Lack of Standardization in Commercial Thickeners Used in the Management of Dysphagia.

INTRODUCTION: Oral feeding safety is necessary to provide nutrition, hydration, and eating pleasure for patients with dysphagia. Commercial thickeners are prescribed for these patients to change food viscosity and may alter the proper preparation of modified food. OBJECTIVE: Analyze composition, employed terminology, preparation instructions, recommended amount and weight of provided measuring spoons, nutritional information, and viscosity of 7 commercial thickeners. METHODS: The sample comprised all thickeners from different brands available in Brazil, named A to G. Products were submitted to viscosity analysis using viscometer and the International Dysphagia Diet Standardization Initiative (IDDSI) test. Samples were prepared with mineral water (25°C) and with the amount of thickener recommended to obtain intermediate viscosity (level 2) according to the manufacturer's instructions. RESULTS: Products B, C, and E presented similar composition. Manufacturer's information about the amount and preparation procedure, time, temperature, and base liquid was incomplete. Viscosity tests revealed that thickener C was basically solid while D displayed results out of the desired viscosity level. CONCLUSIONS: The study showed differences in components and viscosity, beyond the lack of label details. There was no established correlation between viscosity classifications provided by National Dysphagia Diet and IDDSI.

Covid-19: Signs and symptoms related to the feeding behavior.

COVID-19 reached pandemic level in March 2020 and the number of confirmed cases continued to increase worldwide. The clinical course of the disease has not yet been fully characterized, and some specific symptoms related to smell, taste, and feeding behavior require further examination. The present study aimed to assess the presence of symptoms related to the feeding behavior occurred during and/or after COVID-19 in adults residing in Portugal and to link them to disease severity using a multivariate approach. Data were collected from May to September 2020, through a questionnaire answered online containing questions about general and specific symptoms before, during and after COVID-19. 362 participants were included: 201 were symptomatic, being 15 hospitalized and 186 non-hospitalized. Cluster analysis grouped the symptomatic non-hospitalized participants as mild and severe cases. For these patients, the most frequent symptoms related to the feeding process were smell disorders in 40% and 62%, taste disorders in 37% and 60%, and dry mouth, in 23% and 48% of the mild and severe cases, respectively. Dry mouth was significantly associated with difficulty to swallow, pain during swallow, choking when eating or drinking, and preference for mushy/pasty foods (p < 0.01; Chi-squared test). Among the severe cases, the incidence of coughing during the meal (31%), difficulty (19%) and pain during swallow (17%), preference for mushy/pasty foods (10%) and choking when eating or drinking (6%) were clinically relevant and may indicate the presence of swallowing disorders. This group also showed a higher frequency of general symptoms, such as fever, headache, abdominal pain, tiredness, diarrhea, nausea, and shortness of breath (p < 0.05; Chi-squared test). Smell disorders, taste disorders and dry mouth were the most frequent symptoms related to the feeding behavior for both mild and severe cases. Dry mouth was significantly associated with swallowing difficulties and future research should investigate it as a frequent symptom and as a predictive of the presence of eating and swallowing disorders in COVID-19 cases.

Consistencies and terminologies - the use of the International Dysphagia Diet Standardization Initiative.

INTRODUCTION: Introduction: this study aimed to verify the ability of speech therapists to identify, sort and name the different consistencies used in neurogenic oropharyngeal dysphagia (NOD) management, and to compare the results with the terms proposed by the International Dysphagia Diet Standardization Initiative (IDDSI). Methods: this research was approved by the ethics committee. Sixty speech therapists who work with NOD patients sorted 5 commercial foods from thinnest to thickest to match IDDSI levels 0 to 4, and then used a term to designate each consistency. Results: most subjects (76.66%) sorted the foods properly. Terminologies were divergent at all levels. For level 0, practitioners assigned 3 different terms. For level 1, 24 different terms were reported; for level 2 there were 25 terms, 23 terms for level 3, and 18 terms for level 4. Level 0 (IDDSI - thin) was designated by most participants as liquid; level 1 (IDDSI - slightly thick) was referred to as semi-thickened liquid; level 2 (IDDSI - mildly thick) as thickened liquid; level 3 (IDDSI - moderately thick) as honey; and level 4 (IDDSI - extremely thick) as pasty by most subjects. A reduced number of participants used terms in accordance with IDDSI. Level 0 was appropriately named by 5 subjects (8.33%); levels 1, 2 and 4 by 2 practitioners each (3.33%); and level 3 by 1 professional (1.66%). None of the subjects named all 5 IDDSI levels correctly. Conclusion: most practitioners progressed consistencies properly. There was a diversity of terminologies used for the same consistency at all levels, with no standardization.

INTRODUCCIÓN: Introducción: este estudio tuvo como objetivo verificar la capacidad de los logopedas para identificar, clasificar y nombrar las diferentes consistencias utilizadas en el manejo de la disfagia orofaríngea neurogénica (NOD) y comparar los resultados con los términos propuestos por la Iniciativa Internacional de Estandarización de la Dieta para la Disfagia (IDDSI). Métodos: esta investigación fue aprobada por el comité de ética. Sesenta terapeutas del habla que trabajan con pacientes de NOD clasificaron 5 alimentos comerciales, desde los más finos hasta los más gruesos, coincidiendo con los niveles 0 a 4 de la IDDSI; luego, debían nombrar cada consistencia. Resultados: la mayoría de los sujetos (76,66%) clasificaron correctamente las consistencias. Las terminologías fueron divergentes en todos los niveles. Para el nivel 0, los participantes asignaron 3 términos diferentes. Para el nivel 1 usaron 24 términos diferentes, 25 términos para el nivel 2, 23 para el nivel 3 y 18 para el nivel 4. La consistencia del nivel 0 (IDDSI: fina) fue nombrada por la mayoría de los participantes como líquida; la del nivel 1 (IDDSI: ligeramente espesa) la denominaron líquida semi-espesada; la del nivel 2 (IDDSI: poco espesa) como líquida espesada; la del nivel 3 (IDDSI: moderadamente espesa) como miel, y la del nivel 4 (IDDSI: extremadamente espesa) como pastosa. Un número reducido de participantes emplearon términos coincidentes con los de la IDDSI. El nivel 0 fue nombrado correctamente por 5 sujetos (8,33%), los niveles 1, 2 y 4 por 2 participantes cada uno (3,33%), y el nivel 3 por 1 profesional (1,66%). Ninguno de los sujetos nombró correctamente los 5 niveles de la IDDSI. Conclusión: la mayoría de los participantes ordenaron correctamente la progresión de las consistencias. Hubo diversidad en las terminologías utilizadas para una misma consistencia en todos los niveles, sin estandarización alguna.

Consistencies and terminologies - the use of the International Dysphagia Diet Standardization Initiative / Consistencias y terminologías: el uso de la Iniciativa Internacional de Estandarización de la Dieta para la Disfagia

Introduction: this study aimed to verify the ability of speech therapists to identify, sort and name the different consistencies used in neurogenic oropharyngeal dysphagia (NOD) management, and to compare the results with the terms proposed by the International Dysphagia Diet Standardization Initiative (IDDSI). Methods: this research was approved by the ethics committee. Sixty speech therapists who work with NOD patients sorted 5 commercial foods from thinnest to thickest to match IDDSI levels 0 to 4, and then used a term to designate each consistency. Results: most subjects (76.66%) sorted the foods properly. Terminologies were divergent at all levels. For level 0, practitioners assigned 3 different terms. For level 1, 24 different terms were reported; for level 2 there were 25 terms, 23 terms for level 3, and 18 terms for level 4. Level 0 (IDDSI - thin) was designated by most participants as liquid; level 1 (IDDSI - slightly thick) was referred to as semi-thickened liquid; level 2 (IDDSI - mildly thick) as thickened liquid; level 3 (IDDSI - moderately thick) as honey; and level 4 (IDDSI - extremely thick) as pasty by most subjects. A reduced number of participants used terms in accordance with IDDSI. Level 0 was appropriately named by 5 subjects (8.33%); levels 1, 2 and 4 by 2 practitioners each (3.33%); and level 3 by 1 professional (1.66%). None of the subjects named all 5 IDDSI levels correctly. Conclusion: most practitioners progressed consistencies properly. There was a diversity of terminologies used for the same consistency at all levels, with no standardization

Introducción: este estudio tuvo como objetivo verificar la capacidad de los logopedas para identificar, clasificar y nombrar las diferentes consistencias utilizadas en el manejo de la disfagia orofaríngea neurogénica (NOD) y comparar los resultados con los términos propuestos por la Iniciativa Internacional de Estandarización de la Dieta para la Disfagia (IDDSI). Métodos: esta investigación fue aprobada por el comité de ética. Sesenta terapeutas del habla que trabajan con pacientes de NOD clasificaron 5 alimentos comerciales, desde los más finos hasta los más gruesos, coincidiendo con los niveles 0 a 4 de la IDDSI; luego, debían nombrar cada consistencia. Resultados: la mayoría de los sujetos (76,66%) clasificaron correctamente las consistencias. Las terminologías fueron divergentes en todos los niveles. Para el nivel 0, los participantes asignaron 3 términos diferentes. Para el nivel 1 usaron 24 términos diferentes, 25 términos para el nivel 2, 23 para el nivel 3 y 18 para el nivel 4. La consistencia del nivel 0 (IDDSI: fina) fue nombrada por la mayoría de los participantes como líquida; la del nivel 1 (IDDSI: ligeramente espesa) la denominaron líquida semi-espesada; la del nivel 2 (IDDSI: poco espesa) como líquida espesada; la del nivel 3 (IDDSI: moderadamente espesa) como miel, y la del nivel 4 (IDDSI: extremadamente espesa) como pastosa. Un número reducido de participantes emplearon términos coincidentes con los de la IDDSI. El nivel 0 fue nombrado correctamente por 5 sujetos (8,33%), los niveles 1, 2 y 4 por 2 participantes cada uno (3,33%), y el nivel 3 por 1 profesional (1,66%). Ninguno de los sujetos nombró correctamente los 5 niveles de la IDDSI. Conclusión: la mayoría de los participantes ordenaron correctamente la progresión de las consistencias. Hubo diversidad en las terminologías utilizadas para una misma consistencia en todos los niveles, sin estandarización alguna