Update on Thickened Fluids

On Twitter I saw the following article linked: ”

A randomised trial of the effect of different fluid consistencies used in the management of dysphagia on quality of life: a time trade-off study

Briefly, the authors found that “on average those allocated to Grade 2 fluid would be willing to sacrifice 5 years of a 10-year lifespan not to be restricted to fluid of that consistency.” I’m not familiar with how the thicknesses (in this case Irish) compare to those in Australia. ‘Those’ in this case refers to non-dysphagic patients and healthcare professionals.

While I suggest that the study was at least partly lighthearted, there is an issue I have with the paper:

  • All participants only trialed water thickened by powder:
    • “Subjects were randomly allocated to sample from one of two opaque containers prepared within the previous 30 min with Nutilis powder (a modified starch thickener (Nutricia)): one of Grade 1 (very mildly thick [15], equivalent to ‘naturally thick fluid’ in the UK [16]) and the other of Grade 2 consistency (mildly thick, equivalent to Stage 1 thickened fluid in the UK and nectar-like consistency in the USA).”
    • I’ve written before about patients’ dislike of thickened fluids here.
    • Patients generally prefer pre-thickened fluids, and in my experience prefer flavoured fluids to thickened water.
    • It would have been nice to compare this, but perhaps the study was reflecting the fact that many people in the community with chronic dysphagia cannot afford to buy pre-thickened fluids long-term (which is more expensive than thickening at home).

Just a quick thing to think about before presenting this research to patients who are considering long-term management options for chronic dysphagia.

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