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Nutrients
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Modified Diets and Nutritional Strategies for Patients with Swallowing and...
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Modified Diets and Nutritional Strategies for Patients with Swallowing and Mastication Disorders

A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Clinical Nutrition".

Deadline for manuscript submissions: closed (15 November 2023) | Viewed by 6454

Special Issue Editor

Prof. Dr. Pere Clavé

E-Mail Website1 Website2
Guest Editor
1. Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital de Mataró, Consorci Sanitari del Maresme, 08304 Barcelona, Spain
2. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, 28029 Madrid, Spain
Interests: dysphagia; motility disorders; physiology of swallowing; neurostimulation
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Texture modified diets including fluid thickening and texture adaptation are widely used to manage patients suffering from swallowing disorders such as dysphagia and/or mastication impairments. This is very relevant for patients with neurological diseases and older people. Oropharyngeal dysphagia is recognized as a geriatric syndrome. However, viscosity and texture are usually tested by qualitative methods      and no established protocol has been developed yet to guarantee optimal treatment. Saliva, mastication and other factors such as shear rate and tongue pressure can have a remarkable impact on rheological and textural characteristics which can endanger patients’ swallowing. Optimal levels of texture and viscosity need to be quantified for each phenotype of patients. Shear viscosity and extensional viscosity can affect the therapeutic effect of thickened fluids. Analysis of texture profile adaptations can contribute to better understand the properties of texture modified foods. This Collection aims to spread scientific achievements in the quantification of texture and rheology development of standardized protocols to assess the impact of swallowing, mastication and oral processing on texture and viscosity, as well as the research on nutritional complications associated (dehydration, malnutrition). The main aim is to define a framework to develop thickened fluids and texture modified diets, described in SI units, to guarantee quality control and reproducibility for clinicians, researchers and the nutritional industry facing aging, one of the most relevant sociodemographic characteristics of our society.

Prof. Dr. Pere Clavé
Guest Editor

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Keywords

  • dysphagia
  • rheology
  • texture
  • oral processing
  • viscosity
  • fluid thickening

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Published Papers (2 papers)

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14 pages, 1886 KiB  
Article
Rheological Properties and Stability of Thickeners for Clinical Use
by Fernando Calmarza-Chueca, Ana Cristina Sánchez-Gimeno, Javier Raso-Pueyo, José Miguel Arbones-Mainar, Alberto Caverni-Muñoz, Alejandro Sanz-Arque and Alejandro Sanz-Paris
Nutrients 2022, 14(17), 3455; https://doi.org/10.3390/nu14173455 - 23 Aug 2022
Cited by 1 | Viewed by 2147
Abstract
The adaptation of liquids for patients with dysphagia requires precision and individualization in the viscosities used. We describe the variations of viscosity in water at different concentrations and evolution over time of the three compositions of commercial thickeners that are on the market [...] Read more.
The adaptation of liquids for patients with dysphagia requires precision and individualization in the viscosities used. We describe the variations of viscosity in water at different concentrations and evolution over time of the three compositions of commercial thickeners that are on the market (starch, starch with gums, and gum). By increasing the concentration in water, the viscosity of gum-based thickeners increases linearly, but it did not reach pudding texture, whereas the viscosity of the starch-based thickeners (alone or mixed with gums) rapidly reaches very thick textures. We modeled the viscosity at different concentrations of the four thickeners using regression analysis (R2 > 0.9). We analyzed viscosity changes after 6 h of preparation. The viscosity of gum-based thickeners increased by a maximum of 6.5% after 6 h of preparation, while starch-based thickeners increased by up to 43%. These findings are important for correct handling and prescription. Gum-based thickeners have a predictable linear behavior with the formula we present, reaching nectar and honey-like textures with less quantity of thickener, and are stable over time. In contrast, starch thickeners have an exponential behavior which is difficult to handle, they reach pudding-like viscosity, and are not stable over time. Full article
(This article belongs to the Special Issue Modified Diets and Nutritional Strategies for Patients with Swallowing and Mastication Disorders)
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22 pages, 775 KiB  
Systematic Review
Economic Evaluation of Clinical, Nutritional and Rehabilitation Interventions on Oropharyngeal Dysphagia after Stroke: A Systematic Review
by Sergio Marin, Omar Ortega, Mateu Serra-Prat, Ester Valls, Laia Pérez-Cordón and Pere Clavé
Nutrients 2023, 15(7), 1714; https://doi.org/10.3390/nu15071714 - 31 Mar 2023
Cited by 3 | Viewed by 3196
Abstract
Background: Post-stroke oropharyngeal dysphagia (PS-OD) and its complications increase healthcare costs, suggesting that its appropriate management is cost-effective. We aimed to assess the efficiency of healthcare interventions in PS-OD management. Methods: A systematic review was conducted following PRISMA recommendations. Four databases were searched [...] Read more.
Background: Post-stroke oropharyngeal dysphagia (PS-OD) and its complications increase healthcare costs, suggesting that its appropriate management is cost-effective. We aimed to assess the efficiency of healthcare interventions in PS-OD management. Methods: A systematic review was conducted following PRISMA recommendations. Four databases were searched from inception through 30 June 2021. Outcome measures were cost-effectiveness and cost-savings of healthcare interventions. English and Spanish literature were included. Narrative and tables were used to present and synthesise evidence. Quality was evaluated using the CHEERS Statement. Results: A total of 244 studies were identified, and 10 were included. Screening and diagnosis of PS-OD studies found: (1) adjusted reduction in hospitalisation costs when assessed during the first admission day; (2) non-significant reduction in hospitalisation costs with OD management after thrombolysis; and (3) videofluoroscopy as the most cost-effective screening method (compared to bedside evaluation and a combination of both). Two studies showed cost-effective rehabilitation programmes, including OD management. Pelczarska et al. showed an incremental cost–utility ratio of texture-modified diets using a gum-based thickener of 20,977 PLN (4660€) following a dynamic model, and Kotecki et al. commercially prepared thickened fluids that were 44% to 59% less expensive than in situ prepared fluids. Elia et al. showed home enteral nutrition was cost-effective (£12,817/QALY), and Beavan et al. showed higher nutrient intake and low increase in hospitalisation costs using looped-nasogastric tubes (£5.20 for every 1% increase). Heterogeneity between studies precluded a quantitative synthesis. Conclusions: Included studies suggest that healthcare interventions aiming to prevent OD complications are cost-effective. However, studies assessing novel strategies are needed. Full article
(This article belongs to the Special Issue Modified Diets and Nutritional Strategies for Patients with Swallowing and Mastication Disorders)
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