Purpose: This study aimed to evaluate the effects of different barium sulfate concentrations (%0, %20, and %30, v/w) on the rheological properties and International Dysphagia Diet Standardisation Initiative (IDDSI) classifications of thickened liquids prepared with five commercial thickening agents (TUC, NUC, PRA, TUS, NUP).
Method: Samples were formulated to meet IDDSI Levels 1, 2, and 3 and tested at a fixed shear rate of 50 s⁻¹, which is widely used in the literature to simulate swallowing behavior in dysphagia patients. Additionally, the IDDSI syringe test was conducted to assess the volume of fluid remaining in the syringe after 10 seconds.
Results: The results revealed that increasing barium sulfate concentrations led to a systematic rise in both viscosity and residual syringe volume. Some Level 1 and 2 formulations shifted to higher IDDSI levels (Level 2 or 3) when barium was added at 30%. Level 3 formulations often reached Level 4, with no visible flow at all.
Conclusion: These findings highlight that barium sulfate acts not only as a radiopaque agent but also as a physical modifier that significantly affects fluid flow behavior. Even with a 10% or 20% reduction in thickener concentration, the impact of barium was not completely offset in some formulations. Particularly with xanthan-based products, the increase in viscosity due to barium was more pronounced. These results underline the need for formulation-specific calibration of barium-containing liquids used in VFSS procedures to ensure alignment with real-life dietary recommendations.
Keywords
swallowing test, barium sulfate, thickened liquids, viscosity, IDDSI, VFSS, dysphagia, commercial thickeners
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