Chinese Expert Consensus on Food and Nutrition Management for Dysphagia
Asia Pacific Journal of Clinical Nutrition
Chinese Expert Consensus Group of Dysphagia and Nutrition Management. (2020).
Asia Pacific Journal of Clinical Nutrition, 29(2), 434-444.
This is a clinical practice guideline providing consensus recommendations for the management of people with dysphagia, specifically in the context of the dietary habits of the Chinese community. In this guideline, dysphagia diet and nutrition management includes food for dysphagia, which the authors define as "special foods made through processing, including but not limited to breaking down food or adding food additives such as thickening agents and coagulators that meet the oral intake requirements of people with dysphagia" (p. 435).
Dysphagia Rehabilitation Specialty Committee of Chinese Association of Rehabilitation Medicine; Elderly Nutrition Committee of Chinese Nutrition Society
"The swallowing ability of people at high risk of dysphagia should be screened for and evaluated before oral intake; subsequently, whether patients should have oral intake should be considered and appropriate food characteristics determined based on evaluation results" (p. 436).
Food for dysphagia is classified into the six levels below. Each level of food should have clearly described characteristics and the patients that such foods are suitable for should also be defined.
<ol>
<li>First level low-viscosity liquid (e.g., easily dispersed in the mouth, does not require considerable force when swallowing)</li>
<li>Second level mid-viscosity liquid (e.g., viscous, food is slowly dispersed in the mouth, tends to aggregate on the tongue)</li>
<li>Third level high-viscosity liquid (e.g., unsuitable to be consumed with a straw, easily forms a food mass, requires a certain force when swallowing)</li>
<li>Fourth level pureed food (e.g., pastes or gelatinous foods made by stirring various types of meat, vegetables, or congee with food additives)</li>
<li>Fifth level stuffing-like food (e.g., 30% congee, 50% congee, soft foods, and food prepared by adding and stirring food additives)</li>
<li>Sixth level soft food (e.g., soft food including congee and soft rice, as well as harder food made by adding food additives after being stirred with a blender, which is the major part of the diet) and food for swallowing is incorporated into solid food</li>
</ol>
"Patients with dysphagia must have standardized nutrition management, which will reduce their difficulty in swallowing food, achieve oral intake earlier, and improve patients’ nutrition status" (p. 435). Standardized nutrition management can reduce food residues during swallowing and preventing aspiration, as well as shorten the proportion and time of tube feeding. All clinical disciplines have a shared responsibility for the nutrition management of patients with dysphagia.
People with dysphagia should have liquid foods of appropriate viscosity. Solid foods should not be easily dispersed but should be easily deformed and have an even density. "It is not recommended for people with dysphagia to eat rice paste, sesame paste, and other foods in paste form that have not been processed with a thickening agent" (p. 436).
"Screening and nutritional status evaluation should be performed before a dietary nutrition intervention is implemented on patients with dysphagia" (p. 6).
"When oral intake is unable to reach patients’ target nutritional requirement, they should select feeding through a continuous or intermittent oroesophageal tube; moreover, the addition of parenteral nutrition as a supplement should be considered when gastrointestinal nutrition cannot achieve 60% of patients’ daily calorie intake" (p. 8).
"Patients should strive to maintain oral intake or start it early; when their food intake does not meet nutritional requirements, enteral nutrition preparations or special medical foods with modified food characteristics and shapes can be selected" (p. 7).
