The impact of modification techniques on the rheological properties of dysphagia foods and liquids

Exploring the potential of 3D-printed texture-modified diets for the management of dysphagia

Dysphagia is a swallowing disorder characterized by mild to severe pain during food ingestion. Patients with dysphagia require special care and food that meet the patient's requirements of nutrition and ease of swallowing which can be achieved by texture-modified diets. Texture modification is important for improving swallow safety and control and preventing aspiration, pneumonia, and choking. 3D printing is the leading technology in today's era and is widely used for the texture modification of food for patients with swallowing disorders. 3D printing is fast, reliable, and customizable and has the potential to fabricate unappealing and tasteless food into different colours, textures, and shapes. Our discussion brings to review the present and future of 3D printing in preparing texture-modified diets for dysphagia. The challenges associated with dysphagia diets that can be overcome by 3D printing have also been discussed. The review also focuses on the IDDSI framework for determining the suitability of food for dysphagic patients. The key factors such as the material used, and viscosity have been discussed along with various pre-existing literature. The key challenges with the food industry and future research areas have also been discussed.

Comprehensive review of dysphagia and technological advances in dysphagia food

As the global population ages, dysphagia is becoming increasingly common among the elderly, posing serious risks such as choking, aspiration pneumonia, and even death. Leveraging advanced technologies to develop specialized food products for those with dysphagia not only serves the economic interests of the elderly food market but also significantly enhances the nutritional health and social satisfaction of this demographic. This review examines the causes and early symptoms of dysphagia, the development of texture-modified foods (TMFs), and the relevant regulations and standards. It also addresses the key factors influencing the swallowing of foods, focusing on rheology and tribology. Most texture-modified foods currently available do not provide an enjoyable eating experience for the elderly or those with dysphagia. The integration of artificial intelligence (AI) and mathematical modeling with food additive manufacturing technology appears promising for improving foods designed for the elderly and those with dysphagia. This paper highlights the critical benefits and potential applications of AI, mathematical modeling, and food additive manufacturing in creating dysphagia-friendly foods and provides a conceptual system for designing diets based on AI for dysphagic foods. AI and mathematical model-based food processing technology enable the food industry to achieve digitalization and large-scale customization, potentially revolutionizing the approach to dietary management in dysphagia.

Difference in Drinking Times as a Function of Liquid Consistency in Adults With Oculopharyngeal Muscular Dystrophy: A Comparative Study Using Bostwick Consistometer and IDDSI Flow Test Methods

The main objective was to document the differences between drinking times and oral perception between liquids in individuals with dysphagia. A second objective was to assess variations in consistency categorization across instruments. A third objective was to explore the relationship between drinking time and dysphagia severity. A sample of individuals with OPMD (n = 30; 40-75 years) was recruited. Participants drank 80 mL of water, followed by three blinded commercially pre-thickened cranberry cocktails (CranA, CranB, CranC). Flow rates were measured with Bostwick consistometer, IDDSI Flow Test, and Discovery HR 20 rheometer. Patient-reported outcome measures were used to assess dysphagia. Mean drinking times for participants with OPMD were as follows: 7.9 ± 4.4 s for water, 10.7 ± 4.8 s for CranA, 12.3 ± 5.7 s for CranB, and 15.2 ± 7.2 s for CranC. All four times were statistically different from each other. Participants reported noticeable differences in oral perception. The Bostwick flow rates were different for all three cocktails. Based on IDDSI Flow Test, CranA was categorized as IDDSI level-2, while both CranB and CranC were categorized as IDDSI level-3. Correlations ranging from 0.39 to 0.55 were found between drinking times and dysphagia severity. In conclusion, liquids within the same IDDSI category can have different Bostwick flow rates and oral perception. The hypothesis that participants with OPMD may find certain liquids more challenging to swallow, despite being in the same IDDSI category, deserves further exploration in future studies.

Management of Children with Swallowing Problems: New Advances in Paediatric Thickeners

A satellite symposium on the evaluation and management of dysphagia in children was held during the 12th Annual Congress of the European Society for Swallowing Disorders (ESSD) in Leuven, Belgium, on 14th September 2022. Dysphagia is the impairment or difficulty in swallowing and may have an oropharyngeal or oesophageal cause. This can result in delayed transit of liquids or solid food from the mouth to the stomach. Food thickening agents can reduce regurgitation and improve swallowing mechanics, particularly in infants and young children. At this symposium, Karen van Hulst, Speech and Language Therapist and Clinical Epidemiologist at Radboud University Medical Center, Amalia’s Children’s Hospital, the Netherlands, introduced the topic of dysphagia and its complications, and the evaluation of dysphagia. She then discussed the use of thickening agents in children with dysphagia. Ben Hanson from the Department of Engineering, University College London, UK, introduced the International Dysphagia Diet Standardization Initiative (IDDSI). The IDDSI has developed a standardised and practical method of measuring the thickness of liquid and food that can be used when preparing foods at home or in the hospital, and may be applied commercially. Analou Sugar, Clinical Lead in Paediatric Speech and Language Therapy at Chelsea and Westminster Hospital Foundation Trust, London, UK, ended the symposium with a presentation of her recent clinical experience using a new thickener (ThickenUp® Junior, Nestlé Health Science, Vevey, Switzerland) in paediatric patients.

Combining Liquid Oral Drugs with Thickener: Compatibility and Changes in Viscosity

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.

Three-Dimensional Printing of Food Foams Stabilized by Hydrocolloids for Hydration in Dysphagia

Three-dimensional food printing offers the possibility of modifying the structural design, nutrition, and texture of food, which may be used for consumers with special dietary requirements such as dysphagic patients. One of the food matrices that can be used for liquid delivery to dysphagic patients is food foams. Foams are widely used in different food products to adjust food density, rheological properties, and texture. Foams allow the food to stay in the mouth for sufficient time to provide hydration while minimizing the danger of choking. Our work studies the foam properties and printability of both egg white foams and eggless foams with a strong focus on their foaming properties, rheological properties, printability, and suitability for dysphagic patients. Food hydrocolloid, xanthan gum (XG), is added to improve foam stability and rheological properties so that the inks are printable. Rheological and syneresis properties of the pre-printed foam inks are examined. The texture profile and microstructure properties are studied post-printing. International dysphagia diet standardization initiative tests are carried out to assess the inks' potential for dysphagic diets. Inks with XG performed better with minimal water seepage, better foam stability, and excellent printability. This suggests that hydrocolloids lead to more stable food foams that are suitable for 3DFP and safe for hydration delivery to dysphagic patients.

It's crunch time: Exploring the sensibility of food textural acoustics for individuals with dysphagia

BACKGROUND

Various fields of study have alluded to food textural, and its associated acoustic, properties (i.e. food textural acoustics). However, because of the challenging nature of the inclusion of acoustic properties in diet textural modifications in dysphagia (swallowing disorders), this construct has not been sufficiently considered in the field.

OBJECTIVE

To investigate the sensibility of food textural acoustics as a construct to understand eating for individuals with dysphagia.

METHOD

The study design was based on qualitative evidence synthesis methodologies. This involved revised scoping review methods (peer-reviewed published articles from 1980 to 2020 over seven databases), with an adapted consultation phase through online focus group discussions with six world experts. The data was analysed using frequency and thematic analysis, and ideology critique.

RESULTS

A total of 11 articles were included in the revised scoping review analysis (seven research studies and four review articles). The analysis of these articles revealed a lack of diversity in geography, discipline and perspective exploring the construct of food textural acoustics. A total of three themes with three associated core arguments emerged from the revised scoping review and the consultation phase. These arguments highlighted (1) the need to study food textural acoustics because of its salience and pleasure responses, (2) possible methodological dilemmas in studying food textural acoustics due to the complexity of eating, and (3) considerations with regard to the approach and positioning adopted when studying the construct.

CONCLUSION

Food textural acoustics may be a sensible construct to understand eating for individuals with dysphagia. As eating is a complex process, there is a need to challenge the methods we use when studying this construct of food textural acoustics. We hope that this article inspires researchers and practitioners to think differently by using textural, and its associated acoustic, properties as a way to reimagine dysphagia practice, especially for those from low- to middle-income contexts such as South Africa and Brazil.

Rheological and Nutritional Assessment of Dysphagia-Oriented New Food Preparations

Dysphagia that involves difficulty swallowing food and liquids is a symptom of different diseases. In some cases, patients who experience this symptom should be fed with modified consistency foods. Dysphagia is often accompanied by malnutrition and dehydration and an interesting approach to dealing with these conditions is to provide patients with nutrient-rich foods. In this study, two new food formulations for dysphagia patients are proposed: a cereal-based protein meal and a vegetable cream. The nutritional and rheological characteristics of the two innovative preparations were assessed and compared with those of commercial products. The proposed protein meal formulations meet the criteria for the “high protein” claim and the vegetable cream meets those of the “source of fiber” claim. The rheological investigation revealed that the flow properties of the innovative formulations were comparable to those of the commercial ones. Based on these preliminary outcomes, this investigation represents an interesting perspective potentially valuable to enlarge the offer of possibilities for people suffering from swallowing disorders.