What level is a blended diet? Understanding IDDSI Classifications

January 2, 2026 •

4 min read

According to the International Dysphagia Diet Standardisation Initiative (IDDSI), a blended diet is not a specific level but a method of food preparation, with the final texture determining its classification. The consistency must be carefully controlled, especially for tube feeding, to ensure safety and proper nutrition.

Quick Summary

A blended diet's specific level is defined by its final texture, most often corresponding to the International Dysphagia Diet Standardisation Initiative (IDDSI) Level 4 (Puréed). For tube feeding, consistencies can range from Levels 1 to 3 depending on the tube size and patient needs. Proper blending and testing are crucial for safety and nutritional adequacy.

Key Points

Not a Single Level: A blended diet is a method of preparation, not a single, fixed level within the IDDSI framework.
Most Common Level: For oral consumption, a blended diet most often corresponds to IDDSI Level 4 (Puréed), which is smooth and cohesive.
Tube Feeding Consistency: For tube feeding, the blend may be thinner, matching IDDSI Levels 1-3, to prevent blockages, especially in smaller tubes.
Consistency Testing is Vital: Always test the consistency of homemade blends using methods like the fork test or syringe flow test to ensure safety.
Nutritional Guidance is Key: Working with a registered dietitian is essential to ensure homemade blends are nutritionally complete and meet all dietary requirements.
Food Safety Protocols: Proper hygiene during preparation and strict storage guidelines (e.g., refrigerating within 2 hours, using within 24-48 hours) are critical to prevent bacterial contamination.
Homemade vs. Commercial: Homemade blends offer customization and lower cost but require significant time and careful nutritional planning, while commercial options are convenient and consistently complete.

What is a Blended Diet and How is it Classified?

A blended diet, also known as a blenderized diet, involves pureeing or liquidizing regular food into a smooth, consistent mixture. It is a nutritional strategy used for individuals who have difficulty chewing or swallowing, a condition known as dysphagia, or for those who receive nutrition via a feeding tube. The key takeaway is that “blended diet” describes the preparation process, not a final, single texture level. To ensure consistency and safety, healthcare providers rely on the International Dysphagia Diet Standardisation Initiative (IDDSI) framework.

The IDDSI Framework and Blended Diet Levels

The IDDSI framework is a global standard that provides a common terminology for describing modified food textures and thickened liquids. It uses a continuum of eight levels (0–7), with different testing methods for each. For a blended diet, the final consistency of the food product determines its IDDSI level. Here are the most relevant levels:

Level 4 (Puréed): This is the most common texture for an oral blended diet for individuals with dysphagia. It consists of food that is smooth, cohesive, and pudding-like, with no lumps. It holds its shape on a spoon and does not drip continuously through the prongs of a fork.
Level 3 (Liquidised/Moderately Thick): For tube feeding, if the blend is thinner than a purée, it might fall into this category. It requires a syringe or cup for consumption, or for larger tube diameters. It can be sipped from a cup but leaves a coating on the spoon.
Levels 1-2 (Slightly to Mildly Thick): Some liquidized or blended diets, particularly for smaller feeding tubes, need to be even thinner to prevent blockages. These levels are tested using a syringe test to ensure the correct flow rate.

Testing Consistency for Safety

Verifying the correct texture is a critical safety step, especially when preparing blended food at home. For a Level 4 (Puréed) blended food, perform the fork drip test. Place a small amount of the food on a fork. It should hold its shape and not flow or drip through the tines. For thinner consistencies used in tube feeding, the syringe flow test is used to ensure the blend flows correctly through the tube.

Homemade vs. Commercial Blended Diets

Individuals and caregivers can choose between preparing their own blended diets at home or using commercially available products. Both have distinct advantages and drawbacks.

Comparison of Homemade and Commercial Blended Diets


Feature	Homemade Blended Diet	Commercial Blended Diet
Cost	Can be more cost-effective as it uses standard grocery items.	Generally more expensive, though may be covered by insurance.
Preparation Time	Requires significant time for meal planning, cooking, and blending.	Ready-to-use, requiring no preparation time.
Nutritional Control	Offers complete control over ingredients, allowing for customization.	Nutritionally complete and balanced, but lacks customization.
Equipment	Requires a high-powered blender and other kitchen tools.	No special equipment needed, other than possibly a pump for specific feeds.
Portability	Difficult to transport safely due to temperature and storage requirements.	Shelf-stable and portable, ideal for travel or busy schedules.
Consistency	Requires careful and consistent testing to avoid blockages.	Guaranteed consistent thickness and texture.

Safety and Nutritional Considerations for a Blended Diet

Regardless of whether a homemade or commercial blended diet is used, several factors are crucial for patient safety and well-being. These considerations are vital to discuss with a healthcare team, including a registered dietitian.

Potential Risks and How to Mitigate Them

Tube Blockage: This is a major risk, especially with homemade blends, if the consistency is not completely smooth or if the tube is too narrow. Using a high-powered blender and thinning the mixture with appropriate liquids can help. Always ensure the blend is strained if you have a less powerful blender.
Food Safety: Improper preparation and storage can lead to bacterial contamination. Adhere strictly to food hygiene principles, storing blends in the refrigerator for no more than 24-48 hours and never leaving them at room temperature for more than two hours.
Nutritional Inadequacy: Homemade blends, without careful planning, can lack sufficient calories or essential nutrients. A dietitian can help formulate recipes that meet individual needs, monitor growth, and ensure a balanced intake of macro- and micronutrients.

Creating a Balanced Homemade Blended Diet

A well-planned homemade blend can be nutritionally complete. Work with a dietitian to create a recipe that includes a variety of ingredients. Here is an example of components to consider:

Proteins: Cooked and pureed meats (chicken, beef, fish), beans, lentils, or soft tofu. Add gravy or broth to aid blending.
Grains: Cooked rice, pasta, or oatmeal blended to a smooth, pudding-like consistency.
Vegetables: Cooked and pureed vegetables like sweet potatoes, carrots, or broccoli. Avoid stringy or fibrous vegetables.
Fruits: Pureed fruits like bananas, berries, or canned fruit. Avoid skins, seeds, and pips.
Fats: Add sources like olive oil, avocado, or nut butters to increase calorie density.
Dairy/Substitutes: Milk, yogurt, or fortified plant-based alternatives.

Conclusion: The Blended Diet Requires Careful Consideration

In conclusion, asking "what level is a blended diet?" requires understanding that the term refers to the method, not a fixed classification. Its specific IDDSI level—most often Level 4 (Puréed) for oral intake or a thinner level for tube feeding—is determined by its final, verified texture. Whether using a homemade or commercial approach, adhering to food safety, ensuring nutritional completeness, and working closely with healthcare professionals, particularly a registered dietitian, are paramount for a safe and effective regimen. This approach can help normalize mealtime experiences for those with swallowing difficulties while meeting their unique dietary needs.

For more information on IDDSI guidelines and testing methods, visit the official website: International Dysphagia Diet Standardisation Initiative (IDDSI).

Frequently Asked Questions

The International Dysphagia Diet Standardisation Initiative (IDDSI) framework is a global standard for classifying modified food textures and thickened liquids, providing a common language for healthcare providers and patients.

For swallowing (oral consumption), a blended diet is typically IDDSI Level 4 (Puréed), a thick, pudding-like consistency. For tube feeding, the blend is often thinner (Levels 1-3) to flow easily through the tube and prevent blockages.

A high-powered blender is recommended to achieve a consistently smooth texture. Less powerful blenders may require more time and manual straining through a sieve.

Consult a registered dietitian, who can help create recipes to meet your specific needs. They will ensure adequate calories, protein, vitamins, and minerals, especially if the blended diet is your sole source of nutrition.

Blends should be refrigerated promptly and used within 24 to 48 hours. They should not be left at room temperature for more than two hours to prevent microbial growth.

Yes, avoid foods with skins, seeds, pips, or husks, as these do not blend well and can present a safety risk. Fibrous or tough items should also be avoided.

Commercial baby food purees can be used, but they are often lower in nutrients and should not be used for long-term, sole-source nutrition without guidance from a dietitian.