What is the food like that people choke on? A study on food bolus physical properties under different in vitro oral capacities

Abstract

People with oral impairments, such as poor denture status, poor muscle strength, and poor salivary secretion, have more difficulties performing oral processes, which results in the risk of choking. In this study, we aimed to understand, in vitro, how different oral impairments can affect the oral processing of food reported as a choking hazard. Six foods that frequently cause choking were selected and studied, varying three in vitro factors at two levels-saliva incorporation amount, cutting activity, and compression action. The median particle size (a50) and the particle size heterogeneity (a75/25) of the food fragmentation, the hardness, and adhesiveness of the bolus formation, and the final cohesiveness of the bolus were studied. The results showed that all the parameters studied varied depending on the food product. High compression reduced a50 (except in mochi that increased) and a75/25 (except in eggs and fish) but increased bolus adhesion and particle aggregation (except for mochi). Regarding cutting activity, when performing a greater number of strokes, the particle size for sausage and egg, and the hardness of the bolus for mochi and sausage were lower. In contrast, for some food products, the bolus adhesiveness (bread) and particle aggregation (pineapple) were higher at a high number of strokes. The amount of saliva also played an important role in the creation of the bolus. When high amounts of saliva were added, the a50 values (mochi) and hardness (mochi, egg, and fish) decreased; and increased the adhesiveness (mochi) and particle aggregation (bread, pineapple, and sausage). When all oral factors are compromised (lack of muscle strength, denture status, and saliva secretion), some food products create a choking hazard as individuals cannot achieve the right particle size, bolus cohesiveness, and mechanical properties of the bolus to be safe to swallow, there is still a need to elaborate a guide, considering all the safety parameters.

Keywords: Bolus; In vitro oral processing; Mechanical properties; Oral impairment; Particle size; Swallowing.