A puréed diet involves consuming foods that have been pressed, mixed, sieved, blended, or ground up to achieve a smooth consistency, making them easier to ingest and digest. This texture-modified diet is often recommended for individuals with difficulty swallowing or digesting food due to various health conditions. According to the Journal of Nutrition in Gerontology and Geriatrics, puréed food is integral to managing nutritional intake in patients with oral-pharyngeal dysphagia and other conditions.
What Is a Puréed Diet?
Puréed diets modify the texture and consistency of foods, making them easier to consume. A purée meal usually has the consistency of pudding or soft mashed potatoes, allowing individuals with health conditions to obtain the necessary nutrients without needing to chew. LifeSpring Home Nutrition emphasizes that not all foods are ideal for puréeing and employs a nutritionist to ensure the best options are used in their puréed meals.
Suitable Foods for Puréeing
Some of the easiest foods to purée include:
- Pastas
- Meats
- Cooked cereals
- Dairy products
- Fruits
- Vegetables
LifeSpring Home Nutrition ensures that meals have enough essential vitamins and minerals by choosing the most nutrient-rich ingredients, as the puréeing process can sometimes reduce the nutritional content of foods. A registered dietician (RD) directs meal planning for individuals who require texture-modified meals, ensuring they receive the right balance of nutrients in every dish.
Health Conditions Requiring Purée Diets
Individuals diagnosed with health conditions affecting the mouth, throat, swallowing reflex, or gastrointestinal tract may benefit from switching to a purée diet, either temporarily or permanently. Dysphagia (difficulty swallowing food) caused by dementia is one of the most common reasons for this dietary change. According to Dementia and Neuropsychologia, there is a correlation between dysphagia and an individual’s general nutritional status, highlighting the importance of healthy eating for those with chewing or swallowing difficulties.
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Common Reasons for Requiring Puréed Meals
- Mouth or throat pain
- Poorly fitted dentures, missing teeth, or other dental issues
- Dysphagia or other issues affecting the swallowing reflex
- Crohn’s disease
- Ulcerative colitis
- Diverticulitis and other temporary gastrointestinal issues
Puréed meals reduce the risk of injury or illness for individuals at risk of choking on or inhaling foods while eating. Additionally, individuals recovering from some surgical procedures may need a temporary texture-modified diet. Puréed meals allow people to enjoy various foods without risking their health.
Benefits of Purée Diets
People may require texture-modified foods after experiencing a severe illness or injury, and often have multiple co-occurring health issues. A purée diet offers several advantages for people with conditions affecting their ability to eat regularly textured foods.
Primary Benefits
- Reduces the risk of pneumonia or other health complications caused by aspirating food
- Decreased risk of choking on food
- Access to a wider variety of foods
According to BMC Geriatrics, the use of modified diets to prevent aspiration and its consequences in those with dysphagia has increased dramatically. LifeSpring Home Nutrition addresses the need for individuals who require these meals but do not have access to residential or outpatient care services.
Who Should Order Purée Meals?
Not everyone with difficulty eating solid foods requires purée meals. Consulting a medical professional or RD is essential to determine if a puréed diet is appropriate. People who benefit most from purée meals typically have complex or persistent issues related to swallowing or other body functions, and may struggle with malnutrition due to conditions affecting nutrient absorption.
Challenges with Purée Diets
People often find it challenging to stick with purée diets due to issues such as presentation, taste, smell, inconsistency in production and delivery, and lack of variety. LifeSpring Home Nutrition addresses these issues by providing various attractive and tasty meals for people to choose from.
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Purée Meal Considerations
LifeSpring Home Nutrition offers many food options to ensure everyone has access to the meals they need to manage their health successfully. Different ingredients and preparation methods are used to ensure the highest nutritional content.
The company ensures that a registered dietician assesses each meal plan, guaranteeing that individuals receive the best foods to meet their specific needs. Purée diets are designed to provide the best balance of taste and nutrition for individuals who require texture-modified foods.
Improving Pureed Diets in Hospitals
Hospital meals can significantly influence patients’ nutritional, physical, and emotional well-being during their admission. However, patients on puréed diets often report poorer meal satisfaction due to taste, appearance, and recognizability, potentially impacting their nutritional status.
Research on Moulded vs. Unmoulded Purée Diets
A study involving 145 participants, with 126 completing data collection, compared moulded and unmoulded purée diets. The results indicated that 86% of participants correctly identified moulded meat dishes, and 69% correctly identified moulded vegetable dishes, with an overall 77% accuracy in identifying moulded purée side dishes. In contrast, participants correctly identified only 25% of meat dishes and 4% of vegetable dishes in unmoulded purée side dishes, with an overall accuracy of 14%.
Patient Preferences
The moulded purée was preferred, with 81% favoring its appearance, 76% its taste, and 75% for overall preference. When participants had differing preferences for appearance and taste, 95% aligned their overall preference with their taste preference.
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Key Findings
The study found that a moulded puréed diet made from modified maize starch led to improved recognizability, taste, appearance, and overall liking compared to an unmoulded puréed diet made from potato starch. Taste had a stronger influence on overall preference compared to appearance.
These findings suggest that improving hospital puréed diets by focusing on taste, appearance, and recognizability may potentially improve patient nutrition and health outcomes.
Factors Affecting Meal Satisfaction
Patients on puréed diets often experience reduced meal satisfaction due to taste, appearance, and recognizability issues. Pureed foods are easier and safer to consume for patients with difficulties masticating and swallowing harder foods, due to ageing or related medical conditions. However, pureed diets present great challenges with respect to nutrition and appeal.
The Role of Thickeners
Thickeners are frequently used to increase the viscosity of puréed foods to improve swallowing safety. However, patients can taste the thickeners, which dilutes the flavor of pureed foods. Research suggests that using tasteless modified maize starch can improve the taste of puréed foods.
Impact of Appearance
Pureed foods are generally considered unappealing due to their appearance. Studies have shown that the appearance of foods can make patients feel undignified and stigmatized. Moulding pureed foods into recognizable shapes can improve their appeal and increase food intake.
The Importance of Recognizability
Patients on puréed diets have reported that being unable to recognize their food is one of the reasons why they do not finish their meals. Improving recognizability through the use of food moulds can significantly enhance meal satisfaction.
Research Methodology
A study conducted in an acute hospital in Singapore, National University Hospital (NUH), examined the impact of moulded and unmoulded puréed diets on patient preferences. Participants were recruited based on specific inclusion criteria, including age, language proficiency, modified diet status, and cognitive function.
Data Collection
Data was collected using questionnaires administered at participants’ bedsides. Participants were presented with both unmoulded and moulded puréed diets and asked to identify the meat and vegetable sides. They were also asked to indicate their preferences in terms of appearance, taste, and overall liking.
Diet Preparation
The unmoulded puréed diet consisted of porridge, one meat, and one vegetable dish blended with potato starch. The moulded puréed diet also consisted of porridge, one meat, and one vegetable dish, but the meat and vegetables were blended with modified maize starch and shaped using food moulds.
Study Results
The study found that recognizability was improved on the moulded puréed diet compared to the unmoulded puréed diet. Patients also preferred the appearance of the moulded puréed diet made from tasteless modified maize starch. These findings highlight the importance of taste, appearance, and recognizability in improving meal satisfaction for patients on puréed diets.
Influence of Taste and Appearance
Taste was found to have a stronger influence over overall preference compared to appearance. When participants had differing preferences in diet type for taste and appearance domains, 95% of them subsequently aligned their overall preference with their taste preference.
Limitations and Future Research
The scope of the study did not allow for longer-term data collection across multiple timepoints. Future studies could consider oral intake and weight gain as indicators of patient preferences and the impact of moulded purée on overall health outcomes.
Practical Guide to a Level 4 Puréed Diet
A level 4 puréed diet involves eating foods that do not require biting or chewing. Foods should be smooth and moist.
How to Purée Foods
Use a blender, food processor, or other kitchen item to make foods smooth. Add liquid to achieve a smooth, soft, moist, and lump-free consistency. Check the thickness of the food before eating.
Testing Food Thickness and Texture
- Fork Drip Test: Level 4 puréed foods should sit on top of the fork with very little or no drip through the fork.
- Spoon Tilt Test: Pick up some food with a spoon. The food should easily slide off.
Foods to Eat and Avoid
- Recommended: Whipped or smooth mashed potatoes without skin, pureed fruits and vegetables without seeds or skin, yogurt, pudding, custard, and ice cream.
- To Avoid: Fruits with fiber or that are stringy, breads, granola, chips, crackers, pizza, raw whole fruits/vegetables, dried fruits, salads, dry coarse cakes or cookies, hard candies.
Meal Planning Tips
Plan meals ahead of time and consider where you will be eating. Ensure you have access to necessary kitchen equipment like a blender, refrigerator, and microwave.
Tips for Eating at Home
Purée different foods by putting them in a blender with liquid such as water, broth, gravies, sauces, juice, milk, or yogurt.
Tips for Eating at Restaurants
Eat at restaurants offering different types of foods and that will adjust for people on special diets. Call ahead and speak to a manager or chef to inquire about options.
Tips for Eating Away From Home
Bring a food grinder or small food processor. Buy a thermos. Ask if there is a microwave where you’re going. Freeze food in single-serving, microwave-safe containers or bags.
Boosting Nutrition
- Add 2 to 4 tablespoons of canned coconut milk or cream to smoothies, shakes, cereals, and yogurts for extra calories.
- Make ice cubes from milk or fruit nectar to use in smoothies or to keep your shakes cold.
- Add sour cream, half and half, heavy cream, or whole milk to your foods.
- Add puréed tofu to cooked vegetables, soups, or smoothies.
Dysphagia and Diet Modifications
A Dysphagia Diet is used for people who have difficulty swallowing. Foods on this diet are easier to chew and move around in your mouth, reducing the risk of food and liquids going the wrong way.
Recommended Foods for Dysphagia Pureed Diet:
- Beverages/Liquids: Liquids should be thickness recommended by your SLP or doctor (thin, nectar, honey-thickened).
- Starches, Breads, and Cereals: Hot cereals (oatmeals), pureed pancakes or French toast, pureed pasta, mashed potatoes/whipped sweet potatoes.
- Meats/Meat Substitutes and Soups: Pureed meat, pureed cooked eggs, hummus or other pureed legume spreads, all strained, cream-based or broth based soups (thickness as recommended by SLP or doctor).
- Fruits and Vegetables: Pureed fruit without seeds or skin, applesauce, pureed, cooked vegetables without seeds or skin, refried beans.
- Desserts: Pudding, custard, yogurt, jello, sherbet, sorbet, and ice cream.
- Condiments: Butter/margarine, mayonnaise, mustard, ketchup, BBQ sauce, steak sauce, gravy, sour cream, cream cheese, jelly, syrup.
Foods to Avoid on a Dysphagia Pureed Diet:
- Bread/Bread products, granola, chips, crackers, pizza, rice.
- Dry, tough meats (bacon, hot dogs, sausage), sandwiches, peanut butter, non-pureed eggs, soups with chunks of meat/vegetables.
- Raw whole fruits/vegetables, dried fruits, salads.
- Dry, coarse cakes or cookies, rice or bread pudding, hard candies.
- Olives, pickles, sauerkraut, chunky relish.
How to Prepare Pureed Foods:
- Gather supplies: blender or food processor, fork or whisk, plastic container.
- Use cooked foods: one serving = ½ to ¾ cup.
- Add liquid: about ¼ cup per serving of cooked food (broth, clear soups, cream, fruit juice, milk, smooth yogurt, sour cream, tomato or vegetable juice).
- Put small pieces of cooked food in blender.
- Add a small amount of liquid, about ¼ cup.
- Blend until pureed or smooth, with no lumps.
- If puree mix is too thin, try adding flour, cream, sour cream, or yogurt to thicken. If puree is too thick, add more liquid to make it smoother and creamier.
Note: Solid fats, such as butter, blend well if they are first melted. Oil, salad dressing, and cream can be added directly to the puree.
Ensuring Adequate Nutrition
- Try to eat from a variety of food groups to get the nutrients your body needs.
- To ensure you get enough calories and protein, you may include liquid nutrition supplements, such as Ensure, Boost, or Carnation Instant Breakfast if they are thickened to the right texture, if needed.
Potential Risks and Mitigation Strategies
While diet modifications like puréeing foods and thickening liquids seem straightforward, they can have unintended consequences.
Risks:
- Dehydration: Thick liquids can increase the risk of dehydration because people may drink less due to taste and texture preferences.
- Nutritional Deficiency: Texture modifications can be difficult to achieve at home, potentially diluting the food's caloric and protein density.
- Reduced Intake: Pureeing food can reduce flavor intensity, making meals less appetizing and resulting in reduced intake.
- Social Impact: Eating a modified diet can impact social interactions and quality of life, as it may require more focus and less conversation during meals.
Mitigation Strategies:
- Ensure adequate hydration by offering a variety of palatable thickened liquids.
- Work with a registered dietitian to ensure that texture-modified diets are nutritionally complete.
- Enhance the flavor and appearance of puréed meals to improve appeal and increase intake.
- Encourage social interaction during mealtimes by adapting strategies and providing support.
Puréed Diets for Weight Loss
Replacing solid meals with puréed foods may help lower your daily calorie intake, leading to weight loss, especially if your puréed dishes contain higher amounts of low-calorie fruits and vegetables, and less refined grains, fats, and sugary foods. However, restricting calories alone is rarely an effective long-term weight loss strategy.
Tips to Enhance Puréed Meals
- Use herbs and spices to enhance flavor.
- Keep color combinations in mind to improve visual appeal.
- Avoid overcooking foods to preserve their taste and nutritional value.
- Use piping bags or food-shaped molds when plating meals to make them look more appealing.
Specific Food Considerations
- Scrambled Eggs: Can be included in a puréed diet. Blend with a veggie broth and serve with a side of toast blended with plant or dairy milk.
- Puréed Diet for Seniors: Can help older adults who are struggling with swallowing difficulties or have oral issues.
- Bariatric Purée Diet: About 1-2 weeks after bariatric surgery, you can begin to eat some puréed foods, gradually progressing to foods with more texture.