Abstract
While texture modification ensures safe swallowing in dysphagia, homogeneous purees often compromise visual appeal. Treating shaping as the core design objective, this review evaluates established methods for engineering visual realism in pureed foods against available evidence, while explicitly identifying areas where evidence does not yet exist. Direct shaping methods are evaluated across IDDSI (International Dysphagia Diet Standardization Initiative) compliance, sensory acceptability, and practical implementation. Structural approaches that modify food structure rather than reshape purees are evaluated individually by mechanism and applicability due to limited evidence. Three-dimensional printing enables precise, automated deposition over manual piping, but faces throughput and formulation requirements that can complicate IDDSI compliance. Molding is accessible, but demolding remains challenging, and gelled formulations that facilitate demolding may fall outside IDDSI puree definitions. Shear gels may provide an alternative to continuous gelled matrices, although their deliberate use for shaping remains untested. Though not purees, enzymatically softened and transitional textures may yield cohesive, texture-modified states but require oral processing to form a bolus. Overall, these methods differed in their practical advantages and disadvantages, while swallowing-safety evidence remains generally limited. These conclusions inform food scientists, engineers and clinicians, whose collaboration is required to realize engineering visual realism within accessible dysphagia care.