International Dysphagia Diet Standardisation Initiative Research Articles

Gelation properties and swallowing characteristics of heat-induced whey protein isolate/chia seed gum composite gels as dysphagia food

Soft gels based on protein-polysaccharide composite systems play a crucial role in the dietary management of people with dysphagia. The effect of chia seed gum (CSG) on the gelling and swallowing properties of heat-induced whey protein isolate (WPI) gels (3.125–75 mg/mL) was investigated. The results showed that adding CSG reduced the gelation concentration of WPI and weak gels could form at 12.5 mg/mL WPI concentration. In addition, the viscoelasticity and water-binding capacity of the WPI/CSG composite gels were gradually enhanced with increasing WPI concentrations. The WPI/CSG composite systems can be classified as level 2–5 dysphagia-oriented foods according to the International Dysphagia Diet Standardization Initiative (IDDSI) framework. The incorporation of CSG promoted the cross-linking of protein aggregates and the formation of compact and continuous network structures, resulting in improved gelling properties of composite systems. This study contributes to the development of novel soft gel-type dysphagia foods with better textural characteristics.

Texture, swallowing and digestibility characteristics of a low-GI dysphagia food as affected by addition of dietary fiber and anthocyanins

Dysphagia is a common problem in the elderly population, thus texture modifications in foods suitable for dysphagic patients aroused a lot of interest. In the study, low glycemic index (GI) dysphagia foods were designed with adding dietary fiber (DF) and anthocyanins (AS), and their in vitro enzymatic digestion and predicted GI values were investigated by first-order kinetic model and slope log model. Results showed that all samples belonged to dysphagia foods at level 4 (pureed) in the International Dysphagia Diet Standardization Initiative (IDDSI) framework, and exhibited shear thinning behavior. AS reduced the apparent viscosity and storage modulus, increased redness, while DF decreased the hardness and gumminess of dysphagia food masses. DF and AS significantly increased the slowly digestible starch and resistant starch content in food system. With the increased addition of 5 % DF and 3 % AS, the predicted GI value of dysphagia food masses could be decreased to 51.08 ± 2.48, which belonged to the low-GI food, and showed the best water holding capacity and the highest total sensory evaluation score. In addition, a strong correlation was also found between the slow digestion indicators, rheological properties and swallowing ease. This study provides a theoretical foundation for the design of dysphagia food products with slow digestibility and low GI values.

The possibility of the computer simulation-assisted IDDSI framework for the development of thickened brown rice paste

Increasing requests for thickened fluid food are demanded with population aging, while the limited information provided by the International Dysphagia Diet Standardisation Initiative (IDDSI) is insufficient for food development. Recently, the introduction of computer simulation seems to be able to overcome this dilemma. Here, a thickened fluid system (xanthan gum and konjac glucomannan, XG and KGM) at different ratios was kept at the same IDDSI level 3. An obvious synergy was observed in the ratio of 1:9 (XG: KGM) with high surface tension, zero-shear viscosity, firmness and cohesion, and thus was used to prepare the brown rice paste. From computer simulation, the brown rice pastes (0.3 % and 0.5 % thickener) splashed and that with higher thickener content resulted in more residue. The thickener content of 0.7 % provided enough viscosity and cohesion to avoid splash, and most of the bolus flowed consistently, showing the best sensory quality and swallowing properties.

Formulation and characterisation of protein-rich custard-like soft food intended for the elderly with swallowing difficulties

Swallowing problem is prevalent in the elderly which requires high intake of protein through soft foods. This study developed protein-rich custard-type soft foods for elderly with dysphagia and evaluated the impact of milk protein content (3.9% to 8.9%) on the physicochemical properties of the formulations. Kappa-carrageenan and inulin were incorporated as a thickener and dietary fibre. Textural and rheological characteristics including viscosity, hardness, and deformation resistance, were measured using texture analyser and rheometer to compare with international standards for swallowing-friendly foods. The microstructure was visualised by scanning electron microscopy (SEM) and confocal laser scanning microscopy (CLSM), which influenced custard's ease of swallowing. Results showed that the increasing kappa-carrageenan, inulin, and milk protein content increased the gel strength, viscosity, resistance to deformation and storage stability. The swallowability of the formulations was tested using the International Dysphagia Diet Standardization Initiative's (IDDSI) fork pressure and spoon tilt tests, classifying the products as Level 6 – Soft & Bite-Sized Foods. The instrumental IDDSI fork pressure test generated reliable data to optimise formulations. The custard formulation containing 0.7% kappa-carrageenan, 2.4% inulin, and 8.9% milk protein was found to be optimal. This work provides insights for developing high-protein soft foods for the elderly with swallowing difficulties.

Evaluation of the physicochemical and sensory properties of branched‐chain amino acid‐fortified perilla mousse after retort sterilisation as a dysphagia diet

SummaryDysphagia and difficulty swallowing, lead to a heightened risk of respiratory disorders and malnutrition. This study aimed to assess the physicochemical and sensory properties of a branched‐chain amino acids‐fortified perilla mousse (PM) and its retorted version (RPM) to determine their suitability for dysphagia patients. PM and RPM were evaluated for texture, colour, free amino acids content, sensory acceptance, and the International Dysphagia Diet Standardisation Initiative (IDDSI) levels were determined. The results showed that PM and RPM met IDDSI Levels 3–4. RPM exhibited a redder, darker colour and a firmer texture compared with PM. Moreover, RPM showed no syneresis and maintained high viscoelasticity from 20 °C to 80 °C. Additionally, retort sterilisation increased essential amino acid levels in RPM, and it received high sensory acceptance. This mousse offers a promising option for dysphagia patients, providing enhanced nutritional value with ease of swallowing. Future research should explore the long‐term impacts on dysphagia management.

The discriminant ability of the Eating Assessment tool-10 to detect swallowing efficiency in neurogenic dysphagia

Purpose Neurogenic dysphagia causes complications such as malnutrition, dehydration, and aspiration pneumonia. Therefore, early detection with clinically valid tools is essential. This study aimed to investigate the Eating Assessment Tool-10 (EAT-10) ability to detect swallowing efficiency at three different consistencies in neurogenic dysphagia. Methods One hundred twelve patients with neurogenic dysphagia (74 males and 38 females, mean ± SD age 61.83 ± 9.72 years) were included in the study. A Fiberoptic Endoscopic Evaluation of Swallowing (FEES) was performed in the clinic following EAT-10 to assess swallowing efficacy at International Dysphagia Diet Standardization Initiative (IDDSI) consistencies of 0, 3, and 7. The swallowing efficiency of the patients was assessed using the Yale Pharyngeal Residue Severity Rating Scale (YPRSRS). Area under the curve, sensitivity, and specificity values were calculated to evaluate the ability of EAT-10 to discriminate between participants with and without residue and between participants with and without moderate-to-severe residue. Results The EAT-10 significantly detected participants with and without residues for three IDDSI consistent: for IDDSI 0 residue in the vallecula and pyriform sinus (cutoff score ≥ 14, p < 0.001), for IDDSI 3 residue in the vallecula and pyriform sinus (cutoff score ≥ 13, p < 0.001), for IDDSI 7 residue in the vallecula and pyriform sinus (respectively, cutoff score ≥ 13, cutoff score ≥ 14, p < 0.001). Additionally, the EAT-10 significantly detected those with and without moderate-to-severe residue. Conclusions The EAT-10, frequently used in swallowing clinics, can determine swallowing efficiency in individuals with neurogenic dysphagia. Additionally, it has the power to detect moderate-to-severe pharyngeal residue.

Biointerfacial supramolecular self-assembly of whey protein isolate nanofibrils on probiotic surface to enhance survival and application to 3D printing dysphagia foods

Personalized three-dimensional (3D) printed foods rich in probiotics were investigated. Lactiplantibacillus plantarum (Lp), as a representative of probiotics, was used to investigate the 3D printing of probiotic-rich dysphagia foods. Here, whey protein isolate nanofibrils (WPNFs) were coated and anchored on bacterial surfaces via biointerfacial supramolecular self-assembly, providing protection against environmental stress and the 3D printing process. The optimized composite gels consisting of High acyl gellan gum (0.25 g), whey protein isolate (1.25 g), fructooligosaccharides (0.75 g), Lp-WPNFs-Glyceryl tributyrate emulsion (Φ = 40%, 3.75 mL) can realize 3D printing, and exhibit high resolution, and stable shape. The viable cell count is higher than 8.0 log CFU/g. They are particularly suitable for people with dysphagia and are classified as level 5-minced & moist in the international dysphagia diet standardization initiative framework. The results provide new insights into the development of WPNFs-coating on bacterial surfaces to deliver probiotics and 3D printed food rich in probiotics.

Rheological, textural, and swallowing characteristics of xanthan gum-modified Riceberry porridge for patients with dysphagia.

The incidence and prevalence of dysphagia worldwide are increasing yearly requiring a change in food texture to avoid malnutrition, dehydration, or sever complications. Riceberry porridges fortified with protein hydrolysate (1.5%), bio-calcium (589 mg), and thickened with xanthan gum (XG) of varying concentrations (0%, 0.255, 0.50%, 0.75%, 1.0%, and 2.0%) showed suitability for use in enriching diets of these patients. Porridges were examined using specified tests from the International Dysphagia Diet Standardization Initiative (IDDSI) and National Dysphagia Diet (NDD), and coupled with rheological, textural analyses, in vitro swallowing simulator and sensory analysis performed by a trained panel. Porridges with 0%-0.25% and 0.50%-2.0% XG were classified as IDDSI level 3 and 4, respectively, and apparent viscosities of porridges showed samples with XG displayed shear thinning behavior beneficial for patients with dysphagia. Increasing XG concentrations increased the consistency coefficient and decreased the flow behavior index (p < .05) with positive correlation of XG concentration with textural properties including firmness, consistency, cohesiveness, adhesiveness, and stickiness values. The relationship between instrumental measurements, in vitro and in vivo swallowing behavior showed high correlations with regards to XG concentration (r = .995). The findings indicate Riceberry porridges containing XG have significantly improved textural properties over those without XG for patients with dysphagia.

Fabrication of edible inks for 3D printing as a dysphagia food: An emerging application of bigels

With the increasing prevalence of swallowing difficulties among the elderly, 3D printing technology has emerged as a promising approach to create attractive and appetitive dysphagia diets. This study focused on synthesizing bigels composed of beeswax oleogel (OG) and gellan gum hydrogel (HG) to explore their potential for 3D printing dysphagia diets. The ratio of OG to HG plays a pivotal role in determining the gel network structure, rheological properties, and water distribution of the bigels, thereby influencing their suitability as 3D printing ink. Notably, a bicontinuous structure achieved with an OG to HG ratio of 1:1 (sample 1-1) imparted desirable properties for 3D printing, including moderate shear-thinning behavior, ensuring smooth extrusion, excellent thixotropy for maintaining structural integrity, and adequate storage modulus for self-supporting during printing. These were indicated by lower flow index (n value) of 0.18, longer time respond to the applied stress (λ value) of 9.51 ± 0.32 s, higher creep recovery rate of 55.51 ± 1.36%, thixotropic recovery rate up to 93.23 ± 0.72%, and uniform moisture distribution across semi-bound water and free water with ratio of 56.94 to 43.06, compared to bigels with OG-in-HG and HG-in-OG structures. Evaluation of the 3D printed bigels through the International Dysphagia Diet Standardization Initiative (IDDSI) confirmed that sample 1-1 (classified as Level 5-Minced and Moist) was suitable for individuals with swallowing difficulties. This study provides new insights into developing visually appealing dysphagia diet using 3D printing.

The swallowing and speech after transoral robotic surgery-does the site impact the outcome?

Transoral robotic surgery (TORS) has been introduced to head and neck surgery as a minimally invasive techqniques to improve the functional outcomes of patients. Compare the functional outcome for swallowing and speech in each site of TORS within the head and neck. Retrospective cohort study for patients who underwent TORS within the head and neck unit. Patients were assessed at four different time points (one day, one month, six months and twelve months, respectively) with bedside/office testing. Methods of testing for swallowing assessment were by the International Dysphagia Diet Standardization Initiative (IDDSI), and speech assessments were carried out using the Understandability of Speech score (USS). Outcomes were compared to patient-specific pre-treatment baseline levels. 68 patients were included. 75% and 40% of the patients resumed normal fluid intake and normal diet immediately after surgery. 8.8% required a temporary feeding tube, with 1% required gastrostomy. There was a steep improvement in diet between 3 and 6 months. Fluid and diet consistency dropped significantly following the majority of transoral robotic surgery with more noticeable diet changes. Early deterioration in diet is temporary and manageable with a modified diet. Rapid recovery of swallowing is achieved before the first year. There is no long-term effect on speech.

Assessment and Rehabilitation Intervention of Feeding and Swallowing Skills in Children with Down Syndrome Using the Global Intensive Feeding Therapy (GIFT).

Children with Down syndrome (DS) experience more difficulties with oral motor skills, including chewing, drinking, and swallowing. The present study attempts to measure the preliminary effectiveness of Global Intensive Feeding Therapy (GIFT) in DS. GIFT is a new rehabilitation program addressing the specific difficulties and needs of each child, focusing on sensory and motor oral abilities. It follows an intensive schedule comprising 15 sessions over 5 consecutive days, with 3 sessions per day. The principles of GIFT are applied with specific objectives for DS. GIFT was preliminarily implemented among 20 children diagnosed with DS. To measure the efficacy of GIFT, the Karaduman Chewing Performance Scale (KCPS), the International Dysphagia Diet Standardization Initiative (IDDSI), and the Pediatric Screening-Priority Evaluation Dysphagia (PS-PED) were used. Data were analyzed using the Wilcoxon signed-rank test before (T0) and after intervention (T1) and at one-month follow-up (T2). The effect size was also measured for specific outcomes, using Kendall's W. Our findings revealed that children with DS showed no risk of dysphagia according to the PS-PED (mean score 2.80). Furthermore, statistically significant improvements in chewing performance were observed, as measured by the KCPS (p < 0.01), as well as in texture acceptance and modification, as measured by the IDDSI post-intervention (p < 0.01). For both the KCPS and IDDSI, a large effect size was found (Kendall's W value > 0.8). Parents/caregivers continued using GIFT at home, and this allowed for a positive outcome at the one-month follow-up. GIFT proved to be effective in the rehabilitation of feeding and swallowing disorders in children with DS, as well as for food acceptance.

A Preliminary Study of Vallecular Bolus Aggregation in Healthy Swallowing of Solid Food Boluses.

The pharyngeal swallow typically begins within 400 ms following the arrival of a liquid bolus in the pharynx. By contrast, processed food particles aggregate in the valleculae prior to swallow initiation. With solid foods, swallow reaction time (SRT), the interval between bolus passing the ramus of mandible and hyoid burst onset (HYB) can be subdivided into components of vallecular aggregation time (VAT) and the subsequent end of aggregation to hyoid burst interval (EOA-to-HYB). However, expected durations of these timing measures remain unclear. We aimed to study bolus aggregation in healthy swallowing for International Dysphagia Diet Standardisation Initiative Food Levels 5 (minced and moist [MM5]), 6 (soft and bite-sized [SB6]), and 7 (regular [RG7]). Understanding typical patterns and durations of vallecular aggregation with solids in healthy swallowing will inform the identification of impaired swallow timing in patient populations. Twenty healthy adults (10 males, Mage = 28 years, range: 23-55 years) swallowed two boluses each of MM5, SB6, and RG7 foods in videofluoroscopy. Blinded duplicate ratings determined bolus location at swallow onset, SRT, VAT, and EOA-to-HYB. Texture-based differences were measured using Friedman's tests. Bolus location was at/above the valleculae at swallow onset for 85% of boluses, with no differences by texture. SRT, VAT, and EOA-to-HYB did not vary by texture, with overall median values (interquartile range) of 99 ms (-66 to 743 ms) for SRT, 347 ms (66 to 891 ms) for VAT, and -132 ms (-231 to -83 ms) for EOA-to-HYB. These data corroborate prior evidence that it is not unusual for food particles to aggregate in the valleculae prior to swallow initiation in healthy swallowing. However, durations of vallecular aggregation are typically < 1 s in healthy adults.

Rheological characterization of chia seed gum as a thickening agent used for dysphagia management

Dysphagia has emerged as a serious health issue facing contemporary society. Consuming thickened liquids is an effective approach for improving the swallowing safety for dysphagia patients. The thickening effect of chia seed gum (CSG), a novel thickener, in different dispersing media (water, orange juice, and skim milk) was investigated. Moreover, the potential application of CSG for dysphagia management was evaluated by comparison with xanthan gum (XG) and guar gum (GG). The thickened liquids prepared with 0.4 %–1.2 % (w/v) CSG, XG, and GG could be classified into levels 1–4, 2–4, and 1–3, respectively, according to the International Dysphagia Diet Standardization Initiative (IDDSI) framework. All the thickened liquids displayed shear-thinning characteristics that facilitated safe swallowing. The viscosities (η50) of CSG dissolved in water (0.202–1.027 Pa·s) were significantly greater than those of CSG dissolved in orange juice (0.070–0.690 Pa·s) and skim milk (0.081–0.739 Pa·s), indicating that CSG had a greater thickening effect in water than in orange juice and skim milk. Compared with those prepared with GG, the thickened liquids prepared with CSG and XG exhibited greater viscoelasticity, better water-holding capacity, and more compact networks. The findings suggested that CSG can be used as a potential thickener for thickening liquid foods to manage dysphagia.

Engineering plant-based protein-rich soft and bite-sized 3D printed dysphagia food

This study investigates the 3D printability of horse gram (Macrotyloma uniflorum) flour (HGF) substituted with chia (Salvia hispanica L.) seed flour (CSF) for engineering dysphagia food (Level 6) according to the International Dysphagia Diet Standardization Initiative (IDDSI). Four composite formulations of pretreated (germinated and roasted) HGF substituted by 5, 10, 15, and 20% (weight basis) CSF and one formulation without substitution of CSF were prepared, and their rheological characterization and printing performance were analyzed. The IDDSI tests for Level 6 dysphagia food were further conducted on the printed constructs and validated with their texture profile analysis results. The study revealed that germination followed by roasting of horse gram significantly (p < 0.05) increased the water holding capacity (WHC) of the formulations, which further impacted their rheological and textural properties. Substitution of 10% and 15% CSF demonstrated the best printing accuracy (>95%) in 2D and 3D printings. Further, the substitution of CSF in the formulations showed reduced hardness (6.77 ± 0.24 to 3.86 ± 0.10 N) and increased cohesiveness (0.153 ± 0.02 to 0.234 ± 0.01) in the 3D printed constructs, which are desirable for safe bolus formulation. The printed constructs were tested for the fork, spoon, and break-apart tests, and were observed to satisfy the criteria of Level 6 dysphagia food as per IDDSI guidelines.

Emulsion gel-based inks for 3D printing of foods for dysphagia patients: High internal type emulsion gel-biopolymer systems

High internal type emulsion gels (HIPE gels) are usually a soft semi-solid material consisting of tightly packed oil droplets stabilized by a layer of emulsifier. The semi-solid nature of HIPE gels means they can be used as edible inks in 3D food printing applications. However, the rheological properties of HIPE gels are typically unable to satisfy the demands of 3D printing applications, resulting in unsatisfactory printing performance. In this study, HIPE gel-based inks (85% by volume of oil) with improved 3D printing performance were prepared by using pea protein-inulin complexes as emulsifiers. In addition, the effects of oil type (corn, sunflower, flaxseed, or olive oil) on the 3D printing property, rheological properties, and microstructure of the HIPE gels was analyzed since different oils have different nutritional and physicochemical properties. Moreover, International Dysphagia Diet Standardization Initiative (IDDSI) foods created by 3D printing with these edible inks were evaluated in a population of the elderly suffering from dysphagia. It was found that HIPE-based edible inks containing an optimized inulin level (0.75% w/v) had the best 3D printing properties. In terms of oil type, the edible inks formulated from corn oil and from flaxseed oil had the best 3D printing property. As analyzed in the Lissajous plot, the addition of inulin remarkably improved the viscoelasticity of the inks, which improved their 3D printing property. These inks also exhibited high thixotropic recovery and good thermal stability. Moreover, cryo-SEM analysis showed that the PPI-inulin complex formed a barrier on the oil droplets' surface and a dense cross-linked structure between the particles. The IDDSI evaluation found that the HIPE gel inks were able to satisfy the requirements of Class IV and V foods in the IDDSI framework and could be classified as transitional foods, which would satisfy the food needs of patients with dysphagia.

Predictors for Failed Removal of Nasogastric Tube in Patients With Brain Insult.

To construct a prognostic model for unsuccessful removal of nasogastric tube (NGT) was the aim of our study. This study examined patients with swallowing disorders receiving NGT feeding due to stroke or traumatic brain injury in a regional hospital. Clinical data was collected, such as age, sex, body mass index (BMI), level of activities of daily living (ADLs) dependence. Additionally, gather information regarding the enhancement in Functional Oral Intake Scale (FOIS) levels and the increase in food types according to the International Dysphagia Diet Standardization Initiative (IDDSI) after one month of swallowing training. A stepwise logistic regression analysis model was employed to predict NGT removal failure using these parameters. Out of 203 patients, 53 patients (26.1%) had experienced a failed removal of NGT after six months of follow-up. The strongest predictors for failed removal were age over 60 years, underweight BMI, total dependence in ADLs, and ischemic stroke. The admission prediction model categorized patients into high, moderate, and low-risk groups for removal failure. The failure rate of NGT removal was high not only in the high-risk group but also in the moderate-risk groups when there was no improvement in FOIS levels and IDDSI food types. Our predictive model categorizes patients with brain insults into risk groups for swallowing disorders, enabling advanced interventions such as percutaneous endoscopic gastrostomy for high-risk patients struggling with NGT removal, while follow-up assessments using FOIS and IDDSI aid in guiding rehabilitation decisions for those at moderate risk.

Association Between Malnutrition and Food Texture Levels in Integrated Facilities for Medical and Long-Term Care.

This study aims to investigate the association between malnutrition using the global consensus criteria and food texture levels in residents of Integrated Facilities for Medical and Long-Term Care (IFMLCs), which are new long-term care insurance facilities in Japan. This single-center study had a retrospective cross-sectional design. The study was conducted from November 1 to 30, 2021, and the study participants were residents admitted to an IFMLC during the study period. Malnutrition was diagnosed according to the Global Leadership Initiative on Malnutrition (GLIM) criteria. Food texture levels consumed by patients at admission were categorized based on the International Dysphagia Diet Standardization Initiative (IDDSI) framework. Multivariate logistic regression models were used to determine the association between the food texture levels consumed and malnutrition. A total of 98 older residents were analyzed in this study. The median age of the participants was 88 years, and 68 (69%) female participants were included. The IDDSI framework levels were 24% in levels 7 and 6 and 26% in levels 5 and 4. A significant difference in the prevalence of low BMI, reduced muscle mass, and reduced food intake or assimilation was noted between IDDSI framework levels 4 and 7. Multivariate logistic regression analysis was performed for malnutrition, adjusting simultaneously for potential confounders. IDDSI level 4 (odds ratio, 5.074; 95% confidence interval, 1.059-28.092; p=0.042) consumption was independently associated with malnutrition. The consumption of lower food texture levels categorized using the IDDSI framework was associated with a higher malnutrition prevalence in IFMLC residents.

Co (ne) víme o úpravě konzistence stravy u pacientů s dysfagií a s čím by mohla pomoci iniciativa IDDSI (International Dysphagia Diet Standardization Initiative)

Summary Texture-modified diet and thickening liquids are a therapeutic option for dysphagia. Many of the terms referring to liquid viscosity modifications and solid diet modifications are terminologically ambiguous and vague, e. g. “honey consistency liquid” or “soft-textured diet.” The inconsistent terminology adversely affects patient safety and the efficiency of the application of this therapeutic method. Possible misunderstanding of the vague terms between staff members can result in using a different consistency of the fluid or food from the consistency that was found to be safe during the objective swallowing examination. The International Dysphagia Diet Standardization Initiative (IDDSI) is seeking application of international standardized terminology for texture-modified foods and liquids for use in people with dysphagia of all ages, in all care settings, and in different cultural settings. The goal of IDDSI is to improve patient safety of oral intake and evolve the field of dysphagia research. Key words dysphagia – texture-modified food – thickened liquids – IDDSI

Flow Rates of Bottle Nipples/Teats With Different Thicknesses of Barium and Infant Formula

Purpose: The aim of this study was to evaluate the bottle nipple flow rate of liquid barium sulfate of three different International Dysphagia Diet Standardisation Initiative (IDDSI) thicknesses (i.e., thin, slightly thick, and mildly thick) and compare flow rates of infant formula thickened with Gelmix or oatmeal cereal to comparable thicknesses. Method: Liquid preparations were IDDSI flow tested to determine thickness. Nipple flow rate testing was conducted using 50 ml of liquid in a 4-oz Dr. Brown's bottle with the venting system in place. Liquid was extracted using a breast pump. The weight of liquid extracted was converted to flow in milliliters per minute using the density of the liquid in grams per milliliter. Results: Across nipple types and liquid thicknesses, the flow rate through the bottle nipple with formula was faster than with barium of the same thickness. Thickening with oatmeal cereal resulted in clogging of the nipple. Pulverizing the oatmeal did not improve clogging but did impact caloric density of the formula. Conclusions: Bottle nipple flow rates of liquid barium sulfate are not consistent with flow rates of thin infant formula or formula thickened with Gelmix to the same IDDSI thickness. These findings may impact the safety of oral feeding for some infants. Parents and clinicians need to be aware of clogging with oatmeal cereal as a factor that could contribute to variability in flow as well as difficulty extracting fluid for nutrition.

Development of easy-to-swallow and lipid-enhanced 3D printed surimi based on high internal phase emulsions

The elderly often suffered from chewing/swallowing difficulty, it is crucial to develop attractive dysphagia food. High internal phase emulsions (HIPEs) can be used as texture modifiers to create dysphagia food. Firstly, the multiple light scattering and micro-rheology results indicated that HIPEs stabilized by microbial transglutaminase (at 3.0 U/g) crosslinking of fish scale gelatin (FSG-TG-3) exhibited the highest stability. Subsequently, the effect of FSG-TG-3-stable fish oil HIPEs on the rheological properties, water distribution, 3D printability, textural properties, and swallowing behavior of surimi compared to the addition of fish oil were investigated. Results demonstrated that compared with oil-added group, HIPEs-added counterparts had relatively lower apparent viscosity, yield stress, and storage modulus, which was more suitable for 3D printing. Furthermore, the HIPEs addition effectively decreased the hardness and adhesiveness of the surimi gel, which could be classified into the level-6 (soft and bite-sized) diet in the International Dysphagia Diet Standardization Initiative (IDDSI) framework. However, the direct oil-added group not met the dysphagia diet because it returned its original shape when the fork was removed. Finally, we found that the internal structure of surimi-HIPEs was modified by controlling filling types and densities, which might be suitable for the elderly with different degrees of dysphagia. In summary, the surimi-HIPEs might could create attractive and lipid-enhanced 3D printed food for elderly with dysphagia.