The Effect of Oral Processing on the Viscosity of Thickened Drinks for Patients With Dysphagia

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Abstract

Objective

To determine whether a gum-containing thickener maintains its viscosity better during oral processing than a completely starch-based thickener.

Methods

Thirty-five healthy volunteers participated in a double-blind, cross-over study. Artificial tap water was thickened to honey-like consistency (effective viscosity of 1,300±100 mPa·s at a shear rate of 50 per second at 20℃) with a starch-based thickener (SB) or a gum-containing thickener (GC). Bolus viscosity was determined after standardized oral processing of the thickened water by the subjects for 10 and 20 seconds. Significant effects were determined by ANOVA analysis and pairwise comparisons.

Results

Both thickeners were susceptible to breakdown during oral processing. However, GC-thickened water retained its viscosity significantly better than SB-thickened water.

Conclusion

The presence of gums has a protective effect on the starch hydrolysis by salivary amylase in thickened drinks, which may facilitate safer swallowing.

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Most cited references 18

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Individual Differences in AMY1 Gene Copy Number, Salivary α-Amylase Levels, and the Perception of Oral Starch

Abigail Mandel, Catherine Peyrot des Gachons, Kimberly Plank … (2010)

Background The digestion of dietary starch in humans is initiated by salivary α-amylase, an endo-enzyme that hydrolyzes starch into maltose, maltotriose and larger oligosaccharides. Salivary amylase accounts for 40 to 50% of protein in human saliva and rapidly alters the physical properties of starch. Importantly, the quantity and enzymatic activity of salivary amylase show significant individual variation. However, linking variation in salivary amylase levels with the oral perception of starch has proven difficult. Furthermore, the relationship between copy number variations (CNVs) in the AMY1 gene, which influence salivary amylase levels, and starch viscosity perception has not been explored. Principal Findings Here we demonstrate that saliva containing high levels of amylase has sufficient activity to rapidly hydrolyze a viscous starch solution in vitro. Furthermore, we show with time-intensity ratings, which track the digestion of starch during oral manipulation, that individuals with high amylase levels report faster and more significant decreases in perceived starch viscosity than people with low salivary amylase levels. Finally, we demonstrate that AMY1 CNVs predict an individual's amount and activity of salivary amylase and thereby, ultimately determine their perceived rate of oral starch viscosity thinning. Conclusions By linking genetic variation and its consequent salivary enzymatic differences to the perceptual sequellae of these variations, we show that AMY1 copy number relates to salivary amylase concentration and enzymatic activity level, which, in turn, account for individual variation in the oral perception of starch viscosity. The profound individual differences in salivary amylase levels and salivary activity may contribute significantly to individual differences in dietary starch intake and, consequently, to overall nutritional status.

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Evaluation and treatment of swallowing disorders

JA Logemann, J Logemann, J.A. Logemann … (1997)

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The effect of saliva on the viscosity of thickened drinks.

Ben Hanson, Mark O'Leary, Christina Smith (2012)

Powdered thickeners are used to modify drink consistency in the clinical management of dysphagia. These thickeners are composed of primarily modified maize starch; some varieties also incorporate powdered gums. Amylase is a digestive enzyme found in saliva that initiates the breakdown of starch. To determine the significance of this process in dysphagia management, we measured the effects of human saliva on the viscosity of thickened drinks. Two thickeners were studied: one comprising modified maize starch alone and one that included additional gums. These were added to drinks with neutral and acidic pH: water and orange juice. Two clinical scenarios were simulated: (1) the effect of saliva on fluid as it is swallowed and (2) the effect when saliva enters a cup and contaminates a drink. Saliva was found to reduce the viscosity of water thickened with maize starch in both scenarios: (1) 90% reduction after 10 s and (2) almost 100% reduction in viscosity after 20 min. The thickener composed of gums and maize starch showed a significant reduction but retained a level of thickening. In contrast, thickened orange juice (pH 3.8) was not observed to undergo any measurable reduction in viscosity under the action of saliva.

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Author and article information

Journal

Journal ID (nlm-ta): Ann Rehabil Med

Journal ID (iso-abbrev): Ann Rehabil Med

Journal ID (publisher-id): ARM

Title: Annals of Rehabilitation Medicine

Publisher: Korean Academy of Rehabilitation Medicine

ISSN (Print): 2234-0645

ISSN (Electronic): 2234-0653

Publication date (Print): October 2015

Publication date (Electronic): 26 October 2015

Volume: 39

Issue: 5

Pages: 772-777

Affiliations

[1 ]TNO Food and Nutrition, Zeist, The Netherlands.

[2 ]AVEBE U.A., Veendam, The Netherlands.

[3 ]TNO Triskelion B.V., Zeist, The Netherlands.

Author notes

Corresponding author: Katleen J. R. Vallons. TNO Food and Nutrition, Utrechtseweg 48, 3704 HE Zeist, The Netherlands. Tel: +31-88-866-2290, Fax: +31-88-866-2879, katleen.vallons@ 123456tno.nl

Article

DOI: 10.5535/arm.2015.39.5.772

PMC ID: 4654084

PubMed ID: 26605175

SO-VID: f7197099-7685-4897-9ddd-e4afd162b204

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 01 April 2015

Date accepted : 20 May 2015

Funding

Funded by: Nutricia Research

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