Difficulties in thickened water ingestion in healthy subjects

Abstract

For some patients with dysphagia who have airway aspiration, it is not possible to drink water as a thin liquid, as they need their water to be thickened. To evaluate in healthy volunteers the difficulties and dynamics of ingestion of thickened water. In 94 healthy volunteers aged 18-67 years, the ingestion of 100mL of water with consistencies of thin liquid and thickened with 1.2g (nectar-thick), 2.4g (honey-thick) and 3.6g (pudding-thick) of a commercial thickener with maltodextrin, xanthan gum and potassium chloride was evaluated. The volunteers drank in a random sequence 100mL of each consistency. The duration and the number of swallows to drink the volume were measured. The interval between swallows, the flux of ingestion and the volume of each swallow were calculated. After each test, the individual was asked about the sensation during drinking, with ten as the best sensation and zero as the worst sensation, and about the difficulty to swallow each consistency. The analysis was done using a linear model with mixed effects. The time to ingest the volume increased (liquid: 5.8s; nectar: 7.9s; honey: 9.5s; pudding: 12.7s; p<0.01), the flux of ingestion decreased (liquid: 20.3mL/s; nectar: 15.6mL/s; honey: 13.4mL/s; pudding: 10.6mL/s; p<0.01), the sensation worsened (liquid: 9.7; nectar: 5.7; honey: 4.3; pudding: 2.8), and the difficult of ingestion increase with the increase of the water consistency. Individuals with dental prosthesis (n=11) had a decrease in the flux of ingestion with 3.6g of thickener (prosthesis: 11.1mL/s, no prosthesis: 6.8mL/s, p=0.05) and a decrease in the volume in each swallow (prosthesis: 17.6mL, no prosthesis: 10.5mL). There is some difficulty to drink thickened water. The use of dental prosthesis cause further difficulties.