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In Vitro Drug Dissolution: Compendial Testing Models I01:13

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A Sensory Method to Evaluate Food Texture for Oropharyngeal Dysphagia by Emulating Oral Tasks.

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Updated: Jan 11, 2026

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Textural Classification of Commercial Foodstuffs for Dysphagia Using Back-Extrusion Test.

María Teresa Murillo-Arbizu1, Leyre Urtasun Del Castillo2, Sandra González-Casado2

  • 1Institute for Sustainability & Food Chain Innovation (IS-FOOD), Public University of Navarra (UPNA), Jerónimo de Ayanz Building, Arrosadia Campus, 31006 Pamplona, Navarre, Spain.

Foods (Basel, Switzerland)
|November 13, 2025
PubMed
Summary

The Back-Extrusion Test (BET) shows promise for classifying texture-modified foods (TMFs) for oropharyngeal dysphagia (OD) management. While BET2 achieved 76.8% accuracy, further refinement is needed for reliable IDDSI framework classification.

Keywords:
IDDSI frameworkinstrumental textureswallowing disordertextural propertytexture-modified food

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Area of Science:

  • Food Science
  • Biomedical Engineering
  • Clinical Nutrition

Background:

  • Oropharyngeal dysphagia (OD) necessitates texture-modified foods (TMFs) for safe swallowing.
  • The International Dysphagia Diet Standardization Initiative (IDDSI) provides a framework for classifying TMFs.
  • Current instrumental methods struggle with reliable classification of commercial TMFs.

Purpose of the Study:

  • To assess the effectiveness and reliability of the Back-Extrusion Test (BET) for classifying commercial TMFs according to the IDDSI framework.
  • To determine the accuracy of BET in differentiating between IDDSI levels.
  • To explore potential improvements for TMF classification.

Main Methods:

  • Fifty-four commercial TMFs were analyzed using two BET methods: BET1 (firmness, adhesiveness) and BET2 (firmness, consistency, cohesiveness, cohesion work).
  • Discriminant analysis was employed to determine classification accuracy for IDDSI levels.
  • Cluster analysis was used to identify textural complexity groups within the TMFs.

Main Results:

  • A progressive increase in firmness and consistency was observed with rising IDDSI levels, with significant differences between levels.
  • Classification accuracy for IDDSI levels was 66.1% for BET1 and 76.8% for BET2.
  • Both BET methods showed reduced performance for IDDSI level 4 foods, and cluster analysis identified three textural complexity groups.

Conclusions:

  • The Back-Extrusion Test (BET) demonstrates potential for classifying texture-modified foods (TMFs) for oropharyngeal dysphagia (OD) management, with BET2 showing higher accuracy.
  • A simplified classification framework based on textural complexity could enhance objectivity and reliability.
  • Integrating additional instrumental techniques may be necessary to improve classification accuracy for challenging food textures.