Can apple sauce be used as a thickening agent for patients on Nectar (National Dysphagia Diet, level 1) thick liquids?

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Last updated: April 22, 2025View editorial policy

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From the Guidelines

No, applesauce should not be used for patients on nectar-thick liquids. Applesauce has an inconsistent texture that doesn't reliably match the nectar-thick consistency required for patients with swallowing difficulties, as seen in studies on dietary modification for patients with oral-pharyngeal dysphagia 1. Nectar-thick liquids need to have a specific viscosity to reduce the risk of aspiration in patients with dysphagia. Some key points to consider when managing patients on nectar-thick liquids include:

  • The administration of solid foods and liquids commonly available to the patient should be administered during instrumental evaluations, such as the Videofluoroscopic Swallow Study (VSE) or Fiberoptic Endoscopic Evaluation of Swallowing (FEES), to determine which consistencies of these substances can be swallowed without risk for aspiration 1.
  • Studies have shown a dramatic reduction in the aspiration of thickened liquids compared to thin liquids in both adults and children 1.
  • Instead of using applesauce, you should use commercially prepared nectar-thick liquids or properly thicken regular liquids using approved thickening agents like modified food starch or xanthan gum-based products according to manufacturer instructions.
  • These products are designed to create the precise consistency needed for safe swallowing, and the standardized thickness helps control the flow rate of liquids, giving patients more time to coordinate their swallow and reducing the risk of liquids entering the airway.
  • Always consult with a speech-language pathologist for individual patient recommendations regarding appropriate food and liquid consistencies.

From the Research

Using Apple Sauce with Nectar Thick

  • There is no direct evidence in the provided studies that specifically addresses the use of apple sauce with nectar thick.
  • However, the studies do discuss the effects of thickening agents on liquids and their impact on patients with dysphagia 2, 3, 4, 5, 6.
  • One study mentions that flavor deteriorates with increasing thickness, regardless of the thickening agent used 3.
  • Another study highlights the importance of individualized treatment plans and the use of specialized thickening agents to prevent aspiration pneumonia and improve the well-being of affected children 5.
  • A qualitative study exploring the experiences of individuals with swallowing disorders post-stroke found that participants disliked thickened liquids due to their unpleasant taste and texture, which may impact adherence and quality of life 6.
  • While there is no specific guidance on using apple sauce with nectar thick, it is essential to consider the individual patient's needs and preferences when managing dysphagia, and to consult with a healthcare professional for personalized advice.

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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