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      Acceptance of different types of thickeners, with and without flavoring, in hospitalized patients with dysphagia - a pilot study

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          Abstract

          Abstract Introduction: the goal of this work was to evaluate the acceptance of various types of thickeners, specifically modified starch thickener and gum thickener, both with and without flavoring. Patients and methods: a randomized sample of 40 hospitalized patients with oropharyngeal dysphagia was recruited. The taste, smell, and appearance of each type of thickener were evaluated, as well as the volume of liquid ingested by the patients taking each type of thickener (modified starch thickener vs. gum thickener, both with and without flavoring). Results: the overall acceptance of gum thickener was significantly higher than that of modified starch thickener (7.45 (1.57) vs. 5.10 (2.43), respectively; p = 0.001). When a food flavor was added to the thickened water, the overall rating of the product was higher than when no flavor was added (7.70 (1.53) vs. 4.85 (2.16); p < 0.001). The difference between the daily volume of water consumed by the patients who received gum thickeners (928.33 (331.27) mL) and those who received starch thickeners (670.00 (288.35) mL) was statistically significant (p = 0.012). Patient consumption was also higher when flavoring was added as compared to when it was not (943.33 (302.45) mL) vs. (655.00 (304.60) mL; p = 0.005). Conclusion: the acceptances of the thickener and of water intake by patients with dysphagia were both significantly higher when using gum thickeners compared to starch thickeners, and when adding flavoring.

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          Most cited references25

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          Dysphagia: current reality and scope of the problem.

          Dysphagia is a symptom of swallowing dysfunction that occurs between the mouth and the stomach. Although oropharyngeal dysphagia is a highly prevalent condition (occurring in up to 50% of elderly people and 50% of patients with neurological conditions) and is associated with aspiration, severe nutritional and respiratory complications and even death, most patients are not diagnosed and do not receive any treatment. By contrast, oesophageal dysphagia is less prevalent and less severe, but with better recognized symptoms caused by diseases affecting the enteric nervous system and/or oesophageal muscular layers. Recognition of the clinical relevance and complications of oesophageal and oropharyngeal dysphagia is growing among health-care professionals in many fields. In addition, the emergence of new methods to screen and assess swallow function at both the oropharynx and oesophagus, and marked advances in understanding the pathophysiology of these conditions, is paving the way for a new era of intensive research and active therapeutic strategies for affected patients. Indeed, a unified field of deglutology is developing, with new professional profiles to cover the needs of all patients with dysphagia in a nonfragmented way.
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            The effect of bolus viscosity on swallowing function in neurogenic dysphagia.

            To assess the pathophysiology and treatment of neurogenic dysphagia. 46 patients with brain damage, 46 with neurodegenerative diseases and eight healthy volunteers were studied by videofluoroscopy while swallowing 3-20 mL liquid (20.4 mPa s), nectar (274.4 mPa s) and pudding (3931.2 mPa s) boluses. Volunteers presented a safe and efficacious swallow, short swallow response ( or =0.33 mJ). Brain damage patients presented: (i) 21.6% aspiration of liquids, reduced by nectar (10.5%) and pudding (5.3%) viscosity (P or =806 ms) with a delay in laryngeal closure (> or =245 ms), and weak bolus propulsion forces (< or =0.20 mJ). Increasing viscosity did not affect timing of swallow response or bolus kinetic energy. Patients with neurogenic dysphagia presented high prevalence of videofluoroscopic signs of impaired safety and efficacy of swallow, and were at high risk of respiratory and nutritional complications. Impaired safety is associated with slow oropharyngeal reconfiguration and impaired efficacy with low bolus propulsion. Increasing bolus viscosity greatly improves swallowing function in neurological patients.
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              The Influence of Food Texture and Liquid Consistency Modification on Swallowing Physiology and Function: A Systematic Review

              Texture modification has become one of the most common forms of intervention for dysphagia, and is widely considered important for promoting safe and efficient swallowing. However, to date, there is no single convention with respect to the terminology used to describe levels of liquid thickening or food texture modification for clinical use. As a first step toward building a common taxonomy, a systematic review was undertaken to identify empirical evidence describing the impact of liquid consistency and food texture on swallowing behavior. A multi-engine search yielded 10,147 non-duplicate articles, which were screened for relevance. A team of ten international researchers collaborated to conduct full-text reviews for 488 of these articles, which met the study inclusion criteria. Of these, 36 articles were found to contain specific information comparing oral processing or swallowing behaviors for at least two liquid consistencies or food textures. Qualitative synthesis revealed two key trends with respect to the impact of thickening liquids on swallowing: thicker liquids reduce the risk of penetration–aspiration, but also increase the risk of post-swallow residue in the pharynx. The literature was insufficient to support the delineation of specific viscosity boundaries or other quantifiable material properties related to these clinical outcomes. With respect to food texture, the literature pointed to properties of hardness, cohesiveness, and slipperiness as being relevant both for physiological behaviors and bolus flow patterns. The literature suggests a need to classify food and fluid behavior in the context of the physiological processes involved in oral transport and flow initiation.
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                Author and article information

                Journal
                nh
                Nutrición Hospitalaria
                Nutr. Hosp.
                Grupo Arán (Madrid, Madrid, Spain )
                0212-1611
                1699-5198
                October 2021
                : 38
                : 5
                : 1082-1088
                Affiliations
                [2] A Coruña Galicia orgnameUniversidad de Santiago de Compostela orgdiv1Facultad de Medicina Spain
                [1] A Coruña orgnameComplexo Hospitalario Universitario de A Coruña orgdiv1Servicio de Endocrinología y Nutrición Spain
                Article
                S0212-16112021000600025 S0212-1611(21)03800500025
                10.20960/nh.03639
                18597ca8-432c-4100-9e8d-4532933dda94

                This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

                History
                : 09 May 2021
                : 08 April 2021
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 26, Pages: 7
                Product

                SciELO Spain

                Categories
                Trabajos Originales

                Dysphagia,Thickener,Modified starch,Gums,Sensory assessment,Hydration,Flavoring,Disfagia,Espesante,Almidón modificado,Cena,Evaluación sensorial,Hidratación,Saborizante

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