Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2025 Feb 24;37(3):e20240049.
doi: 10.1590/2317-1782/e20240049en. eCollection 2025.

Viscosity study of maternal and formula milks according to the assessment proposed by the International Dysphagia Diet Standardisation Initiative Model: a comparison with Rheological Assessment

Ana Maria Hernandez  1 , Maria Isabel Berto  2 , Esther Mandelbaum Gonçalves Bianchini  1
Affiliations
Comparative Study

Viscosity study of maternal and formula milks according to the assessment proposed by the International Dysphagia Diet Standardisation Initiative Model: a comparison with Rheological Assessment

Ana Maria Hernandez et al. Codas. .

Abstract

Purpose: The present study aimed to investigate the behavior and the viscosity classification of liquids recommended for infants, up to six months, in Brazil, and their formulations used in Videofluoroscopy Swallowing Studies.

Methods: Breast milk from different gestational and breastfeeding time, two regular infant formulas, and one anti-reflux formula were evaluated in five different formulations: pure, mixed with liquid barium sulfate, in two proportions (20 and 33%), thickened with a specific thickener for neonates and thickened and mixed with 20% liquid barium sulfate, using the International Dysphagia Diet Standardisation Initiative model. The results were compared with data obtained from a previous rheological study.

Results: The breast milk samples and the infant formulas, in pure presentation, exhibited similar behavior except for the anti-reflux formula. The thickened samples with the addition of barium and the pure liquid barium sulfate exhibited the highest viscosity among the formulations. The increase in viscosity with the addition of barium occurred for all samples and for the thickened formulations, but not in linear behavior. The results showed minor differences of IDDSI classification compared to the findings obtained in the rheological study.

Conclusion: The present study revealed the variability of liquid viscosity across different formulations, supporting the idea of the importance of this knowledge in videofluoroscopic assessment. It has also highlighted the risk associated with using a subjective method in preparing the stimuli offered, allowing for greater reliability in diagnosing swallowing dynamics in neonates and infants. This approach may help prevent inaccurate diagnoses and harmful interventions.

PubMed Disclaimer

Conflict of interest statement

Conflict of interests: nothing to declare.

Figures

Figure 1
Figure 1. Comparison of pure breast milk samples and barium-added breast milk (Bariogel®) in relation to Gestation time.
Figure 2
Figure 2. Comparison of pure breast milk samples and breast milk added Bariogel® in relation to breastfeeding time
Figure 3
Figure 3. Breast milk pure versus breast milk added barium sulfate Bariogel® - IDDSI classification
Figure 4
Figure 4. Comparison of all products in all formulations according to ml residue
Figure 5
Figure 5. Classification of all products in all formulations according IDDSI category
See this image and copyright information in PMC

References

    1. Cichero J, Nicholson T, Dodrill P. Liquid barium sulfate is not representative of infant formula: characterization of rheological and material properties. Dysphagia. 2011;26(3):264–271. doi: 10.1007/s00455-010-9303-3. - DOI - PubMed
    1. Stokely SL, Molfenter SM, Steele CM. Effects of barium concentration on oropharyngeal swallow timing measures. Dysphagia. 2014;29(1):78–82. doi: 10.1007/s00455-013-9485-6. - DOI - PMC - PubMed
    1. Steele CM, Alsanei WA, Ayanikalath S, Barbon CEA, Chen J, Cichero JAY, et al. The influence of food texture and liquid consistency modification on swallowing physiology and function: a systematic review. Dysphagia. 2015;30(1):2–26. doi: 10.1007/s00455-014-9578-x. - DOI - PMC - PubMed
    1. Gosa MM, Dodrill P. Effect of time and temperature on thickened infant formula. Nutr Clin Pract. 2017;32(2):238–244. doi: 10.1177/0884533616662991. - DOI - PubMed
    1. Fink TA, Ross JB. Are we testing a true thin fluid? Dysphagia. 2009;24(3):285–289. doi: 10.1007/s00455-008-9203-y. - DOI - PubMed

Publication types