A Guide to Macronutrients, Micronutrients, and Boosting Nutritional Intake

1. What Is Nutrition?

Nutrition is the process by which our bodies take in and use food substances to support growth, repair tissues, maintain organ function, and provide energy. For patients with dysphagia or those requiring texture-modified diets, ensuring adequate nutrition becomes more challenging—but also more critical.

Malnutrition and dehydration are common in individuals on modified diets due to food limitations, decreased appetite, dislike of modified foods and the effort involved in eating. Therefore, a strong understanding of nutrients is essential for optimizing care.

Why do we care as an SLP? We are often changing diet consistencies for little regard to nutritional impact on our patients. Nutrition may be overlooked due to lack of knowledge by patients or caregivers or for ease of food preparation. While we cannot recommend specific diets or meal plans for patients we can give them ideas on boosting the nutritional value of food to promote healing, gain or maintain weight and hydration and for the general overall wellbeing of our patients.

2. Macronutrients: The Foundation of Fuel

Macronutrients are the nutrients we need in large amounts. They include carbohydrates, proteins, and fats—each serving a specific role in maintaining health.

Carbohydrates

• Function: Main source of energy for the body and brain.
  
• Sources: Fruits, grains, starchy vegetables, milk.
  
• Tip for Modified Diets: Blend cooked cereals or mashed fruits like bananas into smoothies or purees.
  

Proteins

• Function: Builds and repairs muscle and tissue; supports immune system function.
  
• Sources: Meats, eggs, dairy, legumes, tofu.
  
• Tip for Modified Diets: Add protein powder or dry milk to purees or puddings. Use Greek yogurt for creamy consistency and higher protein content.
  

Fats

• Function: Concentrated energy source; supports brain health, hormone production, and vitamin absorption.
  
• Sources: Avocados, oils, butter, nuts.
  
• Tip for Modified Diets: Stir healthy oils (olive, canola) or nut butters into soups or mashed vegetables for calorie and fat enhancement.
  

Reference: Whitney, E., & Rolfes, S. R. (2019). Understanding Nutrition (15th ed.). Cengage Learning.

3. Micronutrients: Small but Mighty

Micronutrients are vitamins and minerals required in small amounts but are essential for metabolic functions, tissue repair, and immune defense.

Key Micronutrients for Dysphagia Patients

• Iron: Prevents anemia; found in meats, legumes, and fortified cereals.
  
• Calcium: Supports bones and muscle contractions; found in dairy, leafy greens.
  
• Vitamin D: Helps absorb calcium and supports immunity; available in fatty fish, egg yolks, and fortified foods.
  
• B Vitamins: Crucial for energy metabolism and neurological function; found in whole grains and meats.
  

Reference: National Institutes of Health (NIH) Office of Dietary Supplements – https://ods.od.nih.gov/

4. Why Macronutrients Matter

When a person is on a texture-modified diet (e.g., pureed, minced, thickened liquids), the overall volume of food may decrease, making it harder to get enough calories, protein, and essential nutrients. This can lead to:

• Unintentional weight loss
  
• Muscle wasting
  
• Increased risk of pressure sores and infections
  
• Poor wound healing
  

Macronutrient density is vital—patients need more nutrition in less volume.

5. How to Increase Nutritional Value on a Modified Diet

A. Fortify Foods

• Add protein: Powdered milk, protein powder, egg whites, nut butters
  
• Increase calories: Use full-fat dairy, cream, oils, butter, and avocado
  
• Sneak in nutrients: Blend cooked veggies into soups or sauces
  

B. Use Small, Frequent Meals

• Serve 5–6 nutrient-dense meals/snacks instead of 3 large ones.
  
• Offer oral nutrition supplements (ONS) like Boost, Ensure, or homemade smoothies as tolerated.
  

C. Incorporate Hydration and Electrolytes

• Use thickened fluids per the prescribed level (IDDSI Levels 1–4)
  
• Add flavor with fruit purees, electrolyte powders, or bone broth
• Use a free water protocol or ice chips when safe with oral care.
  

D. Texture-Safe Snack Ideas

• Pudding with protein powder
  
• Pureed lentil soup with olive oil
  
• Mashed sweet potatoes with Greek yogurt
  
• Scrambled eggs with cheese (minced and moist)
  
• Smoothies with fruit, protein, and peanut butter (thickened if needed)
  

6. Clinical Tips

• Monitor for signs of malnutrition: fatigue, slow healing, weight loss
  
• Collaborate with dietitians to create texture-safe, nutrient-dense plans
  
• Adapt recipes creatively—purees don’t have to be bland or boring!
  

7. Summary

Modified diets do not have to mean modified health. With thoughtful planning and fortification and a team approach to patient care, patients with dysphagia or texture limitations can still meet their nutritional needs and enjoy satisfying meals.

Are you ready for a deeper dive with even more resources available? Join the Dysphagia Skills Accelerator today. You will get so many great tools with new tools being added all the time! Click here to join now!

Additional Reference:

Cichero, J.A.Y., Lam, P., Steele, C.M., Hanson, B., Chen, J., Dantas, R.O., … & Murray, J. (2017). Development of International Terminology and Definitions for Texture-Modified Foods and Thickened Liquids Used in Dysphagia Management: The IDDSI Framework. Dysphagia, 32(2), 293–314.

Tap on the picture above to go to a download of the 3 Nutrients to Consider in Modified Diets!