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Understanding the Dysphagia Diet: A Guide for Healthcare Professionals

Navigating the dysphagia diet is crucial for ensuring patient safety and adequate nutrition. This guide, contributed by Judy Schlager, RD, LD, outlines the National Dysphagia Diet (NDD) stages, beginning with the pureed diet for individuals with severe dysphagia. Progression includes mechanically altered to advanced diets, each requiring careful assessment and individualized planning. Recommendations focus on food texture and safety, the role of thickening agents, and the importance of supervision. This resource aims to support healthcare professionals in providing effective care for dysphagic patients.

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Understanding the Dysphagia Diet: A Guide for Healthcare Professionals

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

  2. The Dysphagia Diet • 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

  3. Dysphagia Diet Progression • 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

  4. Dysphagia Diet Progression (cont’d) • 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

  5. The Pureed Diet • 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

  6. Dysphagia Diet Progression • 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

  7. Dysphagia Diet Progression (cont’d) • 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

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

  9. Dysphagia Diet Progression (cont’d) • 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

  10. Dysphagia Diet Progression (cont’d) • 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

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

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

  13. Characteristics of Pureed Foods • 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

  14. Foods for Dysphagic Patients • 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

  15. Commercial Thickeners in Liquids • 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

  16. Commercial Thickeners in Liquids (cont’d) • 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

  17. Facility-Thickened vs Prethickened Liquids • 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

  18. Facility-Thickened vs Prethickened Liquids (cont’d) • 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

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

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