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Begen SN, Serel Arslan S. How do visual, auditory and motor dual-tasking each affect swallowing and chewing function? J Oral Rehabil 2024; 51:1579-1588. [PMID: 38783600 DOI: 10.1111/joor.13697] [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: 06/04/2023] [Revised: 01/19/2024] [Accepted: 03/23/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND It can be challenging to perform a second task at the same time as swallowing. OBJECTIVE(S) The study aimed to investigate the effect of visual, auditory and motor dual-tasking on swallowing and chewing function in healthy young adults. METHOD Right-handed healthy adults without any psychological and cognitive problems were included in the study. Swallowing was evaluated based on the dysphagia limit in different liquid textures such as water and nectar consistencies, and chewing was evaluated by the Test of Masticating and Swallowing Solids. For the second task, visual and auditory performance was assessed using reaction time, and the motor performance was assessed using a bilateral tapping task. Assessments were performed in two steps: baseline and dual-task. For baseline, all evaluation methods were applied individually. After completing the baseline assessment, dual-task assessment were carried out the following day. For dual-task assessment, the swallowing and chewing tasks were performed simultaneously with visual, auditory and motor tasks. RESULTS Results showed a significant decrease in dysphagia limit in the nectar consistency, and significant increase in chewing time, visual reaction time and tapping rate (right-left) when compared to baseline and dual-task conditions (χ2(3) = 9.61, p = .02; χ2(3) = 9.02, p = .02; χ2(3) = 28.09, p < .001; χ2(3) = 28.97, p < .001; χ2(3) = 21.56, p < .001, respectively). However, there were no differences in dysphagia limit in the water and auditory reaction time compared to baseline and dual-task conditions (χ2(3) = 3.18, p = .36; χ2(3) = 2.56, p = .50, respectively). CONCLUSION Results shedding light on how simultaneous dual tasks can influence swallowing and chewing. Dual-tasking cause a decrease in both swallowing/chewing and the visual/motor performances. These results may provide valuable information for designing interventions or strategies aimed at improving or maintaining optimal swallowing and chewing during in various populations during daily life.
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Affiliation(s)
- Sena Nur Begen
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Atılım University, Ankara, Turkey
| | - Selen Serel Arslan
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
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Volkert D, Delzenne N, Demirkan K, Schneider S, Abbasoglu O, Bahat G, Barazzoni R, Bauer J, Cuerda C, de van der Schueren M, Doganay M, Halil M, Lehtisalo J, Piccoli GB, Rolland Y, Sengul Aycicek G, Visser M, Wickramasinghe K, Wirth R, Wunderle C, Zanetti M, Cederholm T. Nutrition for the older adult - Current concepts. Report from an ESPEN symposium. Clin Nutr 2024; 43:1815-1824. [PMID: 38970937 DOI: 10.1016/j.clnu.2024.06.020] [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: 06/10/2024] [Accepted: 06/18/2024] [Indexed: 07/08/2024]
Abstract
BACKGROUND & AIMS In view of the global demographic shift, a scientific symposium was organised by the European Society for Clinical Nutrition and Metabolism (ESPEN) to address nutrition-related challenges of the older population and provide an overview of the current state of knowledge. METHODS Eighteen nutrition-related issues of the ageing global society were presented by international experts during the symposium and summarised in this report. RESULTS Anorexia of ageing, dysphagia, malnutrition, frailty, sarcopenia, sarcopenic obesity, and the metabolic syndrome were highlighted as major nutrition-related geriatric syndromes. Great progress has been made in recent years through standardised definitions of some but not all syndromes. Regarding malnutrition, the GLIM approach has shown to be suitable also in older adults, justifying its continuous implementation. For anorexia of ageing, a consensus definition is still required. Intervention approaches should be integrated and person-centered with the aim of optimizing intrinsic capacity and maintaining functional capacity. Landmark studies like EFFORT and FINGER have impressively documented the potential of individualised and multifactorial interventions for functional and health benefits. Combining nutritional intervention with physical training seems particularly important whereas restrictive diets and drug treatment should generally be used with caution because of undesirable risks. Obesity management in older adults should take into account the risk of promoting sarcopenia. CONCLUSIONS In the future, even more individualised approaches like precision nutrition may enable better nutritional care. Meanwhile all stakeholders should focus on a better implementation of currently available strategies and work closely together to improve nutritional care for older adults.
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Affiliation(s)
- D Volkert
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany.
| | - N Delzenne
- Metabolism and Nutrition Research Group, Louvain Drug Research Institute, UCLouvain, Brussels, Belgium.
| | - K Demirkan
- Department of Clinical Pharmacy, Faculty of Pharmacy, Hacettepe University, Ankara, Turkiye.
| | - S Schneider
- Gastroenterology and Nutrition, CHU de Nice, Université Côte d'Azur, Nice, France.
| | - O Abbasoglu
- Department of Clinical Nutrition, Hacettepe University, Ankara, Turkiye.
| | - G Bahat
- Department of Internal Medicine, Division of Geriatrics, Medical Faculty, Istanbul University, Istanbul, Turkiye.
| | - R Barazzoni
- Department of Medical, Surgical and Health Sciences, University of Trieste, Italy.
| | - J Bauer
- Center for Geriatric Medicine, Heidelberg University Hospital, Agaplesion Bethanien Hospital Heidelberg, Germany.
| | - C Cuerda
- Department of Medicine, Universidad Complutense, Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - M de van der Schueren
- Department of Nutrition, Dietetics and Lifestyle, HAN University of Applied Sciences, Nijmegen, The Netherlands; Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, The Netherlands.
| | - M Doganay
- Department of Surgery and Surgical Oncology, University of Health Sciences, Gulhane Medical Faculty, Ankara, Turkiye.
| | - M Halil
- Department of Internal Medicine, Division of Geriatrics, Medical Faculty, Hacettepe University, Ankara, Turkiye.
| | - J Lehtisalo
- Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland.
| | - G B Piccoli
- Nephrologie, Centre Hospitalier Le Mans, Le Mans, France.
| | - Y Rolland
- IHU HealthAge, Centre Hospitalo-Universitaire de Toulouse, France; Centre for Epidemiology and Research in POPulation Health, CERPOP UMR 1295, Toulouse, France.
| | | | - M Visser
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam and the Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
| | - K Wickramasinghe
- Special Initiative on Noncommunicable Diseases and Innovation, WHO Regional Office for Europe, Copenhagen, Denmark.
| | - R Wirth
- Department of Geriatric Medicine, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany.
| | - C Wunderle
- Medical University Department, Division of General Internal and Emergency Medicine, Cantonal Hospital Aarau, Aarau, Switzerland.
| | - M Zanetti
- Geriatric Clinic, Department of Medical Sciences, University of Trieste, Italy.
| | - T Cederholm
- Department of Clinical Nutrition & Metabolism, Uppsala University and Theme Inflammation & Aging, Karolinska University Hospital, Stockholm, Sweden.
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Iwamori H, Magara J, Onuki W, Ita R, Sasa A, Tsujimura T, Inoue M. Effect of carbonation and thickening on voluntary swallow in healthy humans. J Oral Rehabil 2024. [PMID: 38978272 DOI: 10.1111/joor.13793] [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: 07/22/2023] [Revised: 05/21/2024] [Accepted: 06/17/2024] [Indexed: 07/10/2024]
Abstract
BACKGROUND Liquid modification is a widely established strategy of treatment for patients with dysphagia. The modification of liquid particularly by thickening or carbonation is a common approach to promote safe swallowing. OBJECTIVE This study sought to investigate how carbonated and/or thickened water modulates swallowing behaviours during swallowing in healthy young individuals. METHODS Thirty-one healthy volunteers (9 men, 22 women; mean age ± standard deviation [SD], 25.7 ± 6.2 years) were instructed to swallow 20 mL of water, carbonated water and carbonated juice with and without added thickening agent. Electromyograms (EMGs) of the suprahyoid (S-hyo) muscles were recorded to evaluate swallowing behaviours. Obtained S-hyo EMG bursts was analysed using the following outcome parameters: onset latency, the time between swallowing que to onset of EMG burst; rising time and falling time, defined as the time between onset and peak, and between peak and offset, respectively; duration, defined as the time between onset and offset of EMG burst; and area integral value under the waveform. RESULTS Effects of thickening demonstrated the extended onset latency, EMG burst duration including falling time and the larger area of EMG in thickened liquid compared to thin liquid, but there was not much difference between thin and thickened carbonated liquids. Carbonation significantly decreased the duration including falling time for thickened but not for thin liquids. CONCLUSION Patients with dysphagia can benefit from use of carbonated or thickened water while the effects on swallowing physiology may differ between carbonation and thickening.
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Affiliation(s)
- Hajime Iwamori
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
- Department of Health and Nutrition Faculty of Health Science, Niigata University of Health and Welfare, Niigata, Japan
| | - Jin Magara
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
- Unit of Dysphagia Rehabilitation, Niigata University Medical & Dental Hospital, Niigata, Japan
| | - Wakana Onuki
- Unit of Dysphagia Rehabilitation, Niigata University Medical & Dental Hospital, 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
| | - 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
- Unit of Dysphagia Rehabilitation, Niigata University Medical & Dental Hospital, Niigata, Japan
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Venkat S. Improving swallowing function with thickening agents in post-stroke oropharyngeal dysphagia: a real-world experience. Curr Med Res Opin 2024; 40:1163-1170. [PMID: 38864410 DOI: 10.1080/03007995.2024.2365406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 06/04/2024] [Indexed: 06/13/2024]
Abstract
INTRODUCTION Post-stroke dysphagia (PSD) is a widely prevalent and possibly life-threatening consequence that may lead to aspiration pneumonia, malnutrition, dehydration, and higher mortality risk. Recommending thickened fluids (TF) is a longstanding practice in the management of dysphagia. Augmenting liquid viscosity with a xanthan gum-based thickener benefits patients with PSD by aiding in the enhancement of bolus control, facilitating improved coordination in the swallowing mechanism, and lowering the risk of aspiration. Despite the widespread use of TF, limited high-quality evidence supports its benefits in PSD. CASE REPORT This manuscript presents the clinical experience with four varied cases of PSD. A comprehensive approach to management with TF decreased the risk of aspiration pneumonia and facilitated effective management of dietary recommendations both during hospitalization and after discharge (all Cases). In addition, TF maintained nutrition and hydration in patients with multiple hospital admissions (Case 2), maintained hydration in those unable to engage in swallow rehabilitation due to complex medical conditions (Cases 2, 3, and 4), and those who needed slow and longer recovery due to long-term risk of silent aspiration (Cases 2, 3, and 4). In one case (Case 4), the use of TF was extended for more than two years post-stroke with no reported incidence of chest infection. CONCLUSION In routine clinical practice, a comprehensive management approach with xanthan gum-based TFs reduces the risk of aspiration and aspiration pneumonia in patients with PSD while maintaining nutritional and hydration and improving swallowing function based on formal instrumental assessments. This clinical experience highlights the pivotal role of instrumental assessment, patient education, and informed decision-making to optimize outcomes with TF.
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Makhnevich A, Perrin A, Talukder D, Liu Y, Izard S, Chiuzan C, D’Angelo S, Affoo R, Rogus-Pulia N, Sinvani L. Thick Liquids and Clinical Outcomes in Hospitalized Patients With Alzheimer Disease and Related Dementias and Dysphagia. JAMA Intern Med 2024; 184:778-785. [PMID: 38709510 PMCID: PMC11074929 DOI: 10.1001/jamainternmed.2024.0736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 02/15/2024] [Indexed: 05/07/2024]
Abstract
Importance Oropharyngeal dysphagia is common in hospitalized patients with Alzheimer disease and related dementias (ADRD). Although the use of thick liquids in patients with dysphagia has been shown to reduce aspiration on direct visualization, there is no clear evidence that this practice translates into improved clinical outcomes. Objectives To determine whether a diet of thick liquids compared with thin liquids is associated with improved outcomes in hospitalized patients with ADRD and dysphagia. Design, Setting, and Participants This cohort study included adults aged 65 years and older with ADRD who were admitted to the medicine service across 11 diverse hospitals in New York between January 1, 2017, and September 20, 2022, with clinical suspicion of dysphagia during hospitalization and survival for at least 24 hours after hospital arrival. Patients were grouped according to whether at least 75% of their hospital diet consisted of a thick liquid diet or a thin liquid diet. Propensity score matching was used to balance covariates across the 2 groups for the following covariates: demographics (eg, age, sex), baseline clinical characteristics (eg, Charlson Comorbidity Index), and acute presentation (eg, respiratory diagnosis, illness severity, delirium). Main Outcomes and Measures Hospital outcomes included mortality (primary outcome), respiratory complications (eg, pneumonia), intubation, and hospital length of stay (LOS). Results Of 8916 patients with ADRD and dysphagia included in the propensity score matched analysis, the mean (SD) age was 85.7 (8.0) years and 4829 were female (54.2%). A total of 4458 patients receiving a thick liquid diet were matched with 4458 patients receiving a thin liquid diet. There was no significant difference in hospital mortality between the thick liquids and thin liquids groups (hazard ratio, 0.92; 95% CI, 0.75-1.14]; P = .46). Compared with patients receiving thin liquids, patients receiving thick liquids were less likely to be intubated (odds ratio [OR], 0.66; 95% CI, 0.54-0.80), but they were more likely to have respiratory complications (OR, 1.73; 95% CI, 1.56-1.91). Conclusions and Relevance This cohort study emphasizes the need for prospective studies that evaluate whether thick liquids are associated with improved clinical outcomes in hospitalized patients with ADRD and dysphagia.
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Affiliation(s)
- Alexander Makhnevich
- Northwell, New Hyde Park, New York
- Department of Medicine, Zucker School of Medicine at Hofstra/Northwell, Northwell, Hempstead, New York
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell, Manhasset, New York
| | - Alexandra Perrin
- Northwell, New Hyde Park, New York
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell, Manhasset, New York
| | - Dristi Talukder
- Northwell, New Hyde Park, New York
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell, Manhasset, New York
| | - Yan Liu
- Northwell, New Hyde Park, New York
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell, Manhasset, New York
| | - Stephanie Izard
- Northwell, New Hyde Park, New York
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell, Manhasset, New York
| | - Codruta Chiuzan
- Northwell, New Hyde Park, New York
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell, Manhasset, New York
| | - Stefani D’Angelo
- Northwell, New Hyde Park, New York
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell, Manhasset, New York
| | - Rebecca Affoo
- School of Communication Sciences and Disorders, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Nicole Rogus-Pulia
- Division of Geriatrics and Gerontology, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin
| | - Liron Sinvani
- Northwell, New Hyde Park, New York
- Department of Medicine, Zucker School of Medicine at Hofstra/Northwell, Northwell, Hempstead, New York
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell, Manhasset, New York
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Li M, Li M, Mao E, Li M, Cui Y, Chen S. Prevalence and risk factors associated with dehydration of patients with dysphagia in eastern China: A cross-sectional study. Int J Nurs Pract 2024; 30:e13236. [PMID: 38238976 DOI: 10.1111/ijn.13236] [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: 05/05/2023] [Revised: 08/10/2023] [Accepted: 12/27/2023] [Indexed: 06/06/2024]
Abstract
AIMS Dehydration is one of the common complications of dysphagia and poses significant risks including hospitalization and mortality, but the relationship between dysphagia and dehydration has received little attention. This study aims to determine the prevalence and risk factors for dehydration of patients with dysphagia in eastern China, and to provide reference for early identification and prevention of dehydration. METHODS A descriptive, cross-sectional design was conducted. Three hundred and thirty-seven (n = 337) patients with dysphagia participated in the study between August and December 2022. Information relating to participants' demographic variables, nutrition, cognition, functional, hydration status and fluid intake was collected. Univariate analysis was used to examine related impact factors, and then binary logistic regression analysis was conducted to determine reliable impact factors. RESULTS Among 337 patients with dysphagia, the average age was 63.47 ± 16.96, most participants were male (72.1%) and married (91.7%). The prevalence of dehydration was calculated to be 43.9%, the mean plasma osmolality score was 293.53 mmol/L. Diseases with the highest prevalence were stroke (78.3%), followed by hypertension (63.5%). The risk for dehydration increased with older age, usage of more medicines such as diuretics and beta-blockers, worse functional status and lower fluid intake. CONCLUSION This study found a high percentage of dehydration in patients with dysphagia. Findings can provide a basis for targeted nursing interventions for clinical prevention and treatment of dehydration.
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Affiliation(s)
- Mengchao Li
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Mengru Li
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Erli Mao
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Min Li
- The Nanjing Zijin Hospital, Nanjing, China
| | - Yan Cui
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Shen Chen
- School of Nursing, Nanjing Medical University, Nanjing, China
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Martell P, Skogar Ö, Bergström L. Swallowing Characteristics and Water Swallow Capacity in Patients with Parkinsonism. Dysphagia 2024:10.1007/s00455-024-10685-3. [PMID: 38703231 DOI: 10.1007/s00455-024-10685-3] [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: 03/29/2023] [Accepted: 02/09/2024] [Indexed: 05/06/2024]
Abstract
Prevalence and characteristics of dysphagia (including aspiration) in patients with parkinsonism is variable, depending on type of assessment, diagnosis, disease stage and duration. The aim of this study was to further evaluate dysphagia characteristics in patients with different types of parkinsonism with both instrumental (Flexible Endoscopic Evaluation of Swallowing, FEES) and non-instrumental (Timed Water Swallow Test, TWST) assessments. Swallowing characteristics in 74 patients with parkinsonism were prospectively assessed using FEES and TWST. Statistics employed were (a) Spearman rank correlation to measure correlation between dysphagia results and Parkinson subtypes, disease severity and duration and (b) the non-parametric tests Mann Whitney U and Kruskal Wallis to measure difference between groups. Dysphagia was common, with 50 (67.6%) of the patients demonstrating a mild-severe Dysphagia Outcome Severity Scale (DOSS, level 1-5). During FEES, 42% aspirated and 68% of these had silent aspiration. Aspiration was seen more frequently with increased disease severity as per Hoehn and Yahr (H&Y) (r = .459, p = < 0.001) and disease duration (r = .269, p = .021). Thin liquid (IDDSI level 0) was the most common consistency to aspirate, and the frequency of aspiration decreased with thicker liquids. Dysphagia and aspiration are common in all subgroups of parkinsonism and seen in early stages of H&Y and within the first year of disease duration. Hence, it is recommended that these patients are evaluated early for optimal management and to avoid aspiration-related complications.
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Affiliation(s)
- Per Martell
- Department of Speech and Language Pathology, Region Halland, 30185, Halmstad, Sweden
- Logopedics, Phoniatrics and Audiology, Department of Clinical Sciences, Lund University, Lund, Sweden
- Institute of Neuroscience and Physiology, Department of Health and Rehabilitation, Speech and Language Pathology Unit, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Örjan Skogar
- Faculty of Medicine, University of Lund, Lund, Sweden
| | - Liza Bergström
- Institute of Neuroscience and Physiology, Department of Health and Rehabilitation, Speech and Language Pathology Unit, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
- Remeo Stockholm, Torsten Levenstams väg 8, SE-128 64, Stockholm, Sweden.
- Department of Clinical Sciences, Division of Neurology, Karolinska Institute, Danderyd University Hospital, SE-182 88, Stockholm, Sweden.
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Kim D, Ryu J, Lim HS, Kwon YS. Development of cooking method for senior-friendly food using fruits suitable for older adults with masticatory dysfunction. Nutr Res Pract 2024; 18:223-238. [PMID: 38584816 PMCID: PMC10995777 DOI: 10.4162/nrp.2024.18.2.223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 03/18/2024] [Accepted: 03/19/2024] [Indexed: 04/09/2024] Open
Abstract
BACKGROUND/OBJECTIVES The purpose of this study was to establish a fruit-cooking method suitable for older adults with masticatory dysfunction. MATERIALS/METHODS Five types of fruits were selected to make fruit jelly and puree: apple, sweet persimmon, mandarin, Korean melon, and watermelon. Recipes were selected based on the Korean Industrial Standard (KS) for senior-friendly foods (KS H 4897), which classifies foods into 3 levels (L1-L3) based on their hardness and viscosity. RESULTS In South Korea, senior-friendly foods are classified into 3 stages based on their hardness. Stage 1 is for foods that are able to eat with teeth (hardness greater than 50,000 N and less than 500,000 N), Stage 2 is for foods that are able to eat with gums (hardness greater than 20,000 N and less than 50,000 N), and Stage 3 is for foods that are able to eat with the tongue (hardness less than 20,000 N). As a result of measuring the hardness by varying the shape of the fruit, it was found that nearly all fruits could be eaten fresh by chewing with the teeth (L1) but did not meet the KS for mastication using the gums (L2) or tongue (L3), so the cooking method was selected as fruit jelly and fruit puree. Only sweet persimmon, which had a hardness of 61,624-496,393 N, was not suitable for consumption in fresh fruit, unprocessed form. Based on their hardness measurements, fruit jellies (27,869 to 36,343 N) and fruit purees (315 to 1,156 N) met the L2 and L3 requirements, respectively. The viscosity results of all fruit purees met the L3 requirement. CONCLUSION These results offer a simple cooking method to prepare texture-modified fruits suitable for safe consumption by older adults living with masticatory difficulties in general households and nursing facilities.
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Affiliation(s)
- Dasol Kim
- National Institute of Agricultural Sciences, Rural Development Administration, Wanju 55365, Korea
| | - Jihye Ryu
- National Institute of Agricultural Sciences, Rural Development Administration, Wanju 55365, Korea
| | - Hee-Sook Lim
- Department of Gerontology, AgeTech-Service Convergence Major, Graduate School of East-West Medical Science, Kyung Hee University, Yongin 17104, Korea
| | - Yong-Seok Kwon
- National Institute of Agricultural Sciences, Rural Development Administration, Wanju 55365, Korea
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Jones D, Allsopp K, Burden S. Getting the consistency right in thickened liquids using Viscgo Sticks: A validation study. J Hum Nutr Diet 2024; 37:464-473. [PMID: 38017710 DOI: 10.1111/jhn.13268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 11/17/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND Dysphagia is a condition whereby a person's ability to swallow, eat and drink is impacted. One strategy to manage dysphagia and aid safe swallowing is the modification of food and drink, including using thickening agents to thicken drinks. Drinks are thickened to levels appropriate to a person's swallowing abilities and the underutilised 'syringe flow test' is currently the recommended method for checking thickness levels. Viscgo Sticks were developed as a practical alternative to the flow test. METHODS This is a real-world validation study designed to determine validity and reliability of Viscgo Sticks. Independent researchers and healthcare professionals tested Viscgo Sticks (Viscgo Limited) against the flow test in three levels of thickened drinks. Researchers also conducted tests with different thickening agents and different drink types: water, milk, orange juice and hot tea. RESULTS The intra- and inter-rater reliability of Viscgo Sticks was moderate to almost perfect (κ = 0.45-0.98) within and between researchers and substantial (κ = 0.66-0.67) within and between healthcare professionals. When tested by researchers and healthcare professionals against the flow test, Viscgo Sticks correctly classified 83.33%-100% of thickened drinks with high accuracy (area under curve = 0.70-1.00). CONCLUSIONS A simple and reliable tool like Viscgo Sticks, which can verify a prescribed thickness level of liquid, is invaluable in healthcare settings where day-to-day drink preparation occurs. Overall, Viscgo Sticks provide a reliable and valid means to test thickened drinks in clinical practice with a few exceptions identified.
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Affiliation(s)
- Debra Jones
- The University of Manchester, School of Health Sciences, Manchester, UK
| | - Karen Allsopp
- The University of Manchester, School of Health Sciences, Manchester, UK
| | - Sorrel Burden
- The University of Manchester, School of Health Sciences, Manchester, UK
- Northern Care Alliance NHS Foundation Trust, Salford Care Organisation, Salford, UK
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Bice EM, Galek KE, Ward M. Dysphagia and Diets in Skilled Nursing Facilities When Patient's Health Status Changes: The Role of Imaging. J Am Med Dir Assoc 2024; 25:381-386. [PMID: 38109943 DOI: 10.1016/j.jamda.2023.11.008] [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: 07/26/2023] [Revised: 11/06/2023] [Accepted: 11/06/2023] [Indexed: 12/20/2023]
Abstract
OBJECTIVES Research suggests that clinical decision making for assessing and treating patients with swallowing dysfunction varies significantly, and decisions may harm patients. The study aimed to investigate clinical practice of speech-language pathologists (SLPs) assessing and treating swallowing in skilled nursing facilities (SNFs). DESIGN Retrospective review of 120 medical records of patients recommended for a flexible endoscopic evaluation of swallowing (FEES). SETTING AND PARTICIPANTS 120 SNF patients. METHODS Records from 25 SNFs were reviewed to determine which patients were receiving swallowing therapy, their diet level pre- and post-FEES, and if they received prior imaging studies. Recordings of FEES were assigned severity ratings based on the Dynamic Imaging Grade of Swallowing Toxicity-FEES scores to determine the relationship between diet and liquid recommendations before and after FEES, how often patients consume a modified diet in the absence of dysphagia, percentage of patients without dysphagia receiving swallowing treatment, percentage of patients receiving alternative means of nutrition without dysphagia, and the percentage of patients with a feeding tube without an imaging assessment. RESULTS Chi-square tests revealed no agreement between pre- and postimaging diet levels. Ordinal regressions indicated preimaging diets did not fit the DIGEST severity rating model; however, investigators found a good fit with postimaging diet recommendations. Descriptive statistics indicated that 67% of the patients receiving a modified solid and/or liquid did not have dysphagia. Treatment was provided to 100% of the patients without dysphagia. Sixty-one percent of patients with feeding tubes had no dysphagia. Forty-five percent of NPO (nothing by mouth) patients had imaging during their acute stay. CONCLUSIONS AND IMPLICATIONS The results strongly suggest that the practice of continuing acute care diet recommendations in a SNF increases cost and may negatively impact patient quality of life. The practice may also lead to negative health consequences. A new imaging assessment is required to inform treatment when medical status changes.
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Affiliation(s)
- Ed M Bice
- IOPI Medical, LLC, Woodinville, WA, USA.
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11
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Peñalva-Arigita A, Lecha M, Sansano A, Prats R, Vásquez A, Bascuñana H, Vila L. Adherence to commercial food thickener in patients with oropharyngeal dysphagia. BMC Geriatr 2024; 24:67. [PMID: 38229009 DOI: 10.1186/s12877-023-04589-4] [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: 07/17/2022] [Accepted: 12/11/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND Oropharyngeal dysphagia (OD), a common symptom in the elderly, uses commercial thickener (CT) as part of its treatment. This is often accompanied of dislike and poor compliance. AIM Describe adherence to CT and possible differences according to dwelling location in an area of influence of approximately 400.0000 inhabitants. METHODS Cohort prospective observational study. Randomized patients from Nutrition and Dietetic (NDU)-database (4 calls-interviews/year). VARIABLES Age, diagnostic, gender, dwelling/location: Home (H) / Nursing Home (NH), viscosity (nectar, honey, pudding), days with CT. Adherence measured with a questionnaire, considering implementation of treatment by combining CT use and consumption data, categorised in three groups good, moderate and poor. Change in patterns (improvement, maintenance, worsening) and non-adherence reasons. RESULTS One hundred sixty-eight patients recruited with indicated viscosity: Nectar 39.7%, honey 29.3% and pudding 30.8%. Average age of 82.6 ± 11.1 years; 57.8% women (46.4% at H vs. 67% at NH, p < 0.01). Dwelling/location: 80 (47.6%) live at H and 88 (52.4%) at NH. Days with CT prior study were 509 ± 475.28. Implementation found in first call: good in 50%, moderate in 20.2% and poor in 29.8%. At first call, adherence parameters were more favourable in NH compared to H. However these parameters were reversed during the study period as there was an improvement at H vs. NH. Also in terms of change in patterns a significant improvement of implementation was found in patients living at H, 31.1% vs. those living at NH, 15.7%, p < 0.05. CT persistence throughout study was 89.7%. CONCLUSIONS Low adherence to CT found in our community. Telephone follow-up resulted in improved adherence, especially in the H population. Our data provides valuable insights into the variability and changes in CT adherence among patients with OD. Adherence is complex and subject to many factors and dwelling/location is one of them. This study reveals the need to approach CT treatment for OD differently in NH.
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Affiliation(s)
- Amaya Peñalva-Arigita
- Nutritional & Dietetics Unit, Hospital Moisès Broggi, Oriol, C. d'Oriol Martorell, 12, Sant Joan Despí, Barcelona, 08970, Spain.
| | - Maria Lecha
- Nutritional & Dietetics Unit, Hospital Moisès Broggi, Oriol, C. d'Oriol Martorell, 12, Sant Joan Despí, Barcelona, 08970, Spain
| | - Anna Sansano
- Nutritional & Dietetics Unit, Hospital Moisès Broggi, Oriol, C. d'Oriol Martorell, 12, Sant Joan Despí, Barcelona, 08970, Spain
| | - Rosa Prats
- Nutritional & Dietetics Unit, Hospital Moisès Broggi, C. d'Oriol Martorell 12., Sant Joan Despí, Barcelona, 08970, Spain
| | - Aida Vásquez
- Nutritional & Dietetics Unit, Hospital Moisès Broggi, Oriol, C. d'Oriol Martorell, 12, Sant Joan Despí, Barcelona, 08970, Spain
| | - Helena Bascuñana
- Nutritional & Dietetics Unit, Hospital Moisès Broggi, Oriol, C. d'Oriol Martorell, 12, Sant Joan Despí, Barcelona, 08970, Spain
- Physical Medicine and Rehabilitation Department Sant Pau University Hospital, Sant Quintí, 89, Barcelona, 08041, Spain
| | - Lluis Vila
- Endocrinology and Nutrition Department, Hospital Moisès Broggi, C. d'Oriol Martorell, 12, Sant Joan Despí, Barcelona, 08970, Spain
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12
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Meng Q, Xu M, Chen L, Xu S, Li J, Li Y, Fan L, Shi G, Ding Z. Emulsion for stabilizing β-carotene and curcumin prepared directly using a continuous phase of polysaccharide-rich Schizophyllum commune fermentation broth. Int J Biol Macromol 2024; 254:127730. [PMID: 38287588 DOI: 10.1016/j.ijbiomac.2023.127730] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/28/2023] [Accepted: 10/26/2023] [Indexed: 01/31/2024]
Abstract
In this study, we examined the effect of Schizophyllum commune fermentation broth (SCFB) rich in polysaccharides (SCFP) on the stability and bioaccessibility of β-carotene and curcumin. An SCFB-stabilized oil-in-water (o/w) emulsion (SCFBe) was prepared using SCFB as the continuous phase, and then evaluated for storage stability using an SCFP-based emulsion (SCFPe) as the control. The findings revealed that SCFBe is more stable at 60 °C than SCFPe, and stratification or droplet size varied at differing pH levels (3-9) and concentrations of Na+ (0.1-0.5 M) and Ca2+ (0.01-0.05 M). Since the absolute value of the zeta potential of SCFBe is much lower at 60 °C than that at 4 °C and 25 °C, a higher temperature (60 °C) may enhance the reactivity of polysaccharides and proteins in SCFB to improve the stability of SCFBe. Both the protective impact of SCFB on functional food molecules and their capacity to block lipid oxidation increased as polysaccharide content improved. The bioaccessibility of β-carotene after in vitro simulated gastrointestinal digestion is 11.18 %-12.28 %, whereas that of curcumin is 31.64 %-33.00 %. By fermenting edible and medicinal fungi in liquid, we created a unique and environmentally friendly approach for getting food-grade emulsifiers without extraction.
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Affiliation(s)
- Qi Meng
- Key Laboratory of Carbohydrate Chemistry and Biotechnology, Ministry of Education, School of Biotechnology, Jiangnan University, Wuxi 214122, China; National Engineering Research Center for Cereal Fermentation and Food Biomanufacturing, Jiangnan University, Wuxi 214122, China; Jiangsu Provincial Engineering Research Center for Bioactive Product Processing, Jiangnan University, Wuxi 214122, China
| | - Mengmeng Xu
- Key Laboratory of Carbohydrate Chemistry and Biotechnology, Ministry of Education, School of Biotechnology, Jiangnan University, Wuxi 214122, China; National Engineering Research Center for Cereal Fermentation and Food Biomanufacturing, Jiangnan University, Wuxi 214122, China; Jiangsu Provincial Engineering Research Center for Bioactive Product Processing, Jiangnan University, Wuxi 214122, China
| | - Lei Chen
- Key Laboratory of Carbohydrate Chemistry and Biotechnology, Ministry of Education, School of Biotechnology, Jiangnan University, Wuxi 214122, China; National Engineering Research Center for Cereal Fermentation and Food Biomanufacturing, Jiangnan University, Wuxi 214122, China; Jiangsu Provincial Engineering Research Center for Bioactive Product Processing, Jiangnan University, Wuxi 214122, China
| | - Sha Xu
- National Engineering Research Center for Cereal Fermentation and Food Biomanufacturing, Jiangnan University, Wuxi 214122, China; Jiangsu Provincial Engineering Research Center for Bioactive Product Processing, Jiangnan University, Wuxi 214122, China
| | - Jinwei Li
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi 214122, China
| | - Youran Li
- National Engineering Research Center for Cereal Fermentation and Food Biomanufacturing, Jiangnan University, Wuxi 214122, China; Jiangsu Provincial Engineering Research Center for Bioactive Product Processing, Jiangnan University, Wuxi 214122, China
| | - Liuping Fan
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi 214122, China
| | - Guiyang Shi
- Key Laboratory of Carbohydrate Chemistry and Biotechnology, Ministry of Education, School of Biotechnology, Jiangnan University, Wuxi 214122, China; National Engineering Research Center for Cereal Fermentation and Food Biomanufacturing, Jiangnan University, Wuxi 214122, China; Jiangsu Provincial Engineering Research Center for Bioactive Product Processing, Jiangnan University, Wuxi 214122, China
| | - Zhongyang Ding
- Key Laboratory of Carbohydrate Chemistry and Biotechnology, Ministry of Education, School of Biotechnology, Jiangnan University, Wuxi 214122, China; National Engineering Research Center for Cereal Fermentation and Food Biomanufacturing, Jiangnan University, Wuxi 214122, China; Jiangsu Provincial Engineering Research Center for Bioactive Product Processing, Jiangnan University, Wuxi 214122, China.
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Picó-Munyoz R, Tárrega A, Laguna L. Origins of thirstiness sensation and current food solutions. Compr Rev Food Sci Food Saf 2023; 22:4433-4450. [PMID: 37583300 DOI: 10.1111/1541-4337.13229] [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: 12/13/2022] [Revised: 06/15/2023] [Accepted: 08/01/2023] [Indexed: 08/17/2023]
Abstract
The sensation of thirstiness is the desire to drink water. In certain situations, the ingestion of liquid water can be restricted. As a result, thirstiness is not relieved, resulting in an uncomfortable and distressing situation. The present review describes thirstiness and hydration, the food products and beverages that cause thirstiness, and the beverages and food products currently available to quench thirstiness in individuals with restricted access to liquid ingestion. It also discusses how to measure the effectiveness of calming thirstiness. To diminish thirstiness distress, different alternatives to liquids are proposed. Individuals with swallowing disorders are given thickened water, individuals with restricted water ingestion are given ice cubes or ice popsicles of different flavors, and sportspeople are given energy gels. However, current beverage solutions seem not to relieve thirst fully, although some stimuli like iced water, flavors (especially lemon and mint), or acids seem to work better than plain stimuli and could be added to existing products. Therefore, there is still a need to incorporate these strategies into beverage and food formulations and to test their effectiveness.
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Affiliation(s)
- Ruth Picó-Munyoz
- Consumer Perception and Behavior and Adapted Nutrition Laboratory, Institute of Agrochemistry and Food Technology (IATA, CSIC), Paterna, Spain
| | - Amparo Tárrega
- Consumer Perception and Behavior and Adapted Nutrition Laboratory, Institute of Agrochemistry and Food Technology (IATA, CSIC), Paterna, Spain
| | - Laura Laguna
- Consumer Perception and Behavior and Adapted Nutrition Laboratory, Institute of Agrochemistry and Food Technology (IATA, CSIC), Paterna, Spain
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14
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Akçay B, Alkan D. Designing of texture modified fruit juices using food hydrocolloids: Storage influence on viscosity. Heliyon 2023; 9:e21496. [PMID: 37964841 PMCID: PMC10641228 DOI: 10.1016/j.heliyon.2023.e21496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 10/17/2023] [Accepted: 10/23/2023] [Indexed: 11/16/2023] Open
Abstract
Elderly individuals require special dietary considerations due to various physiological dysfunctions (such as dysphagia, constipation, etc.) and specific nutritional needs. Dysphagia, the difficulty associated with swallowing can lead to some challenges in containing and transitioning of food or liquids within the mouth, increasing the risk of aspiration pneumonia. Thickening fluid is an effective method for alleviating swallowing difficulties. It works by slowing down the flow of liquids during swallowing, thus reducing the risk of aspiration into the airway. The purpose of this research is to develop texture-modified (TM) fruit juices to cater to the needs of elderly individuals with impaired swallowing abilities. To achieve this goal, we created TM fruit juices thickened with hydrocolloids, specifically guar gum (GG), xanthan gum (XG), and starch (S), at different concentrations. The thickened liquids, classified at three National Dysphagia Diet levels, were stored at 4 °C for three months. Physicochemical analyzes of the fruit juices were performed before and after storage. The sensory differences and flow behaviors of orange juice samples containing ascending concentrations of all studied thickeners were investigated at the end of the three-month storage. The results indicated significant changes in the physicochemical properties of the samples, depending in the type of fruit, the hydrocolloid used, and the storage period. Sensory evaluation revealed that orange juices containing starch were more preferred compared to other samples. Therefore, using orange juice thickened with easily swallowed, and less viscous starch will be a safer option for the elderly and individuals with swallowing difficulties.
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Affiliation(s)
- Buse Akçay
- Mugla Sitki Kocman University, Graduate School of Health Sciences, Department of Nutrition and Dietetics, Mugla, Turkey
| | - Derya Alkan
- Mugla Sitki Kocman University, Fethiye Faculty of Health Sciences, Department of Nutrition and Dietetics, Mugla, Turkey
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15
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Chen CB. Nutritional and feeding challenges in aerodigestive patients. Curr Opin Pediatr 2023; 35:561-565. [PMID: 37489246 DOI: 10.1097/mop.0000000000001275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Abstract
PURPOSE OF REVIEW Aerodigestive disorders encompass conditions that affect both the airway and gastrointestinal tract. These include conditions such as acquired and congenital defects of the airway and esophagus as well as neuromuscular disorders. Patients often suffer from dysphagia, aspiration, and respiratory disorders. This article will provide a review of current practices in the management of feeding disorders, oropharyngeal dysphagia, and nutritional support in the aerodigestive population. RECENT FINDINGS Oral aversion, aspiration, and feeding-tube dependence are all commonly encountered problems in the aerodigestive population. Intensive inpatient and outpatient programs along with use of appetite stimulants and psychotropic medications may help to improve feeding-related disorders. Aspiration affects many patients and requires close monitoring of clinical symptoms along with routine assessment with video fluoroscopy. Developments in blenderized feeds and formula supplementation have also provided new options for patients with feeding intolerance. SUMMARY Patients with aerodigestive disorders require complex medical care, and multidisciplinary teams are the most effective in addressing their medical needs. Advances in feeding, occupational, and pharmacologic therapy have allowed healthcare providers to better address the needs of these patients.
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Affiliation(s)
- Charles B Chen
- Department of Child Health, University of Missouri School of Medicine, 400 N. Keene St., 65201, Columbia, Missouri, USA
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16
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Martin M, Kendall S, Uveges MK. Traumatic Brain Injury, Dysphagia, and the Ethics of Oral Intake. AACN Adv Crit Care 2023; 34:255-262. [PMID: 37644626 DOI: 10.4037/aacnacc2023789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Affiliation(s)
- Michael Martin
- Michael Martin is Professional Development Director, Tufts Medical Center, Boston Dispensary Building, 29 Bennet St, Boston, MA 02111
| | - Sarah Kendall
- Sarah Kendall is Professional Development Director, Tufts Medical Center, Boston, Massachusetts
| | - Melissa Kurtz Uveges
- Melissa Kurtz Uveges is Assistant Professor, Boston College, Connell School of Nursing, Chestnut Hill, Massachusetts
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17
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El-Masry SM, ElBedaiwy HM, Abd-Alhaseeb MM, Abdel-Maksoud MS, Habib DA. Green polymer altered in-situ gel oral liquid sustainable release preparation of vildagliptin suitable for dysphagic diabetic patients: assessment in-vitro & in-vivo. Pharm Dev Technol 2023; 28:585-594. [PMID: 37310754 DOI: 10.1080/10837450.2023.2223293] [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: 02/17/2023] [Revised: 05/24/2023] [Accepted: 06/06/2023] [Indexed: 06/14/2023]
Abstract
PURPOSE This work aimed to fabricate alginate based in-situ gelling matrix of vildagliptin improved by calcium and carboxy methyl cellulose (CMC) for appropriate adjustment of the onset and duration of action. This easy-to-swallow thickened liquid preparation aimed to improve compliance for dysphagic or elderly diabetic patients. METHODS Vildagliptin dispersions containing alginate were fabricated in the presence or absence of calcium chloride to assess the effect of calcium ion, then a matrix containing 1.5% w/v of sodium alginate with calcium was further examined after the addition of CMC with different concentrations ranging from 0.1% to 0.3%. The viscosity, gelling forming property, Differential scanning calorimetry, and in-vitro drug release were assessed before monitoring the hypoglycemic effect of the selected formulation. RESULTS In-situ gel matrixes were fabricated at gastric pH with and without calcium ions. The best formula concerning viscosity and the gel-forming property was achieved with higher CMC concentrations, which in turn decreased the rate of vildagliptin release in stimulated gastric pH. In-vivo results confirmed the extended hypoglycemic effect of the vildagliptin in-situ gelling matrix compared to the vildagliptin aqueous solution. CONCLUSION This study represents a green polymeric-based in-situ gel as a liquid oral retarded release preparation intended for reducing dose frequency, easier administration of vildagliptin, and improving compliance in geriatric and dysphagic diabetic patients.
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Affiliation(s)
- Soha M El-Masry
- Department of Pharmaceutics, Damanhour University, Damanhour, Egypt
| | - Heba M ElBedaiwy
- Department of Pharmaceutics, Damanhour University, Damanhour, Egypt
| | | | | | - Doaa A Habib
- Department of Pharmaceutics, Damanhour University, Damanhour, Egypt
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18
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Czerwonogrodzka-Senczyna A, Milewska M, Kwiecień P, Szczałuba K. Diet and Nutritional Status of Polish Girls with Rett Syndrome-A Case-Control Study. Nutrients 2023; 15:3334. [PMID: 37571271 PMCID: PMC10420679 DOI: 10.3390/nu15153334] [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: 06/11/2023] [Revised: 07/18/2023] [Accepted: 07/25/2023] [Indexed: 08/13/2023] Open
Abstract
(1) Background: Rett syndrome may be considered a disease strongly associated with nutritional disorders that are likely to require special management strategies, extending beyond what is usually required for children with other developmental disorders. The aim of the study was to assess the nutritional status and diet of Polish girls with Rett syndrome. (2) Methods: Each patient (study group = 49, control group = 22) underwent anthropometric measurements, including body weight and height, waist, hip and arm circumference, and skinfold measurement. The assessment of the diet was based on the analysis of 7-day menus and the Food Frequency Questionnaire (FFQ-6). Data were analyzed using Statistica 13.3. (3) Results: The majority of the girls with Rett syndrome were deficient in weight and height, and consumed fewer calories, less protein, dietary fiber, calcium, and iron than the control group. They also drank less fluid. Soft products that were easy to chew and considered to be high in energy value were significantly more common in the menus. (4) Conclusions: Girls with Rett syndrome are characterized by weight deficiencies, poor growth that deteriorates with age, and are at risk of food shortages. Various nutritional intervention strategies should be explored to reduce and, if possible, prevent malnutrition and cachexia in such patients.
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Affiliation(s)
| | - Magdalena Milewska
- Department of Clinical Dietetics, Faculty of Health Sciences, Medical University of Warsaw, 01-445 Warsaw, Poland;
| | | | - Krzysztof Szczałuba
- Department of Medical Genetics, 1st Faculty of Medicine, Medical University of Warsaw, 01-445 Warsaw, Poland;
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Gotoh Y, Tabata Y, Sugiura S, Obara M, Tomita T, Suzuki T. Yoghurt as a deglutition aid for oral medication: effects on famotidine powder dissolution rate and pharmacokinetics. Sci Rep 2023; 13:1993. [PMID: 36737669 PMCID: PMC9898255 DOI: 10.1038/s41598-023-29258-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 02/01/2023] [Indexed: 02/05/2023] Open
Abstract
Deglutition aid foods are used to help patients with dysphagia take oral medications. Yoghurt is occasionally used to help swallow medications; however, its influence on pharmacokinetics is poorly understood. Yoghurt made with Lactococcus cremoris subsp. cremoris FC has a characteristic viscous texture that facilitates bolus formation and deglutition due to its metabolite exopolysaccharide. We assessed yoghurt prepared with L. cremoris FC as a food deglutition aid. We performed a dissolution test using famotidine powder mixed with yoghurt and a food thickener. Famotidine dissolution rates without deglutition-assisting foods and with yoghurt or food thickener were 102.3 ± 1.7, 85.7 ± 4.6, and 46.4 ± 1.1% after 15 min, respectively. Next, we orally administered famotidine powder with water, yoghurt, and food thickener to rats and measured plasma famotidine levels. We observed no significant differences between all test groups. The Tmax of famotidine mixed with a food thickener was significantly lower than that with yoghurt. These results suggest that yoghurt with L. cremoris FC did not remarkably affect the dissolution and pharmacokinetic profiles of famotidine powder. Thus, the administration of famotidine with yoghurt might be a suitable alternative to powder administration as a deglutition aid for patients.
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Affiliation(s)
- Yayoi Gotoh
- Fujicco Co., Ltd., 6-13-4 Minatojima-Nakamachi, Chuo-Ku, Kobe, Hyogo, 650-8558, Japan
| | - Yoshiyuki Tabata
- Fujicco Co., Ltd., 6-13-4 Minatojima-Nakamachi, Chuo-Ku, Kobe, Hyogo, 650-8558, Japan
| | - Shinya Sugiura
- Sugi Pharmacy Co., Ltd., 62-1, Shin'e, Yokone-Machi, Obu, Aichi, 474-0011, Japan.,Doctoral Program in Pharmaceutical Sciences, Graduate School of Pharmaceutical Sciences, Teikyo Heisei University, 4-21-2 Nakano, Nakano-Ku, Tokyo, 164-8530, Japan
| | - Michiko Obara
- Department of Pharmaceutical Sciences, Faculty of Pharmaceutical Sciences, Teikyo Heisei University, 4-21-2 Nakano, Nakano-Ku, Tokyo, 164-8530, Japan
| | - Takashi Tomita
- Department of Pharmaceutical Sciences, Faculty of Pharmaceutical Sciences, Teikyo Heisei University, 4-21-2 Nakano, Nakano-Ku, Tokyo, 164-8530, Japan
| | - Toshio Suzuki
- Fujicco Co., Ltd., 6-13-4 Minatojima-Nakamachi, Chuo-Ku, Kobe, Hyogo, 650-8558, Japan.
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Gamonpilas C, Kongjaroen A, Methacanon P. The importance of shear and extensional rheology and tribology as the design tools for developing food thickeners for dysphagia management. Food Hydrocoll 2023. [DOI: 10.1016/j.foodhyd.2023.108603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
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Fiszman S, Laguna L. Food design for safer swallowing: focusing on texture-modified diets and sensory stimulation of swallowing via TRP activation. Curr Opin Food Sci 2023. [DOI: 10.1016/j.cofs.2023.101000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Shen Z, Hou Y, Huerman A, Ma A. Patients with dysphagia: How to supply nutrition through non-tube feeding. Front Nutr 2022; 9:1060630. [PMID: 36532550 PMCID: PMC9757495 DOI: 10.3389/fnut.2022.1060630] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 11/17/2022] [Indexed: 08/01/2023] Open
Abstract
OBJECTIVE Dysphagia has become one of the important factors that cause malnutrition in the whole age group. At present, tube feeding is still the mainstream means to solve the problem of dysphagia. However, tube feeding has physical and mental harm to people, and the ways of non-tube feeding are relatively diversified. The significance of the thickening mechanism described in some articles to solve the problem of dysphagia is not clear. SETTING AND PARTICIPANTS All patients with dysphagia worldwide, including oropharyngeal dysphagia (OD) and non-oropharyngeal dysphagia. METHODS We searched the literature in Pubmed, Web of Science and Cochrane Library and initially browsed the titles and abstracts. We reviewed the full text of the articles that met our topic, and the language of the article was limited to English. RESULTS We found that food thickening to a certain degree (350-1,750 cP) can reduce the complications of choking, aspiration, reflux, and other complications in patients with dysphagia, and reduce the social disorder, anxiety, and other psychological problems caused by catheterization and surgery. Significantly, food science engineers should invite clinicians to intervene in the development of specialty foods from different perspectives such as clinical pathophysiology and fluid mechanics. CONCLUSION AND IMPLICATIONS It is necessary to develop special foods for patients with dysphagia, which requires scientists from different disciplines to work together.
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Affiliation(s)
- Zhean Shen
- College of Food Science and Engineering, Xinjiang Institute of Technology, Aksu, China
- Nutritional Department, Shanghai Jiao Tong University Affiliated Sixth People's Hospital South Campus, Shanghai, China
| | - Yingze Hou
- Sanquan College, Xinxiang Medical University, Xinxiang, China
| | - Ayideng Huerman
- College of Food Science and Engineering, Xinjiang Institute of Technology, Aksu, China
| | - Aiqin Ma
- Nutritional Department, Shanghai Jiao Tong University Affiliated Sixth People's Hospital South Campus, Shanghai, China
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Sella‐Weiss O. What could go wrong? Non-standardized versus standardized food texture classification. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2022; 57:1244-1254. [PMID: 36398686 PMCID: PMC9796710 DOI: 10.1111/1460-6984.12749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 05/13/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Texture-modified foods (TMF) is a common intervention for improving swallowing safety and efficiency for people with dysphagia. Non-standardized texture classification (NSTC) of foods is used worldwide. However, as this study documents, it can introduce a lack of clarity and confusion over definitions that can potentially harm patients' safety. The International Dysphagia Diet Standardisation Initiative (IDDSI) framework offers international terminology and standardized methods for texture testing that can address this issue AIMS: To document differences between NSTC and standardized texture classification (STC) of the IDDSI, to document changes in the STC in the 30 min following meal delivery, and to explore the relationship between food intake and texture level. METHODS & PROCEDURES In this observational study, data were collected from 24 long-term care departments during five meals served to 624 residents, including at least one breakfast, lunch and dinner. To document differences between NSTC and STC, all NSTC food textures used in the LTC facilities were reclassified to match the IDDSI texture level at the time food left the kitchen (n = 1276). To document time-related changes in texture, the STC texture as food left the kitchen was compared with texture 30 min later (n = 1276). Finally, to explore the relationship between texture and consumption, estimates were made of single-item food consumption (n = 3820) using a subjective evaluation of consumption percentage OUTCOMES & RESULTS: A total of 1276 food items were classified over the course of five meal services (with at least one each from breakfast, lunch and dinner). Statistically significant differences in NSTC and STC texture levels were found that revealed that residents were consuming food that was more difficult to eat than intended by the TMF prescription. In addition, significant changes in food texture were found over time, with texture levels significantly increasing 30 min after food left the kitchen. Finally, greater consumption was found for softer textures in comparison with regular foods; moreover, food consumption was greatest during breakfast and lowest during lunch. CONCLUSIONS & IMPLICATIONS Residents requiring TMF received harder textures than intended which required complex swallowing ability, thus introducing a choking risk. Using the STC as proposed by the IDDSI could improve patient safety, oral intake and nutritional status. Time-related changes should also be considered in circumstances where patients do not consume food soon after service. Lastly, reduced food consumption during lunch might negatively impact overall nutrient intake, particularly in cultures where lunch is the main meal of the day. WHAT THIS PAPER ADDS What is already known on the subject Despite widespread agreement on the importance of STC, institutional care providers widely use NSTC. The IDDSI framework offers international terminology and standardized methods for texture testing. The clinical importance of using STC is not well understood. What this paper adds to existing knowledge This study found that residents who required texture-modified foods were eating food textures that were more challenging to swallow than intended. Differences were found in food texture between when it left the kitchen compared with texture 30 min later. Pureed texture had greater consumption than regular textured food. Food consumption was found to be the highest during breakfast, and reduced during lunch, which might negatively impact overall nutrient intake. What are the potential or actual clinical implications of this work? Accurate food texture prescription is the first step towards increasing patients' safety. However, food preparation and handling are also very important steps, not to be disregarded. Time-related changes in food texture are remarkable and should be considered in circumstances where patients do not consume food soon after service, as these can compromise patients' safety.
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Affiliation(s)
- Oshrat Sella‐Weiss
- Department of Communication Sciences and DisordersUniversity of HaifaHaifaIsrael
- Department of Communication DisordersOno Academic CollageKiryat OnoIsrael
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Vergara J, Teixeira HS, de Souza CM, Ataide JA, de Souza Ferraz F, Mazzola PG, Mourão LF. Flow test by the International Dysphagia Diet Standardization Initiative reveals distinct viscosity parameters of three thickening agents. JOURNAL OF FOOD SCIENCE AND TECHNOLOGY 2022; 59:3627-3633. [PMID: 35875213 PMCID: PMC9304459 DOI: 10.1007/s13197-022-05369-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Revised: 10/13/2021] [Accepted: 01/10/2022] [Indexed: 06/15/2023]
Abstract
The International Dysphagia Diet Standardization Initiative (IDDSI) flow test is useful for the global standardization of food consistencies of dysphagia patients. In clinical practice, different compositions of food thickeners are commonly used, directly influencing viscosity parameters and swallowing physiology. We aimed to compare the IDDSI thickness levels, remaining volume in the syringe (RVS), and viscosity parameters of three different food thickeners. As a secondary objective, we compared the cost of preparing 100 mL of thickened drinks using the studied thickeners. Thickeners A (xanthan gum), B (corn starch, tara gum, xanthan gum, and guar gum), and C (corn starch) were prepared in increasing concentrations from 1 to 7 g/100 mL and were assayed in quintuplicate using the IDDSI flow test. Thickeners A, B, and C presented statistically different results for the IDDSI levels, RVS, and viscosity parameters at all concentrations. Thickener A reached higher levels in the IDDSI framework, RVS, and viscosity parameters compared with thickeners B and C. A large range of RVS was observed at different concentrations for thickener B compared with C. Regarding viscosity, thickeners B and C, with corn starch in their composition, showed exponential behavior as concentrations increased, while thickener A presented a linear trend. The thickener composition was significantly influenced by IDDSI classification, RVS, and viscosity parameters. The study shows that xanthan gum thickeners present less variability in IDDSI, RVS, and viscosity compared with starch-based thickeners.
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Affiliation(s)
- José Vergara
- Department of Surgery, University of Campinas, R. Tessália Vieira de Camargo, 126, Campinas, SP 13083-887 Brazil
| | - Heloisa Sant’Ana Teixeira
- Speech-Language Pathology and Audiology Sciences, University of Campinas, R. Tessalia Vieira de Camargo, 126, Campinas, SP 13083-887 Brazil
| | - Cinthia Madeira de Souza
- School of Medical Sciences, University of Campinas, Av. Tessalia Vieira de Camargo, 126, Campinas, SP 13083-887 Brazil
| | - Janaina Artem Ataide
- Faculty of Pharmaceutical Sciences, University of Campinas, R. Cândido Portinari, 200, Campinas, SP 13083-871 Brazil
| | | | - Priscila Gava Mazzola
- Faculty of Pharmaceutical Sciences, University of Campinas, R. Cândido Portinari, 200, Campinas, SP 13083-871 Brazil
| | - Lucia Figueiredo Mourão
- Speech-Language Pathology and Audiology Sciences, University of Campinas, R. Tessalia Vieira de Camargo, 126, Campinas, SP 13083-887 Brazil
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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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26
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Deglutition-related cardiorespiratory events. Early Hum Dev 2022; 171:105602. [PMID: 35749800 DOI: 10.1016/j.earlhumdev.2022.105602] [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: 11/23/2022]
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Hernández S, Ribes S, Verdú S, Barat JM, Talens P, Grau R. Developing a homogeneous texture dish by combining solid and liquid foodstuff matrices. Lebensm Wiss Technol 2022. [DOI: 10.1016/j.lwt.2022.113757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Stevens M, O'Rourke S, Casto SC, Benedict J, Lundine JP. Clinical Focus: Findings and Clinical Implications for Thickening Formula With Infant Cereal Using the International Dysphagia Diet Standardisation Initiative Flow Test. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:1601-1610. [PMID: 35580232 DOI: 10.1044/2022_ajslp-21-00298] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE The International Dysphagia Diet Standardisation Initiative (IDDSI) framework was established to provide standardized terminology and objective measures to assess foods and liquids for persons with swallowing difficulties. This clinical focus article reports the findings and clinical implications of the flow testing of infant formulas thickened with infant cereal completed as part of the transition process to IDDSI for one large pediatric quaternary care hospital. METHOD To determine a common recipe that could be used to thicken formulas with infant cereal to the appropriate IDDSI levels, three clinicians completed flow testing on 94 infant formulas. To examine intra- and interclinician variability in the process, they repeated flow testing with three commonly used formulas and infant cereal. RESULTS Clinicians were unable to identify a standard recipe (infant formula + infant cereal combination) that consistently thickened different formula brands to a desired IDDSI thickness level, as there was pronounced variability across and within infant formulas. Reliability testing revealed that, overall, clinician mixers were consistent in replicating similar results to themselves and to each other and that, instead, greater variability lies within the formula (and infant formula + infant cereal combination). CONCLUSIONS Based on findings of pronounced variability within and across infant formulas, our institution determined that the creation of a standard recipe for achieving IDDSI thickness levels of formula mixed with infant cereal was not feasible or clinically appropriate. We offer recommendations for similar institutions for advancing clinical management of infant dysphagia using the IDDSI flow test and directions for future research.
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Affiliation(s)
- Melanie Stevens
- Division of Clinical Therapies, Nationwide Children's Hospital, Columbus, OH
| | - Sara O'Rourke
- Division of Clinical Therapies, Nationwide Children's Hospital, Columbus, OH
| | | | - Jason Benedict
- Department of Biomedical Informatics, Center for Biostatistics, The Ohio State University Wexner Medical Center, Columbus
| | - Jennifer P Lundine
- Division of Clinical Therapies, Nationwide Children's Hospital, Columbus, OH
- Department of Speech and Hearing Science, The Ohio State University, Columbus
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Baixauli R, Bolivar-Prados M, Ismael-Mohammed K, Clavé P, Tárrega A, Laguna L. Characterization of Dysphagia Thickeners Using Texture Analysis-What Information Can Be Useful? Gels 2022; 8:gels8070430. [PMID: 35877515 PMCID: PMC9323126 DOI: 10.3390/gels8070430] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 06/30/2022] [Accepted: 07/01/2022] [Indexed: 02/04/2023] Open
Abstract
Besides shear viscosity, other texture parameters (adhesiveness or cohesiveness) might be relevant for safe swallowing in people suffering from oropharyngeal dysphagia. Shear viscosity is assessed through protocols developed using a viscometer or a rheometer. In contrast, protocols and instruments (capillary break-up rheometer) to assess adhesiveness and cohesiveness are less common and much less developed. Other equipment such as texture analyzers can provide useful information on food properties. Here, we aimed to explore different texture analyzer settings (type of test, probe, and protocol) to characterize four commercial dysphagia thickeners at the shear viscosity levels recommended by manufacturers. Among the tests used (extrusion or penetration) with the different probes (disc, cone and shape holder, sphere, or cylinder), cone extrusion provided information about adhesivity, disc extrusion about sample cohesiveness, and sphere about penetration and sample elasticity. The test speeds used influenced the results, but only one speed is needed as the different speeds provided the same fluid information; for easiness, it is proposed to use 1 mm/s. Comparing the texture analyzer results with viscosity values obtained at different shears, the texture analyzer parameters reflected information that differ from shear viscosity. This information could be relevant for the therapeutic effect of thickening products and food characterization.
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Affiliation(s)
- Raquel Baixauli
- Institute of Agrochemistry and Food Technology (IATA, CSIC), 46980 Valencia, Spain; (R.B.); (A.T.)
| | - Mireia Bolivar-Prados
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, 08304 Mataró, Spain; (M.B.-P.); (K.I.-M.); (P.C.)
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), 08304 Barcelona, Spain
| | - Kovan Ismael-Mohammed
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, 08304 Mataró, Spain; (M.B.-P.); (K.I.-M.); (P.C.)
| | - Pere Clavé
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, 08304 Mataró, Spain; (M.B.-P.); (K.I.-M.); (P.C.)
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), 08304 Barcelona, Spain
| | - Amparo Tárrega
- Institute of Agrochemistry and Food Technology (IATA, CSIC), 46980 Valencia, Spain; (R.B.); (A.T.)
| | - Laura Laguna
- Institute of Agrochemistry and Food Technology (IATA, CSIC), 46980 Valencia, Spain; (R.B.); (A.T.)
- Correspondence:
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Viñas P, Bolivar-Prados M, Tomsen N, Costa A, Marin S, Riera SA, Barcons N, Clavé P. The Hydration Status of Adult Patients with Oropharyngeal Dysphagia and the Effect of Thickened Fluid Therapy on Fluid Intake and Hydration: Results of Two Parallel Systematic and Scoping Reviews. Nutrients 2022; 14:2497. [PMID: 35745228 PMCID: PMC9228104 DOI: 10.3390/nu14122497] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/13/2022] [Accepted: 06/14/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The effect of oropharyngeal dysphagia (OD) and thickened fluid (TF) therapy on hydration status has not been well defined in the literature. We aimed to assess the hydration status in patients with OD and the effect TF therapy has on it. METHODS Two literature reviews following PRISMA methodology (each one including a systematic and a scoping review) were performed: (R1) hydration status in adult patients with OD; (R2) effect of TF therapy on fluid intake and dehydration. Narrative and descriptive methods summarized both reviews. Quality assessment was assessed by Joanna Briggs Institute tools and GRADE. RESULTS (R1) Five out of twenty-two studies using analytical parameters or bioimpedance showed poorer hydration status among OD and 19-100% prevalence of dehydration; (R2) two high quality studies (total of 724 participants) showed positive effects of TF on hydration status. Among the articles included, nine out of ten studies that evaluated fluid intake reported a reduced TF intake below basal water requirements. CONCLUSIONS Dehydration is a highly prevalent complication in OD. There is scientific evidence on the positive effect of TF therapy on the hydration status of patients with OD. However, strict monitoring of fluid volume intake is essential due to the low consumption of TF in these patients.
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Affiliation(s)
- Paula Viñas
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, 08304 Barcelona, Spain; (P.V.); (M.B.-P.); (N.T.); (A.C.); (S.M.); (S.A.R.)
| | - Mireia Bolivar-Prados
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, 08304 Barcelona, Spain; (P.V.); (M.B.-P.); (N.T.); (A.C.); (S.M.); (S.A.R.)
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28029 Madrid, Spain
| | - Noemi Tomsen
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, 08304 Barcelona, Spain; (P.V.); (M.B.-P.); (N.T.); (A.C.); (S.M.); (S.A.R.)
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28029 Madrid, Spain
| | - Alicia Costa
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, 08304 Barcelona, Spain; (P.V.); (M.B.-P.); (N.T.); (A.C.); (S.M.); (S.A.R.)
| | - Sergio Marin
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, 08304 Barcelona, Spain; (P.V.); (M.B.-P.); (N.T.); (A.C.); (S.M.); (S.A.R.)
- Pharmacy Department, Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain
| | - Stephanie A. Riera
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, 08304 Barcelona, Spain; (P.V.); (M.B.-P.); (N.T.); (A.C.); (S.M.); (S.A.R.)
| | - Núria Barcons
- Medical Affairs, Nestlé Health Science, CH-1800 Vevey, Switzerland;
| | - Pere Clavé
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, 08304 Barcelona, Spain; (P.V.); (M.B.-P.); (N.T.); (A.C.); (S.M.); (S.A.R.)
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28029 Madrid, Spain
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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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Schulz S, Scholz V, Lehnert B. [Tasteless thickening agents? A competitive comparison]. HNO 2022; 70:588-594. [PMID: 35476148 PMCID: PMC9329396 DOI: 10.1007/s00106-022-01161-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2022] [Indexed: 11/29/2022]
Abstract
Hintergrund Das Andicken von Flüssigkeiten gehört zu den Standardverfahren der Dysphagietherapie. Diese adaptive Methode soll u. a. einem posterioren Leaking entgegenwirken und die Anforderung an verlangsamte Schutzreflexe durch eine reduzierte Fließgeschwindigkeit des Bolus senken. Bisherige Erhebungen zeigen jedoch aufgrund der Geschmacksperzeption eine ablehnende Haltung von Patienten gegenüber angedickten Flüssigkeiten. Diese Studie untersucht, ob zwischen verschiedenen Andickungsmitteln Geschmacksunterschiede bestehen. Methoden An der Studie haben 37 gesunde Probanden Teil genommen und 8 auf dem deutschen Markt erhältliche Andickungsmittel untereinander verglichen. Zur Testung wurden jeweils 2 mit Wasser angerührte Andickungsmittel einander gegenübergestellt. Die Probanden sollten dann entscheiden, welches sie geschmacklich präferierten. Bis zu 7 dieser Paarvergleiche wurden von jedem Probanden vorgenommen. Insgesamt wurden 224 Paarvergleiche durchgeführt. Aus diesen wurde mittels eines probabilistischen Modells eine relative Geschmacksgüte bestimmt und eine Signifikanztestung der Unterschiede durchgeführt. Ergebnisse und Schlussfolgerung Zwischen den verschiedenen Andickungsmitteln zeigten sich signifikante Geschmacksunterschiede. Es kann vermutet werden, dass sich die Geschmacksunterschiede auf die Inhaltsstoffe der jeweiligen Andickungsmittel zurückführen lassen. Im therapeutischen Setting sollte für eine höhere Akzeptanz von Kostanpassungen nach Möglichkeit die Ausprobe unterschiedlicher Andickungsmittel erfolgen. Unklar bleibt, ob die hier gezeigten Geschmacksunterschiede sich auch zeigen, wenn anstelle von Wasser andere Flüssigkeiten wie Kaffee, Tee oder Säfte angedickt werden.
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Affiliation(s)
- Steffen Schulz
- FB Angewandte Gesundheitswissenschaften, Europäische Fachhochschule, Rostock, Deutschland
| | - Veronika Scholz
- Klinik und Poliklinik für Neurologie, Universitätsmedizin Greifswald, Greifswald, Deutschland.,Klinik und Poliklinik für Hals‑, Nasen‑, Ohrenheilkunde, Kopf- und Halschirurgie, Abteilung Phoniatrie und Pädaudiologie, Universitätsmedizin Greifswald, Ferdinand-Sauerbruch-Str., 17475, Greifswald, Deutschland
| | - Bernhard Lehnert
- Klinik und Poliklinik für Hals‑, Nasen‑, Ohrenheilkunde, Kopf- und Halschirurgie, Abteilung Phoniatrie und Pädaudiologie, Universitätsmedizin Greifswald, Ferdinand-Sauerbruch-Str., 17475, Greifswald, Deutschland.
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Ilgaz F, Timur SS, Eylem CC, Nemutlu E, Erdem Ç, Eroğlu H, Gökmen-Özel H. Do Thickening Agents Used in Dysphagia Diet Affect Drug Bioavailability? Eur J Pharm Sci 2022; 174:106197. [PMID: 35489612 DOI: 10.1016/j.ejps.2022.106197] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 04/01/2022] [Accepted: 04/19/2022] [Indexed: 11/26/2022]
Abstract
Swallowing oral solid dosage forms is challenging in patients with dysphagia who are at risk of aspiration or choking. The most common method to facilitate drug administration in dysphagia patients is to mix the powdered drug with a small amount of thickened water, however little is known about the effects of this method on in vivo bioavailability of drugs. This study aimed to evaluate the impact of thickened liquids on dissolution rate and bioavailability of levetiracetam as a model drug. Powdered commercial tablets of levetiracetam, carbamazepine, atenolol and cefixime were mixed with water thickened with two commercial thickeners, modified maize starch (MS) and xanthan gam (XG), at three thickness levels: nectar, honey and pudding in test groups, and mixed with only water in the control group. At the first stage, the effects of thickened water on in vitro drug release of 4 drugs (levetiracetam, carbamazepine, atenolol and cefixime) were tested by using dialysis membrane method. Addition of both thickeners significantly reduced the release of three drugs compared to the control group, except carbamazepine. Levetiracetam which had the highest solubility was chosen as the model drug for in vivo experiments. In the second stage, New Zealand albino female rabbits (n=24) were divided into two groups as: control group (water+drug, n=6) and test group (thickened water+drug, n=18). Powdered levetiracetam tablets were mixed with water thickened with XG (n=9, 1.2 %, 2.4 %, 3.6 %) and MS (n=9, 4 %, 6%, 8 %) at three thickness levels and administered to the rabbits by intragastric gavage. Blood samples were collected at 9 time points following administration. After two-weeks of wash-out, test groups were crossed over and sample collection was repeated. Blood samples were analysed using liquid chromatography with tandem mass spectrometry (LC-MS/MS). An in vitro-in vivo correlation (IVIVC) model was developed using in vitro drug dissolution (%) and in vivo plasma concentrations of levetiracetam for control group and test groups. The peak plasma concentration (Cmax) was lower and time to reach Cmax (tmax) was relatively higher in test groups compared to control group. The lowest Cmax was detected at the highest thickness level, however, the differences between groups were not statistically significant (p=0.117 and p=0.495 for Cmax and tmax, respectively). No significant difference in total amount of levetiracetam absorbed (AUC) was found between groups (p=0.215 and p=0.183 for AUCinfinity and AUClast, respectively). The comparisons according to the type of thickener also revealed that pharmacokinetic parameters did not significantly differ between groups, except for a significantly lower Cmax when drug was mixed with MS-thickened water at nectar consistency (1.2 %) compared to drug mixed with XG (4 %) at the same thickness level (p=0.038). A good correlation was observed between in vitro and in vivo data, which was characterized by higher r2 values as the concentration of the thickening agents was increased, but not for all thickness levels studied, indicating an inability of this in vitro model to fully predict the in vivo response. These results suggest that regardless of the thickness level, the administration of levetiracetam with two commercial thickening agents commonly used in dysphagia for safe swallowing, do not affect the pharmacokinetic efficiency and thus, the bioavailability of the drug.
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Affiliation(s)
- Fatma Ilgaz
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Hacettepe University, Ankara, 06100, Turkey.
| | - Selin Seda Timur
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Hacettepe University, Ankara, 06100, Turkey.
| | - Cemil Can Eylem
- Department of Analytical Chemistry, Faculty of Pharmacy, Hacettepe University, Ankara, 06100, Turkey.
| | - Emirhan Nemutlu
- Department of Analytical Chemistry, Faculty of Pharmacy, Hacettepe University, Ankara, 06100, Turkey.
| | - ÇiğdemEroğlu Erdem
- Department of Computer Engineering, Faculty of Engineering, Marmara University, Istanbul, 34722, Turkey.
| | - Hakan Eroğlu
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Hacettepe University, Ankara, 06100, Turkey.
| | - Hülya Gökmen-Özel
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Hacettepe University, Ankara, 06100, Turkey.
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Lin S. Dietary fiber in bakery products: Source, processing, and function. ADVANCES IN FOOD AND NUTRITION RESEARCH 2022; 99:37-100. [PMID: 35595397 DOI: 10.1016/bs.afnr.2021.12.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Bakery products are prevalently consumed foods in the world, and they have been regarded as convenient dietary vehicles for delivering nutritive ingredients into people's diet, of which, dietary fiber (DF) is one of the most popular items. The food industry attempts to produce fiber-enriched bakery products with both increasing nutritional value and appealing palatability. As many new sources of DFs become available, and consumers are moving towards healthier diets, studies of using these DFs as functional ingredients in baked goods are becoming vast. Besides, the nutrition value of DF is commonly accepted, and many investigations have also revealed the health benefits of fiber-enriched bakery products. Thus, this chapter presents an overview of (1) trends in supplementation of DF from various sources, (2) impact of DF on dough processing, quality and physiological functionality of bakery products, and (3) technologies used to improve the compatibility of DF in bakery products.
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Affiliation(s)
- Suyun Lin
- Key Lab for Natural Products and Functional Foods of Jiangxi Province, College of Food Science and Engineering, Jiangxi Agricultural University, Nanchang, China.
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Ng ML, Lui HY. Rice congee as an alternative to thickened liquids for patients with swallowing disorders. J Texture Stud 2022; 53:405-416. [PMID: 35255166 DOI: 10.1111/jtxs.12673] [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: 01/13/2022] [Revised: 03/01/2022] [Accepted: 03/02/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Seeing the popularity of rice congee consumption among Asian families, the present study examined the possibility of preparing thickened liquids from rice congee of different consistency levels that are commonly prescribed for individuals with swallowing disorders. METHODS The two most common rice varieties in Hong Kong, indica and japonica rice grains, were used to prepare rice congee from which thickened liquids were extracted. By varying the water-to-rice ratio, cooking time, optional reheating on a frying pan, and temperature, slightly thick, mildly thick, moderately thick, and extremely thick liquids were obtained. RESULTS Recipes for extracting thickened liquids of different consistencies from rice congee cooked with indica and japonica rice grains were established. The consistency levels were defined with reference to although not strictly following the International Dysphagia Diet Standardization Initiative (IDDSI) framework. Results revealed that the consistency of the product varied with water-to-rice ratio, cooking time and temperature. CONCLUSION Recipes were established for preparing thickened liquids using rice grains at both serving and room temperatures. Findings support that thickened liquids so obtained can be used as an alternative to thickened liquids preparing using commercial thickeners.
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Affiliation(s)
- Manwa L Ng
- Speech Science Laboratory, Faculty of Education, University of Hong Kong, Hong Kong, China
| | - Hoi Ying Lui
- Speech Science Laboratory, Faculty of Education, University of Hong Kong, Hong Kong, China
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On the assessment of shear and extensional rheology of thickened liquids from commercial gum-based thickeners used in dysphagia management. J FOOD ENG 2022. [DOI: 10.1016/j.jfoodeng.2021.110820] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Matsuo T, Tabata Y, Sasaki H, Yoshida Y, Gotoh Y, Suzuki T, Obara M, Sadzuka Y, Tomita T. Effects of Yogurt as a Deglutition Aid on Disintegration and Dissolution of Oral Tablets. J Texture Stud 2022; 53:396-404. [PMID: 35147215 PMCID: PMC9303764 DOI: 10.1111/jtxs.12665] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 01/25/2022] [Accepted: 02/03/2022] [Indexed: 12/01/2022]
Abstract
Patients with dysphagia have difficulty swallowing oral medications. Swallowing aid foods, such as deglutition aid jellies and food thickeners, are often used to help such patients take oral medications. Yogurt is occasionally used to help swallow medications. It is also advantageous as it is nutritious and easy to swallow. However, the influence of yogurt on the pharmacokinetics of oral medications is poorly understood. In this study, we aimed to evaluate yogurt as a potential swallowing aid for the intake of oral tablets, by comparing the physical properties and effects of yogurt on disintegration and dissolution profiles of various oral tablets with deglutition aid jelly and xanthan gum‐based food thickener. Yogurt and the food thickener were found to extend the disintegration time of several tablets; however, this increase was unremarkable. Although dissolution of magnesium oxide tablets decreased by 6%, 14%, and 25% after immersion in deglutition aid jelly, food thickener, and yogurt, respectively, at 15 min, this impact on dissolution reduced over time (dissolution rates of all samples at 120 min were over 90%). Rheological measurements showed that yogurt and food thickeners have a weak gel structure and therefore have better fluidity than deglutition aid jelly. The adhesiveness and dynamic viscosity of yogurt were higher than those of the food thickener, which delayed tablet disintegration and reduced the dissolution rate. However, these effects were not substantial. We can thus conclude that yogurt may be a useful swallowing aid for patients with deglutition disorders who take oral medications.
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Affiliation(s)
- Taisuke Matsuo
- Division of Advanced Pharmaceutics, Department of Clinical Pharmaceutical Sciences, School of Pharmacy, Iwate Medical University, 1-1-1 Idaidori, Yahaba-cho, Shiwa-gun, Iwate, Japan
| | - Yoshiyuki Tabata
- Research and Development Laboratories, Fujicco Co., Ltd., 6-13-4, Minatojima-nakamachi, Chuo-ku, Kobe, Japan
| | - Hina Sasaki
- Division of Advanced Pharmaceutics, Department of Clinical Pharmaceutical Sciences, School of Pharmacy, Iwate Medical University, 1-1-1 Idaidori, Yahaba-cho, Shiwa-gun, Iwate, Japan
| | - Yuki Yoshida
- Division of Advanced Pharmaceutics, Department of Clinical Pharmaceutical Sciences, School of Pharmacy, Iwate Medical University, 1-1-1 Idaidori, Yahaba-cho, Shiwa-gun, Iwate, Japan
| | - Yayoi Gotoh
- Research and Development Laboratories, Fujicco Co., Ltd., 6-13-4, Minatojima-nakamachi, Chuo-ku, Kobe, Japan
| | - Toshio Suzuki
- Research and Development Laboratories, Fujicco Co., Ltd., 6-13-4, Minatojima-nakamachi, Chuo-ku, Kobe, Japan
| | - Michiko Obara
- Department of Pharmaceutical Sciences, Faculty of Pharmaceutical Sciences, Teikyo Heisei University, 4-21-2, Nakano, Nakano-ku, Tokyo, Japan
| | - Yasuyuki Sadzuka
- Division of Advanced Pharmaceutics, Department of Clinical Pharmaceutical Sciences, School of Pharmacy, Iwate Medical University, 1-1-1 Idaidori, Yahaba-cho, Shiwa-gun, Iwate, Japan
| | - Takashi Tomita
- Department of Pharmaceutical Sciences, Faculty of Pharmaceutical Sciences, Teikyo Heisei University, 4-21-2, Nakano, Nakano-ku, Tokyo, Japan
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Formulation of a stable water-in-oil nanoemulsion rich in anti-diabetic components of the roselle extract for controlled release. CHEMICAL PAPERS 2022. [DOI: 10.1007/s11696-021-02030-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Sharma M, Pondicherry KS, Duizer L. Understanding relations between rheology, tribology, and sensory perception of modified texture foods. J Texture Stud 2021; 53:327-344. [PMID: 34921392 DOI: 10.1111/jtxs.12656] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 10/27/2021] [Accepted: 12/08/2021] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
- Madhu Sharma
- Department of Food Science, University of Guelph, Guelph, Ontario, Canada
| | | | - Lisa Duizer
- Department of Food Science, University of Guelph, Guelph, Ontario, Canada
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Calmarza-Chueca F, Cristina-Sánchez-Gimeno A, Perez-Nogueras J, Caverni-Muñoz A, Sanz-Arque A, Arbones-Mainar JM, Sanz-Paris A. Institutionalized elderly are able to detect small viscosity variations in thickened water with gum-based thickeners: should texture classifications be reviewed? BMC Geriatr 2021; 21:647. [PMID: 34798812 PMCID: PMC8603478 DOI: 10.1186/s12877-021-02599-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 10/28/2021] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
| | - Ana Cristina-Sánchez-Gimeno
- Food Technology, Faculty of Veterinary, Zaragoza University, AgriFood Institute of Aragon (IA2), C/ Miguel Servet, 177, 50013, Zaragoza, Spain
| | | | | | - Alejandro Sanz-Arque
- Aragón Health Research Institute/ Instituto de Investigación Sanitaria (IIS) Aragón, Zaragoza, Spain
| | - José Miguel Arbones-Mainar
- Aragón Health Research Institute/ Instituto de Investigación Sanitaria (IIS) Aragón, Zaragoza, Spain.,Adipocyte and Fat Biology Laboratory (AdipoFat), Translational Research Unit, University Hospital Miguel Servet, Instituto Aragones de Ciencias de la Salud (IACS), 50009, Zaragoza, Spain.,Center for Biomedical Research in Network Physiopathology Obesity and Nutrition (CIBERObn), Institute of Health Carlos III (ISCIII), Madrid, Spain
| | - Alejandro Sanz-Paris
- Department of Endocrinology and Nutrition, Miguel Servet Hospital, Zaragoza, Spain. .,Aragón Health Research Institute/ Instituto de Investigación Sanitaria (IIS) Aragón, Zaragoza, Spain.
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Farah RI, Althunayyan AA, Al-Haj Ali SN, Farah AI. Reduction of aerosols and splatter generated during ultrasonic scaling by adding food-grade thickeners to coolants: an in-vitro study. Clin Oral Investig 2021; 26:2863-2872. [PMID: 34783913 PMCID: PMC8593632 DOI: 10.1007/s00784-021-04265-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 10/27/2021] [Indexed: 01/25/2023]
Abstract
Objective The effectiveness of using food-grade coolant thickener solutions on the amount of aerosols generated and splatter contamination spread distance during simulated ultrasonic scaling was examined. Materials and methods The study was performed using a phantom lower jaw placed on a black box. Simulated ultrasonic scaling was performed for 2 min using four coolant solutions: distilled water (control), 2% wt. polyacrylic acid (PAA), 0.4% wt. xanthan gum (XA), and 0.4% wt. carboxymethyl cellulose (CMC). The simulation was repeated 10 times for each coolant group. The generated aerosols and droplets were quantified using a handheld particle counter, and the splatter contamination spread distance was evaluated by adding tracing fluorescent dye to the coolant reservoir supplying the scaler unit. One-way multivariate analysis of variance was performed to determine the difference among coolant groups (a = .05). Results The amount of aerosols and droplets and splatter contamination distance (p < .001) pertaining to the three food-grade coolant thickener solutions were considerably lower than those for the distilled water (control). The PAA group exhibited a significantly lower splatter contamination distance (p < .001) and a number of generated droplets (p = .031) than those of the XA group. The CMC group exhibited a significantly lower splatter contamination distance (p < .001) than that of the XA group. No statistically significant difference was observed between the PAA and CMC in terms of the three dependent variables (p > .05). Conclusion The food-grade coolant thickeners could reduce the amount of generated aerosols and splatter contamination distance but not completely eliminate them. PAA and CMC solutions were more effective in reducing the aerosol/splatter during scaling compared to XA. Clinical relevance Many dental procedures generate aerosols and splatter, which pose a potential risk to the patients and dental personnel, especially during the current COVID-19 pandemic.
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Affiliation(s)
- Ra'fat I Farah
- Department of Prosthetic Dental Sciences, College of Dentistry, Qassim University, Al-Mulaydah, Qassim, Kingdom of Saudi Arabia.
| | | | - Sanaa N Al-Haj Ali
- Department of Orthodontic and Pediatric Dentistry, College of Dentistry, Qassim University, Al-Mulaydah, Qassim, Kingdom of Saudi Arabia
| | - Amani I Farah
- Department of Pharmacy, Faculty of Pharmacy, Al-Zaytoonah University of Jordan, Amman, Jordan
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Solid Oral Dosage Forms Use in Adults with Neurological Disorders and Swallowing Difficulties: A Scoping Review. Dysphagia 2021; 37:909-922. [PMID: 34652512 DOI: 10.1007/s00455-021-10352-x] [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: 06/29/2021] [Accepted: 08/02/2021] [Indexed: 10/20/2022]
Abstract
Swallowing difficulties affects the deglutition of solid oral dosage forms (SODFs) and it is a common problem among neurological disorders. Interventions may improve the use of SODFs in healthcare settings. The aim of this study was to map the available research about the interventions aiming the effective and safe use of SODFs in adults with neurological disorders and swallowing difficulties and to identify potential literature gaps in this scientific field. A scoping review was carried out based on Joanna Briggs Institute guidelines and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews, in PubMed, Scopus, and SciELO databases (March 2021). Peer-reviewed observational studies assessed the effectiveness and safety of SODFs in adults with neurological disorders and swallowing difficulties in the healthcare organizations setting were included. 11 studies were included (three case reports, two mixed-methods intervention studies, and six analytic studies). The frequency of women ranged from 49 to 67%, and the age from 57 to 91 years. Most studies (n = 7) included elderly patients, Parkinson (n = 6) and dementia (n = 3). Medication review was the most frequently reported intervention, 35% (9/26). In most studies, interventions were targeted to patients during hospitalization (n = 7) and performed by physicians (n = 8). At least 20 different outcomes were evaluated in the studies. Implementing specific protocols for using SODFs aimed at the swallowing difficulties of this population is not a common practice. Additional studies on interventions aimed at optimizing SODFs are needed to support the safety and efficacy of oral therapy in this patient group.
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Abd Aziz ZH, Katas H, Omar MS, Mohamed Shah N, Yusop SM. Formulation and Cost-Effectiveness of Fluid Gels as an Age-Appropriate Dosage Form for Older Adults with Dysphagia. Dysphagia 2021; 37:1022-1034. [PMID: 34518932 DOI: 10.1007/s00455-021-10365-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 08/30/2021] [Indexed: 12/14/2022]
Abstract
Dysphagia is associated with increased dependency and treatment costs, whereby patients resort to extemporaneous compounding that may further increase the number of adverse events and medical errors. In the management of dysphagia, increasing the bolus viscosity of medication such as fluid gels can be practiced. This study aimed to prepare and characterize the fluid gels as well as to estimate the cost of using fluid gels and compare it to the conventional practice of extemporaneous preparation of thickened liquid. Fluid gels were formulated using gellan gum and determined for physicochemical characteristics and in vitro drug release profile. The cost-based price of the fluid gel was estimated and compared to the cost of administering standard medication as well as administering thickened liquid using thickening powder. Fluid gels exhibited good physicochemical properties with the viscosity within nectar and honey consistency. A similar dissolution profile to the reference was observed for the 0.5% w/v gellan gum fluid gel and exhibiting the Higuchi release model. The price for 100 mL unit of 50 mg/mL paracetamol/acetaminophen and 20 mg/mL ibuprofen fluid gel was estimated to be about USD2.30 and USD2.37, respectively. A dose of 1000 mg paracetamol and 400 mg ibuprofen fluid gel was estimated to be about USD0.46 and USD0.47, respectively, which is lower than the cost of administering the same dose using extemporaneous thickened liquid. Fluid gels could be a cost-effective formulation for delivering medication in patients with dysphagia and can be developed on a profitable scale.
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Affiliation(s)
- Zul Hadif Abd Aziz
- Centre for Drug Delivery Technology, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur Campus, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia
| | - Haliza Katas
- Centre for Drug Delivery Technology, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur Campus, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia.
| | - Marhanis Salihah Omar
- Centre for Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur, Malaysia
| | - Noraida Mohamed Shah
- Centre for Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur, Malaysia
| | - Salma Mohamad Yusop
- Department of Food Sciences, Faculty of Science and Technology, Universiti Kebangsaan Malaysia, Bangi, Selangor, Malaysia
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Combining Liquid Oral Drugs with Thickener: Compatibility and Changes in Viscosity. Dysphagia 2021; 37:889-899. [PMID: 34373976 DOI: 10.1007/s00455-021-10348-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 08/02/2021] [Indexed: 10/20/2022]
Abstract
Older adults with oropharyngeal dysphagia (OD) are unable to swallow pills safely, so some of them use liquid-formulated drugs mixed with thickeners to ensure safety. The aim of this study was to analyze the physical compatibility of a group of drugs with a thickener formulated with modified starch (Thick & Easy®). A secondary goal was to evaluate the amount of thickener needed to obtain the thickness levels 2, 3, and 4 defined by IDDSI framework for each drug. For this purpose, the rheological properties of the mixtures obtained were determined. Samples of each drug were prepared and 7, 10, and 12 g of thickener were added. Physical compatibility of the mixtures was observed; the apparent viscosity of the samples was measured using a rotational viscometer, and the results obtained were compared with the reference drug-free sample. We analyzed 45 medicinal products (38 active substances). Three drugs (almagate, ibuprofen, and macrogol) were found to be physically incompatible with the thickener and should not be mixed. Viscosity measurements indicated that clarithromycin and plantago ovata increased the viscosity of the mixture and required lower amount to achieve the target textures (110 cP, 590 cP, and 2620 cP for 7 g, 10 g, and 12 g in drug-free samples, respectively), whereas another subset reduced viscosity and required more thickener. This proved very relevant for acetylcysteine, amoxicillin, calcifediol, ferrous gluconate, fosfomycin, lactitol, lactulose, mepifiline, paracetamol, rivastigmine, sertraline, and tramadol. Measurements were below 1750 cP. Awareness of how each drug behaves when combined with thickeners is essential to avoid potential complications in OD.
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Poursani P, Razavi SM, Norouzi A. Numerical investigation of a two-phase system on swallowing behavior in dysphagia: A case study on cress seed gum–xanthan gum thickened liquids. FOOD AND BIOPRODUCTS PROCESSING 2021. [DOI: 10.1016/j.fbp.2021.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Giura L, Urtasun L, Belarra A, Ansorena D, Astiasarán I. Exploring Tools for Designing Dysphagia-Friendly Foods: A Review. Foods 2021; 10:1334. [PMID: 34200551 PMCID: PMC8229457 DOI: 10.3390/foods10061334] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 05/28/2021] [Accepted: 06/07/2021] [Indexed: 02/08/2023] Open
Abstract
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.
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Affiliation(s)
- Larisa Giura
- Department of Nutrition, Food Science and Physiology, Faculty of Pharmacy and Nutrition, Instituto de Investigación Sanitaria de Navarra, Universidad de Navarra, IDISNA, C/Irunlarrea s/n, 31008 Pamplona, Spain; (L.G.); (I.A.)
- National Centre for Food Technology and Safety (CNTA)—Technology and Knowledge for Food Sector Competitiveness, Navarre, Crta-Na 134-km 53, 31570 San Adrian, Spain (L.U.); (A.B.)
| | - Leyre Urtasun
- National Centre for Food Technology and Safety (CNTA)—Technology and Knowledge for Food Sector Competitiveness, Navarre, Crta-Na 134-km 53, 31570 San Adrian, Spain (L.U.); (A.B.)
| | - Amanda Belarra
- National Centre for Food Technology and Safety (CNTA)—Technology and Knowledge for Food Sector Competitiveness, Navarre, Crta-Na 134-km 53, 31570 San Adrian, Spain (L.U.); (A.B.)
| | - Diana Ansorena
- Department of Nutrition, Food Science and Physiology, Faculty of Pharmacy and Nutrition, Instituto de Investigación Sanitaria de Navarra, Universidad de Navarra, IDISNA, C/Irunlarrea s/n, 31008 Pamplona, Spain; (L.G.); (I.A.)
| | - Icíar Astiasarán
- Department of Nutrition, Food Science and Physiology, Faculty of Pharmacy and Nutrition, Instituto de Investigación Sanitaria de Navarra, Universidad de Navarra, IDISNA, C/Irunlarrea s/n, 31008 Pamplona, Spain; (L.G.); (I.A.)
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Dysphagia-Related Health Information Improved Consumer Acceptability of Thickened Beverages. BEVERAGES 2021. [DOI: 10.3390/beverages7020032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Most people tend to think that healthy foods do not taste good. This view could have a negative impact on the taste of the food that people eat for health. However, if health-related information is provided to avoid negative aspects, acceptability may improve. Thus, this study investigated changes in consumers’ sensory perception of thickened beverages before and after the provision of dysphagia-related health information. Sixty young (19–39 years old) and middle-aged (40–64 years old) consumers participated in two experiment sessions conducted one week apart. The first session proceeded without any information and the second provided information about dysphagia and the need for dietary modification before evaluation. Three beverages (orange juice, red bean water, and sports drink) were used in nectar-like (51–350 cP) and honey-like (351–1750 cP) forms; original beverage samples (0%) were used as the control. Consumers were asked about acceptability, liking the flavor, intensity, and general health interest (GHI). An analysis of variance was performed to show the change in flavor rating and acceptability between the two sessions. Although there were age-related differences in response to the samples, thickened beverages were rated as more acceptable, in terms of their characteristics (swallowing, viscosity, and mouthfeel) after the information was provided. There were no significant differences for the 0% samples. The mean GHI values were 3.97 ± 0.85 and 4.81 ± 0.68 for the young and middle-aged groups, respectively. High and low GHI groups were analyzed. The high GHI group showed significant differences in acceptability in the informed evaluation, whereas the low GHI group was not influenced by the information.
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Steele SJ, Ennis SL, Dobler CC. Treatment burden associated with the intake of thickened fluids. Breathe (Sheff) 2021; 17:210003. [PMID: 34295407 PMCID: PMC8291955 DOI: 10.1183/20734735.0003-2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 04/08/2021] [Indexed: 12/19/2022] Open
Abstract
The implementation of thickened fluids in patients with dysphagia is widely considered an effective strategy for safe and physiologically improved swallow. However, there is limited evidence to suggest that this intervention reduces the risk of dysphagia-related complications including aspiration pneumonia. In addition, there is growing evidence that this approach is associated with adverse clinical effects including dehydration, malnutrition and reduced health-related quality of life. This review summarises the rationale for thickened fluids, the evidence base (or lack thereof) underpinning their use, and current guideline recommendations. Educational aims To review the evidence base for thickened fluids in the management of dysphagia.To examine the evidence that thickened fluids reduce aspiration pneumonia.To provide an overview of the advantages and disadvantages of thickened fluids in the management of dysphagia.
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Affiliation(s)
- Simon J Steele
- Dept of General and Acute Care Medicine, Alfred Hospital, Melbourne, Australia
| | - Samantha L Ennis
- Dept of Respiratory and Sleep Medicine, Liverpool Hospital, Sydney, Australia
| | - Claudia C Dobler
- Dept of Respiratory and Sleep Medicine, Liverpool Hospital, Sydney, Australia.,The George Institute for Global Health, University of New South Wales, Sydney, Australia
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Brooks L, Liao J, Ford J, Harmon S, Breedveld V. Thickened Liquids Using Pureed Foods for Children with Dysphagia: IDDSI and Rheology Measurements. Dysphagia 2021; 37:578-590. [PMID: 33954811 DOI: 10.1007/s00455-021-10308-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 04/20/2021] [Indexed: 11/30/2022]
Abstract
Children with dysphagia, or swallowing disorder, are at an increased risk for developing respiratory compromise, failure to thrive, and aversion. Thickened liquids can be recommended for children with dysphagia, if shown to be effective on instrumental examination and if strategies/interventions with thin liquids are not successful. Thickened liquids have many benefits, including creating a more cohesive bolus, slowing oropharyngeal transit time, and reducing aspiration. However, preparing thickened liquids with commercially available thickeners can result in poor compliance due to concerns regarding taste, texture, accessibility, cost, thickness variability, and potential negative impact of these substances on a child's immature digestive tract. The purpose of this study was to determine if liquids could be successfully thickened with widely available, commercial pureed foods, and to assess how these mixtures compare to starch and gum based thickening agents. The International Dysphagia Diet Standardisation Initiative (IDDSI) flow test was performed for each sample of puree thickened liquids, gum based thickened water, and cornstarch based thickened water. In addition, rheology testing was performed on each category of the samples to measure viscosity at various shear rates and temperatures, and to assess the presence of yield stress. Results revealed that liquids thickened with smooth textured purees were comparable to commercial starch and gum based thickeners, and may be offered as a viable alternative.
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Affiliation(s)
- Laura Brooks
- Children's Healthcare of Atlanta, 1405 Clifton Road NE, Atlanta, GA, 30322, USA.
| | - Jianshan Liao
- School of Chemical & Biomolecular Engineering and Renewable Bioproducts Institute, Georgia Institute of Technology, Atlanta, GA, 30332, USA
| | - Jaclyn Ford
- Department of Psychology and Neuroscience, Boston College, Boston, MA, USA
| | - Sarah Harmon
- Children's Healthcare of Atlanta, 1405 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Victor Breedveld
- School of Chemical & Biomolecular Engineering and Renewable Bioproducts Institute, Georgia Institute of Technology, Atlanta, GA, 30332, USA
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50
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Dziewas R, Allescher HD, Aroyo I, Bartolome G, Beilenhoff U, Bohlender J, Breitbach-Snowdon H, Fheodoroff K, Glahn J, Heppner HJ, Hörmann K, Ledl C, Lücking C, Pokieser P, Schefold JC, Schröter-Morasch H, Schweikert K, Sparing R, Trapl-Grundschober M, Wallesch C, Warnecke T, Werner CJ, Weßling J, Wirth R, Pflug C. Diagnosis and treatment of neurogenic dysphagia - S1 guideline of the German Society of Neurology. Neurol Res Pract 2021; 3:23. [PMID: 33941289 PMCID: PMC8094546 DOI: 10.1186/s42466-021-00122-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 03/24/2021] [Indexed: 02/06/2023] Open
Abstract
Introduction Neurogenic dysphagia defines swallowing disorders caused by diseases of the central and peripheral nervous system, neuromuscular transmission, or muscles. Neurogenic dysphagia is one of the most common and at the same time most dangerous symptoms of many neurological diseases. Its most important sequelae include aspiration pneumonia, malnutrition and dehydration, and affected patients more often require long-term care and are exposed to an increased mortality. Based on a systematic pubmed research of related original papers, review articles, international guidelines and surveys about the diagnostics and treatment of neurogenic dysphagia, a consensus process was initiated, which included dysphagia experts from 27 medical societies. Recommendations This guideline consists of 53 recommendations covering in its first part the whole diagnostic spectrum from the dysphagia specific medical history, initial dysphagia screening and clinical assessment, to more refined instrumental procedures, such as flexible endoscopic evaluation of swallowing, the videofluoroscopic swallowing study and high-resolution manometry. In addition, specific clinical scenarios are captured, among others the management of patients with nasogastric and tracheotomy tubes. The second part of this guideline is dedicated to the treatment of neurogenic dysphagia. Apart from dietary interventions and behavioral swallowing treatment, interventions to improve oral hygiene, pharmacological treatment options, different modalities of neurostimulation as well as minimally invasive and surgical therapies are dealt with. Conclusions The diagnosis and treatment of neurogenic dysphagia is challenging and requires a joined effort of different medical professions. While the evidence supporting the implementation of dysphagia screening is rather convincing, further trials are needed to improve the quality of evidence for more refined methods of dysphagia diagnostics and, in particular, the different treatment options of neurogenic dysphagia. The present article is an abridged and translated version of the guideline recently published online (https://www.awmf.org/uploads/tx_szleitlinien/030-111l_Neurogene-Dysphagie_2020-05.pdf).
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Affiliation(s)
- Rainer Dziewas
- Klinik für Neurologie, Universitätsklinik Münster, 48149 Münster, Germany. .,Klinik für Neurologie und Neurologische Frührehabilitation, Klinikum Osnabrück, Am Finkenhügel 1, 49076, Osnabrück, Germany.
| | - Hans-Dieter Allescher
- Zentrum für Innere Medizin, Klinikum Garmisch-Partenkirchen GmbH, Auenstraße 6, 82467, Garmisch-Partenkirchen, Germany
| | - Ilia Aroyo
- Klinik für Neurologie und Neurointensivmedizin, Klinikum Darmstadt, Grafenstr. 9, 64283, Darmstadt, Germany
| | | | | | - Jörg Bohlender
- Universitätsspital Zürich, ORL-Klinik, Abteilung für Phoniatrie und Klinische Logopädie, Frauenklinikstr. 24, 8091, Zürich, Schweiz
| | - Helga Breitbach-Snowdon
- Schule für Logopädie, Universitätsklinikum Münster, Kardinal-von-Galen-Ring 10, 48149, Münster, Germany
| | | | - Jörg Glahn
- Universitätsklinik für Neurologie und Neurogeriatrie, Johannes Wesling Klinikum Minden, Hans-Nolte Strasse 1, 32429, Minden, Germany
| | - Hans-Jürgen Heppner
- Private Universität Witten/Herdecke gGmbH, Alfred-Herrhausen-Straße 50, 58448, Witten, Germany
| | - Karl Hörmann
- University Medical Centre Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Christian Ledl
- Abteilung Sprach-, Sprech- und Schlucktherapie, Schön Klinik Bad Aibling SE & Co. KG, Kolbermoorer Str. 72, 83043, Bad Aibling, Germany
| | - Christoph Lücking
- Schön Klinik München Schwabing, Parzivalplatz 4, 80804, München, Germany
| | - Peter Pokieser
- Medizinische Universität Wien, Teaching Center / Unified Patient Program, AKH Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | - Joerg C Schefold
- Universitätsklinik für Intensivmedizin, Inselspital, Universitätsspital Bern, 3010, Bern, Schweiz
| | | | - Kathi Schweikert
- REHAB Basel, Klinik für Neurorehabilitation und Paraplegiologie, Im Burgfelderhof 40, 4012, Basel, Schweiz
| | - Roland Sparing
- VAMED Klinik Hattingen GmbH, Rehabilitationszentrum für Neurologie, Neurochirurgie, Neuropädiatrie, Am Hagen 20, 45527, Hattingen, Germany
| | - Michaela Trapl-Grundschober
- Klinische Abteilung für Neurologie, Therapeutischer Dienst, Universitätsklinikum Tulln, Karl Landsteiner Privatuniversität für Gesundheitswissenschaften, Alter Ziegelweg 10, 3430, Tulln an der Donau, Österreich
| | - Claus Wallesch
- BDH-Klinik Elzach gGmbH, Am Tannwald 1, 79215, Elzach, Germany
| | - Tobias Warnecke
- Klinik für Neurologie, Universitätsklinik Münster, 48149 Münster, Germany
| | - Cornelius J Werner
- Sektion Interdisziplinäre Geriatrie, Klinik für Neurologie, Medizinische Fakultät, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Johannes Weßling
- Zentrum für Radiologie, Neuroradiologie und Nuklearmedizin, Clemenskrankenhaus Münster, Düesbergweg 124, 48153, Münster, Germany
| | - Rainer Wirth
- Klinik für Altersmedizin und Frührehabilitation, Marien Hospital Herne, Universitätsklinikum der Ruhr-Universität Bochum, Katholische Kliniken Rhein-Ruhr, Hölkeskampring 40, 44625, Herne, Germany
| | - Christina Pflug
- Klinik und Poliklinik für Hör-, Stimm- und Sprachheilkunde, Universitäres Dysphagiezentrum Hamburg, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
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