When advised that you need a textured modified diet, a healthcare professional may mention a range of food texture descriptors. A patient might be recommended a texture modified diet in order to reduce the risk of choking and aspiration, where food travels down the windpipe into the lungs rather than the stomach, which can have severe health consequences.

In early 2019, the NHS adapted its criteria around food texture descriptors for those on a dysphagia diet. IDDSI (The International Dysphagia Diet Standardisation Initiative) was rolled out globally to ensure that terminology and food texture descriptors were applied and understood across all cultures, all ages and all settings.

IDDSI is endorsed by reputable bodies such as the British Dietetic Association and the Royal College of Speech & Language Therapists. “A global initiative to improve the lives of over 590 million people worldwide living with dysphagia” - IDDSI Before IDDSI came into practice, food descriptors in the UK were formed on best clinical advice, rather than international standards. There was an established set of national descriptors and terminology in the UK. Differences between countries was often a source of confusion internationally. This has now been addressed by IDDSI.

Food Texture Descriptors

As mentioned above, there are a range of food textures that are designed to meet every dietary requirement. The IDDSI Framework is a continuum of levels 1-7 which covers both drinks and food. A patient’s diet will be based on a clinical assessment, which will be undertaken by a Speech and Language Therapist. This article will focus on levels 4-6 in more detail:

  • Level 4 Diet (previously known as category C) – Purée Meals: Level 4 meals require no chewing, they should be a thick puree consistency which can hold its shape on a fork, requiring less tongue and swallowing muscle strength than level 5 or level 6 diets.

Level 4 Purée Petite Sweet and Sour Chicken

  • Level 5 Diet (previously known as category D) – Minced Meals: Minced and Moist Level 5 meals should be able to be scooped and shaped on a plate. Foods should be easily broken down by the tongue. Biting is not required and should only require minimal chewing.

Level 5 Minced Salmon in Dill Sauce

  • Level 6 Diet (previously known as category E) - Soft and Bite-Sized Meals: A Level 6 meal should be soft and tender throughout. Chewing is required, but biting is not. The food pieces should be designed to minimise any choking.

Level 6 Soft & Bite-Sized Shepherd's Pie

These meals have been carefully designed to help make mealtimes safe and enjoyable for those who are experiencing swallowing difficulties or require a texture modified diet.

A Speech and Language Therapist will be able to provide the best advice to a patient on what IDDSI level is best suitable for their individual circumstances. If a patient wants to try and home blend their own meals, they should always be advised on what foods are and are not safe to eat - our blog foods you should avoid with dysphagia expands on this. It is also extremely important for patients to be testing their home blended food before eating to ensure it is the right consistency for them to consume. The IDDSI Food Test Framework is a good indicator for this.

Why may patients be placed on a Dysphagia Diet?

The reasons for requiring a textured modified diet can vary, in some cases a puréed diet may be required for a temporary amount of time following tooth extraction surgery, while other times it can be required long term, as a result of primary conditions. These reasons range from:

Oro-Pharyngael Dysphagia which can occur in patients who have a neurodegenerative diseases such as Multiple Sclerosis, Motor Neurone disease, Parkinson’s disease, Huntington disease and Dementia or for patients undergoing radiotherapy for a head and neck cancer.

Cancer can weaken muscles when swallowing and this may affect how food passes down the oesophagus. In some cases it can cause structural blockages. To ensure that food and liquids can travel down the oesophagus safely, the patient may require a texture modified diet.

Dysphagia symptoms can also occur in a patient following a stroke. Due to neurological reasons, the swallowing process can become impaired and they may require a texture modified diet to avoid the risk of choking or even aspiration. However, as a patient recovers from stroke, they can progress up through the IDDSI levels as they regain strength in their swallow.

Another reason a patient may be advised to switch to a texture modified diet is due to severe dental problems following surgery. This could leave someone unable to chew or bite without pain when swallowing. Here are some foods to eat after tooth extraction.

Softer Foods Customer, Andy

How is a dysphagia diet recommended?

When a patient is recognised to be experiencing a swallowing difficulty, a Healthcare Professional may recommend that they undergo a comprehensive clinical assessment. This will usually be done by a Speech and Language Therapist and can be assessed by undertaking a barium swallow test. This aims to identify at what stage of the swallow a patient is encountering difficulty. They will then analyse the results from this test and if necessary, work together with a dietitian to recommend a textured modified diet that your patient needs to follow.

Adhering to Food Texture Descriptors

It can be overwhelming for your patients to be placed on a texture modified diet, but with appropriate Healthcare Professional guidance and home modifications to a patient’s diet, they can enjoy mealtimes. The importance of testing food before consumption should always be emphasised.

After diagnosis, a patient might not be familiar on all the additional care that needs to be taken when making their meals to ensure that they can stay safe and manage their diet at home. A healthcare professional can advise on best practise when preparing texture modified food and what to be aware of. For example, due to the natural variability of foods, some ingredients in meals may require additional attention when being introduced to a dish e.g. the texture of the carrots and macaroni cheese will modify more smoothly than fish (muscle fibres) and peas (husks). So it’s important to make sure food is broken down to the appropriate texture to reduce any risk of choking on bits.

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Softer Foods by Wiltshire Farm Foods is an award-winning range of meals designed with your patients in mind. With more variety than ever before, we have over 80 delicious textured modified dishes for those experiencing swallowing difficulties. Created by our in-house chefs Phil and Liam, each of our meals undergo stringent testing and made to the right consistency to ensure they are safe to eat and to help those with dysphagia dine with dignity. You can browse our range of textured modified meals or simply request a brochure today.

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