1. Purees That Please, Part 1 Provided Courtesy of RD411.com Where health care professionals go for information Review Date 3/11 G-1559Contributed by Judy Schlager, RD, LD

2. Choosing the correct diet: –Must individualize –Goal: Rehabilitate to the highest practical level of the dysphagia diet progression –Must use collaborative effort to reach decision –Must have careful swallow evaluation by a qualified therapist The Dysphagia Diet

3. National Dysphagia Diet (NDD) 1— pureed: Pureed, homogenous, and cohesive foods Pudding-like foods No coarse textures, raw fruits or vegetables, nuts, etc All foods requiring bolus formation, controlled manipulation or mastication are excluded Dysphagia Diet Progression

4. NDD 1—pureed: Rationale: This diet is designed for people who have moderate to severe dysphagia, with poor oral phase abilities, and reduced ability to protect their airway Close or complete supervision and alternate feeding methods sometimes are required Dysphagia Diet Progression (cont’d)

5. The pureed diet has only one purpose: To enable the patient/resident to ingest adequate nutrition in comfort and safety Modification is in texture only Further modifications merely impose further complications The Pureed Diet

6. NDD 2—mechanically altered: Foods are moist, soft textured, and easily formed into a bolus Meats are ground or minced, not larger than ¼  pieces—still moist with some cohesion All foods from Level 1 are acceptable at this level Dysphagia Diet Progression

7. NDD 2—mechanically altered: Rationale: This diet is a transition from the pureed textures to more solid textures Chewing ability is required Textures are appropriate for individuals with mild to moderate oral and/or pharyngeal dysphagia Dysphagia Diet Progression (cont’d)

8. NDD 2—mechanically altered: Assess patients for tolerance to mixed textures Expect that some mixed textures are tolerated in this diet Dysphagia Diet Progression (cont’d)

9. NDD 3—dysphagia advanced: Foods are of nearly regular textures, with the exception of very hard, sticky, or crunchy foods Foods still are moist and in bite-size pieces at the oral phase of the swallow Dysphagia Diet Progression (cont’d)

10. NDD 3—dysphagia advanced: Rationale: This diet is a transition to a regular diet Adequate dentition and mastication are required Textures of this diet are appropriate for individuals with mild oral and/or pharyngeal phase dysphagia Dysphagia Diet Progression (cont’d)

11. NDD 3—dysphagia advanced: Assess patients for tolerance of mixed textures Expect that mixed textures are tolerated on this diet Dysphagia Diet Progression (cont’d)

12. NDD 4—regular: Any solid texture food All beverages are included Dysphagia Diet Progression (cont’d)

13. For dysphagic diets: Puree consistency should support straw when placed in center of food Foods are dense in relation to volume Temperatures are cold or hot, not tepid Thicken liquids PRN Textures uniform—no combined textures Smooth, not sticky Foods to avoid—seeds, nuts, crunchy foods Characteristics of Pureed Foods

14. Foods must form a cohesive bolus: Use sauces and gravies Avoid rice, cottage cheese, and ground meats without sauces or gravies Liquids usually are thickened Foods for Dysphagic Patients

15. Properties of starch thickeners: Pregelatinized and agglomerated to instantize Only the water portion of the item is thickened Normal metabolism reverses the thickening process, thus releasing the water to make it available for hydration Commercial Thickeners in Liquids

16. Properties of gum thickeners: Indigestible in upper gastrointestinal tract Low susceptibility to enzymatic hydrolysis High water-binding capability Good fiber source Good bulk for colon Commercial Thickeners in Liquids (cont’d)

17. Facility thickened: Advantages: –For use with all liquids –Less costly Disadvantages: –Unsafe=lumps –Inaccurate measuring=inconsistent results –Constant training of staff members –Risk of fines because of improper viscosity levels Facility-Thickened vs Prethickened Liquids

18. Prethickened: Advantages: –Safer=no lumps –No staff training Disadvantages: –More costly –Not all necessary liquids available –Flavors sometimes not as good as with facility-thickened liquids Facility-Thickened vs Prethickened Liquids (cont’d)

19. For thickened liquids: Thin=1−50 centipoise (cP) Nectar-like=51−350 cP Honey-like=351−1750 cP Spoon thick=>1750 cP Viscosity Borders and Ranges