Bolus Texture Testing as a Clinical Method for Evaluating Food Oral Processing and Choking Risk: A Pilot Study

Area of Science:

• Food science
• Biomechanics
• Clinical nutrition

Background:

• Choking is a significant cause of accidental death, particularly in vulnerable populations.
• Incomplete oral processing can lead to unsafe food boluses, increasing choking risk.
• Current clinical mastication tests do not assess chewed food bolus properties.

Purpose of the Study:

• To characterize expectorated food boluses after oral processing using International Dysphagia Diet Standardisation Initiative (IDDSI) methods.
• To evaluate the suitability of IDDSI testing for assessing oral processing efficacy.
• To determine if expectorated boluses are representative of swallowed boluses.

Main Methods:

• Seventeen adults without dysphagia chewed cracker, carrot, and gummy candy samples.
• Chewing metrics were recorded until the point of swallow readiness.
• Expectorated boluses were analyzed using IDDSI standardized tests.

Main Results:

• No significant differences in chewing metrics between expectorated and swallowed conditions.
• Expectorated cracker and carrot boluses met IDDSI Level SB6 (Soft & Bite-Sized) or lower particle size criteria.
• Gummy candy samples consistently remained at IDDSI Level RG7 (Regular) consistency.

Conclusions:

• Expectorated boluses accurately represent swallowed boluses in adults without dysphagia.
• Oral processing typically reduces food particle size to IDDSI Level SB6 or lower.
• IDDSI testing offers a practical approach to evaluate oral processing and guide food texture recommendations for individuals at choking risk.