4.2 Nutrition and dysphagia food textures

Introduction

A nutritionally sufficient, balanced diet is essential for life and health.  Swallowing problems may lead to weight loss and malnutrition.  

Helping someone with swallowing problems to eat safely is a highly skilled activity which requires great sensitivity to ensure dignity is respected at all times.

This section contains resources about nutrition, particularly the different food textures and equipment to help with eating.  This information is likely to be of interest to: 

  • Staff working in health and social care
  • Trainers delivering sessions about dysphagia
  • People with swallowing problems and their families and friends
  • Students studying health and social care.

See your dietitian, speech and language therapist, nurse or occupational therapist for advice about the texture of food, suitable types of food and adapted utensils.    

Why are there texture modified diets?

Individuals may need to eat a texture modified diet because they are:

a)    generally unwell and need a “soft diet”

b)    or have dysphagia.

Foods for people who are generally unwell may be available from the ‘soft food’ options on a hospital or care home menu.  The Sheffield Easy Eating information leaflet for people on a soft diet is intended for people at home.

A texture modified diet will be recommended following assessment by a speech and language therapist or dysphagia trained practitioner.  

What are the National Descriptors?

The descriptors were developed in the United Kingdom by the National Patient Safety Agency Dysphagia Expert Group and published in 2012. The document, with the UK standard for each descriptor and an audit checklist is available (here). They replace the 2009 descriptors.  

There are four modified food textures.  These are:

·         Texture B – Thin Puree

·         Texture C – Thick Puree

·         Texture D – Pre Mashed

·         Texture E – Fork Mashable 

Each texture is defined and examples of foods can be found on the Swallowing status: Dysphagia Diet sheets. See separate charts for Texture BTexture CTexture DTexture E.    



 

Further information

The National descriptors are also in the Sheffield Teaching Hospitals NHS Foundation Trust Easy Eating patient information leaflets. There is leaflet for Thin PureeThick PureePre Mashed and Fork Mashable textures of food and for patients on a 'Soft Diet'. These contain practical tips on how to prepare and make food more appetising, examples of suitable foods for each of the food textures, and advice on how to add extra nourishment. There is also an Easy Eating leaflet for Smooth Soups with recipe tips and ideas. 

A speech and language therapist or dysphagia trained practitioner may recommend a patient avoid high risk foods. Some foods are identified as high risk because they have very difficult textures to chew and swallow. See here a list of examples of some high risk foods. Not all foods can be listed.  If you have any questions or concerns, contact your speech and language therapist. 

There are also handouts explaining why mixed consistencies or textures and bread should be avoided for patients on modified diets.  

Resources about nutrition

‘Keeping nourished – getting better’ is one of the High Impact Actions for Nursing and Midwifery in the UK.   The report produced by the NHS Institute for Innovation and Improvement is available here. 

Social Care Institute for Excellence has a section on Eating and Nutritional Care with many resources, including a video about the nutritional care of older people, see link 

NHS London.  Allied Health Professions input to the Oral Nutritional Support toolkit.   This toolkit outlines the role of dietitians, radiographers, physiotherapists and others in assessment, treatment and rehabilitation.  Available here 

Resources about food textures 

There is a 6 minute video about modified texture diets on the Stroke4Carers website, see here.

There are videos on the Dysphagia Recipes website, illustrating the UK texture descriptors, see here 

Resources about eating and drinking equipment

The Disabled Living Foundation Is a national charity that provides impartial advice, information and training about independent living, see link. Their Living Made Easy website has a section about eating and drinking equipment, see here.

The Stroke4Carers website has a short section about cutlery and crockery to assist with eating and drinking, see link.