A bite closer: Using 3D food printing to achieve Sustainable Development Goals 2, 3, 9 and 17

Abstract

Purpose

This commentary paper focuses on four Sustainable Development Goals (SDGs): zero hunger (SDG 2), good health and well-being (SDG 3), industry, innovation and infrastructure (SDG 9), and partnerships for the goals (SDG 17). Each bite of food has the potential to impact on nutrition and well-being, particularly for the older adult aged over 65 years with swallowing disability. Better attention to the shape of the foods presented for consumption may help improve access to food and nutrition through food shaping methods such as 3D food printing. Target objectives across these four SDGs should help to improve the physical and emotional health of older people with swallowing disability who need texture-modified foods.

Result

We discuss the potential for methods to improve food shaping and influence better health outcomes for older people, particularly those with swallowing disability. Texture-modified food should be both nourishing and enjoyable while being safe to swallow without coughing or choking; to improve nutrition, health, and quality of life.

Conclusion

Along with temperature and taste, the shape of texture-modified foods influences the appeal of the food as important elements of food design. The link between the enjoyment of food and nutrition sets the foundation for a good quality of life for older people. 3D food printing, among other food shaping methods, helps establish this link through the creation of nutritious and appealing foods. Applying the targets for SDGs relating to food shaping techniques will involve innovation and collaboration with older people and multiple disciplines

Keywords:

• Sustainable Development Goals (SDGs)
• zero hunger (SDG 2)
• good health and well-being (SDG 3)
• industry, innovation and infrastructure (SDG 9)
• partnerships for the goals (SDG 17)
• swallowing disability
• nutrition
• older people
• food shaping

Intersectionality in the SDGs for improved nutrition in older people

Access to good food and nutrition for older people enhances their wellbeing, serving as a strong foundation for people to function physically, mentally, and emotionally. Older adults hold wisdom and experience, enriching society through economic and social contributions for themselves, their families, and their communities (Kerschner & Pegues, 1998). In 2015, the United Nations developed 17 Sustainable Development Goals (SDGs) as key areas in achieving peace and prosperity for people and the planet (United Nations, 2015). Of the 17 SDGs, four are strategically aligned with initiatives and innovations which would help to promote health for older adults with swallowing disability through food and nutrition: zero hunger (SDG 2), good health and well-being (SDG 3), industry, innovation and infrastructure (SDG 9), and partnerships for the goals (SDG 17). The ageing of the population is creating a crisis in healthcare because many countries face challenges in accessing dysphagia support (González-Fernández et al., 2013). An intersectional and person-centred, collaborative approach in using food shaping methods such as 3D food printing to address these goals will help improve the lives of older people with swallowing disability globally.

Good nutrition is the vital foundation for a healthy life from conception and birth through to older age, and nutritional needs are best met through the consumption of food. Older adults, particularly those in residential aged care settings, are at high risk of dysphagia or swallowing disability (Namasivayam-MacDonald & Riquelme, 2019), which reduces their access to food and nutrition, hindering their realisation of a healthy life. Identifying, responding to, and addressing an older person’s swallowing and nutritional support needs will not only help older adults as individuals but also help society at a global scale.

Zero hunger (SDG 2)

Zero hunger (SDG 2) aims to end hunger, achieve food security, improve nutrition, and promote sustainable agriculture (United Nations, 2015). Although hunger appears to be an isolated problem relating to access to food, it is affected by several individual and systems level factors. Hunger is a world food problem (United Nations, 2015) linked to other global issues including climate change, disasters due to natural hazards (e.g. drought, floods, and wildfire) and other major events that impact on food supply, transport and logistics (World Health Organization (WHO), 2021). Hunger is also impacted by pandemics (Food Security Information Network (FSIN), 2021) and war, associated with disruptions to supply and the displacement of large numbers of people from their homes (McKee & Murphy, 2022). The COVID-19 pandemic has disrupted food systems worldwide and threatened people’s access to food (World Health Organization (WHO), 2021). Thus, recognising the many systems and stakeholders involved, zero hunger (SDG 2) will be even more difficult to accomplish unless an interdisciplinary and intersectional approach is taken. Zero hunger (SDG 2) warrants an urgent and thorough assessment of risk factors leading to hunger so that progress on this goal can be maintained and focus on populations at higher risk worldwide.

Zero hunger (SDG 2) also aims to end all forms of malnutrition and ensure improved access to safe, nutritious and sufficient food by all people all year round (United Nations, 2015). Hunger, exacerbated by malnutrition, can cause a series of detrimental effects including reduced immune response, reduction in muscle strength and respiratory function, fatigue, and apathy (Namasivayam-MacDonald & Riquelme, 2019). Populations with motor neuron disease, stroke, Parkinson’s disease or other health conditions affecting swallowing or nutritional disorders (e.g. malnutrition, sarcopenia), are at high risk of hunger because of diminished capacity to eat or drink or reliance upon others for access to food, complicating the matter of nourishment. The provision of nutritious food by itself is necessary but not sufficient to ensure the hunger of older adults and those with swallowing disorders will be satisfied and may not be enough to ensure their good health.

The emergence of a state of hunger in older people arises from the interaction of several factors including age-related changes in physiology, cognitive impairment, and visual perceptual skills. For example, age-related changes in gut function affect nutritional intake, digestion, and nutrient absorption (Nieuwenhuizen et al., 2010). If not adequately managed, the effects of ageing on nutrition may become detrimental to the older person’s long-term health, resulting in a range of conditions including osteoporosis, weight loss, diabetes, and a general decline in functional status (Ney et al., 2009). Decline in function is further exacerbated by malnutrition. Determining the prevalence of malnutrition in older people is difficult, as even people with an adequate food supply may have difficulty accessing enough nutrition. Malnutrition can be associated with swallowing disability, poor oral health, dependence on others for eating, poor food delivery systems, and unappetising food. These factors contribute to poor oral intake and may place the older adult at further health risks (Bernstein et al., 2012).

Good health and well-being (SDG 3)

Ageing, a natural development, can be associated with a decline in function and the onset of a range of age-related health conditions. Ageing can also be associated with reduction in the ability to chew and swallow, leading to a series of negative impacts on nutrition and the older adult’s mealtime-related quality of life (Smith et al., 2022). This detrimental impact is further compounded by any age-related changes in smell and taste (Nieuwenhuizen et al. 2010). Nutrition has a unique role in helping to mitigate the negative impacts of swallowing disability, including modifying food textures to be softer and easier to eat (e.g. pureed or minced and moist textures) (Cichero et al., 2013). Swallowing disability increases the risk of malnutrition and therefore should be identified early to improve clinical outcomes and avoid hospitalisation (Ney et al., 2009).

The consumption of nutritious food can be a powerful first line defense against some of the negative impacts of ageing. However, nutritious food should also be pleasurable in terms of sensory and psychosocial experiences. When a person’s nutritional needs are not met and inadequate dietary intake continues for a long time, malnutrition can result and lead to diminished joy in eating (Bernstein et al., 2012). This in turn negatively impacts on cultural and psychosocial aspects of quality of life. The Academy of Nutrition and Dietetics recommends that the quality of life and nutrition in older adults can be enhanced by individualised nutrition approaches. Such personalised approaches could include attention to the shape and appearance of a person’s food on the plate, so that it is appealing and more likely to be consumed (Smith et al., in press).

Adding life to years and years to life for the older person can be achieved through greater enjoyment of foods and mealtimes (Kerschner & Pegues, 1998). Eating-related pleasures go beyond sensory stimulation, as pleasurable experiences are both anticipated and remembered (Macht & Dettmer, 2006). Texture-modified food may be needed to ensure swallowing safety but can lack visual appeal, impacting on the mealtime experience (Hemsley et al., 2019). The resemblance of an adult’s meal to infant food can reduce the visual appeal of pureed food textures for older adults (Stahlman et al., 2001). Creating an appealing look for foods of the recommended safe texture (e.g. soft, minced and moist, or pureed) is important to prevent food rejection and related malnourishment (Pereira et al., 2021). There is an interaction between the enjoyment of food and nutritional well-being which influences mealtime-related quality of life (Smith et al., 2022), health, and the ageing process itself (Bernstein et al., 2012).

Industry, innovation, and infrastructure (SDG 9)

The food industry is of great importance in the development and delivery of suitable, enjoyable meals for older adults with swallowing disability. To improve mealtimes for individuals across the lifespan and foster communication among healthcare professionals, and guide industry development in this area, the International Dysphagia Diet Standardisation Initiative (IDDSI) developed standardised terminology and methods for testing food textures (e.g. regular, regular easy to chew, soft and bite sized, minced and moist, pureed) (Cichero et al., 2013). Providing suitable texture-modified meals can improve access to good nutrition that is vital for older people whether living in supported accommodation, residential care, or their own homes. The use of texture-modified foods demands consideration of the visual appeal of the meals, so that the texture itself does not have a negative impact on food intake (e.g. through disgust or revulsion, or lack of variety). Novel food shaping methods may help to reduce the risk of malnourishment in older people with swallowing or chewing difficulty. A variety of food shaping options could be used in an attempt to increase the attractiveness of the food and therefore increase food acceptance and intake. These include using food moulds, food piping bags, and 3D food printing, an emergent food processing technology proposed to improve the food design of texture-modified food (Hemsley et al., 2019; Smith et al., in press). 3D food printing is expected to quicken the process of creating the attractive food shape by shortening the traditional trial-and-error stage of the process and automating production of the shaped food (Pereira et al., 2021).

There is little research to date examining the feasibility or impact of food shaping techniques in preparing meals for older people with swallowing disability (i.e. using spoon shapes, ice-cream scoops, food moulds, piping bags, or 3D food printing) on their dietary intake, hunger, or enjoyment of meals. Food shaping techniques have great potential to be used in these dynamic contexts while simultaneously supporting the enjoyment of food and enhance health and wellbeing. With recent food engineering developments, foods that were once considered non-printable can now be printed successfully through the addition of hydrocolloids or gels to improve printability (Pereira et al., 2021). 3D food printing has attracted attention for its versatility and potential application in various sectors including aerospace, electronics, architecture, and medicine (Pereira et al., 2021). An important element of 3D food printing development is its aim to develop the printing of a wider range of natural and nutritious foods for people with swallowing disability (Hemsley et al., 2019). 3D food printers are a technology that could be designed not only for large scale mealtime settings (e.g. in residential aged care) but also for domestic use in the home, for those who wish to age-in-place in their existing homes and communities (Perry & Wolburg, 2011).

The design and delivery of food is an intricate process which requires strong collaborations across multiple disciplines being inclusive of the consumer. To date, there is no research that has included older adults with swallowing disability or their family members and support workers in the co-design, production, or use of 3D food printers or other food shaping methods to improve the appearance or acceptability of meals for people who need texture-modified foods. User-centred and collaborative co-design across all industries with an interest in furthering the field of 3D food printing is needed. Research in the fields of food science, food engineering, and food design should include consultation and co-design with the intended end user. This includes people with swallowing disability, food services staff, and health professionals involved in making or implementing mealtime recommendations.

Partnerships for the goals (SDG 17)

A collaborative, person-centred approach is needed to support older adults’ mealtimes, nutrition, good health, and wellbeing. A person’s level or severity of swallowing disability may require closer management from speech-language pathologists, dietitians, occupational therapists and medical practitioners to manage the intertwined health conditions such as weight loss or malnutrition (Namasivayam-MacDonald & Riquelme, 2019). Alongside speech-language pathologists considering swallowing and communication function, dietitians have a critical role in the multidisciplinary team through meeting nutrition needs through an individualised approach. Nursing staff also play a key role in the coordination and care of older people in residential settings (Ney et al., 2009). In partnership, these health professionals are uniquely positioned to enhance an older person’s self-sufficiency in consuming safe, healthy foods and beverages. Family members and direct support workers also play a key role in providing mealtime assistance and interaction. Food service providers contribute to the set-up of the environment as an enjoyable place to eat. Collaboration with professionals in the food science and food engineering industries to help develop food that is not just visually appealing but easier to manage is vital to improving the mealtime experiences of older adults with swallowing disability. With more understanding of each other’s roles and vital contribution, this diverse team can collaboratively identify and mitigate nutritional problems and ensure the older adult is well supported for a nourishing and enjoyable meal.

Summary and conclusion

The amplification of health inequalities impacting older people can have a devastating impact on their health and well-being. Health becomes fragile due to a lack of available and affordable nutritious food, reduced physical activity, and disruptions in essential nutrition services (United Nations, 2015). In times of uncertainty brought about by unexpected adversity, such as pandemic, war, and disaster, innovation is needed to forge new paths in finding better solutions to world food problems. In doing so, the health of older adults may become resilient against unexpected and detrimental circumstances. Given the interconnectedness of the global economy, strengthening multilateralism and global partnerships is more important than ever in relation to food security for older people. By strategically targeting the objectives in zero hunger (SDG 2), good health and well-being (SDG 3), industry, innovation, and infrastructure (SDG 9), and partnerships for the goals (SDG 17), the health, wellbeing and good quality of life of older people with swallowing disability may be improved. Each advancement in these goals individually and as a group will be integral to the successful implementation of innovative food shaping solutions for older people who need texture-modified foods.

Declaration of interest

No potential conflict of interest was reported by the author(s).