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National Dysphagia Level 1: Pureed Nutrition Therapy

Description
This diet consists of pureed, homogenous, and cohesive foods. Food should be “pudding-like.” No
coarse textures, raw fruits or vegetables, nuts, and so forth are allowed. Any food that require bolus
formation, controlled manipulation, or mastication are excluded.

Rationale
This diet is designed for people who have moderate to severe dysphagia, with poor oral phase abilities
and reduced ability to protect their airway. Close or complete supervision and alternate feeding
methods may be required.

Liquid Consistency (circle one)

Thin Nectar-like Honey-like Spoon-thick
(includes all
unthickened
beverages and
supplements)
 

Food Textures for NDD Level 1: Dysphagia Pureed

Beverages
Recommended • Any smooth, homogenous beverages without chunks or pulp. Beverages
may need to be thickened to appropriate consistency.
Avoid • Any beverages with lumps, chunks, seeds, pulp, etc.
If thin liquids • Milk, juices, coffee, tea, sodas, carbonated beverages, alcoholic
allowed, also beverages, nutritional supplements.
may have: • Ice chips
Breads
Recommended • Commercially or facility-prepared pureed bread mixes, pre-gelled
slurried breads, pancakes, sweet rolls, Danish pastries, French toasts,
etc., that are gelled through entire thickness of product.
Avoid • All other breads, rolls, crackers, biscuits, pancakes, waffles, French
toast, muffins, etc.

Copyright American Dietetic Association. This handout may be duplicated for client education.
National Dysphagia Diet Level 1: Dysphagia Pureed – Page 1
Food Textures for NDD Level 1: Dysphagia Pureed (continued)

Cereals (Cereals may have just enough milk to moisten)

Recommended • Smooth, homogenous, cooked cereals such as farina-type cereals. Cereals
should have a “pudding-like” consistency.
Avoid • All dry cereals and any cooked cereals with lumps, seeds, chunks.
• Oatmeal.
If thin liquids • Enough milk or cream with cereals to moisten; they should be blended in
allowed, also well.
may have:
Desserts
Recommended Smooth puddings, custards, yogurt, pureed desserts and soufflés.
Avoid • Ices, gelatins, frozen juice bars, cookies, cakes, pies, pastry, coarse or
textured puddings, bread and rice pudding, fruited yogurt.
• These foods are considered thin liquids and should be avoided if thin
liquids are restricted: Frozen malts, milk shakes, frozen yogurt, eggnog,
nutritional supplements, ice cream, sherbet, regular or sugar-free gelatin,
or any foods that become thin liquid at either room (70°F) or body
temperature (98°F).
If thin liquids • Frozen malts, yogurt, milk shakes, eggnog, nutritional supplements, ice
allowed, also cream, sherbet, plain regular or sugar-free gelatin.
may have:
Fats
Recommended • Butter, margarine, strained gravy, sour cream, mayonnaise, cream cheese,
whipped topping.
• Smooth sauces such as white sauce, cheese sauce or hollandaise sauce.
Avoid • All fats with coarse or chunky additives.
Fruits
Recommended • Pureed fruits or well-mashed fresh bananas.
• Fruit juices without pulp, seeds, or chunks (may need to be thickened to
appropriate consistency if thin liquids are restricted).
Avoid • Whole fruits (fresh, frozen, canned, dried).
If thin liquids • Unthickened fruit juices
allowed, also
may have:
Meats and Meat Substitutes
Recommended • Pureed meats.
• Braunschweiger.
• Souffles that are smooth and homogenous.
Avoid • Whole or ground meats, fish, or poultry.
• Non-pureed lentils or legumes.
• Cheese, cottage cheese.
• Peanut butter, unless pureed into foods correctly.
• Non-pureed fried, scrambled, or hard-cooked eggs.
National Dysphagia Diet Level 1: Dysphagia Pureed – Page 2
 
Food Textures for NDD Level 1: Dysphagia Pureed (continued)

Potatoes and Starches

Recommended • Mashed potatoes or sauce, pureed potatoes with gravy, butter, margarine,
or sour cream.
• Well-cooked pasta, noodles, bread dressing, or rice that have been pureed
in a blender to smooth, homogenous consistency.
Avoid • All other potatoes, rice, noodles.
• Plain mashed potatoes, cooked grains.
• Non-pureed bread dressing.
Soups
Recommended • Soups that have been pureed in a blender or strained. May need to be
thickened to appropriate viscosity.
Avoid • Soups that have chunks, lumps, etc.
If thin liquids • Broth and other thin, strained soups.
allowed, also
may have:
Vegetables
Recommended • Pureed vegetables without chunks, lumps, pulp, or seeds.
• Tomato paste or sauce without seeds.
• Tomato or vegetable juice (may need to be thickened to appropriate
consistency if juice is thinner than prescribed liquid consistency.)
Avoid • All other vegetables that have not been pureed.
• Tomato sauce with seeds, thin tomato juice.
If thin liquids • Thin tomato or vegetable juices.
allowed, also
may have:
Miscellaneous
Recommended • Sugar, artificial sweetener, salt, finely ground pepper, and spices.
Avoid • Coarsely ground pepper and herbs.
• Chunky fruit preserves and seedy jams.
• Seeds, nuts, sticky foods.
• Chewy candies such as caramels or licorice.
If thin liquids • Smooth chocolate candy with no nuts, sprinkles, etc.
allowed, also
may have:

Notes:

National Dysphagia Diet Level 1: Dysphagia Pureed – Page 3