Art on a Plate Adding Visual Appeal to Vitamised Diets Produced as part of the Vitamised Diet Development Project 2005. Funded by the Don Hutchison Scholarship Project Coordinator: Patricia Forbes Clinical Specialist Speech Pathologist Brightwater Ellison House
Thank you to the staff and residents of Ellison House for all of your ideas, support and encouragement. Your participation in the project has been appreciated. Acknowledgements Tony Taylor and Anita Kufner Brightwater Catering, Malaga Joanne Flannery Consultant Dietitian, Brightwater Care Group Marni Nicholls Chef / Cook Instructor Challenger TAFE, Beaconsfield Karen Keast Dietitian, Lottie Stewart Hospital, West Sydney (for vitamised cottage pie and lasagne ideas) Robert Malekin Head of Nutritional and Diet Therapy, Osborne Park Hospital The information contained in this resource is intended as a guide only. No responsibility is taken for fluctuating or altered resident swallowing status. No responsibility is taken for the provision of incorrectly textured food items to Brightwater residents / other people who have dysphagia.
Why all the Fuss About Vitamised Diets? Modified texture diets are sometimes recommended to help manage a medical condition called dysphagia (swallowing difficulties). Dysphagia is dangerous because, unless appropriately managed, it can place a person at risk of choking, or aspiration. The term aspiration refers to food or fluid entering a person s airways. It can lead to pneumonia (chest infection). A vitamised (or puree) diet is an example of a modified texture diet. This type of diet is generally recommended for people who have significant swallowing difficulties. The food is vitamised in order to eliminate the need for chewing and to promote ease and safety of swallowing. A vitamised diet consists of soft, well cooked foods that have been pureed or blended to a smooth, thick consistency. Vitamised food must be the same consistency throughout it cannot contain lumps. Sometimes when an individual is prescribed a vitamised diet for management of dysphagia, they may be reluctant to eat it. This may be because they consider that the food looks dull or unappealing. A typical comment is that vitamised food sometimes resembles baby food. This can of course be difficult for an adult to accept. Improving the presentation of vitamised diets can help with this. Vitamised food can be easily re-shaped so that it resembles its original form. This is quick and easy to do, using simple culinary techniques or, alternatively, commercially available puree moulds. In addition to this, a few simple garnishing ideas can add to the appeal of vitamised diets. Using these strategies can have a range of potential benefits. Firstly, for the person with dysphagia, improving meal presentation can increase motivation to eat. Increased motivation leads, in turn, to increased compliance with dysphagia management recommendations. This promotes swallowing safety, and can also assist with improved nutritional outcomes, such as weight maintenance. Importantly, presenting vitamised food attractively can promote enjoyment of meals and increased dignity at mealtimes. Let s face it eating is a big part of our lives it is a source of pleasure and social contact. When someone requires a vitamised diet, a few simple
strategies can help to maintain the pleasures associated with this important aspect of daily living. About the Vitamised Diet Development Project The Vitamised Diet Development Project (VDDP) was funded by the Don Hutchison Scholarship program of Brightwater Care Group. It is a four month enquiry into vitamised diet presentation techniques. The project will run from February to May 2005. It will involve a trial of selected presentation techniques at Ellison House, Carlisle. Feedback from residents and staff regarding their perception of the use of these techniques will be obtained as part of the project.
Simple Ideas for Presenting Vitamised Food Enhancing the presentation of vitamised diets does not need to be time consuming or expensive. You can use a few simple utensils and techniques at the time of food service to add visual appeal to the meal. Read on for some quick and easy ideas which will add interest to any vitamised meal. Ideas for Serving Vitamised Meat Products Vitamised meat products can be easily re-shaped to resemble their original form. Re-shaping generally work best when the food is prepared to a thick, smooth, pudding like consistency. You may therefore need to add a thickening agent to the food before reshaping. There are a range of food thickening agents available. Some puree foods can be thickened with other foods, such as dehydrated mashed potato mix, corn flour or fine bread crumbs. The suitability of these products to thicken puree food is dependent on a range of factors. These include the type of food they are being added to, and the consistency of the food they are being added to. If you have any concerns or questions, always consult a speech pathologist before serving the food to someone who has dysphagia. There are also a range of commercial food and beverage thickeners available. Follow the manufacturer s instructions to ensure an appropriate consistency is reached when you thicken food. Again, if you have any concerns contact a speech pathologist. If setting thickened meat in tins or moulds, it is useful to first line the tin with aluminium foil. Alternatively, spray the tin with cooking spray. You may find you have to loosen the meat prior to turning out. This is done by placing the tin in a large container of hot water for one minute. Then turn out the meat onto an inverted plate. Original form
Some simple ideas for serving vitamised meat products include: 1. Making meat patties Place a scoop of vitamised meat on a plate. Use a spatula or large serving spoon to flatten the meat into the shape of a patty. If the mixture is thick enough patties can also be shaped by hand. 2. Making meatballs Use a small scoop or melon baller to shape meat into meatball shapes. Alternatively, shape into meatballs by hand. 3. Making meat loaf Place thickened vitamised meat in a non stick loaf tin. Cover and refrigerate until set. Cut into thick slices and place on plate. Meat loaf preparation 4. Making meat pie Place thickened vitamised meat in a non stick round cake tin. Cover and allow to set. Turn out meat onto an inverted plate. Cut into wedge shaped individual portions to resemble pie. 5. Making sausages Use a cake icing bag or pump to pipe vitamised meat into a sausage shape. Again, if the mixture is thick enough sausages can be shaped by hand. 6. Making cottage pie Place a layer of vitamised meat in a shallow dish or pan. Top with a layer of smooth, thick puree potato or other appropriate vegetable eg puree pumpkin, puree sweet potato. Slice into individual portions and serve. Or assemble directly onto the plate by topping a vitamised meat patty with a layer of puree vegetable. Shape using a spatula or large serving spoon.
7. Making meat lasagne Place a layer of vitamised meat in a shallow dish or pan. Top with a layer of vitamised pasta. Slice into individual portions and serve. Or assemble directly onto the plate by topping a vitamised meat patty with a layer of vitamised pasta. Shape using a spatula or large serving spoon. 8. Making meat and vegetable stacks Use a large scoop (eg icecream scoop) to make a vitamised meat patty. Top with one or two smaller patties shaped from vitamised vegetables in contrasting colours. Use a small scoop or serving spoon to shape the smaller patties. Serve the stack with a tasty sauce or gravy, either drizzled over the top, or spooned around the base of the stack. Many of the ideas listed above can be used for vitamised red meat, chicken and fish. Just consider the type of meal you are serving and how it would usually be presented, then select an appropriate presentation technique. For example, you could make chicken sausages or meatballs. Or how about a fish pie made using the cottage pie technique? You are limited only by your imagination. Remember that if you are shaping foods by hand, you must wear gloves.
Ideas for Serving Vitamised Vegetables Many of the ideas described for presenting vitamised meat can also be used when serving vitamised vegetables. Try making vegetable patties, loaves, pies and stacks. You could also use the ideas in the vitamised meat section to make vegetable cottage pie or lasagne. Some other unique and simple ideas for presenting vitamised vegetables include: 1. Making vegetable swirls Use an icing bag or pump to pipe vitamised vegetables onto a plate in a swirl design. Using piping nozzles of different shapes and sizes can create a variety of patterns. 2. Making piped vegetables Use an icing bag or pump to pipe vitamised vegetables onto a plate so that they resemble their original shape. For example, use a medium sized, basic icing nozzle to pipe long, thin lines of vegetable onto a plate. This technique can be used to create re-shaped vegetables such as green beans. It would also work well for root vegetables such as carrots, presented in julienne style. To make vegetable rings, pipe circular disks of the vitamised vegetable onto a plate. Again, this would work well with carrots. 3. Making rainbow scoops Make rainbow scoops using two vitamised vegetables of contrasting colours. Place a line of each vegetable side by side on a clean surface. Run an ice cream scoop progressively through both vegetables, swirling the vegetables together. Turn the vegetables out of the scoop to create your rainbow swirl. Alternatively, place two kinds of vegetable in an icing bag and pipe onto plate. Ideas for Serving Vitamised Desserts Serving vitamised desserts is a real opportunity to experiment with puree consistency food garnishes and to unleash the creative genius within! Adding sweet sauces, custard or cream to desserts will enhance the flavour of the dessert and provide an opportunity to add some visual appeal to the dish. See the Using Sauces, Gravies and Other Accompaniments section of this resource for ideas. Even just
piping cream onto a dessert, instead of always spooning it on, can add visual interest. There are many desserts that are typically served in puree form. So serving the standard scoop of vitamised dessert may be quite acceptable. In that case, use the puree garnishes to make the dessert look more interesting. You just need to think about the type of dessert you are serving and how it would usually be presented. You may be able to use some of the re-shaping ideas outlined in previous sections depending on the sort of dish you are serving. For example, you could re-shape thickened pureed cake using a round, or loaf, tin. Puree desserts A Note on Meeting Nutritional Requirements In addition to meeting swallowing safety needs, it is very important that any vitamised meals you serve satisfy an individual s nutritional requirements. For example, it may be appropriate for a person who would benefit from gaining weight to have high calorie, high fat additions such as cream served alongside their dessert. This would not be appropriate, however, for a person who had been recommended to lose weight. Always consult a dietitian if you have any questions about an individual s nutritional requirements, or if you are unsure whether the ideas presented in this resource are appropriate for an individual who you are working with. It is also important that the amount of vitamised food you serve is appropriate for the individual. Always ensure that the portion sizes you provide correspond to the information outlined in the Brightwater Catering Manual.
A Note on Using Commercial Puree Food Moulds It is possible to purchase puree food moulds commercially. Using these moulds allows you to easily shape vitamised food, so that the food resembles its original form. There are a range of shapes and sizes available. These moulds may work best when the food you serve is prepared on site at your facility. However, it is possible to use them when the food has been pre-prepared and delivered to your site. Some foods can be successfully thickened to a semi-solid consistency, placed in the moulds and then turned out for heating and serving. It is useful to lightly coat the moulds with cooking spray first. If you would like to try using commercially available puree food moulds, consult a speech pathologist and catering professional. These professionals can provide you with information and advice on how best to use commercial puree food moulds. Using Sauces, Gravies and Other Accompaniments When someone has a swallowing difficulty, it is often suggested that they add gravies, sauces or other similar accompaniments to their meals. This is because these accompaniments moisten the person s food, making them easier to swallow. They therefore serve an important function in promoting the swallowing safety of people who have dysphagia. However, sauces and gravies can also be used as an attractive garnish to enhance both the appearance and taste of vitamised meals. This means that they serve a triple purpose safety, appearance and taste! This principle applies to both savoury and sweet meal items. Cream or fruit based sauces can be added to desserts to add extra moisture. For a list of suggested condiments, please see the Taste Sensations section of this manual. Try the following ideas for using sauces and gravies as a garnish for vitamised meals. A plastic squeeze bottle with a thin nozzle will help you to achieve a more precise placement of the condiment if you are making patterns or shapes. Plastic tomato sauce bottles are ideal and
easy to use. You could also use a piping bag with a thin nozzle for the same purpose. Drizzle the sauce attractively across the meal. For example, place diagonal stripes of gravy across the meat portion of the meal. Or place swirls of cheese sauce across the vegetable portion of the meal. Place the meal in the middle of the plate. Place a thick swirl of sauce around the circumference of the plate. This idea works well with vitamised meals that are presented in a layered or stacked style. Paint a plate with sauce prior to serving the meal. You could use either stripes, or a swirled pattern. Make the pattern on the plate, and then carefully place the meal on top. This idea works particularly well when serving puree desserts. Make a matchstick pattern with the sauce. Place evenly striped horizontal stripes across a plate. Draw a toothpick slowly through the stripes to create the design. Again, this is a lovely idea when serving desserts. Mousses and slices of cheesecake filling look great when placed on top of this design. Use a piping bag with a thick nozzle to create attractive swirls of sauce. This idea will work best with thick accompaniments such as custard or thick gravy. Place the main portion of the meal in the middle of the plate. Use a teaspoon to drop small amounts of sauce around the circumference of the plate. If you like, you could draw a toothpick through the dots of sauce to create a swirled or heartshaped pattern. Make novelty shapes using the sauce. For example, place a heart or flower shape alongside the meal. You could use novelty biscuit cutters to make this job easier place the cutter on the plate, and trace around the shape using the sauce. However, always make sure that the design you use is appropriate to the age and cognitive level of the person you are preparing the meal for.
Serve sauces separately in small attractive glass bowls or serving jugs. Check first that the individual will be able to serve the sauce themselves ask an occupational therapist or speech pathologist if you are not sure. Plate garnish IMPORTANT SAFETY TIPS Always ensure you have added enough of the accompaniment to meet the individual s swallowing requirements. Always consult the individual s swallowing care plan before serving a meal. If in doubt, always ask a speech pathologist. Some of these ideas may not be appropriate if the person you are serving the meal to has reduced cognitive or visual abilities. For example, if the person has difficulties with visual perception making shapes or patterns out of sauce may confuse them. If you are unsure of the person s skills and abilities in these areas, ask an occupational therapist or speech pathologist before trying any of the ideas. Taste Sensations! People s taste preferences obviously vary. Some people like hot, spicy food, while others prefer less fiery meals. Some people have a sweet tooth, others would rather tuck into a savoury snack. Taste is clearly an important factor with all food! This is especially so for vitamised food. Because the food may be visually different to how it would typically look, taste becomes even more important in encouraging people to eat.
There are a huge range of commercially available sauces, condiments and flavourings that can be added to vitamised food to enhance the taste and get the digestive juices flowing! This booklet provides a few suggestions see if you can come up with some of your own. It would be a good idea to talk to the people you are serving meals to, and to try to find out about their taste preferences. Remember that, if sauces, condiments or flavourings are served separately to the meal, they must not be thinner than the person s recommended consistency for fluids. That means that if the person requires thickened fluids, they cannot be served a thin, watery sauce alongside their meal. To promote the person s swallowing safety, the flavour enhancer can be mixed into the vitamised meal. Again, however, you must ensure that adding the flavouring does not make the meal too thin. If you have any concerns or questions, always consult a speech pathologist. And, if you plan to use the sauce or condiment as a garnish for the food, make sure you show the meal to the person eating it before mixing the sauce in! You want to make sure they have the opportunity to look at, and enjoy, your art on a plate before you change its appearance by mixing the sauce through. Another consideration is that any sauce, condiment or flavouring you add to food must not change the overall texture of the meal. This means that any flavour enhancer you add cannot contain lumps, seeds, skin, peel or anything that alters the consistency of the vitamised meal. Vitamised meals must always be thick, smooth and lump free. This is extremely important to promote safety and ease of swallowing. Again, if you have any questions, talk to a speech pathologist.
Sauces, condiments and flavourings that may be suitable to add to savoury vitamised meals include: Salt and pepper Garlic salt Ground herbs or spices Gravy Tomato sauce Sweet chilli sauce Plum sauce Garlic sauce Barbeque sauce Cheese sauce White sauce Hollandaise sauce Béarnaise sauce Worstershire sauce Soy sauce Sweet and sour sauce (without lumps of fruits / vegetables) Mustard or mustard sauces Plain or flavoured mayonnaises Plain or flavoured sour creams Natural or savoury flavoured yoghurts Salad oils or dressings Smooth relishes (without lumps of fruits / vegetables) Plain or smooth flavoured cream cheese Smooth, spreadable plain or flavoured fetta cheese Sauces, condiments and flavourings that may be suitable to add to sweet vitamised meals include: Plain or flavoured sugars (eg vanilla sugar) Cream Cocoa Flavoured food essences eg vanilla essence, coconut essence Sweet favoured sauces or icecream toppings eg chocolate, caramel, vanilla flavours Fruit purees or sauces (no lumps, seeds, fruit skin) Custard Smooth, sweet flavoured yoghurts Honey / golden syrup (ensure that adding these items does not make the food consistency too sticky check with a speech pathologist if unsure).
Useful Tools for Presenting Vitamised Food The following utensils may be useful if you would like to enhance the appearance of vitamised food. They are easily available from supermarkets or department stores. Scoops or serving spoons of various shapes and sizes Cake tins of various shapes and sizes Jelly or mousse moulds Ramekin dishes Dariole or timbale moulds Biscuit cutters of various shapes and sizes Cake icing set (piping bag or pump with nozzles) Non stick pastry cups Sauce or mustard dispensers Small cups or serving jugs