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Open Access 01-08-2020 | Dysphagia | Original Article

The Swallowing Characteristics of Thickeners, Jellies and Yoghurt Observed Using an In Vitro Model

Authors: Simmi Patel, William J. McAuley, Michael T. Cook, Yi Sun, Shaheen Hamdy, Fang Liu

Published in: Dysphagia | Issue 4/2020

Abstract

Drinks and foods may be thickened to improve swallowing safety for dysphagia patients, but the resultant consistencies are not always palatable. Characterising alternative appetising foods is an important task. The study aims to characterise the in vitro swallowing behaviour of specifically formulated thickened dysphagia fluids containing xanthan gum and/or starch with standard jellies and yoghurt using a validated mechanical model, the “Cambridge Throat”. Observing from the side, the model throat can follow an experimental oral transit time (in vitro-OTT) and a bolus length (BL) at the juncture of the pharynx and larynx, to assess the velocity and cohesion of bolus flow. Our results showed that higher thickener concentration produced longer in vitro-OTT and shorter BL. At high concentration (spoon-thick), fluids thickened with starch-based thickener showed significantly longer in vitro-OTT than when xanthan gum-based thickener was used (84.5 s ± 34.5 s and 5.5 s ± 1.6 s, respectively, p < 0.05). In contrast, at low concentration (nectar-like), fluids containing xanthan gum-based thickener demonstrated shorter BL than those of starch-based thickener (6.4 mm ± 0.5 mm and 8.2 mm ± 0.8 mm, respectively, p < 0.05). The jellies and yoghurt had comparable in vitro-OTT and BL to thickeners at high concentrations (honey-like and spoon-thick), indicating similar swallowing characteristics. The in vitro results showed correlation with published in vivo data though the limitations of applying the in vitro swallowing test for dysphagia studies were noted. These findings contribute useful information for designing new thickening agents and selecting alternative and palatable safe-to-swallow foods.

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Wirth R, Dziewas R, Beck AM, Clave P, Hamdy S, Heppner HJ, Langmore S, Leischker AH, Martino R, Pluschinski P, Rosler A, Shaker R, Warnecke T, Sieber CC, Volkert D. Oropharyngeal dysphagia in older persons - from pathophysiology to adequate intervention: a review and summary of an international expert meeting. Clin Interv Aging. 2016;11:189–208. https://doi.org/10.2147/cia.s97481.CrossRefPubMedPubMedCentral

Hashimoto H, Hirata M, Takahashi K, Kameda S, Katsuta Y, Yoshida F, Hattori N, Yanagisawa T, Palmer J, Oshino S, Yoshimine T, Kishima H. Non-invasive quantification of human swallowing using a simple motion tracking system. Sci Rep. 2018;8(1):5095. https://doi.org/10.1038/s41598-018-23486-0.CrossRefPubMedPubMedCentral

Hayoun P, Engmann J, Mowlavi S, Le Reverend B, Burbidge A, Ramaioli M. A model experiment to understand the oral phase of swallowing of Newtonian liquids. J Biomech. 2015;48(14):3922–8. https://doi.org/10.1016/j.jbiomech.2015.09.022.CrossRefPubMed

Newman R, Vilardell N, Clave P, Speyer R. Effect of bolus viscosity on the safety and efficacy of swallowing and the kinematics of the swallow response in patients with oropharyngeal dysphagia: white paper by the european society for swallowing disorders (ESSD). Dysphagia. 2016;31(2):232–49. https://doi.org/10.1007/s00455-016-9696-8.CrossRefPubMedPubMedCentral

Ortega O, Cabre M. Oropharyngeal dysphagia: aetiology and effects of ageing. J Gastroenterol Hepatol Res. 2014;3:1049–54.

Steele CM, Alsanei WA, Ayanikalath S, Barbon CE, Chen J, Cichero JA, Coutts K, Dantas RO, Duivestein J, Giosa L, Hanson B, Lam P, Lecko C, Leigh C, Nagy A, Namasivayam AM, Nascimento WV, Odendaal I, Smith CH, Wang H. The influence of food texture and liquid consistency modification on swallowing physiology and function: a systematic review. Dysphagia. 2015;30(1):2–26. https://doi.org/10.1007/s00455-014-9578-x.CrossRefPubMed

Mackley MR, Tock C, Anthony R, Butler SA, Chapman G, Vadillo DC. The rheology and processing behavior of starch and gum-based dysphagia thickeners. J Rheol. 2013;57(6):1533–53. https://doi.org/10.1122/1.4820494.CrossRef

Qazi WM, Ekberg O, Wiklund J, Kotze R, Stading M. Assessment of the food-swallowing process using bolus visualisation and manometry simultaneously in a device that models human swallowing. Dysphagia. 2019. https://doi.org/10.1007/s00455-019-09995-8.CrossRefPubMedPubMedCentral

Lotong V, Chun SS, Chambers E, Garcia JM. Texture and flavor characteristics of beverages containing commercial thickening agents for dysphagia diets. J Food Sci. 2003;68(4):1537–41. https://doi.org/10.1111/j.1365-2621.2003.tb09680.x.CrossRef

10.

Matta Z, Chambers E, Garcia JM, Helverson JM. Sensory characteristics of beverages prepared with commercial thickeners used for dysphagia diets. J Am Diet Assoc. 2006;106(7):1049–54. https://doi.org/10.1016/j.jada.2006.04.022.CrossRefPubMed

11.

Hiss SG, Postma GN. Fiberoptic endoscopic evaluation of swallowing. The Laryngoscope. 2003;113(8):1386–93.

12.

Logemann JA. The evaluation and treatment of swallowing disorders. Current Opinion in Otolaryngology & Head and Neck Surgery. 1998;6(6):395–400.CrossRef

13.

Mowlavi S, Engmann J, Burbidge A, Lloyd R, Hayoun P, Le Reverend B, Ramaioli M. In vivo observations and in vitro experiments on the oral phase of swallowing of Newtonian and shear-thinning liquids. J Biomech. 2016;49(16):3788–95. https://doi.org/10.1016/j.jbiomech.2016.10.011.CrossRefPubMed

14.

Yoshioka F, Ozawa S, Sumita YI, Mukohyama H, Taniguchi H. The pattern of tongue pressure against the palate during articulating glossal sounds in normal subjects and glossectomy patients. J Med Dent Sci. 2004;51(1):19–25.PubMed

15.

National Dysphagia Diet Task Force (2002) National Dysphagia Diet: Standardization for Optimal Care.

16.

International Dysphagia Diet Standardisation Initiative (2017) The IDDSI framework. https://iddsi.org/Documents/IDDSIFramework-CompleteFramework.pdf. Accessed on 15 July 2019

17.

Sim J, Wright C. Research in healthcare. Cheltenham: Nelson Thomes Ltd; 2000.

18.

Mukaka MM. A guide to appropriate use of correlation coefficient in medical research. Malawi Medical Journal. 2012;24(3):69–71.PubMedPubMedCentral

19.

Cho HM, Yoo B. Rheological characteristics of cold thickened beverages containing xanthan gum-based food thickeners used for dysphagia diets. J Acad Nutr Diet. 2015;115(1):106–11.CrossRef

20.

Pelletier CA. A comparison of consistency and taste of five commercial thickeners. Dysphagia. 1997;12(2):74–8.CrossRef

21.

Garcia JM, Chambers E, Molander M. Thickened liquids. Am J Speech-Lang Pat. 2005;14(1):4–13.CrossRef

22.

Sopade PA, Halley PJ, Cichero JAY, Ward LC. Rheological characterisation of food thickeners marketed in Australia in various media for the management of dysphagia. I: Water and cordial. J Food Eng. 2007;79(1):69–82.CrossRef

23.

Momosaki R, Abo M, Kobayashi K. Swallowing analysis for semisolid food texture in poststroke dysphagic patients. J Stroke Cerebrovasc Dis. 2013;22(3):267–70. https://doi.org/10.1016/j.jstrokecerebrovasdis.2011.08.009.CrossRefPubMed

24.

Marcotte M, Taherian Hoshahili AR, Ramaswamy HS. Rheological properties of selected hydrocolloids as a function of concentration and temperature. Food Res Int. 2001;34(8):695–703. https://doi.org/10.1016/S0963-9969(01)00091-6.CrossRef

25.

Hadde EK, Chen J. Shear and extensional rheological characterization of thickened fluid for dysphagia management. J Food Eng. 2019;245:18–23. https://doi.org/10.1016/j.jfoodeng.2018.10.007.CrossRef

26.

Waqas MQ, Wiklund J, Altskar A, Ekberg O, Stading M. Shear and extensional rheology of commercial thickeners used for dysphagia management. J Texture Stud. 2017;48(6):507–17. https://doi.org/10.1111/jtxs.12264.CrossRefPubMed

27.

Kuhlemeier KV, Palmer JB, Rosenberg D. Effect of liquid bolus consistency and delivery method on aspiration and pharyngeal retention in dysphagia patients. Dysphagia. 2001;16(2):119–22.CrossRef

28.

Leonard RJ, White C, McKenzie S, Belafsky PC. Effects of bolus rheology on aspiration in patients with Dysphagia. J Acad Nutr Diet. 2014;114(4):590–4. https://doi.org/10.1016/j.jand.2013.07.037.CrossRefPubMed

29.

Troche MS, Sapienza CM, Rosenbek JC. Effects of bolus consistency on timing and safety of swallow in patients with Parkinson's disease. Dysphagia. 2008;23(1):26–322. https://doi.org/10.1007/s00455-007-9090-7.CrossRefPubMed

30.

Vilardell N, Rofes L, Arreola V, Speyer R, Clave P. A comparative study between modified starch and xanthan gum thickeners in post-stroke oropharyngeal dysphagia. Dysphagia. 2016;31(2):169–79. https://doi.org/10.1007/s00455-015-9672-8.CrossRefPubMed

31.

Logemann JA, Gensler G, Robbins J, Lindblad AS, Brandt D, Hind JA, Kosek S, Dikeman K, Kazandjian M, Gramigna GD, Lundy D, McGarvey-Toler S, Miller Gardner PJ. A randomized study of three interventions for aspiration of thin liquids in patients with dementia or Parkinson's disease. J Speech Lang Hear Res. 2008;51(1):173–83. https://doi.org/10.1044/1092-4388(2008/013)51/1/173.CrossRefPubMedPubMedCentral

32.

Rofes L, Arreola V, Mukherjee R, Swanson J, Clavé P. The effects of a xanthan gum-based thickener on the swallowing function of patients with dysphagia. Aliment Pharmacol Ther. 2014;39(10):1169–79. https://doi.org/10.1111/apt.12696.CrossRefPubMed

33.

Dantas RO, Kern MK, Massey BT, Dodds WJ, Kahrilas PJ, Brasseur JG, Cook IJ, Lang IM. Effect of swallowed bolus variables on oral and pharyngeal phases of swallowing. Am J Physiol. 1990;258:G675–681.PubMed

34.

Reimers-Neils L, Logemann J, Larson C. Viscosity effects on EMG activity in normal swallow. Dysphagia. 1994;9(2):101–6.CrossRef

35.

Lundy DS, Smith C, Colangelo L, Sullivan PA, Logemann JA, Lazarus CL, Newman LA, Murry T, Lombard L, Gaziano J. Aspiration: cause and implications. Otolaryngol Head Neck Surg. 1999;120(4):474–8. https://doi.org/10.1053/hn.1999.v120.a91765.CrossRefPubMed

36.

Clave P, de Kraa M, Arreola V, Girvent M, Farre R, Palomera E, Serra-Prat M. The effect of bolus viscosity on swallowing function in neurogenic dysphagia. Aliment Pharmacol Ther. 2006;24(9):1385–94. https://doi.org/10.1111/j.1365-2036.2006.03118.x.CrossRefPubMed

37.

Nakauma M, Ishihara S, Funami T, Nishinari K. Swallowing profiles of food polysaccharide solutions with different flow behaviors. Food Hydrocolloids. 2011;25(5):1165–73. https://doi.org/10.1016/j.foodhyd.2010.11.003.CrossRef

38.

Kumagai H, Tashiro A, Hasegawa A, Kohyama K, Kumagai H. Relationship between flow properties of thickener solutions and their velocity through the pharynx measured by the ultrasonic pulse Doppler method. Food Sci Technol Res. 2009;15:203–10.CrossRef

39.

Painter V, Le Couteur DG, Waite LM. Texture-modified food and fluids in dementia and residential aged care facilities. Clin Interv Aging. 2017;12:1193–203. https://doi.org/10.2147/CIA.S140581.CrossRefPubMedPubMedCentral

40.

Sandoval-Castilla O, Lobato-Calleros C, Aguirre-Mandujano E, Vernon-Carter EJ. Microstructure and texture of yogurt as influenced by fat replacers. Int Dairy J. 2004;14(2):151–9. https://doi.org/10.1016/S0958-6946(03)00166-3.CrossRef

41.

Marconati M, Lopez F, Tuleu C, Orlu M, Ramaioli M. In vitro and sensory tests to design easy-to-swallow multi-particulate formulations. Eur J Pharm Sci. 2019. https://doi.org/10.1016/j.ejps.2019.02.026.CrossRefPubMed

Title: The Swallowing Characteristics of Thickeners, Jellies and Yoghurt Observed Using an In Vitro Model
Authors: Simmi Patel
William J. McAuley
Michael T. Cook
Yi Sun
Shaheen Hamdy
Fang Liu
Publication date: 01-08-2020
Publisher: Springer US
Keywords: Dysphagia
Dysphagia
Dysphagia
Published in: Dysphagia / Issue 4/2020
Print ISSN: 0179-051X
Electronic ISSN: 1432-0460
DOI: https://doi.org/10.1007/s00455-019-10074-1

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The Swallowing Characteristics of Thickeners, Jellies and Yoghurt Observed Using an In Vitro Model

Abstract

Keynote webinar | Spotlight on sleep in brain health

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Abstract

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