Skip to main content Accessibility help

A Mix of Bulk and Ready-to-Use Modified-Texture Food: Impact on Older Adults Requiring Dysphagic Food*

  • Heather H. Keller (a1), Larry W. Chambers (a2), Dean A. Fergusson (a3), Helen Niezgoda (a2), Maxim Parent (a2), Danielle Caissie (a4) and Nicole Lemire (a4)...


Ready-to-use modified-texture food (rMTF) products are commercially available and may have greater appeal than conventional in-house or commercial bulk modified-texture food (cMTF) products. A nine-month pilot study using a prospective interrupted time-series design where participants (n = 42) served as their own controls investigated the impact of cMTF + rMTF on weight goals, weight, food intake, and co-morbidity. Seventy-four per cent of participants achieved their weight goals at the end of six months on rMTF and, although insignificant, participants did have a trend towards weight gain while on rMTF (OR 3.5 p = .16). Main-plate food intake (grams) was not significantly different over time, but a downwards trajectory suggests decreased consumption that was compensated for by a significantly higher fat intake during the intervention period (p = .01). Increased co-morbidity and a decreasing volume of food consumed are common in older adults with dysphagia, and enhanced food products are needed to meet nutrient needs. Methodological issues encountered in this study can provide guidance for future work.

Les aliments à texture modifiée prêts à servir (ATMp) sont offerts commercialement et peuvent être plus attrayant que les produits conventionnels maison ou commerciaux en vrac. Une étude prospective de neuf mois utilisant l’approche de séries temporelles interrompues, où les participants (n = 42) agissaient comme leur propre témoin, a examiné l’impact des ATMp sur le poids, les objectifs de poids, l’apport alimentaire et les comorbidités. Soixante-quatorze pour cent des participants ont atteint leurs objectifs de poids à la fin d’une période de six mois où ils consommaient les ATMp. Il était plus probable, mais pas statistiquement significatif, que les participants ont eu un gain de poids pendant l’intervention (6 mois) comparé à la période de contrôle (3 mois) offrant la diète d’aliments conventionnels (ATMc) (RC 3.5, p = .16). L’apport alimentaire (en g) n’a pas différé de façon significative à travers l’étude. Cependant, la pente légèrement négative pourrait être expliquée par une consommation significativement supérieure de gras pendant l’intervention (p = .01), ce qui a aidé à maintenir le poids des participants. L'augementation des comorbidités et une réduction de la consommation alimentaire sont communs chez les personnes âgées atteintes de dysphagie. Des aliments fortifiés en nutriments sont nécessaires pour combler leurs besoins nutritionnels. Les questions méthodologiques rencontrées dans la conduite de cette étude peuvent orienter les travaux futurs.


Corresponding author

Correspondence and requests for offprints should be sent to / La correspondance et les demandes de tirés-à-part doivent être adressées à: Helen Niezgoda, B.Sc.N., M.Sc. Manager, Corporate Research Initiatives Bruyère Research Institute 43 Bruyère Street Ottawa, ON K1N 5C8 (


Hide All

The authors thank Healthcare Food Services (HFS), Ottawa, Ontario, for providing the ready-to-use modified-texture food; Amy Nichols; Andrea Trainor; and the staff and patients/residents across Bruyère Continuing Care.



Hide All
Allard, J.P., Aghdassi, E., McArthur, M., McGeer, A., Simor, A., Abdolell, M., et al. . (2004). Nutrition risk factors for survival in the elderly living in Canadian long-term care facilities. Journal of the American Geriatrics Society, 52, 5965.
Amunrud, E.A., Mitchell, C.O., & Sun, M.M. (1999). Acceptability and health effects of commercially prepared puree foods in nursing home residents. Journal of the American Dietetic AssociationSeptember. 99(9), A119).
Bannerman, E., & McDermott, K. (2011). Dietary and fluid intakes of older adults in care homes requiring a texture modified diet: The role of snacks. Journal of the American Medical Directors Association, 12, 234239.
Canadian Institute for Health Information. (2007). CCRS analysis in brief the “Younger” generation in Ontario complex continuing care. Internet [On-line] Retrieved from:
Chen, C.C., Schilling, L.S., & Lyder, C.H. (2001). A concept analysis of malnutrition in the elderly. Journal of Advanced Nursing, 36, 131142.
Computrition. (2011). Hospitality suite: Computrition foodservice and healthcare software. Internet [On-line]. Retrieved from
Comstock, E.M., St Pierre, R.G., & Mackiernan, Y.D. (1981). Measuring individual plate waste in school lunches. Visual estimation and children’s ratings vs. actual weighing of plate waste. Journal of the American Dietetic Association, 79, 290296.
Crogan, N.L., & Pasvogel, A. (2003). The influence of protein-calorie malnutrition on quality of life in nursing homes. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 58, 159164.
Dhingra, P., Sazawa, S., Menon, V.P., Dhingra, U., & Black, R.E. (2007). Validation of visual estimation of portion size consumed as a method for estimating food intake by young Indian children. Journal of health, Population, and Nutrition, 25, 112115.
Etland, C. (2008). Mortality prognostication in long-term residents: The MDS-CHESS scale. In Doctor of philosophy in nursing. San Diego: University of San Diego–Hahn School of Nursing and Health Science.
Germain, I., Dufresne, T., & Gray-Donald, K. (2006). A novel dysphagia diet improves the nutrient intake of institutionalized elders. Journal of the American Dietetic Association, 106, 16141623.
Green, S.M., & Watson, R. (2006). Nutritional screening and assessment tools for older adults: Literature review. Journal of Advanced Nursing, 54, 477490.
Hirdes, J.P., Frijters, D.H., & Teare, G.F. (2003). The MDS-CHESS scale: A new measure to predict mortality in institutionalized older people. Journal of the American Geriatrics Society, 51, 96100.
Hirdes, J.P., & Carpenter, G.I. (1997). Health outcomes among the frail elderly in communities and institutions: Use of the minimum data set (MDS) to create effective linkages between research and policy. Canadian Journal on Aging, 16, 5369.
Holmes, S. (2008). Nutrition and eating difficulties in hospitalised older adults. Nursing standard, 22, 4757.
Ilhamto, N. (2011). Factors of importance in the production of in-house pureed food: A perspective from nutrition managers and cooks in long-term care [thesis]. Guelph, Ontario, Canada: Univeristy of Guelph.
Information Services Group Health Data Branch. (2008). Long-term care home system report as of February 29, 2008. Toronto, Ontario, Canada: Ministry of Health and Long-term Care.
Johnson, R.M.S.-W.H., & Soucy, I.M.R.J.S. (1995). Nutrient intake of nursing-home residents receiving pureed foods or a regular diet. Journal of the American Geriatrics Society, 43, 344348.
Keller, H.H. (1993). Malnutrition in institutionalized elderly: How and why? Journal of the American Geriatrics Society, 41, 12121218.
Keller, H.H., Chambers, L.W., Niezgoda, H., & Duizer, L. (2012). Issues associated with the use of modified-texture foods. Journal of Nutrition, Health and Aging 16(3), 195200.
Keller, H.H., & Hirdes, J.P. (2000). Using the minimum data set to determine the prevalence of nutrition problems in an Ontario population of chronic care patients. Canadian Journal of Dietetic Practice and Research, 61, 165171.
Keller, H. (2000). The development of: Seniors in the community: Risk evaluation for eating and nutrition. Canadian Journal of Dietetic Practice and Research, 61, 6772.
Landry, K. (2009). A closer look at pureed diets. Gerontology Nutrition Link: Official Newsletter of the Dietitians of Canada, Spring, 79.
Lee, J. (2009). Survival prediction in nursing home residents using the minimum data set subscales: ADL self-performance hierarchy, cognitive performance and the changes in health, end-stage disease and symptoms and signs scales. European Journal of Public Health, 19, 308312.
Morley, J.E. (1997). Anorexia of aging: physiologic and pathologic. American Journal of Clinical Nutrition, 66, 760773.
Niezgoda, H., Trainor, A., Chambers, L.W., Keller, H.H., Caissie, D. (2011). Taking the weight: Standardizing weight measuring and documentation in continuing care. Canadian Nurse, 107(8), 2022.
Pai, M.P., & Paloucek, F.P. (2000). The origin of the “ideal” body weight equations. The Annals of Pharmacotherapy, 34, 10661069.
Parrott, M.D., Young, K.W., & Greenwood, C.E. (2006). Energy-containing nutritional supplements can affect usual energy intake postsupplementation in institutionalized seniors with probable Alzheimer’s disease. Journal of the American Geriatrics Society, 54, 13821387.
Persson, M., Hytter-Landahl, A., Brismar, K., & Cederholm, T. (2007). Nutritional supplementation and dietary advice in geriatric patients at risk of malnutrition. Clinical Nutrition, 26, 216224.
Poss, J.W., Jutan, N.M., Hirdes, J.P., Fries, B.E., Morris, J.N., Teare, G.F., et al. . (2008). A review of evidence on the reliability and validity of minimum data set data. Healthcare Management Forum, 21, 3339.
Reuben, D.B. (2007). Quality indicators for the care of undernutrition in vulnerable elders. Journal of the American Geriatrics Society, 55(Suppl. 2), S438S442.
Salva, A., Corman, B., Andrieu, S., Salas, J., Porras, C., & Vellas, B. (2004). Minimum data set for nutritional intervention studies in the elderly IAG/ IANA task force consensus. The Journal of Nutrition, Health & Aging, 8, 202206.
Shatenstein, B., Claveau, D., & Ferland, G. (2002). Visual observation is a valid means of assessing dietary consumption among older adults with cognitive deficits in long-term care settings. Journal of the American Dietetic Association, 102, 250252.
Shatenstein, B., Kergoat, M.J., & Nadon, S. (2001). Weight change, nutritional risk and its determinants among cognitively intact and demented elderly Canadians. Canadian Journal of Public Health, 92, 143149.
Simmons, S.F., Cleeton, P., & Porchak, T. (2009). Resident complaints about the nursing home food service: Relationship to cognitive status. Journals of Gerontology Series B: Psychological Sciences & Social Sciences, 64B, 324327.
Simmons, S.F., Peterson, E.N., & You, C. (2009). The accuracy of monthly weight assessment in nursing homes: Implications for the identification of weight loss. The Journal of Nutrition, Health and Aging, 13, 284288.
Simmons, S.F., & Reuben, D. (2000). Nutritional intake monitoring for nursing home residents: a comparison of staff documentation, direct observation, and photography methods. Journal of the American Geriatrics Society, 48, 209213.
Simmons, S.F., & Schnelle, J.F. (2006). Feeding assistance needs of long-stay nursing home residents and staff to provide care. Journal of the American Geriatrics Society, 54, 919924.
Steele, C.M., Greenwood, C., Ens, I., Robertson, C., & Seidman-Carlson, R. (1997). Mealtime difficulties in a home for the aged: Not just dysphagia. Dysphagia, 12, 4350.
Welch, P., Porter, J., & Endres, J. (2003). Efficacy of a medication pass supplement program in long-term care compared to a traditional system. Journal of Nutrition for the Elderly, 22, 1928.
Wright, L., Cotter, D., & Hickson, M. (2008). The effectiveness of targeted feeding assistance to improve the nutritional intake of elderly dysphagic patients in hospital. Journal of Human Nutrition and Dietetics, 21, 555562.
Wright, L., Cotter, D., Hickson, M., & Frost, G. (2005). Comparison of energy and protein intakes of older people consuming a texture modified diet with a normal hospital diet. Journal of Human Nutrition and Dietetics, 18, 213219.


A Mix of Bulk and Ready-to-Use Modified-Texture Food: Impact on Older Adults Requiring Dysphagic Food*

  • Heather H. Keller (a1), Larry W. Chambers (a2), Dean A. Fergusson (a3), Helen Niezgoda (a2), Maxim Parent (a2), Danielle Caissie (a4) and Nicole Lemire (a4)...


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed