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Special Issue "Modified Diets and Nutritional Strategies for Patients with Swallowing and Mastication Disorders"

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A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Clinical Nutrition".

Deadline for manuscript submissions: 15 November 2023 | Viewed by 3981

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Prof. Dr. Pere Clavé

E-Mail Website1 Website2
Guest Editor

1. Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital de Mataró, Consorci Sanitari del Maresme, 08304 Barcelona, Spain
2. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, 28029 Madrid, Spain
Interests: dysphagia; motility disorders; physiology of swallowing; neurostimulation
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Dear Colleagues,

Texture modified diets including fluid thickening and texture adaptation are widely used to manage patients suffering from swallowing disorders such as dysphagia and/or mastication impairments. This is very relevant for patients with neurological diseases and older people. Oropharyngeal dysphagia is recognized as a geriatric syndrome. However, viscosity and texture are usually tested by qualitative methods and no established protocol has been developed yet to guarantee optimal treatment. Saliva, mastication and other factors such as shear rate and tongue pressure can have a remarkable impact on rheological and textural characteristics which can endanger patients’ swallowing. Optimal levels of texture and viscosity need to be quantified for each phenotype of patients. Shear viscosity and extensional viscosity can affect the therapeutic effect of thickened fluids. Analysis of texture profile adaptations can contribute to better understand the properties of texture modified foods. This Collection aims to spread scientific achievements in the quantification of texture and rheology development of standardized protocols to assess the impact of swallowing, mastication and oral processing on texture and viscosity, as well as the research on nutritional complications associated (dehydration, malnutrition). The main aim is to define a framework to develop thickened fluids and texture modified diets, described in SI units, to guarantee quality control and reproducibility for clinicians, researchers and the nutritional industry facing aging, one of the most relevant sociodemographic characteristics of our society.

Prof. Dr. Pere Clavé
Guest Editor

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Nutrients is an international peer-reviewed open access semimonthly journal published by MDPI.

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Keywords

dysphagia
rheology
texture
oral processing
viscosity
fluid thickening

Published Papers (3 papers)

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Open AccessArticle

Proposal for a Standard Protocol to Assess the Rheological Behavior of Thickening Products for Oropharyngeal Dysphagia

Mireia Bolivar-Prados

and

Nutrients 2022, 14(23), 5028; https://doi.org/10.3390/nu14235028 - 25 Nov 2022

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Abstract

Increasing shear viscosity (ShV) in thickening products (TP) is a valid therapeutic strategy for oropharyngeal dysphagia (OD). However, salivary amylase in the oral phase and shear rate in the pharyngeal phase of swallowing can change the viscosity of TPs when swallowed. This study aims to design and validate a rheological protocol to reproduce the oral and pharyngeal factors that affect the therapeutic effect of TPs and report the viscosity measurements in a standardized scientific and precise manner. We measured (a) the variability of the ShV measurements across several laboratories; (b) the in vitro and ex vivo properties of TPs and (c) the impact of the X-ray contrast Omnipaque, temperature and resting time on the rheological properties of TPs. A common protocol was applied in four international laboratories to assess five ShV values (100, 200, 400, 800 and 1600 mPa·s) for the xanthan-gum TP Tsururinko Quickly (TQ). The protocol included the dose (g/100 mL water), stirring procedure and standing time before measurement. Each value was characterized at the shear rate of 50 and 300 s⁻¹ pre- and post-oral incubation in eight volunteers. The effect of temperature, standing time and Omnipaque was assessed. The main results of the study were: (a) The mean intra-laboratory variability on the ShV at all levels was very low: 0.85%. The mean inter-laboratory variability was higher: 9.3%; (b) The shear thinning of TQ at 300 s⁻¹ was 75–80%. Increasing the temperature or standing time did not affect the ShV, and oral amylase caused a small decrease; (c) Omnipaque slightly decreased the dose of TP and hardly affected the amylase resistance or shear thinning. This study showed that different laboratories can obtain very accurate and similar ShV measurements using this protocol which uses scientific, universal SI units (mPa·s). Our protocol accurately reproduces oral and pharyngeal factors affecting the therapeutic effect of TPs. The addition of X-ray contrast did not produce significant changes. Full article

(This article belongs to the Special Issue Modified Diets and Nutritional Strategies for Patients with Swallowing and Mastication Disorders)

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Open AccessArticle

Rheological Properties and Stability of Thickeners for Clinical Use

Fernando Calmarza-Chueca

Ana Cristina Sánchez-Gimeno

Javier Raso-Pueyo

José Miguel Arbones-Mainar

Alberto Caverni-Muñoz

Alejandro Sanz-Arque

and

Alejandro Sanz-Paris

Nutrients 2022, 14(17), 3455; https://doi.org/10.3390/nu14173455 - 23 Aug 2022

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Abstract

The adaptation of liquids for patients with dysphagia requires precision and individualization in the viscosities used. We describe the variations of viscosity in water at different concentrations and evolution over time of the three compositions of commercial thickeners that are on the market (starch, starch with gums, and gum). By increasing the concentration in water, the viscosity of gum-based thickeners increases linearly, but it did not reach pudding texture, whereas the viscosity of the starch-based thickeners (alone or mixed with gums) rapidly reaches very thick textures. We modeled the viscosity at different concentrations of the four thickeners using regression analysis (R² > 0.9). We analyzed viscosity changes after 6 h of preparation. The viscosity of gum-based thickeners increased by a maximum of 6.5% after 6 h of preparation, while starch-based thickeners increased by up to 43%. These findings are important for correct handling and prescription. Gum-based thickeners have a predictable linear behavior with the formula we present, reaching nectar and honey-like textures with less quantity of thickener, and are stable over time. In contrast, starch thickeners have an exponential behavior which is difficult to handle, they reach pudding-like viscosity, and are not stable over time. Full article

(This article belongs to the Special Issue Modified Diets and Nutritional Strategies for Patients with Swallowing and Mastication Disorders)

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Open AccessSystematic Review

Economic Evaluation of Clinical, Nutritional and Rehabilitation Interventions on Oropharyngeal Dysphagia after Stroke: A Systematic Review

and

Nutrients 2023, 15(7), 1714; https://doi.org/10.3390/nu15071714 - 31 Mar 2023

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Background: Post-stroke oropharyngeal dysphagia (PS-OD) and its complications increase healthcare costs, suggesting that its appropriate management is cost-effective. We aimed to assess the efficiency of healthcare interventions in PS-OD management. Methods: A systematic review was conducted following PRISMA recommendations. Four databases were searched from inception through 30 June 2021. Outcome measures were cost-effectiveness and cost-savings of healthcare interventions. English and Spanish literature were included. Narrative and tables were used to present and synthesise evidence. Quality was evaluated using the CHEERS Statement. Results: A total of 244 studies were identified, and 10 were included. Screening and diagnosis of PS-OD studies found: (1) adjusted reduction in hospitalisation costs when assessed during the first admission day; (2) non-significant reduction in hospitalisation costs with OD management after thrombolysis; and (3) videofluoroscopy as the most cost-effective screening method (compared to bedside evaluation and a combination of both). Two studies showed cost-effective rehabilitation programmes, including OD management. Pelczarska et al. showed an incremental cost–utility ratio of texture-modified diets using a gum-based thickener of 20,977 PLN (4660€) following a dynamic model, and Kotecki et al. commercially prepared thickened fluids that were 44% to 59% less expensive than in situ prepared fluids. Elia et al. showed home enteral nutrition was cost-effective (£12,817/QALY), and Beavan et al. showed higher nutrient intake and low increase in hospitalisation costs using looped-nasogastric tubes (£5.20 for every 1% increase). Heterogeneity between studies precluded a quantitative synthesis. Conclusions: Included studies suggest that healthcare interventions aiming to prevent OD complications are cost-effective. However, studies assessing novel strategies are needed. Full article

(This article belongs to the Special Issue Modified Diets and Nutritional Strategies for Patients with Swallowing and Mastication Disorders)

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Planned Papers

The below list represents only planned manuscripts. Some of these manuscripts have not been received by the Editorial Office yet. Papers submitted to MDPI journals are subject to peer-review.

Title: Interdisciplinary challenges during implementation of the IDDSI framework for patients with dysphagia
Authors: Traub Julia; Feiner Marlies; Domnanich Sandra; Hofer Sarah; Walcher Barbara; Potzinger Martina; Haring Florian; Roller-Wirnsberger Regina
Affiliation: Department of Clinical Medical Nutrition, University Hospital Graz, 8036 Graz, Austria

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Special Issue "Modified Diets and Nutritional Strategies for Patients with Swallowing and Mastication Disorders"

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