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Nutrients
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Modified Diets and Nutritional Strategies for Patients with Swallowing and...
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Modified Diets and Nutritional Strategies for Patients with Swallowing and Mastication Disorders

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

Deadline for manuscript submissions: closed (15 November 2023) | Viewed by 9342

Special Issue Editor

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
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

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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Keywords

  • dysphagia
  • rheology
  • texture
  • oral processing
  • viscosity
  • fluid thickening

Published Papers (5 papers)

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21 pages, 3550 KiB  
Article
Measuring the Rheological and Textural Properties of Thick Purees Used to Manage Patients with Swallowing Disorders
by Kovan Ismael-Mohammed, Mireia Bolivar-Prados, Laura Laguna and Pere Clavé
Nutrients 2023, 15(17), 3767; https://doi.org/10.3390/nu15173767 - 28 Aug 2023
Viewed by 951
Abstract
Texture-modified diets are the first-line compensatory strategy for older patients with swallowing and mastication disorders. However, the absence of a common protocol to assess textural properties inhibits their standardization and quality control and, thus, patient safety. This study aimed to (a) assess the [...] Read more.
Texture-modified diets are the first-line compensatory strategy for older patients with swallowing and mastication disorders. However, the absence of a common protocol to assess textural properties inhibits their standardization and quality control and, thus, patient safety. This study aimed to (a) assess the rheological and textural properties of ten thick purees (Texture C, British Dietetic Association), (b) understand the effect of oral processing, and (c) measure the properties of the ready-to-swallow bolus after oral processing in healthy adults. Shear viscosity at 50 s−1 and 300 s−1 and textural properties (maximum force, cohesiveness, and adhesiveness) of boluses of ten thick purees were analyzed with a rheometer and a texture analyzer before and after oral processing (ready-to-swallow) in five healthy volunteers. Viscosity varied by 81.78% at 50 s−1 (900–4800 mPa·s) among purees before oral processing. Maximum force varied by 60% (0.47–1.2 N); cohesiveness, 18% (0.66–0.82), and adhesiveness, 32% (0.74–1.1 N·s). The high variability of viscosity was also present in ready-to-swallow boluses, 70.32% among purees. Oral processing significantly reduced viscosity in most purees (French omelet, zucchini omelet, turkey stew, red lentils, noodles, and hake fish) and also significantly reduced maximum force (7–36%) and adhesiveness (17–51%) but hardly affected cohesiveness (<5%). All thick purees met the qualitative textural descriptors for Level C texture. However, all ten purees showed significant differences in all parameters measured instrumentally and were affected differently by oral processing. This study demonstrates the need to use instrumental quality control using standardized protocols and SI units to narrow the variability and provide the optimal values for patients with dysphagia who require texture-modified diets. 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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15 pages, 2106 KiB  
Article
Shear-Viscosity-Dependent Effect of a Gum-Based Thickening Product on the Safety of Swallowing in Older Patients with Severe Oropharyngeal Dysphagia
by Mireia Bolivar-Prados, Yuki Hayakawa, Noemi Tomsen, Viridiana Arreola, Weslania Nascimento, Stephanie Riera, Satomi Kawakami, Kazuhiro Miyaji, Yasuhiro Takeda, Jun Kayashita and Pere Clavé
Nutrients 2023, 15(14), 3279; https://doi.org/10.3390/nu15143279 - 24 Jul 2023
Cited by 1 | Viewed by 1174
Abstract
Fluid thickening is a valid therapeutic strategy for patients with oropharyngeal dysphagia (OD). The main aim of this study was to determine the therapeutic effect of the xanthan-gum-based thickener Tsururinko Quickly (TQ, Morinaga Milk Co., Tokyo, Japan) in older patients with severe OD. [...] Read more.
Fluid thickening is a valid therapeutic strategy for patients with oropharyngeal dysphagia (OD). The main aim of this study was to determine the therapeutic effect of the xanthan-gum-based thickener Tsururinko Quickly (TQ, Morinaga Milk Co., Tokyo, Japan) in older patients with severe OD. A total of 85 patients (83.32 ± 6.75 y) with OD and a penetration–aspiration score (PAS) of n ≥ 3 were studied by videofluoroscopy while swallowing duplicate 10 mL boluses at <50 mPa·s, 100, 200, 400, 800, and 1600 mPa·s, to assess the safety and efficacy of swallowing and the biomechanics of a swallowing response at each viscosity level. At <50 mPa·s, only 16.25% patients swallowed safely, 45% had penetrations (PAS 3–5), and 38.75% had aspirations (PAS 6–8). Fluid thickening with TQ greatly increased the prevalence of patients with safe swallowing from 62.90% at 100 mPa·s to 95.24% at 1600 mPa·s in a shear-viscosity-dependent manner. The penetrations and aspirations were significantly reduced to 3.60% and 1.19%, respectively, at 1600 mPa·s. The threshold viscosity was 100 mPa·s and the increasing viscosity above 800 mPa·s did not further improve the therapeutic effect significantly. Increasing the shear viscosity significantly reduced the time to laryngeal vestibule closure (−16.70%), increased the time to upper oesophageal sphincter opening (+26.88%), and reduced the pharyngeal bolus velocity (−31.62%) without affecting the pharyngeal residue. TQ has a strong shear-viscosity-dependent effect on the safety of swallowing in older patients with severe OD without increasing the pharyngeal residue. The therapeutic range for TQ is 100–800 mPa·s, with 200 and 800 mPa·s being the optimal doses to cover the needs of older patients with OD. 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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16 pages, 1490 KiB  
Article
Proposal for a Standard Protocol to Assess the Rheological Behavior of Thickening Products for Oropharyngeal Dysphagia
by Mireia Bolivar-Prados, Noemí Tomsen, Yuki Hayakawa, Satomi Kawakami, Kazuhiro Miyaji, Jun Kayashita and Pere Clavé
Nutrients 2022, 14(23), 5028; https://doi.org/10.3390/nu14235028 - 25 Nov 2022
Cited by 4 | Viewed by 2056
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 [...] Read more.
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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14 pages, 1886 KiB  
Article
Rheological Properties and Stability of Thickeners for Clinical Use
by 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
Cited by 1 | Viewed by 1725
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 [...] Read more.
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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22 pages, 775 KiB  
Systematic Review
Economic Evaluation of Clinical, Nutritional and Rehabilitation Interventions on Oropharyngeal Dysphagia after Stroke: A Systematic Review
by Sergio Marin, Omar Ortega, Mateu Serra-Prat, Ester Valls, Laia Pérez-Cordón and Pere Clavé
Nutrients 2023, 15(7), 1714; https://doi.org/10.3390/nu15071714 - 31 Mar 2023
Cited by 3 | Viewed by 2495
Abstract
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 [...] Read more.
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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