Dysphagia 18:196–202 (2003)
DOI: 10.1007/s00455-002-0105-0
Gender, Age, Vessel Size, Cup vs. Straw Sipping, and
Sequence Effects on Sip Volume
Harry T. Lawless, PhD, Sharon Bender, BS, Carol Oman, MS, and Cathy Pelletier, PhD, MS, CCC/SLP
Department of Food Science, New York State College of Agriculture and Life Sciences, Cornell University, Ithaca, New York, USA
Abstract. Two experiments were performed to ex-
amine the effects of cup size, gender, age, and pa-
rameters of sipping (cup vs. straw and sequence) on
sip volume. Increasing the size of the vessel from 150
to 600 ml increased the volume of a sip by about 15%.
Males took larger sips and had significantly larger
maximum oral capacities than females. However, in a
second group of taller females and shorter males, the
difference in sip size between genders was minimized.
A second experiment examined sip size from a cup
and straw drinking, the effects of sequential sipping
(one to five sips), personal characteristics (height,
weight), age, and gender on sip volume. Height was a
good predictor of individual differences in sip vol-
ume. Cup drinking produced larger sip volumes than
straw drinking, but only in a group of adults and not
in an elderly group. Volume per sip decreased across
sips. A reasonable guide for cup sipping is about 25
ml per sip for males and 20 ml for females. However,
this rule should be modified as a function of cup size,
straw sipping, and sequential sipping.
Key words: Sip volume — Deglutition
Deglutition disorders.
Halpern [1] classified the sip as ‘‘the basic unit of
human liquid ingestion behavior.’’ A sip is the por-
tion of liquid taken into the mouth at one time during
the process of consuming a beverage. Sip volume is of
interest to clinical practitioners and investigators of
Correspondence to: Harry T. Lawless, Ph.D., Department of Food
1 Science, Cornell University, Ithaca, NY 14853, USA. Telephone:
2 (607) 255-7363; E-mail: htll@cornell.edu
dysphagia, as it has implications for what is to be
considered a normal baseline and what volumes
should be given in diagnostic tests of swallowing
disorders. Sip volume may be influenced by many
variables. Variability in mouth size, the nature of the
container, viscosity, taste and temperature of the
sample, and the subject’s age and gender might all
affect the volume of a sample that is sipped and/or
swallowed.
Different values for a normal sip size have
been reported in the literature. Halpern [1] reported
an average of 12.75 ml for a single sip of water, with a
range of 4–29 ml. Adnerhill et al. [2] reported about
25 ml for men and 20 ml for women but some de-
crease in volume from one to three sips. Nilsson et al.
[3] reported a mean of 25.6 ml for a single sip from a
straw but a decrease to 21.1 ml during three forced
repetitive swallows. In attempting to replicate the
circumstances in poisonings, Jones and Work [4]
asked adult subjects to ingest the entire contents of a
sample container and divided the volume by the
number of swallows. This study of ‘‘piecemeal’’ or
—
multiple swallowing of larger sips led to estimated 21
ml as an average for men and 14 ml for women. Two
studies have reported much lower volumes of sipped
or swallowed samples. Hamlet et al. [5] reported
swallow volumes of 9 ml for water and 7 ml for
thickened juice. However, only 10 ml of sample was
provided. Steele and Van Lieshout [6] reported con-
sistent volumes less than 10 ml from three subjects
using repeated sips of samples of different (available)
volumes.
Several studies have documented a gender
difference in sip size with men taking 20–30% larger
sips than women [2,3]. This difference could be a re-
sult of body size, so a simple question is whether men
and women of approximately the same height and
H.T. Lawless et al.: Age, Gender, and Method Effects on Sip Volume 197

weight would take similar size sips or whether the Table 1. Mean heights and weights
gender difference would persist. Experiment 1 ad-
Males Females
dressed this issue. Another way to examine the body
size question would be to look at the overall size of Height Weight Height Weight
the oral cavity. Because of its irregular shape, this (cm) (kg) (cm) (kg)
could be estimated by filling it with liquid and mea- Group 1 176 62.0 164 49.6
suring the volume of that liquid. Mouth volume was Group 2 174 59.7 168 51.5
examined by two methods: (1) asking participants to Group 3 179 67.0 163 53.7
voluntarily fill their mouth to its maximum capacity Group 4
(Experiment 1) and (2) actually filling the oral cavity Young 181 79.5 164 62.7
Elderly 167 68.2 158 62.2
with water while the participant was supine (Experi-
ment 2).
Given the disparate values for normal sips in
the literature, it seems likely that subject character-
istics and methodological variables influence sip vol-
ume. The general objective of this work was to
investigate variables that might determine or modu-
late the volume of a sip. Due to the possibility of
interaction effects, variables were included that had
been previously studied, such as gender, age, and the
effects of sequential sipping (numbers of sips). In
order to explore the variable of age, a cohort of rel-
atively healthy free-living adults in their seventh
through ninth decades were recruited for comparison
to a group of younger adults.

Experiment 1: Effects of Gender, Body Size,

and Cup Volume

Materials and Methods

Healthy adults between the ages of 19 and 60 years (median = 32)

were recruited from the Cornell community to participate in the
study. Subjects were paid to attend three 15-minute sessions.
Group 1 consisted of 24 males and 26 females. Group 2 was se-
lectively recruited to provide a sampling of taller women and
shorter men in order to provide a gender comparison with the body
size variable minimized. It consisted of 25 males and 25 females.
Heights and weights for all groups are shown in Table 1.
Subjects’ sips and maximum capacities were measured as
follows: The drinking cups were filled to 0.6 cm below the top of
the rim with room temperature spring water and were refilled after
each replicate and task. Subjects sampled from three cups of 150,
300, and 600 ml. Only one cup was presented per session; the cup
order was counterbalanced and assigned randomly to subjects.
Subjects were told to take a sip of water as if to drink, but instead
of swallowing, they were to spit this water into a sample cup. This
was repeated immediately thereafter. Subjects were then instructed
to fill their mouths with as much water as possible without dis-
comfort, and then to spit this water into a sample cup. Expecto-
ration was used to decouple the volume sipped from what might be
swallowed and to avoid any feeling of fullness that might occur
with progression through the samples. Volumes in this experiment
were similar to those found in Experiment 2 in which swallowing
was the rule. Volume was determined by weighing the original cup
before and after expectoration and subtracting the difference.
Fig. 1. Mean sip volume and maximum fluid intake volume plotted as
a function of cup size for males and females in Experiment 1: (upper
panel) Group 1, (lower panel) Group 2.
Data were analyzed using a split-plot design with gender as
a between-group factor. All other factors were repeated measures,
and subjects (within groups) were analyzed as a random effect.
Duncan tests were used to compare individual means. Correlations
were used to examine the relationships among variables.
Results and Discussion
Group 1
Means for the size of a sip are shown in Figure 1 (upper panel).
Males had about 50% higher sip volumes than females for each cup
size [F(l,48) = 16.9, p < 0.001] (filled symbols). Average sip
volumes increased slightly with cup size [F(2,96) = 4.67, p < 0.05],
from 23.7 to 27.2 ml from smallest to largest, a change of about
198
Table 2. Correlations (Pearson) of sip volume and maximum oral
volume with body size measurements
Sip volume Maximum Weight
Group 1
Maximum 0.486*
Weight 0.349* 0.468*
Height 0.357* 0.379* 0.618*
Group 2
Maximum 0.347*
Weight 0.068 0.309*
Height 0.012 0.499* 0.625*
*p < 0.05.
15%. The second replicate was an average of 1.3 ml larger than the
first [F(1,48) = 7.12, p < 0.01]. The means for the maximum
amount of liquid that could be held comfortably in the mouth are
also shown in Figure 1 (upper panel, open symbols). Males could
take more water into their mouths than females across cup sizes
[F(1,48) = 27.3, p < 0.001]. In this case, cup size was irrelevant
(no significant effects). Although the volume of a sip was affected
by cup size, the volume of water a subject could hold in the mouth
was not affected. The second replicate was 2.6 ml larger than the
first [F(l,48) = 11.5, p < 0.001], possibly due to becoming familiar
with the cup sizes and being more comfortable with the task. Sip
and maximum capacity were correlated and related to height and
weight, as shown in Table 2. This suggests that the oral volume
difference may not be entirely a gender effect since the males in this
experiment were generally taller and heavier than the females.
Group 2
Means for the size of a sip in this group are shown in the lower
panel of Figure 1. Here, the gender difference was not significant
(filled symbols). Sips increased again with cup size [F(2,96) = 5.8,
p < 0.01] and the second replicate was larger than the first [F(1,48)
= 5.54, p < 0.05]. The means for the maximum liquid amount that
could be comfortably held in the mouth are also shown in Figure 1
(open symbols). Again, males took more water into their mouths
than females [F(1,48) = 18.3, p < 0.001]. Cup size was irrelevant
for the maximum amount. The second replicate was slightly larger
than the first replicate [F(1,48) = 15.87, p < 0.001]. Decreasing the
body size difference between the genders led to more equal sip
volumes, but the gender difference persisted in the maximum vo-
lume that was taken. Table 2 (Group 2) shows that the sip volume
was no longer correlated with height and weight, perhaps because
of the restricted range of those variables. The maximum volume
was still correlated with height and weight, however.
Experiment 2: Examination of Gender, Number
of Sips, Cup vs. Straw Sipping, and Age
Materials and Methods
Subjects for Experiment 2 made up two groups labeled Group 3
and Group 4 to distinguish them from the two groups in Experi-
H.T. Lawless et al.: Age, Gender, and Method Effects on Sip Volume
Fig. 2. Mean volume per sip for males and females as a function of
the requested number of sips, in Experiment 2, Group 3.
ment 1. Group 3 consisted of 31 men and 30 women recruited from
the Cornell University community. Subjects ranged in age from 19
to 57 years (mean = 27, median = 25). Subjects were paid to
attend five sessions on five separate days for a total of 3.5 hours of
their time. The additional time for this study was due to taste
evaluations which are not reported here.
Group 4 consisted of 89 men and women from two age
groups. The first subgroup was recruited from the Cornell Uni-
versity community (N = 67, a healthy young control group, 34
female, 18–54 years of age, mean = 26, median = 23). The second
subgroup was recruited from the retirement community of Kendal
at Ithaca (N = 22, a group of free-living older adults, 14 female,
60–94 years of age, mean = 79, median = 80). The residents were
asked to be participants only if they could easily carry on a co-
herent conversation. One older subject was confined to a wheel-
chair but weight and height were measured at his monthly doctor’s
appointment. Subjects were paid $20 to attend four sessions on
four separate days for a total of one hour of their time. No subject
reported difficulty swallowing.
For Group 3, data collection proceeded as follows: Subjects
completed five sessions on five different days. Subjects were in-
structed not to eat or drink at least one hour before the session,
come to the lab hungry or thirsty, and to arrive on time. In the first
session height, weight, mouth volume, and sip size measurements
were taken and bitterness sensitivity and salivary flow rates were
estimated (data from the last two not reported here).
For sip size estimation, subjects were presented with five
randomly coded, preweighed 300-ml cups filled 0.6 mm from the
top with water at room temperature (21°C) and a sample ran-
domization sheet with their panelist number. Subjects were asked
to take one, two, three, four or five sequential sips out of each cup.
The order in which they took the sips was randomized at each
session. To each subject, a sip was defined as a normal drink of
water—not a ‘‘taste’’ and not a ‘‘gulp’’—an amount that can be
taken into the mouth and cleared with one swallow. For multiple
sips, they took consecutive (or serial) swallows (no break to take
the cup away from the mouth). The experimenter showed subjects
exactly what was to be done if they expressed any uncertainty at all
about the task at hand. A practice cup of water was also available
for those who felt they needed one. When the task had been
completed, the residual in each cup was weighed and recorded. An
average sip size was calculated by subtracting the residual weight
H.T. Lawless et al.: Age, Gender, and Method Effects on Sip Volume 199

from the original weight and dividing this amount by the number
of sips taken.
For mouth size estimation, subjects were presented with
three randomly coded, preweighed, 300-ml cups filled 0.6 cm from
the top with water at room temperature (21°C). To assure that each
subject’s mouth would have the same position, they were asked to
lie down on the table in the conference room. They were asked to
use their mouth much like a glass. The experimenter would fill the
subject’s mouth with water from the sample cup. Subjects were
asked to form a seal (to prevent leakage into the pharynx) as the
mouth was filled. They were asked to open their mouth as much as
possible (phrased as ‘‘drop your jaw’’ and the experimenter dem-
onstrated), accept the water being poured into the mouth, and
motion to the experimenter when they thought their mouth was
full. A subject’s mouth was considered full if, when closing the lips
together (with the jaw still open, i.e., back teeth not approximating)
the subject could feel the water behind the top front teeth or be-
tween the front teeth and lips. The experimenter practiced with the
subjects until they felt comfortable with the method and measured
in triplicate. No one aspirated or reported discomfort. The residual
in the cups was weighed and the difference recorded. Mouth vol-
ume was estimated by subtracting the residual weight from the
original weight. Mouth volume and sip size tasks were repeated on
four subsequent days to provide five replications.
For Group 4, data collection proceeded as follows: Height,
weight, and mouth volume measurements were made as with
Group 3, except that panelists were not required to lie back to fill
the oral cavity for mouth volume measurements. This would have Fig. 3. Mean volume per sip for males and females of different age
been difficult with elderly subjects. Subjects remained seated for groups as a function cup vs, straw sipping and increasing numbers of
this procedure. For sip size measurements, a sip was defined as a sips in Experiment 2, Group 4.
normal drink of water—not a ‘‘taste’’ and not a ‘‘gulp’’—an
amount that can be taken into the mouth and cleared with one
swallow. In all other respects this procedure was similar to that of highly correlated with height (r = +0.75, p < 0.05).
Group 3. Straw drinking was assessed in the third and fourth ex- This variable along with the requested numbers of
perimental sessions. For the straw-drinking conditions, the cups of sips proved to have the strongest weighting in a re-
water were prepared in the same way as in the first and second
sessions, except that straws were placed in the cups, making sure
gression model, as shown in Table 3. A reasonable
that they were not touching the bottom. A sip was still defined as a predictive equation was constructed from height and
normal drink of water. For multiple sips, panelists were asked to number of sips, with R2 of 27.4% (as opposed to
swallow consecutively, which meant performing a continual sip– 33.2% when all variables are included) as follows:
swallow–sip–swallow action (not removing the straw from the
mouths). Sip volume ¼ 26:7 þ 28:7 ½height(m)
1:70 ðnumber of sipsÞ
The estimated mouth volume using the supine
Results and Discussion filling method was 54 ml for women (range=35.8–
95.8) and 66.4 ml for men (range=36.7–111.2). Note
Group 3 that this method produced lower mean values than
the voluntary filling-to-maximum procedure in Ex-
There was a significant effect of gender on sip size periment 1 which produced values in the range of 65
[F(l,59) = 11.48, p < 0.01]. As expected, males took ml for women and 85 ml for men. The supine position
larger sips. Mean volume per sip decreased as the probably involves different sensory input than a
subjects were instructed to take additional numbers maximal liquid bolus taken in an upright position.
of sips (1–5) as shown in Figure 3 [F(4,236) = 101, Having one’s mouth filled while supine is a somewhat
p < 0.0001]. Sip volumes of men and women con- unnatural feeling and may have induced subjects to
verged as the numbers of sips increased [interaction change their oral configuration or simply be more
F(4,236) = 4.76, p < 0.01]. The question of whether cautious in the amount they would accept in order to
the gender difference was again due to a body size avoid any aspiration.
difference was addressed by a multiple regression, For Group 4, cup sipping produced larger
using age, gender, height, weight, mouth volume, and volumes than straw sipping [F(1,85) = 71.1, p <
sip number as predictor variables. Mean sip size was 0.0001], but this was primarily due to a difference
200
Table 3. Multiple regression predictors for sip size—Group 3
Coefficient t-ratio p-value
Intercept )16.58 )1.98
Age 0.13 2.66
Gender 1.52 1.39
Height 16.49 3.11
Weight 0.04 1.48
Mouth volume 0.06 2.39
Number of )1.70 )6.98 <0.0001
requested sips
noted with the younger subjects and not the elderly
sample. Once again volume per sip decreased as the
number of requested sips increased [F(4,340) = 94.0,
p < 0.0001]. The cup/straw difference attenuated as
the number of sips increased [interaction F(4,340) =
20.0, p < 0.0001].
There were no main effects of age in spite of
the fact that the elderly were shorter and lighter
than the young controls (t-tests, p < 0.01). The
failure to observe an overall age difference in sip
volume is noteworthy in light of the differences in
body size, which might have been expected to fa-
cilitate smaller observed sip sizes for the elderly
subjects. However, an age difference did appear for
the cup sipping that was attenuated for straw sip-
ping [interaction F(l,85) = 25.38, p < 0.0001], there
was a small three-way interaction of this effect with
the increasing number of sips [F(4,340) = 2,46, p <
0.05]. As seen in the lower panel of Figure 3, the
difference between cup and straw sipping was gone
for the elderly group in all comparisons but the
single sip condition. There was no gender effect for
this group, but this equivalence is not conclusive due
to the small numbers of male elderly subjects tested.
Gender differences may be less salient for older age
groups. Data from the young group alone showed
once again that males took larger sips than females
with repeated sipping, but there was no difference
for the single sip condition [interaction F(4,248) =
3.04, p < 0.05].
Mouth volume estimates were similar to those
of Group 3 for the young group, with a mean of 68.7
ml (both genders, range = 25.5–127.4 ml). The older
group had significantly lower mouth volume esti-
mates of 43.4 ml (range = 14.2–73.2 ml) [t(45) = 5.6,
p < 0.0001] and, as noted above, they were shorter
and weighed less. Anecdotal reports noted by one
reviewer suggest that elderly individuals may recruit
the velum to aid in creating a posterior oral seal to
compensate for age-related dysfunction of the tongue
base. This could result in a smaller oral volume.
H.T. Lawless et al.: Age, Gender, and Method Effects on Sip Volume
Another possible reason for decreased volume is in-
creased mucosal thickening [7].
0.0486
0.0082
0.1657 Discussion
0.0020
0.1389
0.0175 The volume of a sample presented in swallowing
studies can alter the temporal characteristics of a
swallow. Tracy et al. [8] examined volumes of 1, 5, 10,
and 20 ml and noted a decrease in oral transit time
and an increase in the duration of cricopharyngeal
opening with increasing volume. These results strike a
cautionary note in that the choice of small sample
volumes relative to a normal sip may produce a
swallow with characteristics that deviate from the
normal temporal pattern. To the extent that re-
searchers wish to study normal swallowing, the
choice of a representative volume for the sample is
important. Current data suggest that uses of very
small volumes such as 1 ml for clinical assessments of
swallowing may be an unrealistically small volume.
However, unnatural but standardized situations may
still be useful as reference conditions for diagnostic
purposes if their value and utility can be demon-
strated.
A gender difference in sip volume has been
noted previously [3,5,6,9]. However, the results
shown here suggest that this might simply be a result
of differences in body size. Although the correlation
itself does not prove a causal relationship, the gender
difference was virtually eliminated when gender
groups were better matched for height. Overall, the
consideration of height provided a good predictor of
sip volume; however, the relationship is not ironclad.
The elderly group tested in Experiment 2 might have
been expected to take much smaller sip volumes but
there was no overall age effect and only an interaction
showing differences in the single sip condition. At-
tempts to estimate overall mouth volume by ad libi-
tum filling were more responsive to age and gender
differences. However, absolute levels (volume esti-
mates) varied as a function of the instructions and
method and should be considered exploratory until
further systematic study.
Parameters defined by the experimental
method can also modify volume estimates. Increases
in cup size produced a small but statistically signifi-
cant increase affecting sip volume. Our interest in this
variable was based on anecdotal reports from the oral
health care industry that cap volumes on mouthwash
products would affect the amount used per wash and
thus affect sales. Researchers in taste perception and
intake studies should be sensitive to the effects of the
H.T. Lawless et al.: Age, Gender, and Method Effects on Sip Volume
serving vessel on ad lib sampling. A difference in cup
vs. straw sipping showed that larger volumes were
taken by the younger group for cup sipping. Steele
and Van Lieshout [6] did not see this difference;
however, they tested only three individuals and
measured volumes over eight sequential sips, which
may have attenuated the effect. Our data showed an
interaction in which the difference between the two
methods was smaller with repeated sips.
Information about normal sip volume is of
obvious importance to clinical and physiological
studies of swallowing. Stimulus volume is also im-
portant in studies of oral perception and particularly
taste. Perceptions of sample volume, taste intensity,
and taste persistence vary with concentration and
volume of the stimulus [10,11]. Taste thresholds
generally decrease as stimulus volume increases [12–
15]. Judgments of taste intensity might vary as a
function of not only the stimulus volume but how
well that volume coats the oral epithelium. Subjects
with larger oral surfaces might report lower intensi-
ties due to stimulus distribution, especially with small
sample volumes and with chemical stimuli that in-
teract with the mucous coating of the mouth, such as
astringents. Astringency is a tactile sensation gener-
ated in the oral cavity by alum, tannins, or acids [16].
In previous studies of astringency [e.g., 17], stimula-
tion parameters were chosen based on previous
studies to allow comparisons of results. However, the
use of arbitrary parameters of stimulus volume de-
serves reexamination. Astringent sensations involve
the binding and precipitation of mucins and proteins
that coat the epithelium [18], and the total sensory
impact depends on the stimulus concentration and
the amount and distribution of salivary protein in the
mouth. If astringent sensations are affected by the
size of a subject’s mouth, the quantity of stimulus
needed to induce equal levels of intensity would
change depending on gender, height, and weight
correlates. One study [18] found an inverse relation-
ship of mouth size and reported intensity of astrin-
gency.
Taste sensations themselves may alter swal-
lowing in dysphagia. Logemann et al. [19] demon-
strated decreases in oral transit time with some
dysphagic patients when an intensely sour stimulus
was mixed into a barium suspension. Recent work by
our group also showed decreased probability of
penetration and aspiration among some patients
when a sour stimulus was presented and also with
sweet–sour mixtures [20]. To the extent that these
effects depend upon the taste impact of the sour
stimulus, volume of the stimulus could also play a
role because it can modify taste intensity.
201
In conclusion, these studies show effects of
gender, age, body size, cup volume, number of sips,
and sipping method (cup vs. straw) on sip volume.
Further research should collect normative data on
conditions such as cup/straw sipping and their in-
teractions with age. Our exploration of maximum
oral volume produced variable results and also re-
quires further study. Reviewers pointed out that some
spillage into the pharynx may have occurred with the
attempts to fill the oral cavity to a maximum amount.
There was no attempt to monitor this possibility in
our study but it could be monitored in future studies
radiographically. Although some of the effects are
small, physiologists and practitioners in swallowing
studies should be cautious in assuming there will be
an overall average sip size for individuals without
reference to the specific methodological parameters
used in the assessments.
Acknowledgments. The authors thank John Horne and Ricky
Nurse for their assistance in this research. This work was supported
by NIH grant DC-00902.
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