IALP 2025

Variability in Thickening Outcomes of Enteral Formulas in Taiwan: Implications for Dysphagia Management

Tien-hsin Liu Ms Hui An Huang Ms Chih Yu Wang
Department of Rehabilitation, National Taiwan University Hsin-Chu Branch, Taiwan

This study explores some of the factors that affect thickening of commonly used enteral formulas in Taiwan to provide clinical recommendations for speech-language pathologists (SLPs). A change in consistency is one of the techniques used for dysphagia management. Previous studies suggest that stirring, standing time, temperature, and energy density of formulas will affect thickening of the mix (Wakita et al., 2012; Badia-Olmos et al., 2022). Thickening of enteral formulas for dysphagic patients is a common practice in Taiwan; however, the results of thickening depend on the formula types.

Five types of enteral formulas: standard formula, formula for renal disease patients, diabetes formula, high-calorie, and elemental formula were tested. Researchers added two scoops (1.2 g per scoop) of thickener to 200 ml of each formula. Viscosity was measured with the IDDSI framework at 1, 5, 10, and 15 minutes. All the samples were divided into two groups: stirred group and unstirred group. Samples in the stirred group will be stirred for 30 seconds before measurement, while in the unstirred group, they are left static. Results demonstrated variable thickening outcomes: standard formula reaches IDDSI Level 2 after 15 minutes, while elemental formula in the stirred group reached the same level within 5 minutes. The stirred group reached IDDSI Level 3 in 10 minutes for the diabetes-specific formula. All stirred samples thickened better than the unstirred group of the same formula. However, after 15 minutes, renal disease and high-calorie formulas did not reach higher IDDSI levels and caused blockages in IDDSI syringes.

These findings showed that enteral formulas vary in their thickening performances, and stirring is a strategy to optimize the thickening properties. The studies provided more details for SLPs to provide better dysphagia management.

References

Badia‐Olmos, C., Laguna, L., Rizo, A., & Tárrega, A. (2022). Dysphagia thickeners in context of use: Changes in thickened drinks viscosity and thixotropy with temperature and time of consumption. Journal of texture studies, 53(3), 383-395.

Wakita, M., Masui, H., Ichimaru, S., & Amagai, T. (2012). Determinant factors of the viscosity of enteral formulas: basic analysis of thickened enteral formulas. Nutrition in clinical practice, 27(1), 82-90.