What is IDDSI Level 3 (Liquidised)?
The International Dysphagia Diet Standardisation Initiative (IDDSI) provides a global framework for classifying food textures and drink thicknesses for individuals with chewing or swallowing difficulties, known as dysphagia. While the term 'pureed food' is often used broadly, the IDDSI framework specifies that Level 3 is 'Liquidised' and Level 4 is 'Pureed'. A Level 3 food is a smooth, moderately thick liquid that does not hold its shape on a plate and drips slowly through the prongs of a fork. It requires no chewing and is swallowed directly, making it suitable for those with severely compromised swallowing abilities.
What is an example of a Level 3 pureed food? A detailed look at meal types
Creating a varied and appetising menu for a Level 3 diet is crucial for encouraging adequate nutritional intake. Below are numerous examples across different meal categories, demonstrating how everyday foods can be adapted to this texture level.
Breakfast Examples
- Smooth porridge or oatmeal: Prepared with full-fat milk and blended until completely smooth, with no husks or lumps.
- Pureed baked beans or spaghetti: Tinned pasta meals like ravioli, macaroni cheese, or baked beans can be liquidised and sieved to remove any skins.
- Fruit smoothies: Made with peeled and seeded fruits like peaches, pears, or bananas, and blended with yoghurt or milk. Thickeners may be needed to achieve the right consistency.
Main Course Examples
- Pureed chicken and gravy casserole: Cooked chicken is blended with plenty of gravy and vegetables until smooth. It may need to be sieved to ensure no lumps remain.
- Liquidised cottage or shepherd's pie: The meat filling and mashed potato are blended separately with extra liquid (stock or gravy) before being combined, ensuring a uniform consistency.
- Creamy fish in sauce: Flaked fish or salmon is liquidised with a creamy sauce, such as a parsley or cheese sauce, to create a smooth, savoury meal.
- Blended macaroni and cheese: A homemade or tinned version can be blended with extra sauce to achieve the required smooth, liquidised texture.
Vegetable and Side Dish Examples
- Pureed root vegetables: Carrots, pumpkin, or sweet potato are boiled until very soft and then blended with milk, cream, or butter.
- Liquidised cauliflower or broccoli: These can be blended with a cheese sauce for added flavour and nutrients.
- Mashed potato with liquid: Instant mashed potato can be blended with extra milk, butter, or gravy to ensure it is smooth and sufficiently thin.
Dessert Examples
- Smooth custard or mousse: Store-bought smooth yoghurts, custards, or mousses are naturally suitable.
- Pureed fruit with cream or yoghurt: Canned peaches, pears, or stewed apple can be pureed and served with thick cream or smooth yoghurt. Ensure fruits with seeds (like berries) are sieved.
- Liquidised milk puddings: Rice pudding or semolina can be blended with extra milk or cream.
How to prepare Level 3 liquidised meals
Preparing Level 3 meals requires specific techniques to ensure safety and palatability. A blender or food processor is essential for achieving the required smooth, consistent texture.
- Add nutritious liquids: To maintain nutritional quality and achieve the correct consistency, always blend with nutritious fluids, such as gravy, sauces, milk, broth, or juice. Avoid using water, which can dilute flavour and nutritional content.
- Blend in small batches: For best results, liquidise small quantities of food at a time.
- Sieve if necessary: After blending, sieve the mixture to remove any remaining bits, seeds, or fibres, especially for fruits and tougher vegetables.
- Check the consistency: Perform the IDDSI fork test to ensure the food slowly drips in dollops through the tines of a fork. If it's too thick, add more liquid; if too thin, a thickener may be needed.
Comparing Level 3 with other modified diets
The IDDSI framework includes other levels for modified texture diets. Understanding the differences is important for appropriate nutritional management.
| Feature | Level 3 (Liquidised) | Level 4 (Pureed) | Level 5 (Minced & Moist) |
|---|---|---|---|
| Texture | Thin, smooth, liquidised; runs off a spoon. | Thick, smooth, cohesive; holds its shape on a spoon. | Finely chopped or minced with moist sauce; soft and easy to mash. |
| Chewing | No chewing required. | No chewing required. | Minimal chewing required. |
| Equipment | Blender, sieve. | Blender or food processor. | Knife, fork, masher. |
| Portability | Can be poured or drunk from a cup. | Eaten with a spoon, not poured. | Eaten with a fork or spoon. |
| Examples | Blended soup, pureed chicken in gravy. | Pudding, hummus, smooth potato mash. | Minced meats, well-cooked soft pasta. |
Nutritional considerations for a Level 3 diet
While a Level 3 diet is medically necessary for some, it poses challenges in maintaining adequate nutrition. Liquidised meals can be less palatable and filling, which can lead to reduced food intake and weight loss.
- Enrich meals: Boost calories and protein by adding full-fat dairy products like milk, cream, butter, or cheese during preparation. Full-fat Greek yoghurt, condensed milk, and seedless jams are also excellent for sweet dishes.
- Eat frequently: Encourage consuming small, frequent meals and nutritious snacks throughout the day, rather than relying on three large meals.
- Use fortified liquids: When blending, use full-fat or fortified milk instead of water to enhance the nutritional value of the food.
- Monitor weight: Regular weight monitoring is essential to catch any signs of unintentional weight loss early.
Conclusion
As this guide has shown, what is an example of a Level 3 pureed food depends heavily on its smooth, liquidised consistency as per the IDDSI framework. Examples like blended casseroles, smooth porridges, and pureed fruits with added liquid are all appropriate, provided they are free of any lumps or bits. While Level 3 is a modified texture diet for individuals with dysphagia, with proper preparation and enrichment techniques, it is possible to create nutritious and appealing meals. Always consult with a healthcare professional, such as a Speech and Language Therapist or Dietitian, to ensure the diet is appropriate for individual needs. For further information, the International Dysphagia Diet Standardisation Initiative website is a valuable resource.
