The preparation of texture modified foods such as minced food and pureed food for the elders suffering from chewing problems may help not only with minimizing the amount of chewing necessary but also allowing these elders to maintain an adequate food and nutrient intake. The causes of chewing difficulties include dental and oral problems, reduced salivation, and impaired oral control resulting from stroke and dementia.

Dietary principles

• The diet should be balanced and include a variety of foods.
• All food groups should be provided daily in portions as suggested by the Healthy Eating Food Pyramid:
  • Grains group: Approximately 3 to 5 bowls of rice (1 bowl of rice is about equal to 2-1/2 bowls of congee)
  • Vegetables group and Fruits group: At least 3 servings of vegetables and at least 2 servings of fruits.
  • Meat, fish, eggs and alternatives group: Approximately 5 to 6 taels.
  • Milk and alternatives group: Approximately 1 to 2 servings of dairy products. (1 serving is about 1 cup of milk or 2 slices of cheese)
• Provide healthy snacks between main meals throughout the day. For example, milk, egg custard, plain yogurt, sweet bean curd pudding, sesame dessert soup, and cakes.
• Provide a daily fluid intake of 6 to 8 cups. This includes water, tea, soup, milk, juice, and fluids added during food processing.

Special features

Minced diet meals: Minced foods should be soft in texture and easy to chew. The food can be chopped or minced.

Pureed diet meals: Pureed foods need to be prepared using a blender or food processor. The texture should be similar to that of baby cereal, smooth with no coarse lumps.

Individual elders have variable levels of tolerance to different food textures. Health professionals should be consulted to assess individual cases and give recommendations on the appropriate food texture and consistency. The diet of elders with diabetes, hypertension or other chronic illnesses should follow the principles of the corresponding therapeutic diet.

Food choices

• Avoid using foods that have a coarse or stringy texture, like whole-grain crackers, celery, pineapple, and brisket.
• Avoid using foods that are too sticky, like glutinous rice flour dumplings and Chinese New Year cake.
• Avoid foods that crumble easily, like egg rolls and pastries.
• Avoid foods that are hard in texture, like nuts and walnut cake.
• Choose seasonings like ground ginger, ground garlic, ground white pepper, ground herbs, vinegar, and ketchup.

Food examples of minced and pureed diets

	Minced Diet	Pureed Diet
Food Examples	Soft breads, cakes, biscuits well-moistened in milk, soup or juice, congee, oatmeal, soft rice. Boneless and skinless meats like diced or minced meats, flaked fish, steamed egg pudding. Gourds, soft vegetable leaves and stems (chopped and cooked until soft). Soft fruits (chopped and diced) like diced papaya or banana. Milk, steamed milk with egg white, plain yogurt, cheese slices.	Well-moistened soft breads, cakes and biscuits soaked in milk, soup or juice. Pureed noodles, congee, oatmeal or rice. Pureed fish, meat, eggs or legumes. Pureed vegetables, gourds, mashed potato, pureed tomato.Fruit juice, pureed fruit. Milk, steamed milk with egg white, plain yogurt, white sauce.

The cooking and processing of foods and common food processing utensils

• Remove the skin, bones, and seeds from the food before processing.
• Foods that are large in size and hard should be chopped into smaller pieces and cooked until soft.
• Use cooking methods that will keep the foods moist, like steaming, boiling, and stewing to facilitate with food processing after cooking.
• Common food processing utensils include juicer, blender, grinder, food processor, sieve, and a large Chinese knife/cleaver.

Using food processing utensils

• Foods should be thoroughly cooked before grinding or pureeing.
• Use adequate amount of soup, milk, or juice during food processing to enhance flavor and nutrition.
• If the pureed food is not smooth in texture, use a sieve to separate the lumps.

An example of a minced or pureed main dish

Stewed chicken with potatoes and onions
Minced Diet	Pureed Diet
Peel and dice the potatoes. Remove the skin of the onions and mince. Chicken should be skinned, de-boned and diced. Stir-fry the onions and add in diced chicken. Cook for a while before adding in diced potatoes and appropriate amount of water. Cook until the ingredients are soft*. * The potatoes should be cooked until it can be mashed using a spoon.	Prepare the main dish like as if making a minced version. Add some water, gravy or milk to the potatoes, and pureed until smooth. Add in gravy or soup to the chicken and onions and pureed until a smooth consistency is reached. Plate the mashed potatoes and pureed chicken separately

Food hygiene

• Special attention should be paid to food hygiene as bacteria on the surface of foods can contaminate the entire food during the mincing and pureeing procedures.
• Please refer to the "Food Poisoning" information for more .

Food presentation

• The ingredients for the main dishes and side dishes should be separately minced or pureed. Rice and noodles should not be pureed together with the ingredients of the main dishes.
• Enhance the flavor and color by using colorful ingredients to prepare the main dishes, like pureed carrot, pureed pumpkin, pureed tomato, mashed egg yolk, jam, and pureed fruit.
• Use separate bowls or dishes with dividers to hold rice and main dishes. This will allow the elders to easily differentiate and taste the different foods.