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Background: Dysphagia is a common condition in infants and young children, particularly among those with neurodevelopmental disabilities. The management of pediatric dysphagia requires customized approaches based on individual clinical features. This report describes our experience in managing pediatric dysphagia using a locust bean- and xanthan gum-based thickener (ThickenUp® Junior), which offers stable consistency and preserves the original taste of liquids., Case Report: Four cases were discussed to highlight the use of the new thickener. Each case illustrates different aspects of dysphagia management, such as improving swallowing safety, enhancing oral control, and maintaining nutritional intake through tailored thickening strategies. Our experience demonstrates the importance of using specialized thickening agents to prevent aspiration pneumonia and, ultimately, improve the well-being of affected children. We also highlighted the importance of individualized treatment plans, which consider each child's unique needs. A comprehensive evaluation by a multidisciplinary team led to an effective treatment strategy tailored to the child's specific condition and challenges., Conclusions: The new locust bean- and xanthan gum-based thickener is effective in managing dysphagia and preventing complications in infants and young children. Such agents can improve swallowing safety, enhance oral control, and maintain nutritional intake, ultimately improving the well-being of the affected children.

Introduction: Post-stroke dysphagia (PSD) is a widely prevalent and possibly life-threatening consequence that may lead to aspiration pneumonia, malnutrition, dehydration, and higher mortality risk. Recommending thickened fluids (TF) is a longstanding practice in the management of dysphagia. Augmenting liquid viscosity with a xanthan gum-based thickener benefits patients with PSD by aiding in the enhancement of bolus control, facilitating improved coordination in the swallowing mechanism, and lowering the risk of aspiration. Despite the widespread use of TF, limited high-quality evidence supports its benefits in PSD., Case Report: This manuscript presents the clinical experience with four varied cases of PSD. A comprehensive approach to management with TF decreased the risk of aspiration pneumonia and facilitated effective management of dietary recommendations both during hospitalization and after discharge (all Cases). In addition, TF maintained nutrition and hydration in patients with multiple hospital admissions (Case 2), maintained hydration in those unable to engage in swallow rehabilitation due to complex medical conditions (Cases 2, 3, and 4), and those who needed slow and longer recovery due to long-term risk of silent aspiration (Cases 2, 3, and 4). In one case (Case 4), the use of TF was extended for more than two years post-stroke with no reported incidence of chest infection., Conclusion: In routine clinical practice, a comprehensive management approach with xanthan gum-based TFs reduces the risk of aspiration and aspiration pneumonia in patients with PSD while maintaining nutritional and hydration and improving swallowing function based on formal instrumental assessments. This clinical experience highlights the pivotal role of instrumental assessment, patient education, and informed decision-making to optimize outcomes with TF.

Despite limited supporting evidence, the practice of thickening breast milk or infant formula with commercially available thickening agents is prevalent. This study explored the viscosity-enhancing impact of carob bean gum (CBG) and sodium carboxymethylcellulose (NaCMC) when added to infant formula at various concentrations and for different thickening durations. The findings indicate that thickening leads to an exponential increase in milk viscosity, from 25% of the recommended dosage onward. This suggests that minor adjustments in dosage can significantly impact formula thickness, underscoring the importance of accurately dosing and preparing infant milk. The considerable variability in viscosity also emphasizes the need for thoughtful selection of teat size, considering the energy expenditure of the sucking infant. When using 50% of the recommended CBG dose or 25% of NaCMC, the resulting viscosity matches that of a commercially available casein-based formula containing CBG for anti-regurgitation. In the case of CBG, a viscosity plateau is only reached after 30 min. Therefore, educating parents on the correct handling and preparation steps for CBG-thickened infant milk is crucial, including a 30-min waiting period to achieve the intended thickening effect., Competing Interests: The authors have no relevant financial or nonfinancial interests to disclose., (© 2024 The Authors. Food Science & Nutrition published by Wiley Periodicals LLC.)

When vancomycin hydrochloride (VCM) powder mixes with xanthan gum-based thickening agents in food, lumps or other property-related changes may occur. Previous studies have reported delayed disintegration and elution of the drug and its adsorption on to xanthan gum, which is the main ingredient of thickened food products. If the addition of thickening agents can affect the antimicrobial activity of VCM powder as previously reported, it might interfere with the treatment of Clostridioides difficile infection (CDI). In this study, we investigated the effect of the addition of xanthan gum-based thickening agents on the antibacterial activity of VCM against Clostridioides difficile in vitro. The VCM concentration at 0 min after adding 3% Tsururinko Quickly (Clinico, Tokyo) to VCM powders (Shionogi, Osaka and Meiji Seika Pharma, Tokyo) was lower than that of the control [Shionogi: 65.15±35.57%, Meiji Seika Pharma: 77.00±15.81% (mean±standard deviation), ** p<0.01, Dunnet's test]. However, the VCM concentration at 30 min after the addition recovered to the control level. The drug susceptibility tests for C. difficile and Staphylococcus aureus using the disk diffusion method showed no effect of addition of 3% Tsururinko Quickly. Our in vitro evaluations showed that the addition of xanthan gum-based thickeners to VCM powders had a negligible effect on the treatment of CDI.

Water containing low amounts of cellulose nanofiber (CNF) is widely used as a thickening agent owing to its three unique properties: high transparency, viscosity, and controllable viscosity based on the shear rate. CNF dry powders are used to reduce the transportation and storage costs or expand applications as a thickening agent. Herein, the preparation of CNF dry powders that can be used to obtain redispersions while maintaining the aforementioned properties is reported. In this regard, the dehydration and vaporization procedures for a CNF water dispersion without using additives are discussed. When dry powders are prepared by removing water by boiling, their redispersions do not exhibit all their unique properties because of dense aggregations. However, when their redispersions are vigorously stirred to break the dense aggregations, they become transparent, although they do not recover their initial viscosity. Freeze-dried powders recover all their initial properties after redispersion. Nevertheless, their large volume does not reduce the transportation and storage costs. When the liquid is evaporated from the solvent-exchanged CNF organogels, their redispersions also fully recover all their properties. Furthermore, the evaporative dry powders with dense small volumes and good handling contribute to reducing the transportation and storage costs., (© 2023 The Authors. Macromolecular Rapid Communications published by Wiley-VCH GmbH.)

Locust bean gum (LBG), a vegetable galactomannan extracted from carob tree seeds, is extensively used in the food industry as a thickening agent (E410). Its molecular conformation in aqueous solutions determines its solubility and rheological performance. LBG is an interesting polysaccharide also because of its synergistic behavior with other biopolymers (xanthan gum, carrageenan, etc.). In addition, this hydrocolloid is easily modified by derivatization or crosslinking. These LBG-related products, besides their applications in the food industry, can be used as encapsulation and drug delivery devices, packaging materials, batteries, and catalyst supports, among other biopharmaceutical and industrial uses. As the new derivatized or crosslinked polymers based on LBG are mainly biodegradable and non-toxic, the use of this polysaccharide (by itself or combined with other biopolymers) will contribute to generating greener products, considering the origin of raw materials used, the modification procedures selected and the final destination of the products.

Viscosity measurement using a cone-and-plate rheometer is considered to provide an objective and reliable evaluation of thickening agents for dysphagia management. Here, we showed its measurement uncertainty in the context of an inter-laboratory study. Eight test samples (i.e., four viscosity standard liquids, one xanthan gum reagent powder, and three commercial thickening agent powders) were distributed to 10 laboratories in a blinded manner. According to the same standard operating procedure, each laboratory dissolved the xanthan gum or thickening agents at four concentrations (0.5-4.0 g/100 g) and then measured their viscosity (35-803 mPa∙s). As for the viscosity of the standard liquids, the grand means were 98-100% of the certified values, and the relative standard deviations for repeatability (RSD r ) and reproducibility (RSD R ) were ca. 1% and ca. 5%, respectively, suggesting good accuracy in the measurement process. On the other hand, as for the viscosity of the thickening agents, RSD r and RSD R were ca. 2-6% and ca. 5-8%, respectively; however, heterogeneity in the preparation process comprising a manual dissolving step may increase these to near 60%. Furthermore, RSD r and RSD R of estimated additive concentrations to achieve targeted viscosities (50-500 mPa∙s) based on concentration-viscosity curves were ca. 1-3% and ca. 3-5%, respectively, with a few exceptions. These findings suggest that a strictly standardized procedure provides reliable data on the viscosity measurements for thickening agents., (© 2022 Wiley Periodicals LLC.)

The aim of this review is to assess the objective and subjective diagnosis, as well as symptomatic topical treatment of dry mouth conditions with a clear focus on textural perspective. We critically examine both the current practices as well as outline emerging possibilities in dry mouth diagnosis and treatment, including a patent scan for saliva substitutes. For diagnosis, salivary flow rates and patient-completed questionnaires have proven to be useful tools in clinical practice. To date, objective measurements of changes in mechanical properties of saliva via rheological, adsorption, and tribological measurements and biochemical properties of saliva such as assessing protein, mucins (MUC5B) are seldom incorporated into clinical diagnostics; these robust diagnostic tools have been largely restricted to application in non-clinical settings. As for symptomatic treatments of dry mouth, four key agents including lubricating, thickening, adhesive, and moisturizing agents have been identified covering the overall landscape of commercial saliva substitutes. Although thickening agents such as modified celluloses, polysaccharide gum, polyethylene glycol, and so forth are most commonly employed saliva substitutes, they offer short-lived relief from dry mouth and generally do not provide boundary lubrication properties of real human saliva. Innovative technologies such as self-assembly, emulsion, liposomes, and microgels are emerging as novel saliva substitutes hold promise for alternative approaches for efficient moistening and lubrication of the oral mucosa. Their adoption into clinical practice will depend on their efficacies, duration of relief, and ease of application by the practitioners and patient compliance., (© 2020 Wiley Periodicals LLC.)

(1) Background: The effect of dopaminergic treatment on swallowing response in patients with Parkinson's disease (PD) suffering oropharyngeal dysphagia (OD) is not understood. Aim: To characterize OD pathophysiology in PD and to assess whether dopaminergic states affect swallow function and the effect of thickeners. (2) Methods: Fifty patients with PD (40 evaluated in OFF/ON states) and 12 healthy volunteers (HVs) were evaluated with videofluoroscopy (VFS) to assess the swallowing biomechanics and kinematics of the swallowing response at three different shear-viscosities (<50, 120, and 4000 mPa·s); (3) Results: Patients presented a mean age of 70.46 ± 10.03 years. Disease evolution was 5.09 ± 3.86 year and Hoehn-Yahr stage was 2.32 ± 0.81. For HVs, mean age was 40.20 ± 2.50 year. Penetrations were present in 37.50% of PD patients and were associated with delayed laryngeal vestibule closure (LVC = 293.33 ± 90.07 ms). In contrast, HVs presented a LVC = 164.00 ± 39.78 ms ( p < 0.05). An LVC ≥ 260 ms cutoff predicted unsafe swallow (sensitivity ≥ 0.83, specificity ≥ 0.57, AUC = 0.80) in PD. Increasing bolus viscosity improved deglutition safety but increased oropharyngeal residue. There were no differences in swallowing between the OFF/ON states. (4) Conclusions: In initial PD stages, oropharyngeal swallow response is severely delayed, while mildly impaired swallow safety improves with increasing bolus viscosity, which increases residue. Dopaminergic treatment does not affect swallowing or the therapeutic effect of thickeners.

The aim of the present study was to determine the effect of four different thickening agents (guar gum, carrageenan, xanthan gum, and gelatin) on the textural and sensory properties of white cheese. For this purpose, various white cheeses were manufactured with brines (the salt ratio was 8% and 12%) that contained different types and concentrations of gums; white cheese textural and sensory properties were studied during storage (at 4 °C). Also, microbiological properties including lactic acid bacteria (LAB) and mesophilic aerobic bacteria were investigated. The physicochemical, textural, microbiological, and sensory properties of the cheeses were determined on the 1st, 15th, and 30th days of storage. During the storage period of cheese, the top-rated samples in terms of sensory properties were cheeses with gelatin and carrageenan gum. The microbiological data displayed that there was an inverse relationship between the number of bacteria and the amount of gum used, although it was not precisely linear. At the same time, the highest values were generally determined in the control samples, and although not to a very great extent, gelatinous examples were found to contain a lower number of lactic acid bacteria than others. Regarding the textural properties, the hardness value of all samples containing gelatin showed a continuous increasing trend, while the springiness values increased only in the samples with xanthan gum and guar gum. At the end of storage, it was observed that the inherent adhesiveness of the samples decreased by more than half and the use of gelatin resulted in an increase in the gumminess of the cheeses. As a result, it was determined that reducing the salt used in the brine by up to 8% did not cause any defect since stabilizers were preventing water passage into the cheese by holding water.

Objectives: This study aimed to provide an overview of the characteristics of thickened formulas to aid health care providers manage infants with regurgitations., Methods: The indications, properties, and efficacy of different thickening agents and thickened formulas on regurgitation and gastroesophageal reflux in infants were reviewed. PubMed and the Cochrane database were searched up to December 2016., Results: Based on the literature review, thickened formulas reduce regurgitation, may improve reflux-associated symptoms, and increase weight gain. However, clinical efficacy is related to the characteristics of the formula and of the infant. Commercial thickened formulas are preferred over the supplementation of standard formulas with thickener because of the better viscosity, digestibility, and nutritional balance. Rice and corn starch, carob bean gum, and soy bean polysaccharides are available as thickening agents. Hydrolyzed formulas have recently shown promising additional benefit., Conclusions: Thickened formulas reduce the frequency and severity of regurgitation and are indicated in formula-fed infants with persisting symptoms despite reassurance and appropriate feeding volume intake., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Objective: To evaluate the compatibility of commercially available eye drop surface tension with the tear film physiological range and to characterize commonly used ophthalmic excipients in terms of their surface activity under eye-biorelevant conditions., Significance: There are a number of quality requirements for the eye drops (e.g. tonicity, pH, viscosity, refractive index) that needs to comply with the physiological parameters of the eye surface. However, the adjustment of surface tension properties of the eye drops to the normal range of surface tension at the air/tear fluid interface (40-46 mN/m) has received rather less attention thus far. Yet, the surface tension at the air/tear fluid interface is of vital importance for the normal function of the eye surface., Methods: The surface tension compatibility of the isotonic aqueous solutions of commonly used ophthalmic excipients as well as 18 approved eye drops with the tear fluid have been evaluated using surface tension method., Results: Each ophthalmic ingredient including the preservatives, solubilizing agents and thickening agents can influence the surface tension of the final formulation. In case of complex ophthalmic formulations one should also consider the possible interactions among excipients and consequent impact on overall surface activity. Out of 18 evaluated eye drops, three samples were within, 12 samples were below and three samples were above the physiological range of the tear fluid surface tension., Conclusions: Our results provide a rationale for clinical studies aiming to assess the correlation between the eye drops surface tension and the tear film (in)stability.