This newsletter is a joint collaboration between Adult Speech Pathology and Nutrition Professionals Australia.

LIQUIDISED DIET- Level 3 (Yellow)

A new food level has been added to the IDDSI guidelines- Liquidised food.

Liquidised food and moderately thick fluids both have the same flow characteristics & testing methods. They may be recommended for someone with reduced tongue control &/or oral preparation, and severe difficulty &/or pain swallowing some consistencies.

Foods in a Liquidised diet are smooth (i.e with no 'bits' like lumps, fibres, bits of shell or skin, husk, seeds). They can be drunk from a cup or eaten from a spoon. An example is runny pureed fruit, or foods such as soup, juice,s, milk drinks, runny custard, melted icecream or smooth yoghurt.

Foods should easily pour from a tilted spoon, having some flow, but no separation of thin (watery) liquid. They should not be able to be eaten from a fork or chop sticks, and they will not hold its shape on a plate.

(For foods like soup at Level 3 Liquidised texture, IDDSI suggests blending with milk, butter, cream or gravy to avoid diluting nutrient and energy content. Consult a dietitian for more information.)


It is important that fluids be as nourishing as possible to provide all the nutrients required for the best overall quality of life. A liquidised diet can be low in many vitamins and minerals, fibre, iron and energy (kilojoules or calories). A multivitamin and an iron supplement many be needed. For example:
- Multivitamin: Supradyn (soluble) one per day
- Iron supplement: Iron Melts or a liquid iron supplement once or twice per week

Your dietitian will advise about the specific quantities of the various nourishing fluids needed. Weight should be monitored closely.

The liquidised food is also providing fluid- it is important to maintain an adequate overall fluid intake.

It is difficult to obtain sufficient fibre, and constipation may become a problem. Ensuring soups are rich in vegetables will help, as will ensuring adequate amounts of fluid daily. Including prune juice with breakfast is one way to help prevent constipation as well as exercise if it can be managed.

Benefibre is a soluble fibre supplement and can be mixed into hot and cold beverages to help improve fibre intake. It is tasteless and colourless and dissolves well unlike some fibre supplements which may form lumps. Follow the directions on the packet.


The Liquidised Diet and Moderately Thick Fluids have been linked in the IDDSI Framework. They have the same characteristics and testing methods.

All thickened fluids must be prepared carefully using the instructions for the specific thickener used. All staff responsible for providing thickened fluids must have training in how to prepare the fluids correctly.

Remember that if the fluid is too thin, there is an aspiration risk. If it is too thick, the resident is likely to drink less.

All thickened fluids must always be referred to by at least two identifiers:
colour & name / name & number / number & colour
e.g. Moderately Thick, Level 3, Yellow.



What is aspiration?

Aspiration occurs when foreign bodies such as food or fluids "go down the wrong way", enter the airway and pass beyond the vocal folds towards the lungs. People with dysphagia are at a greater risk of aspiration. Individuals can also aspirate their own secretions and reflux.

Why is aspiration dangerous?
It increases the risk of contracting aspiration pneumonia, increases the risk of obstructing the airway/choking and  can cause damage to the airway/lungs.

What is Aspiration Pneumonia?
Aspiration pneumonia is a form of bacterial pneumonia, and a common complication of dysphagia. Pathogenic bacteria are aspirated into the lung as soluble particles or attached to surfaces e.g. with food, oral secretions, liquid or stomach contents (i.e. not airborne).

How does an aspiration pneumonia develop?

It may occur 2-3 days after a significant aspiration event. It may also occur when chronic aspiration of small amounts reaches a critical threshold where the bacteria takes hold. (*Individuals may tolerate some level of aspiration without developing a pneumonia.)

How do we reduce this risk?

Preventing aspiration pneumonia is complex, but it includes understanding what alters an individual's bacterial flora to make it pathogenic and also understanding an individual's ability to resist bacterial invasion. However, reducing aspiration itself (i.e. managing any dysphagia) remains a clear goal.Consult a speech pathologist for an assessment to identify the contributing factors and risks for each individual. The speech pathologist can work with care home staff and families to develop a management plan, for example by suggesting diet or fluid modification, or specific safe feeding strategies.


We have set the dates for the 2019 Improving Nutrition 2 day seminars. See the website for more details and for the dates in your region.

This year we will be focussing on IDDSI and the new standards.


NPA's new Meal Plans Manual is a benchtop guide to nutrition care and therapeutic or special diets when catering for older people.

It provides a summary of nutrition for an older person, information regarding menu planning as well as a meal plan for each of the various special diets that are likely to be encountered. 

Many of these special diets eg diabetic and texture modified diets are routinely provided from the main menu, but others will need to be catered for on an individual basis.

The meal plans provide a simple and practical guide that can be readily referred to at the time of serving meals.

Also included in this manual is information regarding standard serve sizes and a standard menu structure to ensure that residents are provided with ample opportunities to choose foods from each of the core food groups and to ensure that the organisation meets Best Practice and/ or Accreditation Guidelines.



Online e-learning Presentations

Have you attended NPA's Improving Nutrition in Aged Care Seminar? We are now offering the seminars as a series of online e-learning presentations.

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Resources for Aged Care

NPA has developed a set of resources and information for aged care homes.You can begin accessing  the NPA resources from our website now.

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