Effect of mixing method on resulting thickness of infant formula

Abstract

Previous research shows that factors such as time, temperature, nutritional make‐up of a liquid, and type of thickening agent can significantly alter the resulting thickness of liquids. This study sought to determine the effect of three distinct mixing methods on the resulting thickness of ready to feed infant formulas mixed to Mildly and Moderately Thick (International Dysphagia Diet Standardization Initiative [IDDSI] Levels 2 and 3) with three different thickening agents. Eight commercially available infant formulas were mixed with three different thickening agents by three different mixing methods. The IDDSI Syringe Flow Test was used to categorize the thickened formulas. Chi square analyses were completed to determine the impact of mixing method on the thickened formulas. The majority (94%) of thickened formula combinations prepared to a target Mildly Thick consistency produced thickened formula that was thinner or thicker than the target. In contrast, the majority (76%) of thickened formula combinations prepared to a target Moderately Thick (IDDSI Level 3) consistency produced thickened formula that was equivalent to the target consistency. A statistically significant relationship was found between mixing methods and resulting IDDSI category for samples mixed to a target of Moderately Thick. The thickening agent and method of mixing must be considered carefully when preparing infant formulas to Mildly and Moderately Thick target IDDSI categories. Based on results of this study, it is recommended that providers utilize a clinical testing method, such as the IDDSI Syringe Flow Test, when attempting to create a Mildly Thick formula consistency.

Assessment of tomato‐based thick fluid diet for patients with dysphagia using a simple and cheap test

“…Individual caregivers, including speech therapists, have exhibited an alarming degree of interindividual variability in the amounts of thickener used to achieve a particular consistency range (Glassburn & Deem, 1998). Despite the theoretical simplicity of adding a thickening agent to a liquid to prevent airway compromise during swallowing, the success of this compensatory strategy's clinical implementation has proved to be a challenge (Rush et al, 2021). Barbon and Steele (2018) All people who suffer changes in swallowing have difficulty in oral feeding, which compromises their nutritional status.…”

“…There are differences in homogenizing thickeners and drinks due to the dissolution rate in a solvent. The method briefly uses a portable blender, sprinkling the thickener, homogenizing for a few seconds, followed by rest for the flow test step (Rush, Bolland, & Gosa, 2021).…”

Instrumental and sensory techniques to characterize the texture of foods suitable for dysphagic people: A systematic review

“…In the works included in the present review, the IDDSI Syringe Test was used to characterize liquid and thickened liquid foods (Table 2). The foods obtained a gravity flow range between 0.0 ml for infant formula at level 0 of IDDSI (Brooks et al, 2021;Rush et al, 2021) and 10 ml for infant formula at level 3 of IDDSI and blended regular food (Rush et al, 2021;Weston & Clarke, 2020). Villiers et al (2019) used the IDDSI Syringe Test to prepare a nutritious food (porridge with grain maize and soybean) for OD management.…”

Effect of commercially available thickening agents on ready‐to‐feed infant formulas

“…Initial investigations into the resulting thickness of infant formulas reveal that following the package instructions when mixing a thickener with infant formula does not reliably produce the desired thickness (Cichero et al, 2011), and that both the amount of time that elapses from when the thickening agent is added to formula and the temperature of the formula impact the resulting thickness (Gosa & Dodrill, 2017). Most recently, investigators have shown that even the method of mixing can have a significant impact on the resulting thickness of infant formula (Rush et al, 2021). Currently, thickening agents come with a standard set of instructions for mixing specific amounts of the thickener with specific amounts of the liquid to achieve a desired thickness.…”

“…The available thickening agents do not provide instructions to account for the variables known to impact the resulting thickness. As a result, special categories of liquid, like infant formula, mixed with commercially available thickening agents frequently do not achieve the desired level of thickness (Gosa & Dodrill, 2009;Gosa et al, 2020;Rush et al, 2021).…”