{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T18:45:10Z","timestamp":1775673910259,"version":"3.50.1"},"reference-count":17,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T00:00:00Z","timestamp":1775606400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Development and Industrialization Demonstration of Nutrition and Health Foods for the Elderly","award":["2023YFF1104405"],"award-info":[{"award-number":["2023YFF1104405"]}]},{"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"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"\n Objective<\/jats:title>\n \n This study adopts a \u201cpathway\u2010priority\u201d perspective to systematically quantify the texture\u2013moisture\u2013nutrition continuum of elderly\u2010preferred food ingredients commonly consumed in China under the\n International Dysphagia Diet Standardisation Initiative<\/jats:italic>\n (IDDSI) framework. It focuses on intra\u2010level differentiation between \u201ctwin\u2010type\/pathway pairs\u201d (MO3 vs. LQ3, EX4 vs. PU4, EC7 vs. RG7), aiming to reveal objective distinctions in texture and nutritional orientation across pathways and to provide quantitative evidence for dietary level classification and prescription substitution in dysphagia management.\n <\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n Twenty\u2010six representative food ingredients were collected from seven major Chinese dietary regions through Python\u2010based web crawling. According to IDDSI classification, samples were grouped into the\n liquid pathway<\/jats:italic>\n (Levels 0\u20132, MO3, EX4) and\n food pathway<\/jats:italic>\n (LQ3, PU4, Levels 5\u20137 including EC7\/RG7). A TA.New Plus texture analyzer was used to measure hardness, adhesiveness, and cohesiveness. Nutritional components per 100 g\u2014including energy, protein, fat, carbohydrate, and dietary fiber\u2014were calculated using\n Huaxi Hospital Nutrition<\/jats:italic>\n software. Statistical analyses included Mann\u2013Whitney U tests with Cliff\u2019s \u03b4 for twin\u2010type comparisons, Spearman correlation and Theil\u2013Sen slope analysis for monotonic trends within pathways, and Kruskal\u2013Wallis followed by Dunn\u2013Bonferroni tests for intra\u2010level differences among food categories. False discovery rate (FDR\u2013BH) correction was applied, with significance set at\n q<\/jats:italic>\n \u2009\u2264\u20090.05.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n (1) In twin\u2010type comparisons, MO3, EX4, and EC7 exhibited significantly lower hardness and energy density but higher moisture content (q\u2009\u2264\u20090.05), whereas LQ3, PU4, and RG7 contained higher energy and protein levels, reflecting hydration\u2010safety orientation in liquid pathways versus structural\u2010nutritional orientation in food pathways. (2) Within\u2010pathway analyses showed that the liquid pathway (Levels 0\u2009\u2192\u20094) followed a \u201cthickening\u2013hardening\u2013dehydrating\u201d monotonic trend, with increasing hardness and energy but decreasing adhesiveness and moisture. The food pathway (Levels 3\u2009\u2192\u20097) displayed a \u201cstructuring\u2013hardening\u2013dehydrating\u2013energizing\u201d trajectory, indicating enhanced granularity and nutritional concentration. (3) Significant texture differences among food categories within the same level were observed (\u03b5\u00b2\u2009=\u20090.37\u20130.67,\n q<\/jats:italic>\n \u2009\u2264\u20090.05), suggesting that \u201csame level \u2260 interchangeable.\u201d. (4) The established \u201csafety\u2013nutrition balance window\u201d identified key control zones: moisture 88.9\u201396.8\u2009g\/100\u2009g and hardness 100\u2013160\u2009N\/m\u00b2 for MO3\/EX4, and energy 70\u2013324 kcal\/100\u2009g for PU4\/RG7, providing practical references for clinical and process optimization.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Twin subtypes within the same IDDSI level exhibit systematic differences in texture and nutrition, confirming the hypothesis that \u201csame level \u2260 interchangeable.\u201d The liquid pathway emphasizes safety and hydration, while the food pathway prioritizes structure and nutrient density. By constructing an intra\u2010pathway \u201ctexture\u2013nutrition continuum\u201d and safety\u2013nutrition balance window, this study offers quantitative evidence for pathway selection, diet prescription, and quality control in dysphagia management. Future work should integrate VFSS\/FEES imaging and clinical outcomes to map laboratory metrics to swallowing safety, facilitating translation from experimental assessment to clinical application.<\/jats:p>\n <\/jats:sec>","DOI":"10.1371\/journal.pone.0344507","type":"journal-article","created":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T17:34:07Z","timestamp":1775669647000},"page":"e0344507","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Objective differences and pathway differentiation between twin subtypes within the same IDDSI level: A texture\u2013nutrition analysis based on commonly consumed foods among Chinese elderly"],"prefix":"10.1371","volume":"21","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":"Yi","family":"Cheng","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juan","family":"Duan","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":[[2026,4,8]]},"reference":[{"key":"pone.0344507.ref001","doi-asserted-by":"crossref","first-page":"628","DOI":"10.1007\/s00455-020-10138-7","article-title":"Prevalence of dysphagia in China: an epidemiological survey of 5943 participants","volume":"36","author":"M Zhang","year":"2021","journal-title":"Dysphagia"},{"key":"pone.0344507.ref002","first-page":"6010","article-title":"Head and neck cancer and dysphagia: an international dysphagia diet standardisation initiative (IDDSI) perspective","volume":"11","author":"JAY Cichero","year":"2022","journal-title":"J Clin Med"},{"key":"pone.0344507.ref003","doi-asserted-by":"crossref","first-page":"295","DOI":"10.2147\/CIA.S346824","article-title":"Dysphagia Management and Outcomes in Elderly Stroke Patients with Malnutrition Risk: Results from Chinese Stroke Center Alliance","volume":"17","author":"G Zhang","year":"2022","journal-title":"Clin Interv Aging"},{"issue":"11","key":"pone.0344507.ref004","first-page":"1629","article-title":"Dysphagia, aspiration pneumonia, malnutrition, frailty, and reduced quality of life: A literature review","volume":"13","author":"J Sun","year":"2024","journal-title":"Foods"},{"issue":"7","key":"pone.0344507.ref005","first-page":"794","article-title":"Development of International Dysphagia Diet Standardisation Initiative (IDDSI) Guidelines","volume":"9","author":"JAY Cichero","year":"2017","journal-title":"Nutrients"},{"key":"pone.0344507.ref006","first-page":"584","article-title":"Regular 7 easy to chew: An IDDSI subcategory","volume":"34","author":"JAY Cichero","year":"2019","journal-title":"Dysphagia"},{"key":"pone.0344507.ref007","first-page":"703","article-title":"International Dysphagia Diet Standardisation Initiative (IDDSI) Implementation: Challenges and Opportunities for Researchers and Clinicians","volume":"35","author":"CM Steele","year":"2020","journal-title":"Dysphagia"},{"issue":"10","key":"pone.0344507.ref008","first-page":"1980","article-title":"Texture-modified diets for the management of dysphagia: A comprehensive review on rheological and textural properties, quality and sensory aspects","volume":"12","author":"N Riquelme","year":"2023","journal-title":"Foods"},{"issue":"11","key":"pone.0344507.ref009","first-page":"1629","article-title":"A critical review on rheology and texture of fluid and semi-solid foods for dysphagia management","volume":"11","author":"E Hadde","year":"2022","journal-title":"Foods"},{"key":"pone.0344507.ref010","first-page":"821","article-title":"Instrumental texture assessment of IDDSI texture levels for dysphagia management. Part 2: Texture modified foods","volume":"53","author":"W Zhou","year":"2022","journal-title":"J Texture Stud"},{"key":"pone.0344507.ref011","first-page":"109267","article-title":"Inter- and intra-level heterogeneity of texture-modified foods based on starch, protein, and gum systems","volume":"146","author":"V Rangarajan","year":"2024","journal-title":"Food Hydrocoll"},{"key":"pone.0344507.ref012","first-page":"110878","article-title":"Effects of different preparation conditions on microstructure, rheological and tribological properties of food gels and their swallowing performance in a rat model","volume":"318","author":"Q Li","year":"2022","journal-title":"J Food Eng"},{"issue":"20","key":"pone.0344507.ref013","doi-asserted-by":"crossref","first-page":"3765","DOI":"10.3390\/foods12203765","article-title":"Quantitative Textural and Rheological Data on Different Levels of Texture-Modified Food and Thickened Liquids Classified Using the International Dysphagia Diet Standardisation Initiative (IDDSI) Guideline","volume":"12","author":"MC Wong","year":"2023","journal-title":"Foods"},{"key":"pone.0344507.ref014","first-page":"111985","article-title":"In vivo evaluation of swallowing safety for texture-modified foods: insights from animal and human studies","volume":"369","author":"J Chen","year":"2024","journal-title":"J Food Eng"},{"key":"pone.0344507.ref015","first-page":"345","article-title":"Designing high-energy and high-protein density food gels for dysphagia management: A review on ingredient interactions and texture control","volume":"12","author":"W Zhou","year":"2024","journal-title":"Food Sci Nutr"},{"key":"pone.0344507.ref016","first-page":"1610","article-title":"Polysaccharide\u2013protein interactions and their application in dysphagia diet: A review","volume":"39","author":"R Wang","year":"2023","journal-title":"Food Reviews International"},{"key":"pone.0344507.ref017","first-page":"827","article-title":"Effect of texture and viscosity on sensory attributes and palatability of IDDSI Level 4 and 5 foods for dysphagia patients","volume":"53","author":"P Lertstianboon","year":"2022","journal-title":"J Texture Stud"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0344507","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T17:34:14Z","timestamp":1775669654000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0344507"}},"subtitle":[],"editor":[{"given":"Ant\u00f3nio","family":"Raposo","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2026,4,8]]},"references-count":17,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,4,8]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0344507","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,8]]}}}