Are Medication Swallowing Lubricants Suitable for Use in Dysphagia? Consistency, Viscosity, Texture, and Application of the International Dysphagia Diet Standardization Initiative (IDDSI) Framework
Abstract
:1. Introduction
2. Materials and Methods
2.1. Materials
2.2. Methods
2.2.1. pH and Density
2.2.2. The International Dysphagia Diet Standardization Initiative (IDDSI)
2.2.3. Rheological Properties
2.2.4. Bostwick Thickness Consistency
2.2.5. Texture Properties
2.3. Statistical Analysis
3. Results
3.1. The International Dysphagia Diet Standardization Initiative (IDDSI)
3.2. Rheological Properties
3.3. Bostwick Consistometer
3.4. Texture Characterisation
4. Discussion
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Product Name | Manufacturer | Flavour | Composition | pH | Density (kg/m3) |
---|---|---|---|---|---|
Gloup Forte | Rushwood, Raamsdonksveer, The Netherlands | vanilla | Water, dried glucose syrup, sucrose, carrageenan, maltodextrin, potassium sorbate, citric acid, aroma | 5.16 | 1.1 |
Gloup Low Sugar | Rushwood, Raamsdonksveer, The Netherlands | raspberry | Water, xylitol, carrageenan, maltodextrin, potassium sorbate, citric acid, colour, aroma | 5.36 | 1.04 |
Gloup Original | Rushwood, Raamsdonksveer, The Netherlands | orange | Water, carrageenan, maltodextrin, potassium sorbate, sucrose, calcium chloride, citric acid, colour, aroma | 5.11 | 1.03 |
Gloup Original | Rushwood, Raamsdonksveer, The Netherlands | strawberry/banana | Water, carrageenan, maltodextrin, potassium sorbate, sucrose, calcium chloride, citric acid, colour, aroma | 5.19 | 1.05 |
Gloup Sugar Free | Rushwood, Raamsdonksveer, The Netherlands | cherry | Water, carrageenan, maltodextrin, potassium sorbate, aspartame, calcium chloride, citric acid, (natural) colour, (natural) aroma | 5.19 | 1.02 |
Heyaxon | Jian An Pharmaceutical, Shenzhen, China | peach | Water, erythritol, xylitol, agar, citric acid, xanthan gum, sodium citrate, locust bean gum, pigment, peach perfumes, sucralose, crocine, glycerol fonostearate | 3.77 | 1.03 |
Magic Jelly (adult) | Ryukakusan, Tokyo, Japan | lemon | Erythritol, hydrogenated maltose starch syrup, agar, gelling agents (polysaccharide thickeners, calcium acetate, sweetener (Stevia) | 3.65 | 1.04 |
Magic Jelly (dysphagia) | Ryukakusan, Tokyo, Japan | lemon | Erythritol, hydrogenated maltose starch syrup, agar, gelling agents (polysaccharide thickeners, calcium acetate, sweetener (Stevia) | 3.64 | 1.05 |
MediSpend | Fagron, Rotterdam, The Netherlands | lemon | Purified water, modified food starch, natural lemon flavour, sodium citrate, citric acid, sucralose, sodium benzoate | 4.2 | 1.01 |
Severo | IMS Medical, Grootebroek, The Netherlands | anise | purified water, cellulose gum, flavour (anise), citric acid, potassium sorbate, aspartame, acesulfame K | 4.41 | 1 |
Slo Tablets | Slo Drinks, Glossop, UK | cherry | Purified water, modified food starch, cherry flavour, sodium citrate, citric acid, sucralose, sodium benzoate, malic acid, simethicone | 4.28 | 1.01 |
Swallow Aid | National Consumer Products Inc, USA | cherry | Malitol, Glycerine, Carboxymethyl cellulose, Acesulfame Potassium | - | - |
Lubricants | Flow Test Validity | Flow Test # | Fork Drip Test * | Spoon Tilt Test ^ | Final IDDSI Classification | ||||
---|---|---|---|---|---|---|---|---|---|
Texture | Interpretation | Volume Remaining (mL) | Interpretation (IDDSI Classification) | Flow/Drip/No Drip | Interpretation (IDDSI Classification) | Pass/Fail | Interpretation (IDDSI Classification) | ||
Heyaxon | Lumpy | Not valid | - | - | - | - | - | - | 7 |
Magic Jelly dysphagia | Lumpy | Not valid | - | - | - | - | - | - | 7 |
Magic Jelly adult | Lumpy | Not valid | - | - | - | - | - | - | 7 |
Slo Tablets | Smooth | Valid | 8.7 | 3 | Flow | <3 | - | - | <3 |
MediSpend | Smooth | Valid | 9.1 | 3 | Flow | <3 | - | - | <3 |
Severo | Smooth | Valid | 7.5 | 2 | - | - | - | - | 2 |
Gloup Original straw/ban | Smooth | Valid | 9.9 | 3 | Drip | 3 | - | - | 3 |
Gloup Sugar Free | Smooth | Valid | 9.9 | 3 | Drip | 3 | - | - | 3 |
Gloup Low Sugar | Smooth | Valid | 9.9 | 3 | Drip | 3 | - | - | 3 |
Gloup Original orange | Smooth | Valid | 9.9 | 3 | Drip | 3 | - | - | 3 |
Gloup Forte | Smooth | Valid | No flow | 4 | No drip | 4 | Pass | 4 | 4 |
Swallow Aid | Smooth | Valid | No flow | 4 | No drip | 4 | Fail | 7 | 7 |
Lubricants | Flow Test Validity | Flow Test # | Fork Drip Test * | Spoon Tilt Test ^ | Final IDDSI Classification | ||||
---|---|---|---|---|---|---|---|---|---|
Texture | Interpretation | Volume Remaining (mL) | Interpretation (IDDSI Classification) | Flow/Drip/No Drip | Interpretation (IDDSI Classification) | Pass/Fail | Interpretation (IDDSI Classification) | ||
Heyaxon | Lumpy | Not valid | - | - | - | - | - | - | 7 |
Magic Jelly dysphagia | Lumpy | Not valid | - | - | - | - | - | - | 7 |
Magic Jelly adult | Lumpy | Not valid | - | - | - | - | - | - | 7 |
Slo Tablets | Smooth | Valid | 9.5 | 3 | Flow | <3 | - | - | <3 |
MediSpend | Smooth | Valid | 8.9 | 3 | Flow | <3 | - | - | <3 |
Severo | Smooth | Valid | 7.8 | 2 | - | - | - | - | 2 |
Gloup Original straw/ban | Smooth | Valid | 9.9 | 3 | No drip | 4 | Pass | 4 | 4 |
Gloup Sugar Free | Smooth | Valid | No flow | 4 | No drip | 4 | Pass | 4 | 4 |
Gloup Low Sugar | Smooth | Valid | No flow | 4 | No drip | 4 | Pass | 4 | 4 |
Gloup Original orange | Smooth | Valid | No flow | 4 | No drip | 4 | Pass | 4 | 4 |
Gloup Forte | Smooth | Valid | No flow | 4 | No drip | 4 | Pass | 4 | 4 |
Swallow Aid | Smooth | Valid | No flow | 4 | No drip | 4 | Fail | 7 | 7 |
Lubricants | Flow Test Validity | Flow Test # | Fork Drip Test * | Spoon Tilt Test ^ | Final IDDSI Classification | ||||
---|---|---|---|---|---|---|---|---|---|
Texture | Interpretation | Volume Remaining (mL) | Interpretation (IDDSI classification) | Flow/Drip/No Drip | Interpretation(IDDSI Classification) | Pass/Fail | Interpretation (IDDSI Classification) | ||
Room temperature | |||||||||
Gloup Original straw/ban | Smooth | Valid | 9.9 | 3 | No drip | 4 | Pass | 4 | 4 |
Gloup Sugar Free cherry | Smooth | Valid | 9.9 | 3 | No drip | 4 | Pass | 4 | 4 |
Gloup Low Sugar raspberry | Smooth | Valid | 9.9 | 3 | No drip | 4 | Pass | 4 | 4 |
Gloup Original orange | Smooth | Valid | No flow | 4 | No drip | 4 | Pass | 4 | 4 |
Gloup Forte | Smooth | Valid | No flow | 4 | No drip | 4 | Pass | 4 | 4 |
Fridge temperature | |||||||||
Gloup Original straw/ban | Smooth | Valid | No flow | 4 | No drip | 4 | Pass | 4 | 4 |
Gloup Sugar Free cherry | Smooth | Valid | No flow | 4 | No drip | 4 | Pass | 4 | 4 |
Gloup Low Sugar raspberry | Smooth | Valid | No flow | 4 | No drip | 4 | Pass | 4 | 4 |
Gloup Original orange | Smooth | Valid | No flow | 4 | No drip | 4 | Pass | 4 | 4 |
Gloup Forte | Smooth | Valid | No flow | 4 | No drip | 4 | Pass | 4 | 4 |
Lubricants | Hardness (g) | Adhesiveness (mJ) | Cohesiveness | Gumminess (g) | Springiness (mm) | |||||
---|---|---|---|---|---|---|---|---|---|---|
Room T | Fridge T | Room T | Fridge T | Room T | Fridge T | Room T | Fridge T | Room T | Fridge T | |
Heyaxon | 4.38 ± 0.56 a | 3.67 ± 0.14 ab | 0.13 ± 0.00 a | 0.10 ± 0.03 a | 0.85 ± 0.01 ab | 0.88 ± 0.02 a | 3.7 ± 0.45 a | 3.20 ± 0.17 ab | 19.74 ± 0.05 a | 19.70 ± 0.02 a |
Magic Jelly dysphagia | 4.17 ± 0.54 a | 5.17 ± 0.14 ac | 0.09 ± 0.01 a | 0.09 ± 0.03 a | 0.74 ± 0.02 ab | 0.84 ± 0.11 a | 3.1 ± 0.49 a | 4.30 ± 0.45 ac | 19.68 ± 0.05 a | 19.27 ± 0.34 a |
Magic Jelly adult | 4.17 ± 0.36 a | 3.83 ± 0.49 ab | 0.07 ± 0.20 a | 0.24 ± 0.15 a | 0.94 ± 0.07 ab | 0.84 ± 0.04 a | 4.03 ± 0.24 a | 3.23 ± 0.28 ab | 19.16 ± 0.30 a | 19.64 ± 0.02 a |
Slo Tablets | 3.67 ± 0.14 a | 3.17 ± 0.14 ab | 0.06 ± 0.01 a | 0.05 ± 0.01 a | 0.98 ± 0.02 a | 0.79 ± 0.05 a | 3.60 ± 0.08 a | 2.50 ± 0.24 ab | 19.02 ± 0.39 a | 14.88 ± 0.47 ab |
MediSpend | 3.33 ± 0.36 a | 3.50 ± 0.00 ab | 0.07 ± 0.04 a | 0.07 ± 0.01 a | 0.85 ± 0.01 ab | 0.80 ± 0.04 a | 3.17 ± 0.14 a | 2.80 ± 0.12 ab | 19.37 ± 0.22 a | 19.08 ± 0.36 ab |
Severo | 3.33 ± 0.14 a | 2.00 ± 0.24 b | 0.08 ± 0.02 a | 0.05 ± 0.01 a | 0.59 ± 0.13 b | 0.59 ± 0.09 a | 2.00 ± 0.50 a | 1.23 ± 0.33 a | 19.65 ± 0.04 a | 17.00 ± 0.43 ab |
Gloup Original straw/ban | 4.33 ± 0.27 a | 5.50 ± 0.24 ac | 0.08 ± 0.02 a | 0.12 ± 0.01 a | 0.93 ± 0.03 ab | 0.80 ± 0.02 a | 4.03 ± 0.40 a | 4.4 ± 0.21 ac | 19.70 ± 0.06 a | 19.60 ± 0.19 a |
Gloup Sugar Free | 4.67 ± 0.49 a | 6.50 ± 0.24 c | 0.09 ± 0.00 a | 0.13 ± 0.03 a | 0.83 ± 0.01 ab | 0.79 ± 0.02 a | 4.33 ± 0.10 a | 5.13 ± 0.23 bc | 16.90 ± 1.68 a | 18.32 ± 1.14 ab |
Gloup Low Sugar | 4.83 ± 0.68 a | 6.83 ± 0.59 c | 0.12 ± 0.04 a | 0.15 ± 0.00 a | 0.75 ± 0.09 ab | 0.54 ± 0.05 a | 3.67 ± 0.73 a | 3.60 ± 0.66 ab | 16.79 ± 2.29 a | 12.55 ± 2.36 b |
Gloup Original orange | 5.67 ± 0.27 a | 7.67 ± 0.14 c | 0.14 ± 0.02 a | 0.15 ± 0.01 a | 0.80 ± 0.04 ab | 0.60 ± 0.03 a | 4.60 ± 0.45 a | 4.63 ± 0.20 ac | 19.14 ± 0.29 a | 16.56 ± 1.10 ab |
Gloup Forte | 9.17 ± 0.14 b | 11.00 ± 0.41 e | 0.33 ± 0.01 a | 0.36 ± 0.06 a | 0.83 ± 0.01 ab | 0.65 ± 0.05 a | 7.60 ± 0.19 b | 7.17 ± 0.43 c | 19.62 ± 0.06 a | 15.64 ± 1.67 ab |
Swallow Aid | 16.50 ± 0.62 c | 18.80 ± 0.83 f | 1.95 ± 0.21 b | 1.50 ± 0.05 b | 0.99 ± 0.01 a | 1.62 ±0.15 b | 16.4 ± 0.41 c | 30.40 ± 1.37 d | 22.39 ± 2.02 a | 14.10 ± 0.58 ab |
Lubricants | Back Extrusion | Forward Extrusion | ||||
---|---|---|---|---|---|---|
Hardness (g) | Consistency (mJ) | Adhesive Force (g) | Adhesiveness (mJ) | Hardness (g) | Consistency (mJ) | |
Heyaxon | 62.17 ± 0.82 ab | 7.42 ± 0.27 ac | 28.50 ± 2.05 a | 4.85 ± 0.35 ab | 1150.8 ± 75.0 a | 68.2 ± 3.92 ab |
Magic Jelly dysphagia | 63.33 ± 9.61 ab | 7.67 ± 1.11 abe | 26.50 ± 4.14 ab | 4.47 ± 0.44 ac | 1012.5 ± 40.9 ab | 145.1 ± 7.88 c |
Magic Jelly adult | 51.67 ± 0.31 ac | 6.33 ± 0.07 cde | 19.67 ± 0.76 ab | 3.39 ± 0.01 bc | 936.0 ± 31.5 abc | 133.5 ± 6.18 c |
Slo Tablets | 32.50 ± 0.20 c | 4.31 ± 0.01 d | 16.83 ± 0.14 b | 2.87 ± 0.02 c | 131.3 ± 1.7 d | 17.7 ± 0.22 e |
Medispend | 36.67 ± 0.12 c | 5.00 ± 0.02 cd | 18.50 ± 0.24 ab | 3.32 ± 0.06 bc | 315.5 ± 31.1 ed | 22.7 ± 2.84 de |
Severo | 40.17 ± 0.85 ac | 5.46 ± 0.08 cde | 22.83 ± 0.27 ab | 3.57 ± 0.09 bc | 405.2 ± 46.9 def | 42.8 ± 0.91 ae |
Gloup Original straw/ban | 80.67 ± 1.55 b | 10.15 ± 0.15 b | 43.67 ± 0.54 c | 6.04 ± 0.10 a | 681.8 ± 11.9 bf | 86.1 ± 0.2 b |
Gloup Sugar Free | 78.33 ± 1.83 b | 9.82 ± 0.12 ab | 41.50 ± 0.62 c | 5.71 ± 0.13 a | 472.5 ± 76.6 def | 50.4 ± 2.71 acf |
Gloup Low Sugar | 80.83 ± 1.33 b | 9.87 ± 0.20 ab | 40.50 ± 1.65 c | 5.51 ± 0.09 a | 642.6 ± 70.0 cef | 68.4 ± 3.31 ab |
Gloup Original orange | 106.50 ± 1.95 d | 13.57 ± 0.38 f | 59.67 ± 1.77 d | 7.84 ± 0.28 d | 665.3 ± 32.5 be | 77.7 ± 7.34 bf |
Gloup Forte | 219.50 ± 1.89 e | 28.11 ± 0.40 g | 77.00 ± 0.85 e | 21.56 ± 0.56 e | 1258.5 ± 25.8 a | 164.8 ± 2.34 c |
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Malouh, M.A.; Cichero, J.A.Y.; Manrique, Y.J.; Crino, L.; Lau, E.T.L.; Nissen, L.M.; Steadman, K.J. Are Medication Swallowing Lubricants Suitable for Use in Dysphagia? Consistency, Viscosity, Texture, and Application of the International Dysphagia Diet Standardization Initiative (IDDSI) Framework. Pharmaceutics 2020, 12, 924. https://doi.org/10.3390/pharmaceutics12100924
Malouh MA, Cichero JAY, Manrique YJ, Crino L, Lau ETL, Nissen LM, Steadman KJ. Are Medication Swallowing Lubricants Suitable for Use in Dysphagia? Consistency, Viscosity, Texture, and Application of the International Dysphagia Diet Standardization Initiative (IDDSI) Framework. Pharmaceutics. 2020; 12(10):924. https://doi.org/10.3390/pharmaceutics12100924
Chicago/Turabian StyleMalouh, Marwa A., Julie A.Y. Cichero, Yady J. Manrique, Lucia Crino, Esther T. L. Lau, Lisa M. Nissen, and Kathryn J. Steadman. 2020. "Are Medication Swallowing Lubricants Suitable for Use in Dysphagia? Consistency, Viscosity, Texture, and Application of the International Dysphagia Diet Standardization Initiative (IDDSI) Framework" Pharmaceutics 12, no. 10: 924. https://doi.org/10.3390/pharmaceutics12100924
APA StyleMalouh, M. A., Cichero, J. A. Y., Manrique, Y. J., Crino, L., Lau, E. T. L., Nissen, L. M., & Steadman, K. J. (2020). Are Medication Swallowing Lubricants Suitable for Use in Dysphagia? Consistency, Viscosity, Texture, and Application of the International Dysphagia Diet Standardization Initiative (IDDSI) Framework. Pharmaceutics, 12(10), 924. https://doi.org/10.3390/pharmaceutics12100924