Optimizing Sensory, Rheologic and Swallowing Parameters

in the Development of Biophysically Designed Beverages

for Swallowing Impaired Elders
K. Banaszynski1, J. Hind2, 5, H. Mendenhall3, H. Damodhar4, C. Grummer3, A. Joyce1, Z. Vickers4, J. Robbins1, 2, 5, R. Hartel3
University of Wisconsin, Madison, WI Department of Nutrition1, Department of Medicine2, Department of Food Science3, University of Minnesota, St. Paul, MN
Department of Food Science and Nutrition4, William S. Middleton Memorial Veterans Hospital, Geriatric Research Education and Clinical Center, Madison5

Background
Nearly 40% of Americans over age 60 experience swallowing
problems (dysphagia)1
Dysphagia can lead to pneumonia, malnutrition and
dehydration2
One common treatment for people with dysphagia is to thicken
the beverages they drink3
Thickened liquids move slower than thin liquids, making them
less likely to enter the airway, however little is known regarding
the important parameters for designing optimal biophysically
 
4, 5

Results
Sensory (Table 2)
t
Y !""* '= [ 
highest in overall liking and thirst quenching
t
Y #$""* '= \
Methoxyl Pectin as lowest in liking and thirst quenching and
     +  
t
Dysphagic subjects liked the 1500cp Iota Carageenan best,
       +  

Swallowing Pressures
t
[+ ' +    
generated during the swallow
t
Methylcellulose (300cp) had faster time to reach peak
pressure compared with the barium standard

Table 2

t
15 Healthy males and females, 22-72yr (mean 43yr)

t
5 Dysphagic males and females, 23-87yr (mean 68yr)

Data Collection and Analysis:

t
 !"" #$""&
'     * *   
yield stress) and sensory attributes to best represent a wide range of
  +(Table 1)

Table 1
1500 cp

Agar

High Methoxyl Pectin

Methycellulose

Iota Carrageenan

Xanthan Gum

Tara Gum

Table 1. '=  

hydrocolloids in two viscosity groups (300cp and 1500cp).

t
/+!<' + + +

radiopaque
t
Sensory
o '=+       
questionnaire with labeled affective magnitude and visual analog
scales
o Outcome Measures>  *  * +
coating and thirst quenching
t
Digital Fluoroscopy
o '= $+?' 
and standard barium products (Varibar Nectar and Varibar Thin
Honey, Bracco)
o Outcome Measures: direction, duration and completeness of
'
t
Swallowing Pressures
o Lingual pressures generated during swallowing were measured
  !@''    Q    
the Digital Swallowing Workstation (KayPentax)(Figure 1)
o Outcome Measures: maximum pressure (mmHg) and the gradient
of the pressure rise (mmHg/sec) were calculated from pressure
waveforms produced at each bulb location during each swallow

Conclusions
Although further work is necessary, these preliminary results
      
rheological properties so they are refreshing and mouth
clearing, with the swallowing characteristics needed for people
suffering from dysphagia

Future Work
t
Continue data collection
t
Partner with commercial manufacturers to develop
    
to match the standard barium materials used for diagnosing
dysphagia, while maintaining appealing sensory and nutrition
characteristics
t
       
Madison VA hospitals to determine the effectiveness of the
developed products as a treatment for diagnosed dysphagic
patients

Subjects:

300 cp

Measures of central tendency were computed for sensory data.

Repeated-measures analysis of variance models were used to
+   ' +  
on peak pressure, time to peak pressure, swallowing durations,
residue and penetration-aspiration scale, adjusting for age,
sex, dysphagia and bulb (for pressure only). Analyses were
conducted using Proc Mixed in SAS Version 9.1 (SAS Institute
Inc, Cary NC). A nominal p-value of 0.05 was regarded as
   Q ^

Digital Fluoroscopy
t
[ +    
associated barium standards
t
Agar (300cp) and Tara Gum (1500cp) varied most from their
respective barium standards in terms of faster pharyngeal
transit and total swallow duration

Methods

Statistical Analysis

References
Table 2. Overall Liking was measured using a labeled affective
magnitude scale from 0 (greatest possible dislike) to 15.6 (greatest
'&^?   *+   _  
were rated using a visual analog scale (0-15) with 0 being none/not
at all and 15 being large amount or very.

Figure 1

1. Ney DM, Weiss JM, Kind AJ, Robbins J. Senescent swallowing:

impact, strategies, and interventions. Nutr Clin Pract
2009;24(3):395-413
2. Marik PE, Kaplan D. Aspiration pneumonia and dysphagia in the
elderly. Chest 2003;124(1):328-36
3. Diagnosis and treatment of swallowing disorders (dysphagia) in
acute-care stroke patients. Evid Rep Technol Assess (Summ)
1999:1-6
4. Lazarus CL, Logemann JA, Rademaker AW, Kahrilas PJ, Pajak T,
Lazar R, Halper A. Effects of bolus volume, viscosity, and repeated
swallows in nonstroke subjects and stroke patients. Arch Phys Med
Rehabil 1993;74:1066-70

Acknowledgments
USDA Grant NRI2007-2234
This material is the result of work supported with resources and use
of facilities at the William S. Middleton Memorial Veterans Hospital,
Madison, WI
The contents do not represent the views of the Department of Veterans
Affairs or the United States Government