Dysphagia and Pureed Diets

Dysphagia is defined as a disruption in the normal swallowing process (2). Thus, making it hard to swallow, chew, or digest certain foods and textures.  Individuals with dysphagia will need a modified dysphagia diet (pureed diets) to ensure that they are still meeting their dietary needs. Although the medical term “dysphagia” is frequently considered as a symptom or sign, it is sometimes used to describe the condition itself. There are multiple causations of dysphagia such as but not limited to; neurological diseases (stroke), esophageal obstructions (carcinoma), and acute or chronic paralysis (Achalasia). If it occurs once or twice, the likelihood of it being a prominent issue is minimal, but if it occurs regularly, one should consider consulting a medical professional. Enteral nutrition may also be required for individuals with extreme dysphagia, who are also at risk for malnutrition or dehydration.

Modified Diets

A modified dysphagia diet is broken down by the International Dysphagia Diet Standardization Initiative (IDDSI) into food and drink categories with several sub levels (3). These levels range from zero being thin liquids to seven which is considered a regular diet. The diet modification level is dependent upon the severity of the individual’s condition. According to IDDSI, the food and drink categories meet in the middle with a pureed/ extremely thick diet (level 4).  A pureed diet is often used in many skilled nursing, and long-term care facilities. Recent data shows that about 15% of all individuals 65 and older, and about 68% of institutionalized seniors present some type of swallowing difficulty (4). 

Pureed Diet

A Pureed Diet is one of the most used diet modifications for Dysphagia.

Although pureed, all ingredients used to make the meal of choice should be homogenous, smooth, cohesive and hold its shape on a plate. This modification does not require chewing and is usually eaten with a spoon or fork if possible. It should not have the ability to be sipped from a cup or poured. Note that large chunks, hard, sticky, and/or crunchy foods are not recommended and should be avoided. To ensure it meets the proper texture and consistency of a IDDSI level 4 pureed diet several testing methods have been created. These testing methods included the “Fork Pressure” test, “Fork Drip” test, “Spoon Tilt” test, and the “Finger test” (3).

When performing these tests the puree should sit in a pile on top of the fork with minimal flow through, have a clear prong pattern after pressing with a fork, hold its shape on a spoon, plop off a spoon when tilted sideways, and can be held using fingers if needed. Examples of proper testing can be found on the IDDSI website (3). 

When creating a pureed diet for individuals with swallowing or chewing difficulties those that are preparing the food should be sure that the puree closely resembles a normal meal. The meal should be nutritionally balanced, aesthetically pleasing, and flavorful. Puree food molds are great for enhancing presentation. A general rule of thumb is to present the meal as you would for yourself, or a family member. Finding recipes that fit the guidelines for a pureed diet can be difficult when first starting out but become much easier with time and practice.

Some examples of delicious puree recipes can be found below: 

Buffalo Chicken Puree:

Ingredients:

– 1 can of chicken

– 1 Tbsp. low-fat blue cheese crumbles

– 2 Tbsp. light ranch dressing

– 1 tsp. buffalo sauce

– salt & pepper, to taste

Directions: Add ingredients to a food processor or blender and puree until smooth or desired consistency.

Chicken Potato Avocado puree:

Ingredients:

1 small potato peeled and cut into chunks

2 oz skinless and boneless chicken thigh or breast

1/2 ripe avocado peeled and stoned

2 tsp skimmed milk

salt and freshly ground black pepper, to taste

Directions:

1.  Steam the potato and chicken together for 25-30 minutes (or cook until tender in the microwave if you prefer).

2.  Place in cooked items a blender or mini food processor with the avocado, milk and salt and pepper to taste. Puree until smooth or the desired consistency (thin with further milk if needed).

Sources

  1. “Buffalo Chicken – Pureed Food.” DFW Bariatric Institute, www.dallasweightloss.com/recipes/buffalo-chicken/.
  2. “Dysphagia – Nutrition Care Manual.” – Nutrition Care Manual, www.nutritioncaremanual.org/
  3. .International Dysphagia Diet Standardisation Initiative, IDDSI, July 2019, iddsi.org/framework/food-testing-methods/. 
  4. Says, Shea, and CAROL says. “Home.” Bariatric Cookery, 21 May 2014, www.bariatriccookery.com/softpureed-delight/.“Complete IDDSI Framework Detailed Definitions.
  5. Sura, Livia et al. “Dysphagia in the elderly: management and nutritional considerations