Abstract
The International Dysphagia Diet Standardization Initiative (IDDSI) flow test is useful for the global standardization of food consistencies of dysphagia patients. In clinical practice, different compositions of food thickeners are commonly used, directly influencing viscosity parameters and swallowing physiology. We aimed to compare the IDDSI thickness levels, remaining volume in the syringe (RVS), and viscosity parameters of three different food thickeners. As a secondary objective, we compared the cost of preparing 100 mL of thickened drinks using the studied thickeners. Thickeners A (xanthan gum), B (corn starch, tara gum, xanthan gum, and guar gum), and C (corn starch) were prepared in increasing concentrations from 1 to 7 g/100 mL and were assayed in quintuplicate using the IDDSI flow test. Thickeners A, B, and C presented statistically different results for the IDDSI levels, RVS, and viscosity parameters at all concentrations. Thickener A reached higher levels in the IDDSI framework, RVS, and viscosity parameters compared with thickeners B and C. A large range of RVS was observed at different concentrations for thickener B compared with C. Regarding viscosity, thickeners B and C, with corn starch in their composition, showed exponential behavior as concentrations increased, while thickener A presented a linear trend. The thickener composition was significantly influenced by IDDSI classification, RVS, and viscosity parameters. The study shows that xanthan gum thickeners present less variability in IDDSI, RVS, and viscosity compared with starch-based thickeners.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Abbreviations
- IDDSI:
-
International dysphagia diet standardization initiative
- RVS:
-
Remaining volume in the syringe
- XG:
-
Xanthan gum
- ST:
-
Starch
References
Alves DC, Alves NA, Dantas RO (2017) Consistency stability of water thickened with maltodextrin, xanthan gum and potassium chloride. J Texture Stud 48(6):530–533
Barbon CEA (2018) Characterizing the flow of thickened barium and non-barium liquid recipes using the IDDSI flow test. Dysphagia. https://doi.org/10.1007/s00455-018-9915-6
Barbon CEA, Steele CM (2018) Thickened liquids for dysphagia management: a current review of the measurement of liquid flow. Curr Phys Med Rehabil Rep 6(4):220–226. https://doi.org/10.1007/s40141-018-0197-6
Cichero JAY (2013) Thickening agents used for dysphagia management: effect on bioavailability of water, medication and feelings of satiety. Nutr J. https://doi.org/10.1186/1475-2891-12-54
Cichero JAY, Lam P, Steele CM, Hanson B, Chen J, Dantas RO, Duivestein J, Kayashita J, Lecko C, Murray J, Pillay M, Riquelme L, Stanschus S (2017) Development of international terminology and definitions for texture-modified foods and thickened fluids used in dysphagia management: the IDDSI framework. Dysphagia 32(2):293–314. https://doi.org/10.1007/s00455-016-9758-y
Clavé P, Kraa MDE, Arreola V, Girvent M, Farre R (2006) The effect of bolus viscosity on swallowing function in neurogenic dysphagia. Aliment Pharmacol Ther 24:1385–1394. https://doi.org/10.1111/j.1365-2036.2006.03118.x
de Toneli JTCL, Murr FEX, Park KJ (2005) Estudo da reologia de polissacarídeos utilizados na indústria de alimentos. Rev Brasileira Prod Agroind 7(2):181–204
Ekberg O, Hamdy S, Woisard V, Hannig AW, Ortega P (2002) Social and psychological burden of dysphagia : its impact on diagnosis and treatment. Dysphagia 17:139–146. https://doi.org/10.1007/s00455-001-0113-5
Flynn E, Ch S, Cd W, Walshe M (2018) Modifying the consistency of food and fluids for swallowing difficulties in dementia (Review). Cochrane Library 9:1–51. https://doi.org/10.1002/14651858.CD011077.pub2.www.cochranelibrary.com
Garcia JM, Iv EC, Matta Z, Clark M (2005) Viscosity measurements of nectar- and honey-thick liquids : product, liquid, and time comparisons. Dysphagia 335:325–335. https://doi.org/10.1007/s00455-005-0034-9
Garcia JM, Iv EC, Matta Z, Clark M (2008) Serving temperature viscosity measurements of nectar- and honey-thick liquids. Dysphagia 23:65–75. https://doi.org/10.1007/s00455-007-9098-z
Hanson B, Cox B, Kaliviotis E, Smith CH (2012a) Effects of saliva on starch-thickened drinks with acidic and neutral pH. Dysphagia 27:427–435
Hanson B, O’Leary MT, Smith CH (2012b) The effect of saliva on the viscosity of thickened drinks. Dysphagia 27:10–19
Hind J, Divyak E, Zielinski J, Taylor A, Hartman M, Gangnon R, Robbins J (2012) Comparison of standardized bariums with varying rheological parameters on swallowing kinematics in males. JRRD 49(9):1399–1404
IDDSI - International Dysphagia Diet Standardization Initiative. (2020). https://www.iddsi.org/. Accessed 20 May 2020
Killeen L, Lansink M, Schröder D (2015) Tolerability and product properties of a gum-containing thickener in patients with dysphagia. Rehab Nurs J. https://doi.org/10.1097/rnj.0000000000000011
Kim Y, Jeong GY, Yoo B (2018) Comparative study of IDDSI flow test and line spread test of thickened water prepared with different dysphagia thickeners. J Texture Stud. https://doi.org/10.1111/jtxs.12360
Law V, Knox C, Djoumbou Y, Jewison T, Guo AC, Liu Y, Maciejewski A, Arndt D, Wilson M, Neveu V, Tang A, Gabriel G, Ly C, Adamjee S, Dame ZT, Han B, Wishart YZ, Wishart DS (2015) Xanthan gum. drugbank 4.0: shedding new light on drug metabolism. Nucleic Acids Res 42:1091–1097
Lazarus C, Logemann A, Wook C, Rademaker AW, Kahrilas J (2002) Effects of voluntary maneuvers on tongue base function for swallowing. Folia Phoniatr Logop 10016:171–176
Lee H, Yoon S, Yoo W, Yoo B, Hy L (2016) Effect of salivary reaction time on flow properties of commercial food thickeners used for Dysphagic patients. Clin Nutr Res 5:55–59
Logemann JA (1998) Evaluation and treatment of swallowing disorders. Curr Opin Otolaryngol Head Neck Surg 6:395–400
Logemann JA (1999) Behavioral management for oropharyngeal. Dysphagia 60208:199–212
Lotong V, Chun SS, Chambers E IV, Garcia JM (2003) Texture and flavor characteristics of beverages containing commercial thickening agents for dysphagia diets. J Food Sci 68(4):1537–1541. https://doi.org/10.1111/j.1365-2621.2003.tb09680.x
Molfenter SM, Steele CM (2013) The relationship between residue and aspiration on the subsequent swallow: an application of the normalized residue ratio scale. Dysphagia 28(4):494–500. https://doi.org/10.1007/s00455-013-9459-8
Newman R, Vilardell N, Clavé P, Speyer R (2016) Effect of bolus viscosity on the safety and efficacy of swallowing and the kinematics of the swallow response in patients with oropharyngeal dysphagia: white paper by the European Society for Swallowing Disorders (ESSD). Dysphagia 31(2):232–249. https://doi.org/10.1007/s00455-016-9696-8
Ong JJ, Steele CM, Duizer LM (2018) Sensory characteristics of liquids thickened with commercial thickeners to levels specified in the International Dysphagia Diet Standardization Initiative (IDDSI) framework. Food Hydrocoll. https://doi.org/10.1016/j.foodhyd.2017.12.035
Ortega O, Martín A, Clavé P (2017) Diagnosis and management of oropharyngeal Dysphagia among older persons, state of the art. J Am Med Dir Assoc 18(7):576–582. https://doi.org/10.1016/j.jamda.2017.02.015
Park JH, Kim H, Oh B, Lee M, Hwang I, Lee S, Han TR (2014) Comparison of different gum-based thickeners using a viscometer and line spread test : a preliminary study. Ann Rehabil Med 38(1):94–100
Salles A, Lenz D, Souza D (2019) Lack of Standardization in commercial thickeners used in the management of Dysphagia. Analls Nutr Metab 75:246–251. https://doi.org/10.1159/000504334
Schmidt H, de Oliveira VR (2015) Avaliação reológica e sensorial de espessantes domésticos em diferentes líquidos como alternativa na disfagia. Brazilian J Technol 18(1):42–48
da Silva APS, Cuti LK, Mancopes R, Prolla ID (2017) Thickeners sold in Brazil: analysis of the composition and suitability for children under the age of 3. BRASPEN J 32(4):4–7
Steele CM, Abdulrahman W, Sona A, Lam P, Lecko C, Leigh C, Nagy A, Namasivayam AM, Nascimento WV, Odendaal I, Smith CH, Wang H (2015) The influence of food texture and liquid consistency modification on swallowing physiology and function : a systematic review. Springer 30:2–26. https://doi.org/10.1007/s00455-014-9578-x
Steele CM, Peladeau-Pigeon M, Barbon CAE, Guida BT, Tapson MS, Valenzano TJ, Waito AA, Wolkin TS, Hanson B, Ong JJ-X, Duizerd LM (2019) Modulation of tongue pressure according to liquid flow properties in healthy swallowing. JSLHR 62:22–33
Stokes JR, Boehm MW, Baier SK (2013) Oral processing, texture and mouthfeel: from rheology to tribology and beyond. Curr Opin Colloid Interface Sci 18(4):349–359. https://doi.org/10.1016/j.cocis.2013.04.010
Valenzano TJ, Guida BT, Peladeau-Pigeon M, Steelea CM (2020) Respiratory – swallow coordination in healthy adults during drinking of thin to extremely thick liquids: a research note. JSLHR 63:702–709
Vallons KJR, Helmens HJ, Oudhuis AACM (2014) Effect of human saliva on the consistency of thickened drinks for individuals with dysphagia. Int J Lang Commun Disord 50(2):1–11. https://doi.org/10.1111/1460-6984.12120
Vallons KJR, Oudhuis LAACM, Helmens HJ, Kistemaker C (2015) The effect of oral processing on the viscosity of thickened drinks for patients With Dysphagia. Ann Rehabil Med 39(5):772–777
Vilardell N, Rofes L, Arreola V, Speyer R, Clave P (2015) A comparative study between modified starch and xanthan gum thickeners in post-stroke oropharyngeal Dysphagia. Dysphagia 31(2):169–179. https://doi.org/10.1007/s00455-015-9672-8
Funding
This study did not provide funding to any institution, company or industry.
Author information
Authors and Affiliations
Contributions
JVH, main author of the manuscript, conceptualization, and design, conducting the analysis and critical interpretation of the literature, writing original draft, editing and final review. HSAT, investigation, methodology, analysis, and interpretation of the literature, editing and final review of the manuscript; CM de S, investigation, conducting the methodology, supervision (supporting), analysis, and interpretation of the literature, editing and final review of the manuscript; JAA, investigation, methodology, analysis, editing and final review of the manuscript; F de SF, analysis, editing and final review of the manuscript; PGM, methodology, analysis, editing and final review of the manuscript; LFM, senior author, conceptualization, and design, conducting the analysis and critical interpretation of the literature, writing and final revision.
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they do not have any conflict of interest.
Ethical statement
This study did not involve any human or animal testing. This research did not require submission to analysis by the Ethics Committee because there were no interventions performed with humans nor any data collected from them. This research was conducted in accordance to the World Medical Association Declaration of Helsinki.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Vergara, J., Teixeira, H.S., de Souza, C.M. et al. Flow test by the International Dysphagia Diet Standardization Initiative reveals distinct viscosity parameters of three thickening agents. J Food Sci Technol 59, 3627–3633 (2022). https://doi.org/10.1007/s13197-022-05369-5
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s13197-022-05369-5