The behavior of lemon-based thickened fluids submitted to the IDDSI flow test as a strategy for dysphagia treatment

The behavior of lemon-based thickened fluids submitted to the IDDSI flow test as a strategy for dysphagia treatment

Authors

DOI:

https://doi.org/10.58951/fstoday.v1i1.8

Keywords:

Swallowing disorder, IDDSI, thickened liquids, hypertension, beverages

Abstract

Dysphagia is a health condition that causes swallowing difficulty, which may be treated by many techniques. Feeding modified foods should be a usual protocol for these individuals, as it will rarely be a diet of choice but a diet necessary to maintain a safe oral intake of nutrients. All people who suffer from changes in swallowing have difficulty in oral feeding, which compromises their nutritional status, mainly due to dehydration. Thickening of fluids is a well-established management strategy for oropharyngeal dysphagia. Thus, this research aimed to evaluate commercial lemon-based beverages (juices and flavored waters) with the addition of thickeners through the gravity flow test, according to the protocol established by the International Dysphagia Diet Standardization Initiative (IDDSI). Eight commercial beverage samples, categorized as flavored carbonated water (L01, L02, L03, L04), isotonic beverage (L05), liquid soft drink (L06) and powdered soft drink (L07 and L08), in addition to two thickeners based on xanthan gum were used. A 10 mL slide-tip syringe with a barrel length of 61.5 mm was employed for the flow test. thickening agents to lemon-based beverages caused substantial changes in their rheological properties. Differences between samples and treatments were observed according to the type and amount of thickener. Samples L05 and L08 showed 8.55 and 8.05 mL retention in the syringe, respectively, classifying them as moderately thickened liquids, while the others samples were classified as slightly thickened liquids. The ideal treatment for the dysphagic patient aims to ensure a safe intake and a correct nutritional and water supply, in addition to the consequent improvement of the patient’s general clinical condition. According to their nutritional profile, the inclusion of these beverages may be interesting in increasing some micronutrients such as sodium, potassium, calcium, phosphorus and magnesium. The flow properties of lemon-based beverages can be a good option for patients with dysphagia when improved using low amounts of thickening agents to suit their diets.

References

Barbon, C.E.A., & Steele, C.M. (2018). Thickened liquids for dysphagia management: A current review of the measurement of liquid flow. Current Physical Medicine and Rehabilitation Reports, 6(4), 220–226. https://doi.org/10.1007/s40141-018-0197-6 DOI: https://doi.org/10.1007/s40141-018-0197-6

Bassi, D., Furkim, A.M., Silva, C.A., Coelho, M.S.P.H., Rolim, M.R.P., Alencar, M.L.A., & Machado, M.J. (2014). Identificação de grupos de risco para disfagia orofaríngea em pacientes internados em um hospital universitário. CoDAS (Communication Disorders, Audiology and Swallowing), 26(1), 17-27. https://doi.org/10.1590/S2317-17822014000100004 DOI: https://doi.org/10.1590/s2317-17822014000100004

Burgos, R., Bretón, I., Cereda, E., Desport, J. C., Dziewas, R., Genton, L., Gomes, F., Jésus, P., Leischker, A., Muscaritoli, M., Poulia, K. A., Preiser, J. C., Van der Marck, M., Wirth, R., Singer, P., & Bischoff, S. C. (2018). ESPEN guideline clinical nutrition in neurology. Clinical nutrition (Edinburgh, Scotland), 37(1), 354–396. https://doi.org/10.1016/j.clnu.2017.09.003 DOI: https://doi.org/10.1016/j.clnu.2017.09.003

Cho, H.M., & Yoo, B. (2015). Rheological characteristics of cold thickened beverages containing xanthan gum-based food thickeners used for dysphagia diets. Journal of the Academy of Nutrition and Dietetics, 115(1), 106–111. https://doi.org/10.1016/j.jand.2014.08.028 DOI: https://doi.org/10.1016/j.jand.2014.08.028

Cichero, J.A.Y., Jackson, O., Halley, P.J., & Murdoch, B.E. (2000). How thick is thick? Multicenter study of the rheological and material property characteristics of mealtime fluids and videofluoroscopy fluids. Dysphagia, 15(4), 188–200. https://doi.org/10.1007/s004550000027 DOI: https://doi.org/10.1007/s004550000027

de Villiers, M., Hanson, B., Moodley, L., & Pillay, M. (2019). The impact of modification techniques on the rheological properties of dysphagia foods and liquids. Journal of Texture Studies, 51(1), 154–168. https://doi.org/10.1111/jtxs.12476 DOI: https://doi.org/10.1111/jtxs.12476

Dewar, R.J., & Joyce, M.J. (2006). Time-dependent rheology of starch thickeners and the clinical implications for dysphagia therapy. Dysphagia, 21(4), 264–269. https://doi.org/10.1007/s00455-006-9050-7 DOI: https://doi.org/10.1007/s00455-006-9050-7

Dias, J. G., Lombardi, I, J. (2021). Prevalence of swallowing difficulties in older people without neurological disorders: Swallowing profile of older people in the city of Santos, Brazil. Journal of Oral Rehabilitation, 48(5), 614-620. https://doi.org/10.1111/joor.13157 DOI: https://doi.org/10.1111/joor.13157

Garcia, J.M., Chambers, E., Matta, Z., & Clark, M. (2005). Viscosity measurements of nectar- and honey-thick liquids: Product, liquid, and time comparisons. Dysphagia, 20(4), 325–335. https://doi.org/10. 1007/s00455-005-0034-9 DOI: https://doi.org/10.1007/s00455-005-0034-9

Glassburn, D.L., & Deem, J.F. (1998). Thickener viscosity in dysphagia management: Variability among speech-language pathologists. Dysphagia, 13(4), 218–222. https://doi.org/10.1007/PL00009575 DOI: https://doi.org/10.1007/PL00009575

IDDSI (2019). The IDDSI Framework. Available at: <https://www.iddsi.org>. Accessed on Aug 22, 2022.

Lavoisier, A., Boudrag, S., & Ramaioli, M. (2022). Effect of α-amylase and pH on the rheological properties of thickened liquids containing starch in in vitro conditions relevant to oral processing and swallowing. Journal of texture studies, 53(4), 550–557. https://doi.org/10.1111/jtxs.12693 DOI: https://doi.org/10.1111/jtxs.12693

Lee, H.Y., Yoon, S.R., Yoo, W., & Yoo, B. (2016). Effect of salivary reaction time on flow properties of commercial food thickeners used for Dysphagic patients. Clinical Nutrition Research, 5(1), 55–59. https:// doi.org/10.7762/cnr.2016.5.1.55 DOI: https://doi.org/10.7762/cnr.2016.5.1.55

Loyola, I. P., Sousa, M. F., Jardim, T. V., Mendes, M. M., Barroso, W. K. S., Sousa, A. L. L., & Jardim, P. C. B. V. (2022). Comparison between the Effects of Hymalaian Salt and Common Salt Intake on Urinary Sodium and Blood Pressure in Hypertensive Individuals.. Arquivos brasileiros de cardiologia, 118(5), 875–882. https://doi.org/10.36660/abc.20210069 DOI: https://doi.org/10.36660/abc.20210069

Maieves, H.A., & Teixeira, G.L. (2021). Assessment of tomato-based thick fluid diet for patients with dysphagia using a simple and cheap test. Journal of Texture Studies, 52(5), 647-655. https://doi.org/10.1111/jtxs.12617 DOI: https://doi.org/10.1111/jtxs.12617

Matsuo, K., & Fujishima, I. (2020). Textural Changes by Mastication and Proper Food Texture for Patients with Oropharyngeal Dysphagia. Nutrients, 12(6), 1613. https://doi.org/10.3390/nu12061613 DOI: https://doi.org/10.3390/nu12061613

Mello, R. P., Xavier, M. O., Tomasi, E., Gonzalez, M. C., Demarco, F. F., & Bielemann, R. M. (2022). Dysphagia Perception Among Community-Dwelling Older Adults from a Municipality in Southern Brazil. Dysphagia, 37(4), 879–888. https://doi.org/10.1007/s00455-021-10347-8 DOI: https://doi.org/10.1007/s00455-021-10347-8

Moriel, P., Madureira, H.L., Uwagoya, A.K.Y., Wlian, L., & Pincinato, Ed.C. (2010). Influence of smoking on salivary amylase activity and glycemic curve. Revista de Nutrição, 23(4), 565-572. https://doi.org/10.1590/S1415-52732010000400007 DOI: https://doi.org/10.1590/S1415-52732010000400007

Reber, E., Gomes, F., Dähn, I. A., Vasiloglou, M. F., & Stanga, Z. (2019). Management of Dehydration in Patients Suffering Swallowing Difficulties. Journal of clinical medicine, 8(11), 1923. https://doi.org/10.3390/jcm8111923 DOI: https://doi.org/10.3390/jcm8111923

Rush, O. M., Bolland, A. C., & Gosa, M. M. (2021). Effect of mixing method on resulting thickness of infant formula. Journal of Texture Studies, 52 (1), 57–70. https://doi.org/10.1111/jtxs.12566 DOI: https://doi.org/10.1111/jtxs.12566

Santos, M. T., Batista, R., Guaré, R. O., Leite, M. F., Ferreira, M. C., Durão, M. S., Nascimento, O. A., & Jardim, J. R. (2011). Salivary osmolality and hydration status in children with cerebral palsy. Journal of oral pathology & medicine : official publication of the International Association of Oral Pathologists and the American Academy of Oral Pathology, 40(7), 582–586. https://doi.org/10.1111/j.1600-0714.2011.01027.x DOI: https://doi.org/10.1111/j.1600-0714.2011.01027.x

Steele, C. M., Alsanei, W. A., Ayanikalath, S., Barbon, C. E., Chen, J., Cichero, J. A., Coutts, K., Dantas, R. O., Duivestein, J., Giosa, L., Hanson, B., Lam, P., Lecko, C., Leigh, C., Nagy, A., Namasivayam, A. M., Nascimento, W. V., Odendaal, I., Smith, C. H., & Wang, H. (2015). The influence of food texture and liquid consistency modification on swallowing physiology and function: a systematic review. Dysphagia, 30(1), 2–26. https://doi.org/10.1007/s00455-014-9578-x DOI: https://doi.org/10.1007/s00455-014-9578-x

Streicher, M., Wirth, R., Schindler, K., Sieber, C. C., Hiesmayr, M., & Volkert, D. (2018). Dysphagia in Nursing Homes-Results From the NutritionDay Project. Journal of the American Medical Directors Association, 19(2), 141–147.e2. https://doi.org/10.1016/j.jamda.2017.08.015 DOI: https://doi.org/10.1016/j.jamda.2017.08.015

Sura, L., Madhavan, A., Carnaby, G., & Crary, M. A. (2012). Dysphagia in the elderly: management and nutritional considerations. Clinical interventions in aging, 7, 287–298. https://doi.org/10.2147/CIA.S23404 DOI: https://doi.org/10.2147/CIA.S23404

Thibault, R., Chikhi, M., Clerc, A., Darmon, P., Chopard, P., Genton, L., Kossovsky, M.P., Pichard, C. (2011). Assessment of food intake in hospitalised patients: A 10-year comparative study of a prospective hospital survey. Clinical Nutrition, 30(3), 289–296. https://doi.org/10.1016/j.clnu.2010.10.002 DOI: https://doi.org/10.1016/j.clnu.2010.10.002

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Published

2023-01-28

How to Cite

Maieves, H. A., Silva, B. V. da, Ewerling, M., Comparotto, U. R., Lessa, F. B., Lemos, A. N., & Hepp, J. P. (2023). The behavior of lemon-based thickened fluids submitted to the IDDSI flow test as a strategy for dysphagia treatment. Food Science Today, 1(1). https://doi.org/10.58951/fstoday.v1i1.8

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