Professional Documents
Culture Documents
Jonathan Tellier
October 4, 2018
Abstract
Objective:
to investigate if the current NDDIII diet at Patton State Hospital could be transitioned
Methods:
NDDIII recipes in computrition were analyzed and compared to the criteria set by IDDSI.
Results:
138 total recipes or food items were evaluated using computrition, with one fourth of all
recipes not meeting IDDSI criteria for soft and bite sized level 6.
Conclusion:
in analyses of the current recipes being used for NDDIII, transition to the IDDSI
Introduction.
and liquids (Zaletal 2016). Texture modification of food and liquids is a very important
intervention in the management of dysphagia. Dysphagia research has been hard, due
to the lack of standardized nomenclature concerning drink thickness and food texture.
Phrases such as “nectar-thick” may not be interpreted the same way in every country
eight levels (0 to 7). These levels include both foods and liquids existing on a single
continuum. Color codes, numbers and text labels developed by IDDSI represent
standardized definitions for liquid classifications and texture-modified foods. IDDSI flow
test uses a 10-ml syringe that is filled with 10-ml of test liquid and evaluated after 10-
seconds. The remaining fluid in the syringe determines what level of the IDDSI the liquid
is consistent with. Each level of the IDDSI framework has specification that need to be
met. Recommended measurement of bite-sized pieces for soft and bite-sized are 1.5cm
pieces for adults and 8mm pieces for pediatric patients. Currently the U.S. uses the
National Dysphagia Diet (NDD), and for the purpose of this study NDD3 will be defined.
NDD3 includes moist foods in bite size-pieces and an assortment of foods that may be
suitable. For this study the guidelines for soft and bite sized were analyzed in order to
see if the current NDDIII recipes at Patton State Hospital could be used for the new
Methods.
Implementation of IDDSI 4
This study did not involve human patients or animals and was exempt from ethics
committee approval.
Computrition was evaluated to see if current recipes fall within the guidelines of
IDDSI level 6. Due to time restraints only, categories of food that are listed in the criteria
of soft and bite sized in the IDDSI framework were evaluated in this study.
Menus were evaluated, and each recipe served to NDDIII was compared to
criteria given by IDDSI. The recipes were broken into eight groups and color coded on
vegetables, cereal, bread, and rice. If the recipe is highlighted red it does not currently
meet the criteria for that category of the IDDSI framework and needs to be revised.
Results.
There was a total of 138 recipes or items evaluated and 35 of those items or recipes
currently do not meet the criteria for transition to IDDSI framework. Jelly and gelatin
removal from diet. Various reasons why criteria was not met include specification of cut
size of at least 1.5cm, soups having a liquid that is not thickened, fruits not being
mashed, raw vegetables being served, foods that can’t be cut by a fork, and food
Discussion.
Proper nutrition depends on food and fluid intake, many patients with dysphagia are not
able to masticate food properly and this may lead to aspiration. Foods that are texture
Institutions currently treating dysphagia have their own understanding of related terms.
Varied understandings of the terminologies such as “puree” and “nectar thick” depend
on the culture and habits of the certain population as well as ethnical and racial aspects
health care for the same disease different. Across countries standardization of
The IDDSI framework aims to standardize terminology and definitions related to the
treatment of dysphagia. Categories using color, name, and number are used to make
the selection of a modified food easier. These standardized terminologies could be used
in any region because they define food consistencies and not certain foods.
For classification of food proper method for texture testing using the fork pressure test
should be done. Various other methods of testing texture for soft and bite-sized exist
such as spoon pressure test, chopstick test, and finger test. The fork pressure test has
The reason computrition was used to assess all recipes and food items and each food
was not tested individually, was for liability reasons and time restraints. Some recipes
were saying cut vegetables to one inch, which is not meeting the bite-sized
requirements, set by IDDSI. Easily fixable this recipe and many others should include a
cut size of 1.5cm. Some problems seen in the recipes were the use of raw vegetables
and cut fruits. According to IDDSI all vegetables should be cooked and all fruits should
be mashed.
Conclusion.
Implementation of IDDSI 6
The current NDDIII diet recipes can be transferred into soft and bite-sized with minor
References.
10.1016/j.clnesp.2016.04.019
Dysphagia Diet Standardisation initiative flow test. Revista CEFAC. 20, 3. doi:
10.1590/1982-021620182031818
J., Hanson, B., Lam, P., Riquelme, F. (2018). Creation and Initial Validation of
doi:10.1016/j.apmr.2018.01.012
Ong, J., Steele, M. C., Duizer, M. L. (2018). Sensory characteristics of liquids thickened
doi:10.1016/j.foodhyd.2017.12.035.