{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T00:22:24Z","timestamp":1768868544816,"version":"3.49.0"},"reference-count":18,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2025,8,29]],"date-time":"2025-08-29T00:00:00Z","timestamp":1756425600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Key Technologies and New Product Development for Intelligent and Safe Production of Foods for Special Medical Purposes","award":["JH2019045"],"award-info":[{"award-number":["JH2019045"]}]},{"name":"Development and Industrialization Demonstration of Nutrition and Health Foods for the Elderly","award":["2023YFF1104405"],"award-info":[{"award-number":["2023YFF1104405"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Objective<\/jats:title>\n<jats:p>This study aimed to investigate the impact of different energy levels and ingredient ratios on the nasogastric tube patency of pureed diets, optimizing the formulations to meet the nutritional requirements of elderly nasogastric feeding patients while minimizing tube blockage risk.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>The study followed the guidelines of the \u201c<jats:italic>Chinese Resident\u2019s Balanced Diet Pyramid<\/jats:italic>\u201d and formulated five different energy levels of pureed diets (900 kcal, 1200 kcal, 1500 kcal, 1800 kcal, and 2100 kcal) using natural food groups. The diets consisted of seven major food categories: cereals and tubers, vegetables, meats, milk, oil, salt, and fruits. The liquid formulations for the above energy levels were prepared according to the concentration standards for special medical purpose foods (FSMPs). The maximum injection force required for nasogastric feeding was measured via a texture analyzer. The nutritional components of the pureed diets at different energy levels and ingredient ratios were evaluated via West China Hospital Nutrition Software. Spearman correlation analysis, multiple regression analysis, and random forest models were used to explore the relationships between energy levels, nutritional components, ingredients, maximum injection force, and tube patency.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>The study revealed that as the energy density increased, the maximum injection force of the pureed diets significantly increased (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05), particularly at the 2100 kcal energy level, where the \u201crice\u2012carrot\u2012beef\u201d formula reached the highest value (117.59\u2009\u00b1\u20090.26\u2009N), whereas the \u201cFSMP\u201d formula at 900 kcal presented the lowest injection force (9.62\u2009\u00b1\u20090.20\u2009N). There was a significant difference in the impact of different energy levels and formulations on the maximum injection force (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05). Spearman correlation analysis indicated that carbohydrate (<jats:italic>\u03c1<\/jats:italic>\u2009=\u20090.736) and dietary fiber (<jats:italic>\u03c1<\/jats:italic>\u2009=\u20090.668) contents were significantly positively correlated with the maximum injection force (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05). Multiple regression analysis further revealed that carbohydrates were the primary factor influencing the injection force, with a regression coefficient of 0.247 (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05), suggesting that each additional gram of carbohydrate increased the maximum injection force by approximately 0.247\u2009N, whereas the effects of protein, fat, and dietary fiber were not significant (<jats:italic>p<\/jats:italic>\u2009&gt;\u20090.05). All nutritional components (energy (<jats:italic>\u03c1<\/jats:italic>\u2009=\u20090.629), carbohydrates (<jats:italic>\u03c1<\/jats:italic>\u2009=\u20090.621), protein (<jats:italic>\u03c1<\/jats:italic>\u2009=\u20090.582), fat (<jats:italic>\u03c1<\/jats:italic>\u2009=\u20090.547), and dietary fiber (<jats:italic>\u03c1<\/jats:italic>\u2009=\u20090.544)) were significantly positively correlated with tube blockage (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05). Mann\u2012Whitney U tests revealed that the energy, carbohydrate, protein, fat, and dietary fiber contents in the tube blockage group were significantly greater than those in the nonblockage group (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05). With respect to food categories, cereals (<jats:italic>\u03c1<\/jats:italic>\u2009=\u20090.742) and meats (<jats:italic>\u03c1<\/jats:italic>\u2009=\u20090.766) were significantly positively correlated with the maximum injection force (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05). Specifically, rice (<jats:italic>\u03c1<\/jats:italic>\u2009=\u20090.7886) and sweet potato (<jats:italic>\u03c1<\/jats:italic>\u2009=\u20090.506) were significantly positively correlated (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05), whereas rice flour (<jats:italic>\u03c1<\/jats:italic>\u2009=\u2009\u22120.411) and milk (<jats:italic>\u03c1<\/jats:italic>\u2009=\u2009\u22120.690) were significantly negatively correlated (P\u2009&lt;\u20090.05). Moreover, cereals (<jats:italic>\u03c1<\/jats:italic>\u2009=\u20090.615) and meats (<jats:italic>\u03c1<\/jats:italic>\u2009=\u20090.628) were significantly positively correlated with the risk of tube blockage at all energy levels (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05), with rice (<jats:italic>\u03c1<\/jats:italic>\u2009=\u20090.660) and beef (<jats:italic>\u03c1<\/jats:italic>\u2009=\u20090.153) significantly increasing the risk of blockage, whereas rice flour (<jats:italic>\u03c1<\/jats:italic>\u2009=\u2009\u22120.350) and milk (<jats:italic>\u03c1<\/jats:italic>\u2009=\u2009\u22120.557) were significantly negatively correlated with the risk of blockage (P\u2009&lt;\u20090.05). The random forest model\u2019s feature importance analysis revealed that carbohydrates (33.33%) and dietary fiber (23.01%) were the most important factors for predicting tube blockage, with an AUC value of 0.91, indicating strong predictive ability.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>This study explores the impact of nutritional components and ingredient characteristics on tube patency and blockage risk in nasogastric pureed diets, revealing key optimization pathways for pureed diet formulations. The energy density and ingredient selection of pureed diets significantly affect tube patency. High-energy diets provide higher nutritional density but significantly increase the injection force and blockage risk. Diet formulations should be optimized by reducing high-viscosity and high-hardness ingredients such as rice and beef, using rice flour to replace rice, and milk as the liquid component. For high-energy demands, the carbohydrate and dietary fiber contents should be controlled to reduce the injection force requirements and blockage risk. The study also developed a five-dimensional blockage risk warning model based on energy, protein, fat, carbohydrate, and dietary fiber (AUC\u2009=\u20090.91), classifying low-, medium-, and high-risk levels. Low-risk patients (energy\u22641400 kcal\/d, carbohydrates\u2264200\u2009g\/d, protein\u226470\u2009g\/d) are recommended to use homemade formulas, whereas high-risk patients (energy\u22651601 kcal\/d, carbohydrates\u2265241\u2009g\/d, protein\u226586\u2009g\/d) should use FSMP for full feeding to balance nutritional supply and tube patency. The findings of this study provide both theoretical and practical guidance for optimizing diets for dysphagia patients, emphasizing that adjusting formulations can effectively balance nutritional supply and tube patency, reduce blockage risk, and prevent malnutrition in homemade pureed feed. This has significant implications for reducing nasogastric complications and ensuring the safety of medical procedures.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0329207","type":"journal-article","created":{"date-parts":[[2025,8,29]],"date-time":"2025-08-29T17:56:04Z","timestamp":1756490164000},"page":"e0329207","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Optimizing pureed diets via texture analysis: A study on the impact of different energy levels and ingredient ratios on nasogastric tube patency"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-0981-8767","authenticated-orcid":true,"given":"Muxi","family":"Chen","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dongyu","family":"Mu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-6495-8842","authenticated-orcid":true,"given":"Yi","family":"Cheng","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lingli","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lei","family":"Shi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuan","family":"Liu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2025,8,29]]},"reference":[{"issue":"12","key":"pone.0329207.ref001","first-page":"1496","article-title":"Prevalence of swallowing disorders in Chinese elderly: a meta-analysis","volume":"26","author":"Y Liu","year":"2023","journal-title":"Chin General Pract"},{"issue":"12","key":"pone.0329207.ref002","first-page":"881","article-title":"Chinese Expert Consensus on the Assessment and Treatment of Swallowing Disorders (2017 Edition) - Part 1: Assessment","volume":"39","author":"Chinese Consensus Group on Swallowing Disorder Rehabilitation and Treatment","year":"2017","journal-title":"Chin J Phys Med Rehabil"},{"key":"pone.0329207.ref003","article-title":"Interpretation of the 2019 ESPEN home enteral nutrition guidelines","author":"Q You","year":"2019","journal-title":"Chin Gener Pract"},{"issue":"14","key":"pone.0329207.ref004","first-page":"2387","article-title":"Effect of early feeding training mediated by the volume-viscosity swallowing test on patients with nasogastric tube placement after acute stroke","volume":"33","author":"X Zhang","year":"2019","journal-title":"Nurs Res"},{"issue":"13","key":"pone.0329207.ref005","first-page":"946","article-title":"Clinical practice guidelines for parenteral and enteral nutrition in Chinese adult patients (2023 edition)","volume":"103","author":"Chinese Society for Parenteral and Enteral Nutrition, Chinese Medical Association","year":"2023","journal-title":"Chin Med J"},{"key":"pone.0329207.ref006","article-title":"Comparison of the effects of enteral nutrition formulations and homemade blended feeds on nutritional support in nasogastric feeding patients","author":"LH Peng","year":"2019","journal-title":"Chin Folk Ther"},{"key":"pone.0329207.ref007","volume-title":"Chinese Food Composition Table (Standard Edition) 2024","author":"Chinese Nutrition Society, Chinese Center for Disease Control and Prevention, Institute of Nutrition and Health","year":"2024"},{"key":"pone.0329207.ref008","volume-title":"Chinese Dietary Nutrient Reference Intakes (2023 Edition)","author":"Chinese Nutrition Society, Chinese Center for Disease Control and Prevention, Institute of Nutrition and Health","year":"2023"},{"issue":"12","key":"pone.0329207.ref009","first-page":"881","article-title":"Chinese expert consensus on dietary and nutritional management for swallowing disorders (2019 edition)","volume":"41","author":"Chinese Expert Consensus Group on Dietary and Nutritional Management for Swallowing Disorders","year":"2019","journal-title":"Chin J Phys Med Rehabil"},{"key":"pone.0329207.ref010","article-title":"Comparative study of nutritional components between homemade blended diet and commercial enteral nutrition formulations","author":"FM Yu","year":"2019","journal-title":"Chin J Clin Nutr"},{"key":"pone.0329207.ref011","doi-asserted-by":"crossref","first-page":"136188","DOI":"10.1016\/j.foodchem.2023.136188","article-title":"Effects of different cooking methods on physicochemical, textural properties of yak meat and its changes with intramuscular connective tissue during in vitro digestion","volume":"422","author":"Y Wang","year":"2023","journal-title":"Food Chem"},{"key":"pone.0329207.ref012","author":"Chinese Medical Association","year":"2023","journal-title":"Chinese guidelines for swallowing disorder rehabilitation management (2023 edition). 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