Texture Modified Diets

Being a student dietitian is like embarking on a thrilling food adventure, and I'm here to share one exciting chapter from my journey.

I found myself in a new hospital during a 3-week public health placement.

My mission? To dig into the food scene and figure out if it’s meeting the needs of their patients. And let me tell you, it wasn't just about regular food –

I was exploring the specifics for those dealing with a unique challenge: swallowing difficulties, medically known as dysphagia.

Have you ever considered that something as basic as eating could have a surprising twist? For those with swallowing difficulties, it's a significant shift. In this scenario, the texture of your food isn't just about flavor – it's crucial for safety. This is where texture modification diets come into play like a superhero.

Photo by Louis Hansel on Unsplash

What is a Texture Modified Diet?

Texture modification, as the term suggests, involves altering the consistency of food to make it safer for consumption. This process, often involving mashing or pureeing, plays a crucial role in reducing the risk of choking or aspiration – a situation where food or liquid enters the airway, leading to potential health hazards. People who grapple with swallowing difficulties or lack control over food within the mouth can benefit immensely from texture-modified diets.

Photo by Elena Leya on Unsplash

Who Benefits from Texture Modified Diets?

These tailored dietary approaches prove to be helpful for various conditions and situations, ensuring safe and enjoyable eating experiences for those in need. Texture modified diets are particularly relevant for individuals facing various health challenges, including:

1. Stroke Survivors: Those recovering from strokes may experience compromised swallowing function, necessitating adjustments in their diet.

2. Progressive Neurological Disorders: Conditions like motor neurone disease and Parkinson's disease can impact swallowing abilities, requiring tailored dietary solutions. Additionally, muscular dystrophy, amyotrophic lateral sclerosis (ALS), and multiple sclerosis can impact swallowing and chewing abilities, making texture modifications crucial for maintaining adequate nutrition.

3. Learning Disabilities: Individuals with learning disabilities might benefit from textures that enhance safe consumption.

4. Elderly Patients: Aging can change swallowing patterns, making texture modification essential for maintaining health.

5. Head and Neck Injuries or Cancers: Trauma to the head and neck, or certain types of cancers, can lead to difficulty managing food and liquids.

6. Gastrointestinal Disorders: Individuals with gastrointestinal disorders such as gastroesophageal reflux disease (GORD) or eosinophilic esophagitis may find relief through texture modifications that ease the passage of food.

7. Oral Health Issues: Dental problems, oral surgeries, or conditions affecting the oral cavity can hinder effective chewing and swallowing. Texture modifications accommodate these challenges.

8. Respiratory Conditions: People with chronic respiratory diseases may benefit from texture modified diets, as they reduce the risk of aspiration-related respiratory issues.

Remember, texture modified diets are not just about adapting to challenges; they're about empowering individuals to enjoy meals, receive proper nourishment, and enhance their overall well-being.

Each case is unique, and the guidance of healthcare professionals, including dietitians, speech therapists, and medical practitioners, is essential in tailoring these diets to individual needs.

What are the guidelines?

For healthcare providers, particularly hospital caterers, adhering to the International Dysphagia Diet Standardisation Initiative (IDDSI) guidelines is paramount.

These guidelines ensure that patients receive meals that align to consistency levels for safe consumption.

To stay updated with the latest framework, level descriptions, testing methods, and resources, a valuable resource is the official IDDSI website: https://iddsi.org/

Whether you're preparing homemade meals or opting for ready-made delights, following the IDDSI descriptors ensures you're in line with the recommended texture level advised by speech and language therapists. It's like a secret code that guarantees safe and enjoyable eating experiences.

Which Levels to Cater For?

The IDDSI framework outlines various food texture levels, each designed to cater to different swallowing abilities and safety considerations. While aiming to progress patients through all levels is ideal, practical limitations may arise. Thus, hospitals often offer specific levels based on patient needs and in consultation with the Speech and Language Therapy team.

Best practice entails offering for levels 3, 4, 5, and 6. The standard menu, meanwhile, features regular level 7 foods supplemented by ample easy-to-chew options.

The modified textures applying to fluids are as follows:

Level 0 – Thin

Level 1 – Slightly Thick

Level 2 – Mildly Thick

Level 3 – Moderately Thick

Level 4 – Extremely Thick

The modified textures applied to food are as follows:

Level 3 – Liquidised

Level 4 – Pureed

Level 5 – Minced & Moist

Level 6 – Soft & Bite-Sized

Level 7 is Regular texture (not modified) as per Standard Menus and includes the ‘Easy to

Chew’ subcategory.

What is the role of a dietitian?

When it comes to texture-modified diets, dietitians take center stage as the experts in ensuring nutritional needs are met. As a dietitian we assess individual dietary requirements and provide guidance on achieving them while consuming texture-modified foods and drinks. But it doesn't end there – dietitians team up with speech and language therapists to address nutritional concerns, especially after a dysphagia diagnosis.

People with dysphagia often struggle to maintain adequate fluid intake and dehydration isn't a small concern, it can lead to various issues like low blood pressure, infections, constipation, and more.

Collaboration between dietitians and speech and language therapists ensures hydration risks are minimized without compromising swallowing safety.

Dietitians will work closely with the SLT find the best strategies:

1. Adjusting the thickness of drinks.

2. Dietitians assess whether the person needs an alternative.

3. Dietitians consider if a person can make their own drink or needs a ready-to-drink solution.

When it comes to ensuring proper nutrition for individuals with dysphagia, fortifying food takes center stage. As mentioned above dysphagia, or difficulty in swallowing, can pose challenges in meeting nutritional needs. However, with some creativity and knowledge, you can enhance the nutritional value of meals while ensuring they are safe and enjoyable to consume. (I will cover food fortification in the next article)

As we wrap up this topic around texture-modified diets, remember that every bite we take can be a step towards improving the lives of those facing dysphagia.

Whether you are a healthcare provider, a caregiver, or someone dealing with the challenges of dysphagia, I hope this journey has highlighted the importance of texture modification. By collaborating, we can ensure that those with swallowing difficulties get the nutrition they require while enjoying the pleasure of eating.

If you have any questions, experiences to share, or topics you'd like to delve into further, I'm here to continue this conversation.

Thank you for joining me on this exploration, and I look forward to continuing this journey towards better health and happiness together.

Stay tuned for more insights, tips, and discussions on nutrition and well-being.

William Stivaletta

Additional resources

BDA Spotting and treating malnutrition: Food Fact Sheet https://www.bda.uk.com/resource/malnutrition.html

The International Dysphagia Diet Standardisation Initiative https://iddsi.org/

NICE CG 32 Nutrition support for adults: oral nutrition support, enteral tube feeding and parenteral nutrition https://www.nice.org.uk/guidance/cg32