Texture‐modified foods and thickened fluids as used for individuals with dysphagia: Australian standardised labels and definitions

Abstract

Thickened fluids and texture-modified foods are provided for the therapeutic treatment of dysphagia. Review of the literature indicated that numerous labels are applied to a small number of food textures and fluid thickness levels. The consequences of inconsistent terminology affect patient safety and the efficiency of communication. A joint project of the Dietitians Association of Australia and The Speech Pathology Association of Australia Limited (Speech Pathology Australia) was undertaken to develop consensus standards for number of levels, labels and definitions of thickened fluids and texture-modified foods within the Australian context. A project officer and multidisciplinary advisory committee were appointed by competitive process to carry out and oversee the project. The project determined that there were 39 different labels in use for thickened fluids and 95 different labels in use for texture-modified foods used in Australia. Dietitians and speech pathologists demonstrated overwhelming support for a standardised labelling and terminology system (99.2% of respondents). A national consultative process encompassing the views of more than 580 clinicians helped to formulate the final standards. A scale for modified fluids and a scale for texture-modified foods were developed and consensus was achieved between the Dietitians Association of Australia and Speech Pathology Australia. The standards are now recommended for use throughout Australia.

The Need for International Terminology and Definitions for Texture-Modified Foods and Thickened Liquids Used in Dysphagia Management: Foundations of a Global Initiative

“…With regard to patient safety, texture-modified foods are generally provided to reduce risks associated with choking, while thickened liquids are provided to reduce risks associated with aspiration. Consequently, the ingestion of texture-modified foods and thickened fluids is rarely the diet of choice, but rather a diet of necessity for the person with dysphagia if they wish to maintain safe oral intake of nutrients [6]. …”

“…An American task force identified 40 different names used to label solid food, while an Australian study found 95 different labels used to describe texture-modified foods [6]. If such variability exists within countries, global inconsistency is likely to be staggering.…”

“…Atherton et al [6] reported 39 different labels for thickened liquids used by clinicians in Australia, used prior to national standardization. In addition, words used to describe thickened liquids in the dysphagia literature are also variable and often not well defined.…”

“…We are aware that Australia, Ireland, Japan, New Zealand, Sweden, the UK, the USA and Denmark have published national descriptors [6, 40–43, 44••, 45, 46]. At the time of writing, Canada is in the process of developing national guidelines.…”

Oral Perceptual Discrimination of Viscosity Differences for Non-Newtonian Liquids in the Nectar- and Honey-Thick Ranges

“…Despite the widespread use of thickened liquids in clinical practice, the field still lacks clear evidence regarding the degree of thickening required for optimal patient benefit. Consensus-based guidelines in North America (i.e., the National Dysphagia Diet [5, 6]), Australia [7], and the UK [8] concur in classifying liquids in three categories of increasing viscosity. In North America, these categories are commonly labeled as “nectar-thick,” “honey-thick,” and “spoon-thick.” The proposed viscosity boundaries for these categories span quite large ranges of apparent viscosity at a shear rate of 50 reciprocal seconds (50/s), as summarized in Table 1.…”