the challenges in creating saliva-like formulations for dysphagia patients and opportunities for using DoS rheometry for diagnostics and designing biomimetic fluids.

Undaria pinnatifida gel inks for food 3D printing are developed based on the colloidal properties of Undaria pinnatifida slurry and protein/colloidal/starch substances

Currently, people eat Undaria pinnatifida (UP) in a single way, and processing homogeneity is serious. However, UP has not gained any traction in the 3D printing industry to date. This study explored the incorporation of soy protein isolate (SPI), pea protein (PP), xanthan gum (XG), guar gum (GG), corn starch (CS), and potato starch (PS) into UP slurry liquid, the primary component of the study, to formulate a UP gel ink. The UP gel 3D printing ink system based on UP paste was established and characterized. The results show that hydrogen bonds are formed, and three-dimensional gel network structure is formed in all UP gel inks. UP gel inks containing high concentrations of SPI and GG exhibited good texture and rheological qualities and good 3D printing effect, with storage modulus (G') values of 8440.405 ± 3.893 and 8111.730 ± 3.585 Pa. The loss of modulus (G″) values were 1409.107 ± 3.524 and 1071.673 ± 3.669 Pa. Unfortunately, the properties of other UP gel inks are not suitable, resulting in poor 3D printing results. The food 3D printing method developed in this study provides valuable insights for expanding food 3D printing material choices and achieving high-value applications of UP.

Development of high internal phase Pickering emulsions stabilized by egg yolk and carboxymethylcellulose complexes to improve β-carotene bioaccessibility for the elderly

The work aimed to develop the multi-protein mixture of egg yolk as natural particles to stabilize high internal phase Pickering emulsions (HIPPEs) to improve the bioaccessibility of β-carotene in the elderly. The results showed that the depletion attraction drove the adsorption of egg yolk protein particles at the oil-water interface and the formation of osmotic droplet clusters due to the attachment of particle-coated droplets in the dispersed phase, leading to kinetic blocking and stable gelation of HIPPEs. Rheological measurements showed that HIPPEs had shear thinning, low shear stress, viscoelastic properties, and structural recovery properties, which facilitated easy consumption for the elderly. The stability of HIPPEs was verified by ionic and centrifugal stability tests, demonstrating their potential for application to complex gastric environments. HIPPEs have been applied to the International Dysphagia Dietary Standardization Initiative (IDDSI) test and simulated in vitro digestion in older adults, demonstrating their safe swallowability and high β-carotene bioaccessibility. Our findings suggest solutions for food practitioners facing the aging problem and provide new insights for preparing age-friendly foods.

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.

Comparison between the use of hydrocolloids (xanthan gum) and high-pressure processing to obtain a texture-modified puree for dysphagia

Enriched lentil protein vegetable purees (10% zucchini, 10% carrots, 2.5% extra virgin olive oil and 21.8% lentil protein concentrate) suitable for people with dysphagia were developed with 0.8% xanthan gum (XG) or 600 MPa/5 min high pressure processing (HPP) treatment with the aim of comparing their rheological and textural properties. Selection of the appropriate XG % and HPP conditions was made by performing initial pilot trials. Purees showed a good nutritional profile (12% protein, 3.4% fiber, 100 Kcal/100 g), being adequate for people with dysphagia. Microbiological testing of HPP treated purees indicated that it has a good shelf-life under refrigerated conditions 14 days). Both types of purees showed a gel-like character (tan delta 0.161-0.222) and higher firmness, consistency and cohesiveness than control samples. Comparing XG and HPP samples at time 0, HPP treated purees showed the highest stiffness ( G'), the lowest deformability capacity (yield strain_LVR) and the lowest structural stability (yield stress_LVR). With storage, HPP treatment samples showed significant increases in all rheological and textural parameters. These results confirm the suitability of HPP as an alternative technology to hydrocolloids for the obtained dysphagia dishes.

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.

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).

Review of the effect of amylase-resistant dysphagia products on swallowing safety

PURPOSE OF REVIEW

Thickened fluids are a widely utilised compensatory management strategy for people with impaired swallowing (dysphagia). Over recent years there has been a shift in practice to offer gum-based instead of starch-based products. A key marketing message has been that gum-based thickeners with amylase-resistant properties are superior in promoting 'safer swallowing'. This review sought evidence to evaluate the effect of amylase-resistant products on swallowing safety.

RECENT FINDINGS

No studies directly compared the effect of amylase-resistant products with usual care or products without amylase resistance. Five studies cited amylase-resistant properties and compared gum-based to starch-based dysphagia products or thin fluids. Swallowing safety was frequently judged subjectively with rating scales. Swallowing biomechanics were not included and clinically meaningful outcomes, such as incidence of aspiration pneumonia, were not reported. A scoping review of the grey literature found little evidence that amylase-resistant properties of dysphagia products were of significant concern to clinicians or patients.

SUMMARY

Despite references to the 'importance' of amylase-resistant properties of dysphagia products there is no evidence that this property improves swallowing safety. Further research is needed using objective and clinically meaningful outcome measures to allow clinicians and patients to make informed decisions for dysphagia management.

Understanding relations between rheology, tribology, and sensory perception of modified texture foods

The aim of this work was to examine relations between instrumental and sensory parameters in a texture modified food matrix, with and without saliva. Nine pureed carrot samples (eight thickened and a control) were developed with starch (0.4 and 0.8% wt/wt), xanthan (0.2 and 0.4% wt/wt) or starch-xanthan blends that met International Dysphagia Diet Standardisation Initiative (IDDSI) Level 4 guidelines using fork and spoon tests. Rheological and tribological tests were conducted on the food and simulated bolus prepared by adding fresh stimulated saliva to the food (1:5, saliva:food) to mimic oral processing. Perceived sensory properties were identified using a temporal dominance of sensations (TDS) test (n = 16) where panelists were given a list of nine attributes. The area under the curve was extracted from TDS curves for each attribute/sample and this was correlated with rheological (viscosity at 10 s^-1 , G', G″, and tan δ at 1 Hz) and tribological (friction coefficient in three regimes) data. The viscosity of the control sample decreased after adding hydrocolloids (except Starch_0.8%) and with saliva incorporation. G' and G″ either increased or were similar for xanthan and blends and decreased for starch-thickened samples. Hydrocolloid addition increased friction for all samples and was higher with saliva addition. Sensory results showed that samples with starch were perceived as thick and grainy while xanthan was perceived as smooth and slippery. A greater number of sensory attributes correlated with viscoelastic parameters compared to friction coefficients. Correlations were highest with the saliva added samples, further highlighting the importance of including saliva during instrumental testing.

Oral behavior of emulsified systems with different particle size and thickening agents under simulated conditions

Food behavior during oral processing plays an essential role in the perception of texture. It depends on different factors, including food structure and composition, as well as its behavior when interacting with saliva. This study aimed to investigate the effect of particle size and thickener type of emulsified systems on physical, rheological, tribological, and oral oily coating properties under oral conditions. Six matrices based on oil-in-water emulsions with different particle sizes (NE-nanoemulsion and CE-conventional emulsions) were prepared using a mixture of emulsifiers (10% w/w) and sunflower oil (10% w/w). Thickened agents were added to the matrices (NE and CE) at different concentrations (3-4.5% w/w of starch-ST or 0.4-0.8% w/w xanthan gum-XG) to obtain equi-viscous samples (NE-EV) with their CE-based counterpart. Results showed a decrease in apparent viscosity values under oral conditions (saliva and shearing at 10 s^-1) during the shear time, but this behavior was more evident in starch-based matrices. The lubrication properties of the different matrices depended mainly on the thickener concentration since equi-viscous samples (NE-ST-EV and NE-XG-EV) showed higher coefficient of friction (CoF) values. Finally, oral oily coating was more related to the oil droplets size than to the type of thickener since all NE-based matrices showed a higher amount of coating retained compared to the CE-based ones. Therefore, NE-based matrices could be used as an alternative to increase mouthfeel sensations in food emulsions.

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.

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.