A feast for the eyes — smooth puree diet moulding improves oral intake

Texture modified diets, particularly smooth puree diets, have long been known to have little visual appeal, with a loss of texture and resemblance of the original food and even change in flavour from dilution of the food to achieve the right consistency. Such diets are frequently used in acute and residential aged care predominantly for people with dysphagia (swallowing difficulty) and who are at risk of aspiration, which can result in serious illness or even death. Approximately 10% of patients in acute care and 30–60% of residents in aged care have dysphagia and require management with a texture-modified diet, which is likely to be long term with very few returning to normal texture diets.

Modified texture diets are often associated with a poor oral intake, which is frequently cited as being due to appearance, texture and mouthfeel of the food. Malnutrition in institutional care is prevalent in up to 60% of hospital inpatients and aged care residents alike. Poor nutrition can increase hospital length of stay and negatively impact health, such as through poor wound healing or affecting immunity, and can increase risk of aged care resident hospital admissions and overall healthcare costs. Therefore, strategies for improving oral intake are of great interest to all agents involved in institutional food service.

A smooth pureed diet is, by definition, smooth, moist and lump-free with no coarse fibres, and efforts to improve presentation have so far been limited to serving each meal component separately on a divided plate rather than blended together. More recently, studies have been trialling moulded puree food to a three-dimensional form that where possible closely resembles the original food, with some international food service providers being able to go so far as providing puree salads.

A moulded breakfast. Image courtesy Textured Concept Foods.

Of the studies that have examined changes in oral intake through puree food moulding, one study found a 15% increase in overall volume of the meal eaten, contributing to an increase of 41% energy and 36% protein. Similarly, a pilot study in acute care trialling smooth puree moulded protein serves at main meal times saw a mean reduction of 126 g in plate waste and an increase in patients consuming all of their meals when provided a moulded smooth puree diet.

For the patient or resident on a moulded smooth puree diet, this may mean being able to look forward to mealtimes again, better recognising the foods on their plate and consuming more food as a result. For food providers this should mean less wastage, improved nutrition outcomes and in acute care, shortened length of stay — how much this relates to in food service dollars is uncertain and more research is clearly needed in this growing practice.

Olivia Farrer.

Olivia Farrer, a UK-qualified dietitian, has now been living in Australia and working as an Accredited Practising Dietitian for almost 10 years. After working clinically, Olivia embarked on a career change pursuing lecturing at the University of South Australia where a passion for food service dietetics developed. Olivia is now at Flinders University (SA) finishing her PhD examining policies and practices around food provision in aged care under the supervision of Prof Michelle Miller, Dr Alison Yaxley and A/Prof Karen Walton of the University of Wollongong. In addition, Olivia provides menu consultancy services for Avanticare — allied healthcare and training for residential aged care services (SA).
Olivia is an Accredited Practising Dietitian and member of the Dietitians Association of Australia’s Food Service Interest Group. To find an Accredited Practising Dietitian (APD), visit the ‘Find an APD’ section of the DAA website at www.daa.asn.au or call 1800 812 942.

Image at top of page: Fish and vegetables. Image courtesy Textured Concept Foods http://texturedconceptfoods.com.au.