Systematic review and evidence based recommendations on texture modified foods and thickened fluids for adults (≥18 years) with oropharyngeal dysphagia

Andersen, Ulla Tolstrup; Beck, Anne Marie; Kjærsgaard, Anders; Hansen, Tina; Poulsen, Ingrid

doi:10.1016/j.clnme.2013.05.003

Cited by 80 publications

(75 citation statements)

References 24 publications

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“…People with dysphagia, find the turbulent and fast flow of liquids difficult to control during passage through the pharynx, resulting in impaired airway protection (Cichero, 2013). The consequences of dysphagia can result in reduced oral intake and related malnutrition, dehydration, aspiration and aspiration pneumonia (Andersen, Beck, Kjaersgaard, Hansen, & Poulsen, 2013).…”

Section: Introductionmentioning

confidence: 99%

“…A variety of interventions are used in the management of dysphagia, including texture modified food and thickened fluids, which have the purpose of making the swallowing process slower and thereby safer and more efficient (Andersen et al, 2013;Cichero, 2013). Thickened fluids are classified into several levels of different consistency, or classes.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

et al. 2015

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2015

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“…Australia, Ireland, Japan, New Zealand, Sweden, the UK, USA and Denmark have published national descriptors/guidance [8,9,61,[62][63][64] however all these acknowledge the lack of clinical evidence; IDDSI [60] concurred with the needed for a systematic review of evidence and for consistent international guidelines; these points were further echoed by the European Society for Swallowing Disorders (ESSD) in a white paper at their 2015 meeting. In 2015 IDDSI created a framework of global standardised terminology and definitions based on current clinical and research evidence for texture modified foods and thickened drinks, Figure 3 [65**].…”

Section: Current Practice and Standardisation Approaches Internationallymentioning

confidence: 99%

A review of diet standardization and bolus rheology in the management of dysphagia

Hanson

2016

Current Opinion in Otolaryngology & Head and Neck Surgery

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Purpose: Texture modification is a widespread practice as a strategy for the management of dysphagia and can be very effective in individual cases. However, it is often performed in a qualitative, subjective manner and practices vary internationally according to multiple sets of national guidelines. This paper aims to identify best practice by reviewing the theory and practice of texture modification, focussing on recent advances. Recent findings:Instrumental assessment of texture modification in-vivo is challenging, but studies including rheology and perception have indicated that fluid viscosity is only one of many factors affecting texture modification in practice. Systematic reviews have identified a historical lack of high-quality clinical evidence, but recent controlled studies are beginning to identify positive and negative aspects of thickened fluids. Research and practice to date have been limited by the lack of control and standardisation of foods and drinks. However in 2015 a notfor-profit organisation, the International Dysphagia Diet Standardisation Initiative, has published a framework for texture modification from thin liquids to solid foods based on all the existing documentation and guidance, and the -limited-available clinical evidence. Summary:Rheology exists in the lab, however normal practice is often subjective or lacking control and standardisation. In the near future, cohesion of practice and the availability of practical standardisation tools may increase awareness and use of rheology. KeywordsDysphagia, Swallowing, Rheology, Viscosity, Texture modification Key points •The relationships between rheology and swallowing are beginning to be characterised using oral pressure sensing and videofluoroscopy, together with careful control of bolus rheology.• It is becoming clearer that viscosity alone is not sufficient to categorise texture modification.• Literature to date shows a trend for reduced aspiration with increased thickness of liquids, and increased residue with some thicker consistencies, however evidence is scarce.• An inconsistent approach to definition of texture modification techniques has been limiting the collation of a coherent evidence base.• A new international standard (IDDSI) has been created, drawing on available evidence and including practical objective measures.

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“…A recent systematic review of texture modified foods literature investigated if there was evidence to support the claim that texture modified foods reduce aspiration, improve dietary intake of foods and improve nutritional status of people suffering from oropharyngeal dysphagia (Andersen et al 2013).…”

Section: Current Issues With Texture Modified Foodsmentioning

confidence: 99%

“…Andersen et al (2013) did find evidence that the incidences of aspiration pneumonia were reduced in people suffering from chronic dysphagia if they used the "chin down" procedure when consuming thin fluids. This review highlighted the lack of evidence to support the use of texture modified foods and fluids guidelines in the treatment and management of dysphagia in general.…”

Section: Current Issues With Texture Modified Foodsmentioning

confidence: 99%

Insights into rational design of plant based foods to improve management of dysphagia

Tobin¹

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Normal swallowing is a complex process which requires sufficient mastication and lubrication of the food to transport the bolus from the mouth to the pharynx. In people suffering from dysphagia this process is not well coordinated and they often have difficulty in transporting food and water from the mouth to the stomach, which can lead to choking or aspiration. Modification of food texture by mincing or pureeing normal food is used to prevent these complications; however inconsistencies in texture can affect the consumption of these foods. Hence, malnutrition, dehydration and aspiration pneumonia, are a common problem with dysphagia sufferers.Using green peas as a model food system, this project investigated the effect of three method of comminution -mincing, pureeing and freeze-fracturing (processing whilst frozen) -on the macro and microstructure of the peas and its impact on rheological behaviour and sensory perception.Comminution of peas resulted in a particulated soft solid with hierarchical structures with broad range of particle sizes and shapes i.e. from large clusters of cells (5 mm) to starch granules (10 µm) which were released from broken cells. These pea particles were suspended in serum released during cellular structure breakdown. The high concentration, broad particle size distributions, variations in morphology and deformability of particles made this system complex and challenging to measure. Vane geometry was used to evaluate the rheological behaviour of comminuted peas, as it enabled accurate measurement of dispersions containing large particles without altering the product structure and it also eliminated any wall slip effects. The effect of pea variety, particle size distribution and amount of serum or added water on rheological behaviour was studied.Results demonstrated that comminuted peas were characteristically solid-like with higher elastic than viscous modulus (G´ > G˝). They also exhibited a yield stress which is an important parameter in these systems as it is a good indicator of the amount of effort required to initiate flow during oral processing. Minced peas with over 50% of the particle >1 mm in size had broader size distribution, which packed better than narrower distributions of pureed peas, resulting in higher G´ and yield stress. Changing the particle size distributions by systemically increasing the percentage of minced peas in a mince/puree blend also increased G´ and yield stress. This indicated that particle size distribution can be used to modify flow behaviour, while keeping the solids content the same.Diluting minced and pureed peas with incremental amounts of water showed that in such concentrated systems, small changes in solid to liquid ratio had a considerable impact on G´ and yield stress, as small increments in the liquid phase decreased G´ and yield stress dramatically. The variety of pea did not impact on the particle size distribution, but it affected the amount of serum released and particle firmness. These findings showed that particle concentratio...

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Systematic review and evidence based recommendations on texture modified foods and thickened fluids for adults (≥18 years) with oropharyngeal dysphagia

Cited by 80 publications

References 24 publications

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

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

A review of diet standardization and bolus rheology in the management of dysphagia

Insights into rational design of plant based foods to improve management of dysphagia

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