What is a Level 5 Liquidised Diet? Understanding the IDDSI Minced and Moist Standard

November 19, 2025 •

4 min read

Up to 59% of residents in long-term care facilities have dysphagia, a condition that may necessitate a modified diet texture. While often mistakenly called a Level 5 liquidised diet, this is more accurately known as a Minced and Moist diet under the International Dysphagia Diet Standardisation Initiative (IDDSI). This specific food texture is designed to support individuals with difficulties in chewing and swallowing.

Quick Summary

This diet, formally known as the IDDSI Minced and Moist standard, consists of soft, cohesive foods with small, moist lumps, suitable for people with mild to moderate chewing problems. It is different from a pureed diet, offering more texture while ensuring food is safe to swallow for those with dysphagia.

Key Points

Diet Name: A Level 5 liquidised diet is officially known as a Minced and Moist diet under the IDDSI framework.
Food Texture: Foods are soft, moist, and cohesive, with small, easily mashed lumps no larger than 4mm for adults.
Key Purpose: This diet is for individuals with mild to moderate chewing or swallowing difficulties, offering more texture than a pureed diet.
Preparation: Foods are mashed or minced and moistened with sauce, gravy, or other liquids to the correct, non-separating consistency.
Nutritional Focus: Fortifying meals with extra protein and calories is often recommended to maintain adequate nutrition and prevent weight loss.
Foods to Avoid: Hard, dry, crunchy, sticky, or fibrous foods are considered high-risk and must be avoided.

What is a Level 5 Minced and Moist Diet (IDDSI)?

A Level 5 Minced and Moist diet is part of the IDDSI framework, a global standard for texture-modified foods and thickened fluids designed to improve safety for individuals with dysphagia. The term "liquidised" is a misnomer, as this level includes small, distinct food particles, unlike a fully liquid diet. The defining characteristics of this diet are foods that are soft, moist, and tender, holding their shape on a fork but easily mashed with a little pressure.

Key Characteristics of the Minced and Moist Diet

Foods at this level require minimal chewing and are designed for safe swallowing. Key features include:

Particle Size: For adults, food particles should be no larger than 4mm, which is the approximate width of the gap between the tines of a standard fork. For children, the size is smaller, at 2mm.
Cohesion: Food should be soft and moist enough to stick together when scooped onto a fork, with no thin liquid separating from the food.
Masheability: Food must be easily squashed with the tongue or a fork, indicating its softness.
Minimal Chewing: Biting is not required, and only a small amount of chewing is necessary.

Who Needs a Minced and Moist Diet?

Speech and Language Therapists or dietitians may recommend a Level 5 diet for various reasons:

Chewing Problems: For those unable to chew regular food safely or efficiently.
Swallowing Difficulties (Dysphagia): When weak swallowing muscles increase the risk of choking on larger, harder food pieces.
Fatigue: Individuals who tire easily while eating may struggle with the effort required for chewing and swallowing tougher foods.
Cognitive Issues: People with cognitive impairment may find it safer and easier to manage pre-minced and moistened foods.

How to Prepare a Level 5 (Minced and Moist) Diet

Preparing a Level 5 diet requires attention to detail to ensure both safety and palatability. It involves modifying everyday foods to achieve the correct texture and moisture. Using a blender or food processor can help, but a fork is often sufficient for softer ingredients.

Essential Preparation Techniques

Add Moisture: Always add extra fluids like gravy, sauce, milk, or broth to food during blending or mashing to ensure it is sufficiently moist. Avoid using just water, as this can reduce the nutritional value.
Check Lump Size: For adults, ensure all lumps are smaller than 4mm. The IDDSI fork test, where food is pressed with a fork, can confirm that it passes through the tines.
Remove Unsafe Textures: Thoroughly remove all skins, seeds, bones, and gristle. Avoid preparing mixed-texture foods, like thin broth with hard vegetable chunks.
Fortify for Nutrition: To increase energy and protein, add high-calorie ingredients such as butter, cream, or skim milk powder.

Examples of Suitable and Unsuitable Foods

Suitable Foods:

Finely minced meats, poultry, or fish served with a thick, non-dripping sauce or gravy.
Mashed, cooked vegetables like potatoes, carrots, or peas with added butter or sauce.
Thick, moist breakfast cereals, like porridge, where the milk is fully absorbed.
Soft, mashed ripe fruit, like bananas or stewed apples, with no seeds or skin.
Dairy products such as thick and creamy yogurt, custard, and milk puddings.

Unsuitable Foods (High Choking Risk):

Regular dry bread and crackers.
Tough, dry, or stringy meats.
Crispy, crunchy, or crumbly foods.
Hard or sticky candies.
Nuts, seeds, and hard pieces of fruit or vegetables.

Comparison: Level 4 Pureed vs. Level 5 Minced and Moist


Feature	IDDSI Level 4: Pureed	IDDSI Level 5: Minced and Moist
Texture	Smooth, lump-free, thick liquid consistency.	Soft, moist, and tender with small, defined lumps.
Biting Required?	No biting or chewing required.	Minimal chewing required; biting is not necessary.
Particle Size	No particles present.	Adults: 4mm or smaller; Children: 2mm or smaller.
Cohesion	Smooth and homogenous throughout.	Holds shape on a fork; no separation of thin liquid.
Preparation	Often requires blending or sieving for smoothness.	Mashing or finely mincing is sufficient for soft foods.
Purpose	For severe chewing/swallowing difficulties.	For mild to moderate chewing/swallowing problems.

Maintaining Nutrition and Hydration

Because the volume of food in a Level 5 diet can be smaller and less energy-dense, it's crucial to prevent malnutrition and dehydration.

Nutrient Fortification: Enriching meals with additional fats and proteins helps boost nutritional intake. Suggestions include adding butter, cheese, or protein powders to mashed foods.
Smaller, Frequent Meals: Encouraging six smaller meals a day instead of three large ones can help combat fatigue and increase overall consumption.
Hydration: Ensuring sufficient fluid intake is vital. Opt for nutritious drinks like milkshakes or smoothies thickened to the appropriate consistency, rather than just water.

Conclusion

To ensure safety for individuals with chewing and swallowing issues, it is important to correctly understand what is a Level 5 liquidised diet, which is properly identified as a Minced and Moist diet under IDDSI standards. This diet offers a safer and more manageable eating experience than regular solid food by providing soft, moist food with very small, chewable lumps. Proper preparation and nutritional management, often guided by a Speech and Language Therapist or dietitian, are essential for ensuring both safety and adequate nutrient intake. For more information on the IDDSI framework and its various levels, you can visit IDDSI.org.

Frequently Asked Questions

The main difference is the texture. A Level 4 pureed diet is completely smooth and lump-free, while a Level 5 Minced and Moist diet contains small (4mm for adults), soft lumps that can be easily chewed and mashed with the tongue.

A Level 5 Minced and Moist diet is typically recommended by a healthcare professional, such as a Speech and Language Therapist or dietitian, after a clinical assessment of a person's chewing and swallowing abilities.

To prepare meat for a Level 5 diet, it should be finely minced or chopped into 4mm pieces for adults. It must then be served with a thick, smooth sauce or gravy to ensure it is moist and cohesive, and all gristle and bones must be removed.

No, dry foods like regular bread, toast, and crackers are not allowed on a Level 5 Minced and Moist diet. These foods are considered a high choking risk for individuals with dysphagia due to their hard, dry, and crumbly nature.

IDDSI stands for the International Dysphagia Diet Standardisation Initiative. It is a globally recognized framework that provides standardized terminology and definitions for texture-modified foods and thickened fluids for people with swallowing difficulties.

To ensure nutritional completeness, meals can be fortified with high-protein and high-energy ingredients like butter, cream, cheese, or milk powder. Eating smaller, more frequent meals can also help increase calorie and nutrient intake.

You can perform the IDDSI fork test by pressing a standard fork on the food. The food should pass easily through the prongs and hold its shape cohesively on the fork without dripping thin liquid.