Implications of the National Dysphagia Diet

Noel McAuliffe
Wayne State University
Dr. Fleming
March 2013
Explore the existing literature concerning the
implications of the National Dysphagia Diet
Research in the literature suggests several
variables that complicate the standardization
of the National Dysphagia Diet
Variables: temperature, time, thickening
agents used, and clinician interpretations
The goal of dysphagia treatment: ensure safe
and adequate nutrition and hydration for the
◦ Diet modifications
American Dietetic Association established a
set of standards and terminology to regulate
the application of diet modifications used to
manage dysphagia
This set of standards and terminology is
known as the National Dysphagia Diet
Inconsistencies in the rheological properties of
both instant food thickeners and commercially
packaged pre-thickened beverages
◦ Temperature influence both of these products
Commercially packaged pre-thickened beverages
were less viscous than the guidelines set by the
National Dysphagia Diet Task Force
Instant food thickener was more likely to be
within the guidelines than the commercially
packaged pre-thickened beverages
Adeleye & Rachal, 2007
Variation among the starch-based thickening
All of the viscosity limits were within the
guidelines set by the National Dysphagia Diet
Task Force
However, there was variation of the
consistency and structure of the liquids that
used the starch-based thickening agents
Payne, Methven, Fairfield, & Bell, 2011
Subjective Measurements
◦ Interpretation of product directions
◦ Correctly identify the viscosity of a physical sample
of the liquid
The study found that physical manipulation
of the liquids was a more accurate subjective
Steele and Goff, 2003
gum-based food thickeners were more likely
, than starch-based food thickeners to
maintain a consistent level of viscosity over
As the amount of time that the liquid is
allowed to thicken increases, the viscosity of
the liquid also increases
As temperature increased, the viscosity
Garcia, Chambers, Matta, & Clark, 2008
Increase in viscosity measurements over time
with nectar-thick and honey-thick liquids
Garcia, Chambers, Matta, and Clark, 2005
Increased viscosity for starch-thickeners
when the thickening agent was allowed to
thicken for thirty minutes
Dewar and Joyce, 2006
Inconsistencies regarding the application of
the National Dysphagia Diet
Clinical Application
◦ Patient drink preferences
◦ Patient’s rate of beverage consumption
◦ Type of thickening products the facility has
Adeleye, B., & Rachal, C. (2007). Comparison
of the rheological properties of ready-toserve powdered instant food thickeners at
different temperatures for dysphagic patients.
Journal of the american dietetic association,
10, 1176-1182.
Dewar, R., & Joyce, M. (2006). Timedependent rheology of starch thickener and
the clinical implications for dysphagia
therapy. Dysphagia, 10, 264-269.
Garcia, J., Chambers, E., Matta, Z., & Clark, M.
(2005). Viscosity measurements of nectarand honey-thick liquids: Product liquid and
time comparisons. Dysphagia, 20, 325-335.
Garcia, J., Chambers, E., Matta, Z., & Clark, M.
(2008). Serving temperature viscosity
measurements of nectar- and honey-thick
liquids. Dysphagia, 23, 65-75.
Payne, C., Methven, L., Fairfield, C., & Bell, A.
(2011). Consistently inconsistent:
Commercially available starch-based
dysphagia products. Dysphagia, 26, 27-33.
Steele, C., & Goff, H. (2003). The rheology of
liquids: A comparison of clinicians’ subjective
impressions and objective measurement.
Dysphagia, 18, 182-195.

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