{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T11:34:51Z","timestamp":1789385691359,"version":"build-2803163510"},"reference-count":46,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2020,6,23]],"date-time":"2020-06-23T00:00:00Z","timestamp":1592870400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Fresenius Kabi Deutschland GmbH","award":["Research Grant"],"award-info":[{"award-number":["Research Grant"]}]},{"DOI":"10.13039\/501100004587","name":"Instituto de Salud Carlos III","doi-asserted-by":"publisher","award":["14\/00453"],"award-info":[{"award-number":["14\/00453"]}],"id":[{"id":"10.13039\/501100004587","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004587","name":"Instituto de Salud Carlos III","doi-asserted-by":"publisher","award":["18\/00241"],"award-info":[{"award-number":["18\/00241"]}],"id":[{"id":"10.13039\/501100004587","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Sistema Nacional de Salud","award":["INT\/00026"],"award-info":[{"award-number":["INT\/00026"]}]},{"name":"Sistema Nacional de Salud","award":["INT16\/00111"],"award-info":[{"award-number":["INT16\/00111"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Thickened fluids are a therapeutic strategy for oropharyngeal dysphagia (OD). However, its therapeutic effect among different phenotypes of OD patients has not yet been compared. We aimed to assess the therapeutic effect and \u03b1-amylase resistance of a mixed gum\/starch thickener [Fresubin Clear Thickener\u00ae (FCT)] on four phenotypes of OD patients: G1) 36 older; G2) 31 head\/neck cancer (HNC); G3) 30 Parkinson\u2019s disease; and G4) 31 chronic post-stroke. Therapeutic effect of FCT was assessed during videofluoroscopy using the Penetration-Aspiration Scale (PAS), for 5\/20 mL boluses, at four levels of shear-viscosity (&lt;50, 250, 1000 and 2000 mPa\u00b7s). The effect of \u03b1-amylase was assessed after 30 s of oral incubation. Patients had high prevalence of VFS signs of impaired efficacy (98.44%) and safety (70.31%) of swallow with a severe PAS score (4.44 \u00b1 0.20). Most severe OD was in HNC (80.6% unsafe swallows). FCT showed a strong therapeutic effect on the safety of swallow at a range between 250\u20131000 mPa\u00b7s (74.19\u201396.67%, safe swallows in G1, G3, G4, and 58.06% in G2), without increasing pharyngeal residue. Viscosity was unaffected by \u03b1-amylase. Increasing shear-viscosity with FCT causes a strong viscosity-dependent therapeutic effect on the safety of swallow. This effect depends on the phenotype and is similar among older, Parkinson\u2019s and post-stroke patients.<\/jats:p>","DOI":"10.3390\/nu12061873","type":"journal-article","created":{"date-parts":[[2020,6,23]],"date-time":"2020-06-23T09:05:33Z","timestamp":1592903133000},"page":"1873","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":74,"title":["Therapeutic Effect, Rheological Properties and \u03b1-Amylase Resistance of a New Mixed Starch and Xanthan Gum Thickener on Four Different Phenotypes of Patients with Oropharyngeal Dysphagia"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6178-3748","authenticated-orcid":false,"given":"Omar","family":"Ortega","sequence":"first","affiliation":[{"name":"Gastrointestinal Physiology Laboratory, CIBERehd CSdM-UAB, Hospital de Matar\u00f3, 08404 Matar\u00f3, Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red, Enfermedades Hepato-Digestivas (CIBERehd) Instituto de Salud Carlos III, 28029 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8896-1150","authenticated-orcid":false,"given":"Mireia","family":"Bol\u00edvar-Prados","sequence":"additional","affiliation":[{"name":"Gastrointestinal Physiology Laboratory, CIBERehd CSdM-UAB, Hospital de Matar\u00f3, 08404 Matar\u00f3, Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red, Enfermedades Hepato-Digestivas (CIBERehd) Instituto de Salud Carlos III, 28029 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Viridiana","family":"Arreola","sequence":"additional","affiliation":[{"name":"Gastrointestinal Physiology Laboratory, CIBERehd CSdM-UAB, Hospital de Matar\u00f3, 08404 Matar\u00f3, Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red, Enfermedades Hepato-Digestivas (CIBERehd) Instituto de Salud Carlos III, 28029 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1267-3475","authenticated-orcid":false,"given":"Weslania Viviane","family":"Nascimento","sequence":"additional","affiliation":[{"name":"Gastrointestinal Physiology Laboratory, CIBERehd CSdM-UAB, Hospital de Matar\u00f3, 08404 Matar\u00f3, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7149-7948","authenticated-orcid":false,"given":"Noem\u00ed","family":"Tomsen","sequence":"additional","affiliation":[{"name":"Gastrointestinal Physiology Laboratory, CIBERehd CSdM-UAB, Hospital de Matar\u00f3, 08404 Matar\u00f3, Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red, Enfermedades Hepato-Digestivas (CIBERehd) Instituto de Salud Carlos III, 28029 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Crispulo","family":"Gallegos","sequence":"additional","affiliation":[{"name":"Product and Process Engineering Center, Fresenius Kabi Deutschland GmbH, 61352 Bad Homburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edmundo","family":"Brito-de La Fuente","sequence":"additional","affiliation":[{"name":"Product and Process Engineering Center, Fresenius Kabi Deutschland GmbH, 61352 Bad Homburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0696-8560","authenticated-orcid":false,"given":"Pere","family":"Clav\u00e9","sequence":"additional","affiliation":[{"name":"Gastrointestinal Physiology Laboratory, CIBERehd CSdM-UAB, Hospital de Matar\u00f3, 08404 Matar\u00f3, Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red, Enfermedades Hepato-Digestivas (CIBERehd) Instituto de Salud Carlos III, 28029 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,6,23]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (2020, February 19). International Statistical Classification of Diseases and Related Health Problems 10th Revision. Available online: http:\/\/apps.who.int\/classifications\/icd10\/browse\/2016\/en."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1038\/nrgastro.2015.49","article-title":"Dysphagia: Current reality and scope of the problem","volume":"12","author":"Shaker","year":"2015","journal-title":"Nat. Rev. Gastroenterol. Hepatol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1403","DOI":"10.2147\/CIA.S107750","article-title":"European Society for Swallowing Disorders\u2013European Union Geriatric Medicine Society white paper: Oropharyngeal dysphagia as a geriatric syndrome","volume":"11","author":"Baijens","year":"2016","journal-title":"Clin. Interv. Aging"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1118","DOI":"10.1046\/j.1532-5415.2002.50270.x","article-title":"Prevalence of impaired swallowing in institutionalized older people in taiwan","volume":"50","author":"Lin","year":"2002","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1111\/j.1532-5415.2010.03227.x","article-title":"Prevalence Of Oropharyngeal Dysphagia And Impaired Safety And Efficacy Of Swallow In Independently Living Older Persons","volume":"59","author":"Hinojosa","year":"2011","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"410","DOI":"10.1016\/j.ijrobp.2008.04.048","article-title":"Factors Associated With Long-Term Dysphagia After Definitive Radiotherapy for Locally Advanced Head-and-Neck Cancer","volume":"73","author":"Caudell","year":"2009","journal-title":"Int. J. Radiat. Oncol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2756","DOI":"10.1161\/01.STR.0000190056.76543.eb","article-title":"Dysphagia After Stroke","volume":"36","author":"Martino","year":"2005","journal-title":"Stroke"},{"key":"ref_8","unstructured":"Muriana, D. (2016). Factors de risc cl\u00ednics, fisiopatol\u00f2gics i topogr\u00e0fics associats a disf\u00e0gia orofar\u00edngea en pacients amb ictus. [Ph.D. Thesis, Unitat d\u2019Exploracions Funcionals Digestives\/Servei Neurologia\/Departament Medicina, Universitat Aut\u00f2noma de Barcelona, (UAB)]."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e13338","DOI":"10.1111\/nmo.13338","article-title":"Prevalence, risk factors and complications of oropharyngeal dysphagia in stroke patients: A cohort study","volume":"30","author":"Rofes","year":"2018","journal-title":"Neurogastroenterol. Motil."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1016\/j.parkreldis.2011.11.006","article-title":"Prevalence of oropharyngeal dysphagia in Parkinson\u2019s disease: A meta-analysis","volume":"18","author":"Kalf","year":"2012","journal-title":"Park. Relat. Disord."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"851","DOI":"10.1111\/j.1365-2982.2010.01521.x","article-title":"Pathophysiology of oropharyngeal dysphagia in the frail elderly","volume":"22","author":"Rofes","year":"2010","journal-title":"Neurogastroenterol. Motil."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1093\/ageing\/afs006","article-title":"Oropharyngeal dysphagia as a risk factor for malnutrition and lower respiratory tract infection in independently living older persons: A population-based prospective study","volume":"41","author":"Palomera","year":"2012","journal-title":"Age Ageing"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"American Gastroenterological Association (1999). American Gastroenterological Association medical position statement on management of oropharyngeal dysphagia. Gastroenterology, 23, 452\u2013454.","DOI":"10.1016\/S0016-5085(99)70143-5"},{"key":"ref_14","unstructured":"Logemann, J.A. (1998). Manual for the Videofluorographic Study of Swallowing, Pro-Ed. [2nd ed.]."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1159\/000266348","article-title":"Dysphagia: Evaluation and Treatment","volume":"47","author":"Logemann","year":"1995","journal-title":"Folia Phoniatr. et Logop."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1385","DOI":"10.1111\/j.1365-2036.2006.03118.x","article-title":"The effect of bolus viscosity on swallowing function in neurogenic dysphagia","volume":"24","author":"Arreola","year":"2006","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1007\/s00455-009-9239-7","article-title":"Effects of Therapy in Oropharyngeal Dysphagia by Speech and Language Therapists: A Systematic Review","volume":"25","author":"Speyer","year":"2009","journal-title":"Dysphagia"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1007\/BF00714593","article-title":"Videofluoroscopic predictors of aspiration in patients with oropharyngeal dysphagia","volume":"9","author":"Perlman","year":"1994","journal-title":"Dysphagia"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1044\/1058-0360(2005\/003)","article-title":"Thickened liquids: Practice patterns of speech-language pathologists","volume":"14","author":"Garcia","year":"2005","journal-title":"Am. J. Speech-Language Pathol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1093\/ageing\/afi187","article-title":"Improving care for patients with dysphagia","volume":"34","author":"Rosenvinge","year":"2005","journal-title":"Age Ageing"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1016\/bs.afnr.2016.11.008","article-title":"Nutritional Aspects of Dysphagia Management","volume":"81","author":"Gallegos","year":"2017","journal-title":"Adv. Food Nutr. Res."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1007\/s00455-011-9330-8","article-title":"The Effect of Saliva on the Viscosity of Thickened Drinks","volume":"27","author":"Hanson","year":"2011","journal-title":"Dysphagia"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1111\/1460-6984.12120","article-title":"Effect of human saliva on the consistency of thickened drinks for individuals with dysphagia","volume":"50","author":"Vallons","year":"2014","journal-title":"Int. J. Lang. Commun. Disord."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1007\/s00455-016-9696-8","article-title":"Effect of Bolus Viscosity on the Safety and Efficacy of Swallowing and the Kinematics of the Swallow Response in Patients with Oropharyngeal Dysphagia: White Paper by the European Society for Swallowing Disorders (ESSD)","volume":"31","author":"Newman","year":"2016","journal-title":"Dysphagia"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1169","DOI":"10.1111\/apt.12696","article-title":"The effects of a xanthan gum-based thickener on the swallowing function of patients with dysphagia","volume":"39","author":"Rofes","year":"2014","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1007\/s00455-015-9672-8","article-title":"A Comparative Study Between Modified Starch and Xanthan Gum Thickeners in Post-Stroke Oropharyngeal Dysphagia","volume":"31","author":"Vilardell","year":"2015","journal-title":"Dysphagia"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e13695","DOI":"10.1111\/nmo.13695","article-title":"Effect of a gum-based thickener on the safety of swallowing in patients with poststroke oropharyngeal dysphagia","volume":"31","author":"Rofes","year":"2019","journal-title":"Neurogastroenterol. Motil."},{"key":"ref_28","unstructured":"Gallegos, C. (2010). Non-Newtonian Fluids. Rheology, Vol. I. Oxford: Encyclopaedia of Life Support Systems (EOLSS), Springer."},{"key":"ref_29","unstructured":"Ekberg, O. (2017). Rheological Aspects of Swallowing and Dysphagia: Shear and Elongational Flows. Dysphagia. Medical Radiology, Springer."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"806","DOI":"10.1016\/j.clnu.2008.06.011","article-title":"Accuracy of the volume-viscosity swallow test for clinical screening of oropharyngeal dysphagia and aspiration","volume":"27","author":"Arreola","year":"2008","journal-title":"Clin. Nutr."},{"key":"ref_31","first-page":"61","article-title":"FUNCTIONAL EVALUATION: THE BARTHEL INDEX","volume":"14","author":"Mahoney","year":"1965","journal-title":"Md. State Med, J."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"337","DOI":"10.3109\/07853890109002087","article-title":"EQ-5D: A measure of health status from the EuroQol Group","volume":"33","author":"Rabin","year":"2001","journal-title":"Ann. Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"782","DOI":"10.1007\/s12603-009-0214-7","article-title":"Validation of the Mini Nutritional Assessment short-form (MNA\u00ae-SF): A practical tool for identification of nutritional status","volume":"13","author":"Kaiser","year":"2009","journal-title":"J. Nutr. Health Aging"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1159\/000339979","article-title":"The Volume-Viscosity Swallow Test for Clinical Screening of Dysphagia and Aspiration","volume":"72","author":"Rofes","year":"2012","journal-title":"Nestl\u00e9 Nutr. Inst. Workshop Ser."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"706","DOI":"10.1007\/s00455-016-9736-4","article-title":"A Comparative Study Between Two Sensory Stimulation Strategies After Two Weeks Treatment on Older Patients with Oropharyngeal Dysphagia","volume":"31","author":"Ortega","year":"2016","journal-title":"Dysphagia"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1007\/BF00417897","article-title":"A penetration-aspiration scale","volume":"11","author":"Rosenbek","year":"1996","journal-title":"Dysphagia"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1111\/nyas.12234","article-title":"Neuogenic and oropharyngeal dysphagia","volume":"1300","author":"Rofes","year":"2013","journal-title":"Ann. N. Y. Acad. Sci."},{"key":"ref_38","unstructured":"World Health Organization and Uppsala Monitoring Centre (2014). The use of the WHO-UMC system for standardized case causality assessment. Uppsala Uppsala Monit. Cent., 48, 194\u2013203."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"576","DOI":"10.1016\/j.jamda.2017.02.015","article-title":"Diagnosis and Management of Oropharyngeal Dysphagia Among Older Persons, State of the Art","volume":"18","author":"Ortega","year":"2017","journal-title":"J. Am. Med Dir. Assoc."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"e13111","DOI":"10.1111\/nmo.13111","article-title":"Videofluoroscopic assessment of the pathophysiology of chronic poststroke oropharyngeal dysphagia","volume":"29","author":"Vilardell","year":"2017","journal-title":"Neurogastroenterol. Motil."},{"key":"ref_41","first-page":"1066","article-title":"The effects of sensory stimulation on neurogenic oropharyngeal dysphagia","volume":"3","author":"Rofes","year":"2014","journal-title":"J. Gastroenterol. Hepatol. Res."},{"key":"ref_42","first-page":"97","article-title":"Presbyphagia and Sarcopenic Dysphagia: Association between Aging, Sarcopenia, and Deglutition Disorders","volume":"3","author":"Wakabayashi","year":"2014","journal-title":"J. Frailty Aging"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1177\/000348949710600201","article-title":"Silent Laryngopharyngeal Sensory Deficits after Stroke","volume":"106","author":"Sacco","year":"1997","journal-title":"Ann. Otol. Rhinol. Laryngol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"e12916","DOI":"10.1111\/nmo.12916","article-title":"Spatiotemporal characteristics of the pharyngeal event-related potential in healthy subjects and older patients with oropharyngeal dysfunction","volume":"29","author":"Rofes","year":"2016","journal-title":"Neurogastroenterol. Motil."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1355","DOI":"10.1111\/ene.13392","article-title":"Chronic post-stroke oropharyngeal dysphagia is associated with impaired cortical activation to pharyngeal sensory inputs","volume":"24","author":"Cabib","year":"2017","journal-title":"Eur. J. Neurol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1016\/j.wjorl.2018.05.001","article-title":"Taste acceptability of thickening agents\u2606","volume":"4","author":"Yver","year":"2018","journal-title":"World J. Otorhinolaryngol. -Head Neck Surg."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/12\/6\/1873\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T09:41:46Z","timestamp":1760175706000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/12\/6\/1873"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,6,23]]},"references-count":46,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2020,6]]}},"alternative-id":["nu12061873"],"URL":"https:\/\/doi.org\/10.3390\/nu12061873","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,6,23]]}}}