Nutrition Diet: What is a Level 7 diet in the hospital?

According to the International Dysphagia Diet Standardisation Initiative (IDDSI), the Level 7 diet is a regular, easy-to-chew diet prescribed in hospitals for patients with mild chewing difficulties. This nutritional diet is designed to ensure patients can eat safely and comfortably without facing the challenges of tougher food textures.

Quick Summary

This article explains the Level 7 easy-to-chew diet used in hospitals, outlining its purpose, common foods, and specific textures to avoid based on IDDSI guidelines. It details how the diet helps patients with chewing issues eat safely and maintain nutrition.

Key Points

• International Standard: A Level 7 diet is defined by the IDDSI framework as 'Regular Easy to Chew'.

• Patient Population: It is for individuals with mild chewing difficulties, such as from dental issues or fatigue, not severe swallowing disorders.

• Required Texture: Foods must be soft and tender, easily broken apart with the side of a fork or spoon.

• Forbidden Textures: Hard, crunchy, chewy, tough, fibrous, and sticky foods are to be avoided.

• Nutritional Focus: Due to reduced appetite, fortification with extra calories and protein may be necessary, and frequent, small meals are encouraged.

• Professional Guidance: A healthcare team, including a speech-language pathologist and dietitian, assesses and monitors the patient's dietary needs.

• Safety Check: Food service staff must test foods using the fork pressure test to ensure safety and consistency.

Understanding the IDDSI Framework

To understand what is a Level 7 diet in the hospital, it's crucial to first grasp the International Dysphagia Diet Standardisation Initiative (IDDSI) framework. IDDSI is a global framework that provides a standardized terminology for describing texture-modified foods and thickened liquids for people with swallowing difficulties (dysphagia). The framework consists of eight levels, with foods ranging from Level 3 (liquidised) to Level 7 (regular). The Level 7 Easy to Chew diet is at the top of this food scale, indicating the least restrictive texture modification. This standardization is critical for patient safety, preventing confusion, and ensuring consistent care across different healthcare facilities. A speech-language pathologist or dietitian typically assesses a patient's chewing and swallowing abilities to recommend the appropriate IDDSI level.

The Goal of an Easy-to-Chew Diet

The primary purpose of the Level 7 easy-to-chew diet is to accommodate individuals who have trouble with hard or firm textures but do not have significant swallowing problems or an increased risk of choking. The reasons for needing this diet can vary, including age-related muscle weakness, dental issues (e.g., missing or poorly fitting dentures), jaw pain, fatigue, or recovery from an illness. By providing softer, more tender foods, the diet reduces the effort and discomfort associated with chewing, allowing the patient to consume adequate nutrition without tiring easily.

What is a Level 7 diet in the hospital? The Easy-to-Chew Standard

A Level 7 easy-to-chew diet consists of normal, everyday foods that are soft and tender. Unlike lower-level diets that require specific particle sizes, there is no restriction on food piece size at this level. Patients on this diet are expected to have enough chewing strength to break down soft foods and form a bolus (a soft mass of food) before swallowing safely.

How to Test Level 7 Food

Hospitals and care facilities use a simple test to ensure food meets the Level 7 criteria:

• Fork/Spoon Pressure Test: The food should be soft enough to be easily separated or squashed with the side of a fork or spoon. If you apply pressure with the back of a fork until your thumbnail turns white, the food should squash completely and not return to its original shape.

Foods to Enjoy and Foods to Avoid

Following a Level 7 diet involves careful selection and preparation of foods to ensure they are soft and safe. Patients should focus on tender, moist foods while steering clear of textures that are tough, chewy, or crunchy.

Foods Allowed

• Proteins: Tender, well-cooked meats like stews, casseroles, or minced meat in gravy; boneless fish (steamed, poached, or flaked); eggs (scrambled, poached); soft tofu; tuna or egg mayonnaise sandwiches.
• Starches: Well-cooked pasta or noodles; soft rice (including risotto); baked potato (scooped out, no skin); softened cereals like porridge or Weetabix.
• Fruits and Vegetables: Soft-cooked vegetables (steamed or boiled carrots, cauliflower, potatoes); soft, ripe, peeled fruits like bananas, peaches, or tinned fruit; smooth applesauce.
• Dairy: Smooth yogurts, milk puddings (rice pudding, semolina), cottage cheese, soft cheeses, ice cream.
• Desserts: Plain cake or sponge with custard or cream; mousse; trifle.

Foods to Avoid

• Hard or Dry: Nuts, raw vegetables (like carrot sticks), dry cakes, crusty bread, dry cereals.
• Tough or Fibrous: Steak, fibrous fruits like pineapple or rhubarb, chicken skin.
• Chewy or Sticky: Chewy candies, marshmallows, chunky peanut butter, dried fruit.
• Crispy or Crunchy: Crisps, cornflakes, crispy bacon, raw apples.
• Pips, Seeds, and Gristle: Seeds, bones, and gristle must be removed.
• Mixed Consistencies: Foods with both thin liquid and solid pieces, such as soup with lumps, unless otherwise instructed by a clinician.

Comparison: Regular Diet vs. Level 7 Diet

Feature	Regular Diet (IDDSI Level 7)	Level 7 (Easy to Chew) Diet
Texture	No restrictions on food texture.	All foods must be soft and tender.
Chewing	Requires normal, unrestricted chewing ability.	Accommodates mild chewing difficulties due to factors like dental issues or fatigue.
Particle Size	No restrictions on food piece size.	No restriction on food piece size, but food must break apart easily.
Safety Risk	Minimal risk for individuals without swallowing issues.	Low risk for individuals who meet the criteria; not for those with high choking risk.
Patient Population	General patient population without chewing or swallowing problems.	Patients recovering from illness, with dental problems, or fatigue.
Example Meal	Steak, crispy fries, salad.	Tender casserole, mashed potatoes, boiled vegetables.

Nutritional Considerations and Patient Well-being

Even with an easy-to-chew diet, patients may experience reduced appetite or feel less satisfied with the modified textures. To prevent weight loss and maintain energy levels, healthcare teams focus on nutritional enrichment.

Here are some common strategies:

• Frequent Meals: Encouraging smaller, more frequent meals or adding nutritious snacks throughout the day can help boost overall intake.
• Energy-Rich Additions: Adding extra calories by incorporating full-fat dairy products, butter, margarine, cream, or gravy into meals.
• Hydration: Ensuring adequate fluid intake is important. Nutritious liquids like milkshakes or nourishing drinks can be consumed between meals to avoid feeling full too quickly.
• Monitoring: Regular weight monitoring helps healthcare professionals track patient progress and adjust the nutritional plan as needed.

Conclusion: Safe Eating and Patient Comfort

In a hospital setting, the Level 7 easy-to-chew diet is a crucial component of patient care, providing a safe and effective way for individuals with chewing difficulties to maintain their nutritional intake. Guided by the IDDSI framework, this diet standardizes the preparation of soft, tender foods to minimize the risk of complications, especially during recovery. By understanding the principles and examples of this diet, patients and caregivers can ensure a smoother, more comfortable eating experience, supporting recovery and overall well-being. Effective communication with a healthcare team is vital for proper assessment and implementation of this texture-modified diet.

How This Diet is Prescribed and Monitored

Properly managing a Level 7 diet involves a multidisciplinary team to ensure patient safety and nutritional adequacy. A speech-language pathologist (SLP) performs a swallowing assessment to confirm that the patient does not have significant dysphagia or a high risk of aspiration, and can safely manage soft, tender foods without supervision. A dietitian then works with the patient to ensure nutritional needs are met, especially if appetite is poor, by incorporating strategies like food fortification or providing extra snacks. Consistent training of food service staff on IDDSI standards is also essential to guarantee all meals are prepared and tested correctly. Ongoing monitoring and regular reassessments are conducted to address any changes in the patient's eating or swallowing abilities over time.

The Role of the Patient and Caregivers

Patients and their caregivers are active participants in the diet management process. Understanding the rationale behind the diet is key for adherence and safety. The patient is encouraged to communicate any discomfort or difficulty with food textures, enabling the care team to make necessary adjustments. Caregivers play a vital role in providing supervision if needed and ensuring the patient consumes enough fluids and nutrient-rich foods. In some cases, a clinician might prescribe specific textures for food and drinks separately, so clear communication is essential.

Adapting Your Favorite Recipes

For patients transitioning home or wanting more variety, many regular recipes can be adapted to fit the Level 7 criteria. Here are a few tips:

• Slow Cooker: Use a slow cooker or pressure cooker to prepare meats until they are exceptionally tender and fall apart easily.
• Add Moisture: Incorporate extra gravies, sauces, or broths to moisten foods like meats or rice dishes.
• Modify Ingredients: For dishes like casseroles or shepherd's pie, use finely minced meat and ensure vegetables are cooked until very soft.
• Enrich: Mash potatoes or other vegetables with cream cheese, full-fat milk, or butter to increase calories.
• Fruit Preparation: Remove fibrous parts, skins, or seeds from fruits before serving.
• Smoothies and Shakes: Blend fruits with yogurt or ice cream for a nutritious and easy-to-chew snack.

By creatively adapting recipes, individuals can enjoy a wider variety of meals while still adhering to the soft and tender texture requirements of a Level 7 diet.

Frequently Asked Questions

What is the difference between an IDDSI Level 7 diet and a regular diet?

The main difference is texture. A Level 7 diet requires all foods to be soft and tender, whereas a regular diet has no texture restrictions. Both are considered 'normal' food consistency, but the Level 7 is specifically modified for easier chewing.

Who should be on a Level 7 easy-to-chew diet?

This diet is suitable for patients with mild chewing problems due to factors like dental issues, fatigue, or recovery from an illness. It is not for individuals with an increased choking risk or significant swallowing problems.

What happens if a patient on a Level 7 diet is losing weight?

If a patient on this diet experiences weight loss, a dietitian may recommend strategies like food fortification, which involves adding extra calories and protein to meals using ingredients like full-fat dairy, butter, or gravy.

How can I check if food is soft enough for a Level 7 diet?

The IDDSI framework recommends the fork pressure test. If you press a fork down on the food, it should squash completely without returning to its original shape. It should also be easily broken apart with the side of a fork or spoon.

Are mixed-consistency foods allowed on a Level 7 diet?

No, foods with a mixed consistency, such as soup with chunks of meat or vegetables, are typically avoided unless cleared by a clinician. The mixture of thin liquid and solid pieces can be difficult to manage for some individuals.

What are some common snacks for a Level 7 diet?

Suitable snacks include smooth yogurts, milk puddings, soft fruit (like bananas or peeled peaches), plain cake with cream or custard, and moistened biscuits.

Can bread be eaten on a Level 7 diet?

Some bread, such as soft sandwich bread, can be included, especially if softened with a filling like tuna or egg mayonnaise. However, hard-crusted or dry breads are generally avoided.