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Cassandra Detgen

KNH 413

April 16, 2012

Medical Nutrition Therapy Diet

1. Purpose

Indicators that this diet is needed include pocketing food in the cheeks, drooling, hoarseness, frequent heartburn, weight loss, and coughing. There could also be signs that the individual may want to eat softer foods and that they are taking awhile and moving food around their mouth before actually swallowing (MayoClinic, 2011).

In order to diagnose and prescribe this diet, individuals are given a swallowing diagnostic test to see how well they could handle certain textures of foods and liquids (McCullough, Pelletier, & Steele, 2003). Other possible tests that could be done include an x-ray, an endoscopy, and/or a manometry (MayoClinic, 2011). The diet is used to help individuals feel more comfortable when eating. The diet also helps the individuals receive the appropriate nutrition.

Choosing the diet for an individual depends on how severe the dysphagia really is.The National Dysphagia Diet was developed through consensus by a panel of dietitians, speech language pathologists, and a food scientist. The diet helps classify foods according to eight different textural properties (McCullough, Pelletier, & Steele., 2003). There are four levels of semisolid/solid foods that were decided on:

Level 1: Pureed (homogenous, pudding like, little chewing required)

Level 2: Mechanical altered (moist, semisolid foods, some chewing required)

Level 3: Advanced (soft foods that need some chewing)

Level 4: Regular (all foods allowed)

2. Population

The dysphagia diet could be needed as a result of many different health problems. Most of the health problems that need this diet are mainly related to the esophagus and throat muscles. Some of these include achalasia, esophageal stricture and tumors, gastroesophageal reflux disease, esophagitis, neurologic problems, and cancer (WebMD, 2009).

It would be hard to determine the disease process since it can come from many different factors. It would be important to follow the diet in order to maintain comfort and get all the necessary nutrients. Also, since the dysphagia varies in how severe it can be, having each person look at their own nutrient needs and follow the appropriate diet could help establish normal biochemical data results and levels.

3. General Guidelines

As stated earlier, the level of dysphagia is determined by various tests. These tests help show what the cause was and help determine what each person can eat. The nutrition differs for each person because they would still follow the dietary guidelines. Dysphagia does not majorly affect many things inside the body. As a result of this, getting the proper nutrition into the person will help a lot.

Since the National Dysphagia Diet was decided on by a panel of dietitians, speech language pathologists, and a food scientist, it will meet all the necessary requirements to get a person feeling better and back to normal.

4. Education Material

For nutrition therapy, we want to help maintain and possibly restore each person back to their normal weight if they lost any. We will also want to check biochemical values, anthropometric values, and past medical history to see if anything can cause more problems. Creating a diagnostic criterion such as having an inadequate food and energy intake related to swallowing difficulty as evidence by a 24-hour recall could further help understand where some of the problems are. For the intervention, we want to find and use acceptable textures to develop an appropriate menu. Diets 1, 2, and 3 are the options to choose from. Diets can change if there is a noticed progression or regression with the food intake. There are thickening agents that can be used to help with the consistency of some foods (Edelstein, & Sharlin. 2009). After speaking with each person, we would want to monitor and watch their food and energy intake, as well as their nutrient chemistry making sure they are not deficient. Watching their hydration level and making sure they are getting the correct amount is also important. As a result of adding thickeners, it may cause a decreased food intake because it is unappealing, so will want to watch their intake and look at other options if needed. The tolerance of the diet may improve with treatment, but if there are problems, the diet may need to be further restricted or changed. It is also important to reevaluate each person’s ability to progress out of the diet (Nelms, Sucher, Lacey, & Roth, 2011).

Trying out new things is always one way to get a person to comply. Looking at their interest and what they expect is important.

5. Sample Menu

|Food Allowed |Foods Not Allowed |

|Moist and soft textured |Break |

|Tender ground or diced meats |Dry cake |

|Soft cooked vegetables |Rice |

|Soft ripe or canned fruit |Cheese cubes |

|Some moistened cereals |Corn and peas |

| |Sample Menu |

|Breakfast |1 Pancake, moistened with syrup |

| |2 scrambled eggs, with milk |

| |1 Banana, cut into pieces |

| |1 cup Apple juice, thickened |

|Lunch |1 cup tomato soup |

| |1 cup canned green beans |

| |1 sweet roll |

| |1 cup water, thickened |

|Dinner |1 cup mashed potatoes, with gravy |

| |1 cup chocolate milk |

| |3 oz chicken, finely ground, mixed with the gravy |

| |1 cup apple sauce |

|Snack |1 container vanilla pudding |

| |1 cup water, thickened |

6. Websites

To learn general information about the diet the following websites will provide a better understanding:









Learning more specifically about the different diets can be seen through these websites:

OSU Medical Center: patienteducation.osumc.edu/Documents/dys-2.pdf

ASHA: Publications/leader/2003/031104/f031104c.htm

Thick-it Products: Products.aspx

7. References

Difficulty Swallowing. (2011). Retrieved from MayoClinic website:



Difficulty Swallowing (Dysphagia) . (2009). Retrieved from WebMD website:



Dysphagia Mechanically Altered Diet (Level II). (2011). Retrieved from The Ohio State

University Medical Center website:

Edelstein, & Sharlin. (2009). Malnutrition and Nutrient Deficits . In Life Cycle Nutrition (pp.

415-417). Massachusetts: Jones and Bartlett Publishers.

McCullough, Pelletier, & Steele. (2003). National Dysphagia Diet: What to Swallow? Retrieved

from ASHA website:

Nelms, Sucher, Lacey, & Roth. (2011). Diseases of the Upper Gastrointestinal Tract. In Nutrition

Therapy & Pathophysiology (pp. 355-358). Cengage Learning.

Thick-It® Products. (2011). Retrieved from Precision Foods Inc. website:



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