Testing and Optimising Nutrition on a Liquidised Diet

August, 2020

Texture modified diets are often recommended for people who have difficulty chewing or swallowing because they require less chewing. They hold together and move more slowly through the mouth and throat, thus allowing more time for airway protection.

These diets allow people to continue to eat balanced, nutritious meals. Texture modified diets may also be recommended following head and neck surgery, for people with dental issues, for people who fatigue quickly during meals or who have reduced levels of alertness, and for people undergoing treatments such as chemotherapy and radiotherapy.

Under IDDSI Level 3, there is no previous equivalent for the Liquidised diet. It may be used for people who have difficulty moving their tongues. No chewing, and minimal tongue movement is required.

A Level 3 liquidised diet consists of foods that are smooth, moist and lump-free, with no lumps, husks or fibres, and are moderately thick in consistency. A blender or food processor is often required to produce food of a suitable texture.

These foods do not require chewing, and they are not sticky. They can be eaten by a spoon or drunk from a cup. They cannot be eaten by a fork.


The IDDSI Fork Drip Test and the IDDSI Flow Test are required to assess if a food item is suitable for Level 5 minced and moist diet.

IDDSI Fork Drip Test Method:

  • Pick up food with a metal fork
  • The fluid will drip slowly or dollop through the prongs
(c) The International Dysphagia Diet Standardisation Initiative 2016 @ http://iddsi.org/framework/.

IDDSI Flow Test Method:

  • Liquid will flow through the syringe with 8-10ml left after 10 seconds
(c) The International Dysphagia Diet Standardisation Initiative 2016 @ http://iddsi.org/framework/.

Foods such as jelly (and gelatin-based desserts), ice cream and chocolate are unsuitable for residents on Level 3 liquidised diet as they melt in the mouth.

Optimising nutrition on a liquidised diet

Individuals maintained on a liquidised diet often experience a reduced appetite and intake for a number of reasons, including illness, sore mouth and throat, difficulty swallowing, disinterest in food, and this puts them at greater risk of malnutrition.

It is important, regardless of dietary texture, to maintain a well- balanced diet and choose from a variety of foods.

It is vital to make every mouthful count, by ensuring you include a good amount of protein and energy (kcals/KJ) in your diet.

Protein is important for the repair and maintenance of your body, as well as the production of hormones and enzymes, and supporting your immune system, while Energy (kcals/KJ) is important to help maintain your weight/ prevent weight loss.

The following table lists foods and fluids to include when aiming to increase protein and energy:

High Protein FoodsHigh Energy Foods
Dairy products e.g. milk, cheese, yogurt, custard (including fortified soy and low lactose alternatives)
Nuts and seeds
Meat, chicken or fish
Baked beans
Legumes such as chick peas, kidney beans, lentils
Full fat dairy
Butter, oil, margarine
Cream, sour cream
Mayonnaises, dressings
Chocolates, sweets, ice cream
Cordial, soft drink, juice
Sugar, honey, syrup

Tips for maximising food and nutrient intakes include:

  • choosing foods and flavours that you like
  • where possible, choosing the same foods as the rest of your household/family while altering the texture to suit your tolerance
  • Choosing small, frequent meals and snacks throughout the day rather than relying on larger main meals
  • Experimenting with different milkshake and smoothie recipes to add variety
  • Including fruit and vegetables as well as protein sources in your daily meals
  • Aiming to include protein at each meal.
  • Ensuring the quantity of food/fluids consumed meets energy requirements and prevents weight loss

Fortifying Foods

If you are unable to eat sufficiently to meet your nutrition needs and to maintain or regain lost weight, it is helpful to fortify your meals. This improves the quality of your meals without increasing the quantity.

Aim to fortify 2-3 meals per day where possible to optimise intake.

Adding the following foods to milk drinks, soups and other liquidised meals, can improve the protein and energy/ nutrient intake.

  • Milk, milk powder, evaporated milk
  • Cheese
  • Yoghurt
  • Butter
  • Margarine
  • Cream
  • Sour cream
  • Cream cheese
  • Oil
  • Mayonnaise
  • Rich sauces such as hollandaise, bechamel
  • Pulses and legumes e.g. lentils, chick peas, kidney beans

Another strategy is to use enriched milk at every opportunity throughout the day – on cereal or porridge, in tea or coffee, in soups, milky drinks, desserts.

High Protein Enriched Milk (makes 1 Litre)

  • 900mls milk (full cream)
  • 1 cup milk powder (125g)

It is also possible to use commercial nutritional supplements to fortify meals.

Your Dietitian is able to discuss with you the choices available and most suited to your needs, as well as providing more practical suggestions for adding variety and enjoyment to your diet and eating.

Dietitians Australia

Don’t let your residents or budget experience the side effects of malnutrition or dysphagia.
Call us on 1300 850 246 or email and request a call back.

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