Protein gel with designed network and texture regulated via building blocks to study dysphagia diet classifications

We described the successful fabrication of protein gels with varying textures through a mild enzymatic reaction where Ca2+ regulated the structure of gel network building blocks (i.e., casein micelles). Using identical starting components, different building blocks were constructed into a fine- or thick-chain network through Ca2+ concentration to tune the texture of the gels. The fabricated proteins were characterized and their classifications for dysphagia diets according to the guidelines of Universal Design Food (UDF)/International Dysphagia Diet Standardization Initiative (IDDSI) were also reported. The classifications by both guidelines were found to be confusing as a single protein gel could be categorized into different tolerated levels of chewing/swallowing ability, and recommended to patients with different severity of dysphagia. For instance, a gel (with 0.0267 g Ca2+/g CM) considered safe for dysphagia patients who could only use tongue to swallow under IDDSI recommendation, but it was suggested by UDF standards to be crushed with the help of gums before swallowing. Mismatch between international standards should be taken into account during classification to prevent irreparable clinical impact. In conclusion, this research focused on the design and creation of food models which could be useful in the future clinical studies to investigate dysphagia diets and their categorization. [Display omitted] •Gels with varying networks and controllable texture affected their oral processing.•Investigations on the similarities and differences of UDF and IDDSI are inadequate.•Occasional mismatch in classification by the two standards should not be ignored.•To establish measurable, quantifiable and clinically validated standards is urgent.