Dietary Advice for a Puree Diet

How do I make every bite count?

During your consultation you were asked about your appetite and if you had lost any weight recently.  You may have had your weight and height recorded.

This information has identified you as being at risk of malnutrition.  You have also been advised to alter the texture of your diet following a swallow assessment.

It is important to maintain your weight and prevent any or further weight loss to reduce the risk of further health problems and to keep you as well as possible. 

To do this, it is important to eat nourishing foods; high in energy and protein and in line with the recommendations for texture and consistency.

This leaflet gives you ideas about small changes that can be made which will help you achieve a more nourishing diet. This will help prevent further weight loss. 

The following suggestions may help and should be followed until your healthcare professional is happy with your weight or there is a change in the recommended texture of your diet and fluids.

This diet sheet considers the texture of your food only.  If you have been advised to alter the consistency of your fluids, then you should follow the recommendations of the Speech and Language Therapist.

What should I choose when following a pureed diet?

• Foods that do not require any chewing.

• Foods that cannot be sucked through a straw.

• Soft foods that can be eaten with a fork, spoon or chopstick.

• Foods that do not have any lumps.

• Are not sticky.

• Foods that when prepared should not have any liquid that is separate from the solid part.

• Foods that can be piped, layered or moulded.

• Foods that have some movement with gravity but cannot be poured.

• Foods that fall off a spoon in a single spoonful when tilted and continues to hold its shape when on a plate.

How do I puree my food?

• A blender, liquidiser, food processor, masher and sieve can all be used to prepare pureed foods.

• If you have a freezer, make several portions at once.

• Using a slow cooker can ensure that meat, fish and chicken are very soft which can then be pureed. 

• Foods that do not puree well include raw vegetables or vegetables with skin on, salads, seeds, nuts and dried fruit, bread or toast, biscuits, or foods with husks.
• Foods should be cut into small pieces, removing any tough skins, bones or seeds before putting these in a blender.

• Each food should be pureed separately to retain individual portions on the plate.  Don’t puree the whole meal together.

• Puree small quantities of food to avoid lumps and blend until smooth.  Stir and check for any lumps and blend again.  A lumpy consistency may cause choking. If blending does not completely break up any lumps and husks, the food will need to be sieved. 

• Try experimenting with different liquids and sauces in pureed foods to help enhance the flavour and appearance such as tomato ketchup, gravy or cream.  Combinations that work well include:

• Pork – barbecue sauce, apple sauce, and mushroom soup.

• Chicken – cream, condensed soups such as mushroom or chicken.

• Fish – mayonnaise and lemon juice, tartar sauce or cheese sauce.

• Ham – pineapple juice.

• Pureed foods can be put on a plate using an ice-cream scoop or by piping.  Moulds can be purchased to make different shapes from pureed thickened foods.

• Occasionally puree separates into solids with a watery fluid.  If you have been advised to thicken all fluids, you will need to add thickener to the finished puree.

How do I eat a nourishing diet?

• Eat 3 small meals each day as well as a mid-morning, mid-afternoon and supper time snack or eat small amounts every 2 to 3 hours. 

• Include nourishing drinks (to be thickened if needed).

• Fortify full-cream milk with dried milk powder (3 to 4 tablespoons to a pint). Use at least 1 pint of this a day in foods and drinks (to be thickened if needed).

• Nourishing fluids can be added to pureed food that is too thick or is not pureeing well.  These included full cream milk, cheese sauce, condensed soups, mayonnaise, salad cream, stocks or gravy or melted butter. 

Fluid should be added gradually. Avoid adding water as this dilutes the nutritional value of the food.

• Avoid “low fat” or “diet” products.

• To have a milk-based pudding after each meal.

• Choose 2 good protein sources each day, such as: meat, fish, chicken, eggs, cheese, nuts, yogurt or beans and pulses.

• Herbs or spices can be used to add flavour. Taste the food and add seasoning.

• Drink 6 to 8 glasses of fluid each day (tea, coffee, fruit juice, milky drinks). Sip on these throughout the day and take drinks after your meals, to avoid filling up on them (to be thickened if needed).

Choose nourishing snacks

If you are able to have un-thickened fluids then you should aim to have nourishing drinks such as a glass of milk or a milky drink.

Quick meal ideas

• Wheat biscuits with warm full cream milk.

• Pureed banana, honey and apple juice.

• Pureed, sieved fruit served with full fat Greek yogurt and honey or syrup.

• Bolognaise sauce with added cheese or cheese sauce pureed and served with pureed pasta.

• Middle of a baked white or sweet potato with added butter, double cream or full fat cream cheese, pureed and served with pureed meat or fish and pureed vegetables.

• Some takeaways may be suitable for pureeing (Indian curries or Italian dishes can be pureed with potato rather than rice.   Though these dishes need to be sieved as well as pureed.

• Pureed avocado with full fat cream cheese or full fat mayonnaise.

• Tinned fish pureed with mayonnaise or full fat cream cheese.

• Cauliflower cheese pureed with full fat cream, cheese or mayonnaise.

• Pureed well cooked pasta in a cheesy sauce.

• Store cupboard standbys that can be pureed include tinned meats (corned beef, chicken or steaks in gravy or cream sauce. Tinned spaghetti, baked beans (sieved to remove skins), tinned soups, instant sauces such as cheese or parsley sauce.

Dessert or nourishing snack ideas

• Tinned desserts and packets such as custards, mousses and milk puddings. 

• Angel Delight®/instant whip made with full cream milk.

• Tinned/stewed fruit liquidised with 1tbsp of double cream and sugar.

• Thick and creamy yogurt with jam.

• Ready to eat custard pot with 2tbsp added double cream.

• Rice pudding pureed with seedless jams, syrup or honey.

• Smooth mousses.

• Fromage frais.

• Smoothies made with fruit, full cream milk and full fat yogurts.

• Pureed banana with added double cream, chocolate spread or smooth peanut butter.

• Egg custards.

• Pureed ground rice pudding or semolina with added double cream, syrups or seedless jam.

Fats and sugars are higher in energy and can be added to foods to increase calories.  This is what you can do to your normal menu to make it higher in energy.

Sample menu

Breakfast:

Wheat biscuit or pillow (e.g. Weetabix® or Ready brek®) made with full cream milk and with added honey or syrup.

Mid-morning snack:

(see suggestions in leaflet)

Thick and creamy smooth yogurt.

Lunch:

Middle of jacket potato with butter and cheese pureed served with pureed beans.

Pureed banana with added double cream, chocolate spread or smooth peanut butter.

Mid-afternoon snack:

 (see suggestions in leaflet)

Smooth mousse.

Evening meal:

Pureed chicken and mushroom casserole, pureed carrots and creamed potatoes.

Pureed tinned fruit with custard.

Supper:

Hot chocolate.

Contact numbers

If you need further help or advice, please contact:

North Tees and Hartlepool NHS Foundation Trust

Specialist Services Admin Hub

Telephone: 01429 522471

Opening hours: 8.30am to 4.30pm (Monday to Friday excluding Bank Holidays)

Wiltshire Farm Foods

147 Stockton Street

Middlesbrough

TS2 1BU

Telephone: 01642 643999

Opening hours: 9.00am to 5.00pm (Monday to Friday)

Information and references used in the development of this leaflet:

1. Food Standards Agency (2002) McCance and Widdowson’s The Composition of Foods, Sixth Summary Edition. Cambridge: Royal Society of Chemistry
2. Gandy, J. (2014). The Manual of Dietetic Practice (5^th Ed). Wiley Blackwell Ltd. 
3. Complete IDDSI Framework Detailed definitions 2.0 | 2019 (http://ftp.iddsi.org/Documents/Complete_IDDSI_Framework_Final_31July2019.pdf)

Comments, concerns, compliments or complaints

Patient Experience Team (PET)

We are continually trying to improve the services we provide. We want to know what we’re doing well or if there’s anything which we can improve, that’s why the Patient Experience Team (PET) is here to help. Our Patient Experience Team is here to try to resolve your concerns as quickly as possible. The office is based on the ground floor at the University Hospital of North Tees if you wish to discuss concerns in person. If you would like to contact or request a copy of our PET leaflet, please contact:

Telephone: 01642 624719

Freephone: 0800 092 0084

Opening hours: Monday to Friday, 9:30am to 4:00pm

Email: [email protected]

Out of hours

Out of hours if you wish to speak to a senior member of Trust staff, please contact the hospital switchboard who will bleep the appropriate person.

Telephone: 01642 617617

Data protection and use of patient information

The Trust has developed Data Protection policies in accordance with Data Protection Legislation (UK General Data Protection Regulations and Data Protection Act 2018) and the Freedom of Information Act 2000. All of our staff respect these policies and confidentiality is adhered to at all times. If you require further information on how we process your information please see our Privacy Notices.

Telephone: 01642 383551

Email: [email protected]

Leaflet feedback

This leaflet has been produced in partnership with patients and carers. All patient leaflets are regularly reviewed, and any suggestions you have as to how it may be improved are extremely valuable. Please write to the Clinical Governance team, North Tees and Hartlepool NHS Foundation Trust, University Hospital of North Tees, TS19 8PE or:

Email: [email protected]