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

Moret-Tatay, Amparo; Rodríguez-García, Julia; Martí-Bonmatí, E.; Hernando, Isabel; Hernández, María Jesús

doi:10.1016/j.foodhyd.2015.05.019

Cited by 75 publications

(54 citation statements)

References 23 publications

(44 reference statements)

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“…viscosity and viscoelasticity as a function of time and shear rate, to allow an understanding of the effect of viscosity on the swallowing process [10][11][12]15].…”

Section: Accepted Manuscriptmentioning

confidence: 99%

“…Patients affected by dysphagia have difficulty controlling the flow of food bolus or liquid through the pharynx resulting in severe complications to those affected, such as malnutritio n and increased risks of aspiration, choking and pneumonia. Aspiration is the major risk of dysphagia that occurs when food residues accidentally enters the respiratory pipe blocking the airways causing coughing and possible infections [5,6,9,10].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Gellan gum: A new member in the dysphagia thickener family

et al. 2019

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Please cite this article as: O. Torres, A. Yamada, N.M. Rigby, et al., Gellan gum: A new member in the dysphagia thickener family, Biotribology, https://doi. AbstractIn this study, gellan gum (GG) (0.075-0.3 wt%) is proposed as a new dysphagia thickener and compared against commercial starch-based thickeners (modified starch with or without gums, 5 wt%) and xanthan gum (XG, 0.5-1.0 wt%) using apparent viscosity, oral tribology using polydimethylsiloxane (PDMS) ball-on-disc set up and ζ-potential measurements. The measurements were conducted in presence of artificial saliva containing mucin with or without α-amylase at 37 ○ C. Viscosity results suggested that the commercial starch-based thickeners behaved like water in orally relevant shear, largely associated with the hydrolysis of modified starch by α-amylase, while, XG and GG showed no responsiveness to α-amylase.In the case of oral tribology, artificial saliva containing mucin adsorbed to the PDMS surfaces reducing friction as compared to water. The increase in boundary friction coefficients in commercial starch-based thickeners was likely associated with α-amylaseinduced hydrolysis, increasing the PDMS-PDMS asperity contacts. Interestingly, the tribological behaviour of XG and GG was dictated mainly by viscous lubrication. However, in simulated oral conditions, the increase in friction coefficients in presence of XG and GG was influenced by depletion of artificial saliva from the PDMS surfaces due to electrostatic interaction between the gums and mucin. A combination of rheological and tribological techniques in orally relevant conditions appears as a reliable approach to understand the potential of GG (0.3 wt%) to act as a dysphagia thickener that offers similar mechanical properties as XG (1.0 wt%) at a lower concentration. Extensional viscosity measurement of GG is needed to understand its applications in dysphagia management.

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“…viscosity and viscoelasticity as a function of time and shear rate, to allow an understanding of the effect of viscosity on the swallowing process [10][11][12]15].…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Gellan gum: A new member in the dysphagia thickener family

et al. 2019

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“…Lastly, more fundamental viscosity measurements are not accessible to most clinicians or food production centers (Steele et al, 2015). The evidence suggests that thickened liquids prepared for the management of dysphagia are highly complex fluids with non-Newtonian characteristics (Hadde, Nicholson, & Cichero, 2015;Moret-Tatay, Rodríguez-García, Martí-Bonmatí, Hernando, & Hernández, 2015;Rofes, Arreola, Mukherjee, Swanson, & Clave, 2014;Vilardell, Rofes, Arreola, Speyer, & Clave, 2016;Wagner, Barbati, Engmann, Burbidge, & McKinley, 2017) namely due to their ingredient composition, pH, thickening agents, temperature of consumption, and preparation methods. Yet, it is possible that properties other than viscosity may have clinical relevance (Steele et al, 2015).…”

Section: Introductionmentioning

confidence: 99%

Comparison of two methods to categorize thickened liquids for dysphagia management in a clinical care setting context: The Bostwick consistometer and the IDDSI Flow Test. Are we talking about the same concept?

Côté

Germain²,

Dufresne³

et al. 2018

Journal of Texture Studies

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The Bostwick consistometer and the International Dysphagia Diet Standardization Initiative (IDDSI) Flow Test are both proposed methods to measure and categorize thickened liquids for dysphagia management. The objectives were to: (a) compare the Bostwick consistometer reference values used in clinical settings and the IDDSI reference values of thickened liquids suggested for nutrition care plans in the management of dysphagia when measuring commercially available preprepared thickened liquids; (b) explore the relationship between the two methods; (c) assess the interchangeability; (d) document the intra‐rater reliability. Preprepared thickened liquids (n = 32) were measured twice with the Bostwick consistometer and 3 times with the IDDSI Flow Test, using a rigorous methodology. A registered dietitian nutritionist and a registered nutrition and dietetic technician performed the measurements. The Pearson's correlation coefficient was calculated to explore the relationship between the two methods. Using a linear regression equation, back‐calculations of the IDDSI Flow Test values were done, based on the experimental Bostwick results. Interchangeability was assessed by documenting the level of agreement between the results with a Bland and Altman graphical analysis. Intraclass correlation coefficients calculation and a Bland and Altman graphical analysis were performed to assess reliability. The strong correlation (r = −.93, p < .001) between the IDDSI Flow Test and the Bostwick consistometer measurements suggests that they measure flow rate in a similar manner, but not exactly the same, as confirmed with the Bland and Altman graphical analysis. Thus, they produced results that are not interchangeable. However, both tests show excellent intra‐rater reliability (ICC ≥ 0.99) when using a rigorous methodology. Practical applications Thickened liquids are used to manage oropharyngeal dysphagia. Clinicians need to provide quality assurance/quality control (QA/QC) support in the selection or production of thickened liquids as well as staff training or patient education regarding these products. Methods and classification have been proposed to measure and categorize thickened liquids for dysphagia management, such as the line spread test, the Bostwick consistometer method, and the IDDSI Flow Test. Although empirical, these methods are more accessible to clinicians than viscometer or rheometer assessments. Clinicians need to understand the limitations of these techniques as neither appear to capture the full extent of consistency for potential beverages available on the market or produced in‐house. In this article, we compare the Bostwick consistometer and the IDDSI Flow Test methods and classifications and propose a standard operating procedure in order to maximize the quality of results. We point out the large variations in consistency levels of commercial preprepared thickened liquids in light of the absence of evidence of clinical outcomes associated with either proposed methods or consistency classifications.

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“…A thickened diet is a common food‐based strategy to manage dysphagia. The underlying idea is that a viscous food bolus travels with lower velocity, thereby providing more time for the oropharyngeal apparatus to close (Moret‐Tatay, Rodríguez‐García, Martí‐Bonmatí, Hernando, & Hernández, ; Steele, ; Tashiro et al, ). However, highly viscous liquids require the exertion of more force by the tongue to push the bolus through which may increase the chances of postswallow residues (Clavé et al, ; Steele, ).…”

Section: Introductionmentioning

confidence: 99%

“…Thickener‐based powders, which can be either gum or starch based, are available in the market (Mackley et al, ). These thickeners are added to liquids to thicken the texture and promote ease of swallowing (Moret‐Tatay et al, ). Gum‐based and starch‐based thickeners differ in the way that they absorb water.…”

Section: Introductionmentioning

confidence: 99%

Shear and extensional rheology of commercial thickeners used for dysphagia management

Qazi

Wiklund

Altskär³

et al. 2017

Journal of Texture Studies

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Thickeners available for dysphagia management were characterized for extensional viscosity to improve the understanding of these thickeners in large scale deformation. Extensional deformation behavior was further explained by using microcopy as corresponding technique for better understanding of structure/rheology relationship. Moreover, the major challenge in capturing human swallowing process is the short transit times of the bolus flow (<1 s). Therefore, the ultrasound-based rheometry method; PUV+PD which measures the real-time flow curve in ∼50 ms was used in addition to classical shear rheometry. The two methods complimented each other indicating that the PUV+PD method can be applied to study the transient swallowing process which is part of our future research, where we are studying the flow properties of fluids in an in vitro swallowing tract.

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

Cited by 75 publications

References 23 publications

Gellan gum: A new member in the dysphagia thickener family

Gellan gum: A new member in the dysphagia thickener family

Comparison of two methods to categorize thickened liquids for dysphagia management in a clinical care setting context: The Bostwick consistometer and the IDDSI Flow Test. Are we talking about the same concept?

Shear and extensional rheology of commercial thickeners used for dysphagia management

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