Testing Meals for Accuracy

By: Elizabeth O’Donnell

Have you ever known anyone who has been on a special diet for medical reasons? Individuals, for multiple reasons, might be placed on a special diet for a medical condition such as diabetes or kidney disease. Additionally, there are reasons why texture or consistency may be altered such as poor dentition or swallowing difficulty.

I recently completed a two-week rotation at a non-profit organization named Food & Friends in Washington DC. Food & Friends offers medically tailored meals and groceries for clients living with cancer, HIV/AIDS, and other serious medical conditions. Some of the meals they offer their clients include pureed meals. Individuals might need a pureed meal diet because of swallowing/chewing difficulties or digestive issues.

On two separate occasions, I was able to test four pureed dishes with a dietitian to determine which aspects of the dish would be able to follow the International Dysphagia Diet Standardization Initiative (IDDSI) guidelines. We tested the meals for accuracy and consistency to see what needed to be adjusted. We also tested them to see if they had a pleasant taste. All the meals were prepared with intention to fit within the IDDSI level 4 standards. However, the puree meals are still in the testing process. Eventually, after continued testing and changes made, these
meals will be able to meet standards and be appropriate to serve to clients. There are 5 levels for IDDSI foods which are, level 3-liquidized, level 4-pureed, level 5-minced and moist, level 6-soft and bite sized, and level 7-regular/easy to chew. Levels 5-7 are considered transitional foods. Transitional foods are considered as food that begins as one texture but changes to a different texture when a temperature change or moisture is introduced to the food. Examples of
transitional foods are ice cream and cotton candy.

The four pureed foods I got to test included a tomato cinnamon soy strip, whole wheat pasta, oatmeal, and peaches. I had never tried foods pureed intentionally for certain medical conditions and, as many people do, I anticipated them to be bland, boring, and unappetizing. However, they are not with the utilization of plating techniques and the addition of various flavors. I expected the tomato cinnamon soy strip and the whole wheat pasta to taste worse than they did, but I found them to be flavorful.

There are other aspects that were tested in the specific IDDSI based audit we performed. This included lumpiness of the food, the ability of the food to hold shape on a teaspoon, whether or not the food drips or flows through a fork, and whether or not a fork can make indentation marks in the puree. Out of the four foods that were tested, ultimately none of them were ready to be served as a level 4 pureed meal according to IDDSI guidelines. Because none of the tested pureed meals were ready to be added and served as part of the pureed meal plan, the dietitians and chefs at Food & Friends will continue to work together to alter the components and test the
meals so they can meet the guidelines in the future and can be served to clients. The chefs and dietitians are currently in the process of updating and revamping their pureed meal plan, which I was able to help with.

Overall, it is very important to perform these audits before serving the meals to clients in order to make sure food intended to meet a certain IDDSI level does and is consistent. Serving IDDSI level foods that are not qualified or labeled incorrectly can pose serious health threats such as aspiration (when food or liquid enters the airway accidentally), vomiting, choking, or breathing
difficulty while eating. Performing the test audits prepared me for future experiences I may have as a dietitian. By taste testing different types of medically tailored meals, I can provide accurate feedback and knowledge to my patients on how a food tastes, what the texture is like, and if I personally enjoy it. This is important as I want to relate and bond with my future clients and patients.

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