A review of the impact of food design on the mealtimes of people with swallowing disability who require texture-modified food

Abstract

Texture-modified foods are a common component of interventions provided to people with dysphagia (swallowing disorders) to maintain their respiratory health, nutritional health and to reduce the risk of aspiration-related illness or choking on food. However, the unsightly and unappetizing appearance of texture-modified foods may negatively impact on the mealtime experience and acceptance of texture-modified foods of persons with dysphagia. The aim of this review was to determine what is known about the impact of specific elements of food design ‐ food structure and visual appeal ‐ on the mealtime experiences of people with dysphagia. This review of 35 studies presents evidence on how the physical characteristics of texture-modified foods for people with dysphagia can be considered during food production, formulation or service to improve their mealtime experience. Overall, the visual appeal, texture, taste, aroma, temperature, mealtime environment and mealtime assistance all impact upon mealtime experiences and should be considered carefully in the design of a person’s mealtime plan and food-related dysphagia interventions to improve their mealtime-related quality of life. Further research needs to include the views of people with dysphagia, particularly those with lifelong conditions, who might require texture-modified food for an extended period over their lifespan.

The true cost of dysphagia on quality of life: The views of adults with swallowing disability

“…This research provided an in-depth understanding of the impacts of dysphagia and its management on quality of life for people with lifelong and ongoing acquired dysphagia, in particular the impacts on their choice and control, social engagement, experiences with food, physical health and the ways that they move to self-manage and implement dysphagia and mealtime management strategies. This helped to close the gap identified in Smith et al (2022b) in understanding the lived experiences of people with lifelong or ongoing dysphagia; providing insights from people with dysphagia and their supporters. In doing so, it has also highlighted barriers and facilitators that may influence the person's mealtime related quality of life and the importance of self-advocacy.…”

“…The first author conducted the conversational-style indepth interviews using an interview protocol, developed on the basis of two prior literature reviews (Smith et al, 2022a(Smith et al, , 2022b. While the interview guide was designed to ask similar questions across interviews, the conversational style of the interview meant that probing questions could be modified according to the participant's relevant lived experiences (see Appendix C).…”

“…To understand the impact of modifying food textures on perceptions of food or mealtime enjoyment, a recent narrative review of 35 studies examined how visual appeal, texture, taste, smell, temperature and mealtime environment may impact the mealtime experience for people with dysphagia (Smith et al., 2022b ). The authors reported that the use of food moulds, piping bags, spherification, gelification, or 3D food printing may help improve the appeal of texture‐modified foods.…”

Multisensory and nutritional innovations: A narrative review of opportunities for food designers in supporting long SARS‐CoV‐2 patients

“…Of note, many studies on food design for individuals with olfactory dysfunction are primarily geared towards the elderly and may not be suitable for other age groups' textural requirements. For instance, many research efforts have been directed towards textures modified foods and thickened liquids for dysphagia management [see reviews (Aguilera & Park, 2016;Gallego et al, 2022;Smith et al, 2022)]. A recent review article examined the possibility of replicating satisfying texture for SARS-CoV-2 patients with anosmia and ageusia including highlights of food trends and International Journal of Food Science and Technology 2023 technologies to modify food textures [see review by de Oliveira et al, 2022].…”

Adapting dysphagia meals for acceptance among a broader group of older adults

“…Modifying texture is an efficient method that improves oral food processing, but the altered texture and appearance hinder product acceptance since they also influence flavor release and mouthfeel, consequently affecting attractiveness and palatability (Keller et al, 2012). Appearance may also affect the social aspects of dining since TMF may look unappetizing (Roy et al, 2007; Smith et al, 2022). Moreover, the nutritional quality of TMF is lower (Beck & Hansen, 2010; Wu et al, 2022).…”