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Li L, Zhou TQ, Wang YQ, Zhang Q, Yan JN, Wang C, Lai B, Zhang LC, Wu HT. Rheological characterization of chia seed gum as a thickening agent used for dysphagia management. Int J Biol Macromol 2024; 275:133413. [PMID: 38945723 DOI: 10.1016/j.ijbiomac.2024.133413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 06/11/2024] [Accepted: 06/23/2024] [Indexed: 07/02/2024]
Abstract
Dysphagia has emerged as a serious health issue facing contemporary society. Consuming thickened liquids is an effective approach for improving the swallowing safety for dysphagia patients. The thickening effect of chia seed gum (CSG), a novel thickener, in different dispersing media (water, orange juice, and skim milk) was investigated. Moreover, the potential application of CSG for dysphagia management was evaluated by comparison with xanthan gum (XG) and guar gum (GG). The thickened liquids prepared with 0.4 %-1.2 % (w/v) CSG, XG, and GG could be classified into levels 1-4, 2-4, and 1-3, respectively, according to the International Dysphagia Diet Standardization Initiative (IDDSI) framework. All the thickened liquids displayed shear-thinning characteristics that facilitated safe swallowing. The viscosities (η50) of CSG dissolved in water (0.202-1.027 Pa·s) were significantly greater than those of CSG dissolved in orange juice (0.070-0.690 Pa·s) and skim milk (0.081-0.739 Pa·s), indicating that CSG had a greater thickening effect in water than in orange juice and skim milk. Compared with those prepared with GG, the thickened liquids prepared with CSG and XG exhibited greater viscoelasticity, better water-holding capacity, and more compact networks. The findings suggested that CSG can be used as a potential thickener for thickening liquid foods to manage dysphagia.
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Affiliation(s)
- Lin Li
- SKL of Marine Food Processing & Safety Control, National Engineering Research Center of Seafood, Collaborative Innovation Center of Seafood Deep Processing, School of Food Science and Technology, Dalian Polytechnic University, Dalian 116034, China
| | - Tian-Qi Zhou
- SKL of Marine Food Processing & Safety Control, National Engineering Research Center of Seafood, Collaborative Innovation Center of Seafood Deep Processing, School of Food Science and Technology, Dalian Polytechnic University, Dalian 116034, China
| | - Yu-Qiao Wang
- SKL of Marine Food Processing & Safety Control, National Engineering Research Center of Seafood, Collaborative Innovation Center of Seafood Deep Processing, School of Food Science and Technology, Dalian Polytechnic University, Dalian 116034, China
| | - Qian Zhang
- College of Food Science and Engineering, Jilin University, Changchun 130062, China
| | - Jia-Nan Yan
- SKL of Marine Food Processing & Safety Control, National Engineering Research Center of Seafood, Collaborative Innovation Center of Seafood Deep Processing, School of Food Science and Technology, Dalian Polytechnic University, Dalian 116034, China
| | - Ce Wang
- SKL of Marine Food Processing & Safety Control, National Engineering Research Center of Seafood, Collaborative Innovation Center of Seafood Deep Processing, School of Food Science and Technology, Dalian Polytechnic University, Dalian 116034, China
| | - Bin Lai
- SKL of Marine Food Processing & Safety Control, National Engineering Research Center of Seafood, Collaborative Innovation Center of Seafood Deep Processing, School of Food Science and Technology, Dalian Polytechnic University, Dalian 116034, China
| | - Li-Chao Zhang
- Institutes of Biomedical Sciences, Shanxi University, Taiyuan 030006, China
| | - Hai-Tao Wu
- SKL of Marine Food Processing & Safety Control, National Engineering Research Center of Seafood, Collaborative Innovation Center of Seafood Deep Processing, School of Food Science and Technology, Dalian Polytechnic University, Dalian 116034, China.
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Hino H, Suzuki T, Maekawa K, Ita R, Sasa A, Kulvanich S, Takei E, Magara J, Tsujimura T, Inoue M. Effect of bolus property on swallowing dynamics in patients with dysphagia. J Oral Rehabil 2024; 51:1422-1432. [PMID: 38685709 DOI: 10.1111/joor.13709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 02/20/2024] [Accepted: 04/12/2024] [Indexed: 05/02/2024]
Abstract
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.
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Affiliation(s)
- Haruka Hino
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Taku Suzuki
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Kazuya Maekawa
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Reiko Ita
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Anna Sasa
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Sirima Kulvanich
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
- Department of Community Dentistry & Gerodontology, Faculty of Dentistry, Thammasat University, Pathumthani, Thailand
| | - Eri Takei
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Jin Magara
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Takanori Tsujimura
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Makoto Inoue
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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Wang K, Cheng Z, Qiao D, Xie F, Zhao S, Zhang B. Polysaccharide-dextrin thickened fluids for individuals with dysphagia: recent advances in flow behaviors and swallowing assessment methods. Crit Rev Food Sci Nutr 2024:1-25. [PMID: 38556920 DOI: 10.1080/10408398.2024.2330711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
The global aging population has brought about a pressing health concern: dysphagia. To effectively address this issue, we must develop specialized diets, such as thickened fluids made with polysaccharide-dextrin (e.g., water, milk, juices, and soups), which are crucial for managing swallowing-related problems like aspiration and choking for people with dysphagia. Understanding the flow behaviors of these thickened fluids is paramount, and it enables us to establish methods for evaluating their suitability for individuals with dysphagia. This review focuses on the shear and extensional flow properties (e.g., viscosity, yield stress, and viscoelasticity) and tribology (e.g., coefficient of friction) of polysaccharide-dextrin-based thickened fluids and highlights how dextrin inclusion influences fluid flow behaviors considering molecular interactions and chain dynamics. The flow behaviors can be integrated into the development of diverse evaluation methods that assess aspects such as flow velocity, risk of aspiration, and remaining fluid volume. In this context, the key in-vivo (e.g., clinical examination and animal model), in-vitro (e.g., the Cambridge Throat), and in-silico (e.g., Hamiltonian moving particles semi-implicit) evaluation methods are summarized. In addition, we explore the potential for establishing realistic assessment methods to evaluate the swallowing performance of thickened fluids, offering promising prospects for the future.
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Affiliation(s)
- Kedu Wang
- College of Food Science and Technology, Huazhong Agricultural University, Wuhan, China
- Chongqing Key Laboratory of Speciality Food Co-Built by Sichuan and Chongqing, College of Food Science, Southwest University, Chongqing, China
| | - Zihang Cheng
- College of Food Science and Technology, Huazhong Agricultural University, Wuhan, China
- Chongqing Key Laboratory of Speciality Food Co-Built by Sichuan and Chongqing, College of Food Science, Southwest University, Chongqing, China
| | - Dongling Qiao
- Chongqing Key Laboratory of Speciality Food Co-Built by Sichuan and Chongqing, College of Food Science, Southwest University, Chongqing, China
| | - Fengwei Xie
- Department of Chemical Engineering, University of Bath, Bath, UK
- School of Engineering, Newcastle University, Newcastle upon Tyne, UK
| | - Siming Zhao
- College of Food Science and Technology, Huazhong Agricultural University, Wuhan, China
| | - Binjia Zhang
- Chongqing Key Laboratory of Speciality Food Co-Built by Sichuan and Chongqing, College of Food Science, Southwest University, Chongqing, China
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Liu T, Zheng J, Du J, He G. Food Processing and Nutrition Strategies for Improving the Health of Elderly People with Dysphagia: A Review of Recent Developments. Foods 2024; 13:215. [PMID: 38254516 PMCID: PMC10814519 DOI: 10.3390/foods13020215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 12/29/2023] [Accepted: 01/05/2024] [Indexed: 01/24/2024] Open
Abstract
Dysphagia, or swallowing difficulty, is a common morbidity affecting 10% to 33% of the elderly population. Individuals with dysphagia can experience appetite, reduction, weight loss, and malnutrition as well as even aspiration, dehydration, and long-term healthcare issues. However, current therapies to treat dysphagia can routinely cause discomfort and pain to patients. To prevent these risks, a non-traumatic and effective treatment of diet modification for safe chewing and swallowing is urgently needed for the elderly. This review mainly summarizes the chewing and swallowing changes in the elderly, as well as important risk factors and potential consequences of dysphagia. In addition, three texture-modified food processing strategies to prepare special foods for the aged, as well as the current statuses and future trends of such foods, are discussed. Nonthermal food technologies, gelation, and 3D printing techniques have been developed to prepare soft, moist, and palatable texture-modified foods for chewing and swallowing safety in elderly individuals. In addition, flavor enhancement and nutrition enrichment are also considered to compensate for the loss of sensory experience and nutrients. Given the trend of population aging, multidisciplinary cooperation for dysphagia management should be a top priority.
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Affiliation(s)
- Ting Liu
- Key Laboratory of Public Health Safety of the Ministry of Education, School of Public Health, Fudan University, Shanghai 200032, China;
| | - Jianheng Zheng
- Nutrilite Health Institute, Shanghai 200032, China; (J.Z.); (J.D.)
| | - Jun Du
- Nutrilite Health Institute, Shanghai 200032, China; (J.Z.); (J.D.)
| | - Gengsheng He
- Key Laboratory of Public Health Safety of the Ministry of Education, School of Public Health, Fudan University, Shanghai 200032, China;
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Hou Y, Sun Y, Zhang P, Wang H, Tan M. Development and characterization of emulsion gels prepared via gliadin-based colloidal particles and gellan gum with tunable rheological properties for 3D printed dysphagia diet. Int J Biol Macromol 2023; 253:126839. [PMID: 37696376 DOI: 10.1016/j.ijbiomac.2023.126839] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 09/08/2023] [Indexed: 09/13/2023]
Abstract
Dysphagia, a condition characterized by difficulty swallowing, has emerged as a threat to health. Herein, we investigated the feasibility of preparing a novel 3D-printed dysphagia diet using emulsions and gellan gum. A gel network was facilitated by the inclusion of gellan gum, which also helped to reduce the size of the oil droplets. Emulsion gels (with 0.3 %-0.5 % gellan gum) were stable at 25 °C for 30 days and tolerated a high ionic concentration of 800 mmol L-1. Emulsion gels remained stable after heat treatment and centrifugation. The excellent stability of the emulsion gels was related to the three-dimensional network developed by the gellan gum. The rheological results validated the solid-state behavior, shear thinning behavior and structural recovery of emulsion gels. Emulsion gels with 0.3 %-0.5 % gellan gum were suitable for 3D printing since they had high printing accuracy, self-support, and smooth surface texture. International Diet Standardization Initiative (IDDIS) tests have shown that emulsion gels can be classified as a level 3-5 dysphagia diet. In addition, the bioaccessibility of astaxanthin increased 1.7 times after being encapsulated by emulsion gels. Overall, these results demonstrate the potential of emulsion gels in the development of novel 3D-printed diets for dysphagia and bioactive protection.
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Affiliation(s)
- Yitong Hou
- Academy of Food Interdisciplinary Science, School of Food Science and Technology, Dalian Polytechnic University, Qinggongyuan1, Ganjingzi District, Dalian 116034, Liaoning, China; National Engineering Research Center of Seafood, Dalian Polytechnic University, Dalian 116034, Liaoning, China; Collaborative Innovation Center of Seafood Deep Processing, Dalian Polytechnic University, Dalian 116034, Liaoning, China; State Key Laboratory of Marine Food Processing and Safety Control, Dalian Polytechnic University, Dalian 116034, Liaoning, China
| | - Yuanda Sun
- Academy of Food Interdisciplinary Science, School of Food Science and Technology, Dalian Polytechnic University, Qinggongyuan1, Ganjingzi District, Dalian 116034, Liaoning, China; National Engineering Research Center of Seafood, Dalian Polytechnic University, Dalian 116034, Liaoning, China; Collaborative Innovation Center of Seafood Deep Processing, Dalian Polytechnic University, Dalian 116034, Liaoning, China; State Key Laboratory of Marine Food Processing and Safety Control, Dalian Polytechnic University, Dalian 116034, Liaoning, China
| | - Pengjing Zhang
- Academy of Food Interdisciplinary Science, School of Food Science and Technology, Dalian Polytechnic University, Qinggongyuan1, Ganjingzi District, Dalian 116034, Liaoning, China; National Engineering Research Center of Seafood, Dalian Polytechnic University, Dalian 116034, Liaoning, China; Collaborative Innovation Center of Seafood Deep Processing, Dalian Polytechnic University, Dalian 116034, Liaoning, China; State Key Laboratory of Marine Food Processing and Safety Control, Dalian Polytechnic University, Dalian 116034, Liaoning, China
| | - Haitao Wang
- Academy of Food Interdisciplinary Science, School of Food Science and Technology, Dalian Polytechnic University, Qinggongyuan1, Ganjingzi District, Dalian 116034, Liaoning, China; National Engineering Research Center of Seafood, Dalian Polytechnic University, Dalian 116034, Liaoning, China; Collaborative Innovation Center of Seafood Deep Processing, Dalian Polytechnic University, Dalian 116034, Liaoning, China; State Key Laboratory of Marine Food Processing and Safety Control, Dalian Polytechnic University, Dalian 116034, Liaoning, China.
| | - Mingqian Tan
- Academy of Food Interdisciplinary Science, School of Food Science and Technology, Dalian Polytechnic University, Qinggongyuan1, Ganjingzi District, Dalian 116034, Liaoning, China; National Engineering Research Center of Seafood, Dalian Polytechnic University, Dalian 116034, Liaoning, China; Collaborative Innovation Center of Seafood Deep Processing, Dalian Polytechnic University, Dalian 116034, Liaoning, China; State Key Laboratory of Marine Food Processing and Safety Control, Dalian Polytechnic University, Dalian 116034, Liaoning, China
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6
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Bitencourt BS, Guedes JS, Saliba ASMC, Sartori AGO, Torres LCR, Amaral JEPG, Alencar SM, Maniglia BC, Augusto PED. Mineral bioaccessibility in 3D printed gels based on milk/starch/ĸ-carrageenan for dysphagic people. Food Res Int 2023; 170:113010. [PMID: 37316077 DOI: 10.1016/j.foodres.2023.113010] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 05/15/2023] [Accepted: 05/17/2023] [Indexed: 06/16/2023]
Abstract
Dysphagia is a condition that affects the ability to chew and swallow food and beverages, having a major impact on people's health and wellbeing. This work developed gel systems with a customized texture suitable for intake by dysphagic people using 3D printing and milk. Gels were developed using skim powdered milk, cassava starch (native and modified by the Dry Heating Treatment (DHT)), and different concentrations of kappa-carrageenan (ĸC). The gels were evaluated in relation to the starch modification process and concentration of gelling agents, 3D printing performance, and suitability for dysphagic people (following both the standard fork test described by the International Dysphagia Diet Standardization Initiative (IDDSI), and also using a new device coupled to a texture analyzer). Moreover, the best formulations were evaluated for mineral bioaccessibility through simulated gastrointestinal digestion based on INFOGEST 2.0 standardized method. The results showed that ĸC had a dominant effect compared to the DHT-modified starch on gel texture, 3D printing performance, and fork tests. The gels obtained by molding or 3D printing resulted in different behaviors during the fork test, which was associated with the gel extrusion process that breaks down their initial structure. The strategies applied to tailor the texture of the milk did not affect the mineral bioaccessibility, which was kept high (>80%).
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Affiliation(s)
- B S Bitencourt
- Department of Agri-food Industry, Food and Nutrition (LAN), "Luiz de Queiroz" College of Agriculture (ESALQ), University of São Paulo (USP), Piracicaba, SP, Brazil
| | - J S Guedes
- Department of Agri-food Industry, Food and Nutrition (LAN), "Luiz de Queiroz" College of Agriculture (ESALQ), University of São Paulo (USP), Piracicaba, SP, Brazil
| | - A S M C Saliba
- Center of Nuclear Energy in Agriculture (CENA), University of São Paulo (USP), Piracicaba, SP, Brazil
| | - A G O Sartori
- Department of Agri-food Industry, Food and Nutrition (LAN), "Luiz de Queiroz" College of Agriculture (ESALQ), University of São Paulo (USP), Piracicaba, SP, Brazil
| | - L C R Torres
- Center of Nuclear Energy in Agriculture (CENA), University of São Paulo (USP), Piracicaba, SP, Brazil
| | - J E P G Amaral
- Center of Nuclear Energy in Agriculture (CENA), University of São Paulo (USP), Piracicaba, SP, Brazil
| | - S M Alencar
- Department of Agri-food Industry, Food and Nutrition (LAN), "Luiz de Queiroz" College of Agriculture (ESALQ), University of São Paulo (USP), Piracicaba, SP, Brazil; Center of Nuclear Energy in Agriculture (CENA), University of São Paulo (USP), Piracicaba, SP, Brazil
| | - B C Maniglia
- Instituto de Química de São Carlos (IQSC), Universidade de São Paulo (USP), São Carlos, SP, Brazil
| | - P E D Augusto
- Université Paris-Saclay, CentraleSupélec, Laboratoire de Génie des Procédés et Matériaux, Centre Européen de Biotechnologie et de Bioéconomie (CEBB), 3 rue des Rouges Terres 51110 Pomacle, France.
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7
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Giura L, Urtasun L, Ansorena D, Astiasaran I. Comparison between the use of hydrocolloids (xanthan gum) and high-pressure processing to obtain a texture-modified puree for dysphagia. Food Res Int 2023; 170:112975. [PMID: 37316059 DOI: 10.1016/j.foodres.2023.112975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 05/10/2023] [Accepted: 05/13/2023] [Indexed: 06/16/2023]
Abstract
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 strainLVR) and the lowest structural stability (yield stressLVR). 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.
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Affiliation(s)
- Larisa Giura
- Department of Nutrition, Food Science and Physiology, Center for Nutrition Research, Faculty of Pharmacy and Nutrition, Universidad de Navarra, IDISNA - Instituto de Investigación Sanitaria de Navarra, Pamplona, C/Irunlarrea s/n 31008 Pamplona, Spain; National Centre for Food Technology and Safety (CNTA), NA 134, Km. 53, 31570 San Adrián, Navarre, Spain.
| | - Leyre Urtasun
- National Centre for Food Technology and Safety (CNTA), NA 134, Km. 53, 31570 San Adrián, Navarre, Spain.
| | - Diana Ansorena
- Department of Nutrition, Food Science and Physiology, Center for Nutrition Research, Faculty of Pharmacy and Nutrition, Universidad de Navarra, IDISNA - Instituto de Investigación Sanitaria de Navarra, Pamplona, C/Irunlarrea s/n 31008 Pamplona, Spain.
| | - Iciar Astiasaran
- Department of Nutrition, Food Science and Physiology, Center for Nutrition Research, Faculty of Pharmacy and Nutrition, Universidad de Navarra, IDISNA - Instituto de Investigación Sanitaria de Navarra, Pamplona, C/Irunlarrea s/n 31008 Pamplona, Spain
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8
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Su K, Wang YJ, Yu YS, Zheng XY, Huang ZS. Removable partial prosthesis combined with swallowing training is an efficient clinical solution for oral cancer post-operation patients with palatal defect and dysphagia: a prospective study. Clin Oral Investig 2023; 27:305-312. [PMID: 36214938 DOI: 10.1007/s00784-022-04725-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 09/27/2022] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Dysphagia is one of the major complications of oral cancer patients, and is disturbing thousands of patients worldwide. Our study aim to evaluate the clinical efficacy of prosthesis combined with swallowing training on palatal defect and dysphagia in post-operative oral cancer patients. MATERIALS AND METHODS Sixteen oral cancer patients with palatal defect and dysphagia post-operation were treated with removable prosthesis and individualized swallowing function training. Swallowing function of patients before and after treatment was analyzed and compared by videofluoroscopic swallowing examination. The severity of depression and life quality were evaluated by Depression Scale (SDS) and Functional Assessment of Cancer Therapy-Head and Neck (FACT-H&N) scores, respectively. RESULTS Oral transit time (OTT) significantly shortened after treatment (P < 0.01), and Penetration-Aspiration Scale (PAS) scores was significantly higher after treatment (P < 0.001). Different consistency bolus showed different risk of aspiration. Thickened liquids were related to lower PAS scores (P < 0.001). SDS standard score was significantly lower after treatment (P < 0.05). The total score of FACT-H&N after treatment was significantly higher (P < 0.05). No patients came back for regressed swallowing function during the follow-up period (17.06 ± 2.376 months). CONCLUSION Removable prosthesis and swallowing training can significantly improve swallowing function, reduce depression degree, and improve quality of life (QOL). CLINICAL RELEVANCE Removable prosthesis combined with swallowing training is a cheap and effective method to improve QOL in patients with palate defect and dysphagia after oral cancer.
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Affiliation(s)
- Kai Su
- Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Stomatology, 56 Lingyuan Road, Guangzhou, Guangdong, China
| | - Yu-Jia Wang
- Department of Stomotology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yanjiang Road, Guangzhou, Guangdong, China
| | - Yan-Song Yu
- Department of Stomotology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yanjiang Road, Guangzhou, Guangdong, China
| | - Xiu-Yuan Zheng
- Department of Rehabilitation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yanjiang Road, Guangzhou, Guangdong, China
| | - Zhuo-Shan Huang
- Department of Stomotology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yanjiang Road, Guangzhou, Guangdong, China.
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Calmarza-Chueca F, Sánchez-Gimeno AC, Raso-Pueyo J, Arbones-Mainar JM, Caverni-Muñoz A, Sanz-Arque A, Sanz-Paris A. Rheological Properties and Stability of Thickeners for Clinical Use. Nutrients 2022; 14:nu14173455. [PMID: 36079712 PMCID: PMC9460253 DOI: 10.3390/nu14173455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 08/16/2022] [Accepted: 08/18/2022] [Indexed: 11/16/2022] Open
Abstract
The adaptation of liquids for patients with dysphagia requires precision and individualization in the viscosities used. We describe the variations of viscosity in water at different concentrations and evolution over time of the three compositions of commercial thickeners that are on the market (starch, starch with gums, and gum). By increasing the concentration in water, the viscosity of gum-based thickeners increases linearly, but it did not reach pudding texture, whereas the viscosity of the starch-based thickeners (alone or mixed with gums) rapidly reaches very thick textures. We modeled the viscosity at different concentrations of the four thickeners using regression analysis (R2 > 0.9). We analyzed viscosity changes after 6 h of preparation. The viscosity of gum-based thickeners increased by a maximum of 6.5% after 6 h of preparation, while starch-based thickeners increased by up to 43%. These findings are important for correct handling and prescription. Gum-based thickeners have a predictable linear behavior with the formula we present, reaching nectar and honey-like textures with less quantity of thickener, and are stable over time. In contrast, starch thickeners have an exponential behavior which is difficult to handle, they reach pudding-like viscosity, and are not stable over time.
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Affiliation(s)
| | - Ana Cristina Sánchez-Gimeno
- Food Technology, Faculty of Veterinary, AgriFood Institute of Aragon (IA2), Zaragoza University, C/Miguel Servet, 177, 50013 Zaragoza, Spain
| | - Javier Raso-Pueyo
- Food Technology, Faculty of Veterinary, AgriFood Institute of Aragon (IA2), Zaragoza University, C/Miguel Servet, 177, 50013 Zaragoza, Spain
| | - José Miguel Arbones-Mainar
- Aragón Health Research Institute, 50009 Zaragoza, Spain
- Adipocyte and Fat Biology Laboratory (AdipoFat), Translational Research Unit, Instituto Aragones de Ciencias de la Salud (IACS), University Hospital Miguel Servet, 50009 Zaragoza, Spain
- Biomedical Research Center in Physiopathology of Obesity and Nutrition (CIBERObn), Institute of Health Carlos III (ISCIII), 28029 Madrid, Spain
| | | | - Alejandro Sanz-Arque
- Department of Endocrinology and Nutrition, Miguel Servet Hospital, 50009 Zaragoza, Spain
| | - Alejandro Sanz-Paris
- Department of Endocrinology and Nutrition, Miguel Servet Hospital, 50009 Zaragoza, Spain
- Aragón Health Research Institute, 50009 Zaragoza, Spain
- Correspondence:
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Yang Y, Xu J, Sang TT, Wang HY. A review and evidence based recommendations on starch- and gum-based thickeners for dysphagic patients. JOURNAL OF FOOD MEASUREMENT AND CHARACTERIZATION 2022. [DOI: 10.1007/s11694-022-01418-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ibañez FC, Merino G, Marín-Arroyo MR, Beriain MJ. Instrumental and sensory techniques to characterize the texture of foods suitable for dysphagic people: A systematic review. Compr Rev Food Sci Food Saf 2022; 21:2738-2771. [PMID: 35481665 DOI: 10.1111/1541-4337.12957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 03/14/2022] [Accepted: 03/18/2022] [Indexed: 11/29/2022]
Abstract
The interest to characterize texture-modified foods (TMFs) intended for people with oropharyngeal dysphagia (OD) has grown significantly since 2011. Several instrumental and sensory techniques have been applied in the analysis of these foods. The objective of the present systematic review was to identify the most appropriate techniques, especially for the food industry and clinical setting. The search was carried out in three online databases according to the "Preferred Reporting Items for Systematic Reviews and Meta-Analyses" (PRISMA). Across the multiple trials reviewed, Texture Profile Analysis and the Uniaxial Compression Test were most used as the instrumental technique for solid foods, and the Back Extrusion Test for fluid and semisolid foods. All trials used descriptive analysis as the sensory technique. However, the experimental conditions of the trials lacked standardization. Consequently, the results of the trials were not comparable. To properly characterize the texture of TMFs intended for OD by each technique, an international consensus is needed to establish standardized experimental conditions. Methods based on these techniques should also be validated by collaborative studies to verify repeatability, replicability, and reproducibility.
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Affiliation(s)
- Francisco C Ibañez
- Institute for Sustainability and Food Chain Innovation, Universidad Pública de Navarra, Pamplona, Spain
| | - Gorka Merino
- Institute for Sustainability and Food Chain Innovation, Universidad Pública de Navarra, Pamplona, Spain
| | | | - María José Beriain
- Institute for Sustainability and Food Chain Innovation, Universidad Pública de Navarra, Pamplona, Spain
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Himashree P, Sengar AS, Sunil CK. Food thickening agents: Sources, chemistry, properties and applications - A review. Int J Gastron Food Sci 2022. [DOI: 10.1016/j.ijgfs.2022.100468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Hadde EK, Chen J. Food texture and texture modification for dysphagia management. J Texture Stud 2021; 52:538-539. [PMID: 34927259 DOI: 10.1111/jtxs.12650] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Enrico Karsten Hadde
- Faculty of Engineering and Information Technology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jianshe Chen
- Institute of Food Oral Processing and Sensory Science, Zhejiang Gongshang University, Hangzhou, China
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