Standard Diets

Recommended Menu Code

H or ♥

Suggested Menu Type

Standard – a la carte or cyclical menu

Suitable Patient Groups

General population

Type 1 or type 2 diabetes

Dyslipidaemia and cardiovascular risk

Weight management

Hypertension

Rationale for Diet

To maintain good general nutrition and meet Dietary Reference Values (DRVs)

To support public health messages on eating to protect and promote health and wellbeing

To support the clinical management of patients with the above medical conditions

Nutritional Criteria for Diet Coding

Lunch and dinner meals

The following criteria is recommended as best practice.

Table 12.2: Healthier Eating per Meal Coding Criteria (maximum figures shown):

Fat (g)

Saturated Fat (g)

Sugars (g)

Salt (g)

Starters

5.3

1.7

8

0.3

Main course

16

5

15

1.5

Desserts

5.3

1.7

18

n/a

Table 12.3: Healthier Eating per Main Course Coding Criteria (maximum figures shown):

Fat

Saturated Fat

Sugars

Salt

Entree

16

5

15

1.5

Starch

no added

n/a

n/a

no added

Veg

no added

n/a

n/a

no added

Snacks

Snacks are considered a healthier eating option if they meet the same fat, saturated fat and salt criteria as a starter option (as outlined in Table 12.2) and either contain no added sugar (i.e., only contain naturally occurring sugars like those found in fruit and dairy products) or contain <5g sugar/100g.

Note: A food service dietitian may decide to exercise clinical judgement in deciding not to give certain dishes a healthier eating code. For example, battered fish may meet the above criteria, but in some settings, it may be felt that this provides a confusing message to patients who are being given contradictory dietary advice.

Source

Food Services Specialist Group (FSSG)

Recommended Menu Code

E or ↑

Recommended Menu Type

Standard – a la carte or cyclical menu

Patient Groups Suitability

Patients with a small or poor appetite

Patients with increased energy (and protein) requirements - including critical care, major trauma, burns, cancer and any patients at risk of malnutrition

Rationale for Diet

To provide a high intake of protein, vitamins, minerals and other essential nutrients for patients with increased requirements. This could include around one third of hospital admissions (4).

To provide a diet which can meet increased nutritional requirements in modest portion sizes that are well presented and appealing for patients with reduced appetites.

Nutritional Criteria for Menu Coding

Lunch and dinner meals

The following criteria is recommended as best practice.

Aim for 800kcals per mealtime (lunch and dinner meals) to ensure the day part energy figures are met for nutritionally vulnerable patients.

Higher energy options should also be nutrient dense and be able to at least meet the minimum protein target for nutritionally well patients (15g/meal).

Note: These protein targets are not intended to be used in the same way as the protein targets for the optional ‘Higher Protein’ menu code. The coding criteria outlined in table 12.4 are designed to ensure that any item marked as higher energy is also nutrient dense and will help nutritionally vulnerable patients towards meeting their daily protein requirements.

Table 12.4: Higher Energy Suggested Coding Criteria for a 3-Course Meal:

Meal type

Energy (kcals/portion)

Protein (g/portion)

Soup

≥100

≥2

Main course

Total main course: ≥450

Recommended main course breakdown

Entree: ≥300

Total side dishes*: ≥150

Total main course: ≥11

Recommended main course breakdown

Entree: ≥9

Total side dishes*: ≥2

Dessert (incl. accompaniments)

≥250

≥2

Total

≥800

≥15

Or Table 12.5: Higher Energy Suggested Coding Criteria for a 2-Course Meal:

Meal type

Energy (kcals/portion)

Protein (g/portion)

Main course

≥500

Recommended main course breakdown

Main meal dish: ≥350

Total side dishes*: ≥150

≥12

Recommended main course breakdown

Main meal dish: ≥10

Total side dishes*: ≥2

Dessert (incl. accompaniments)

≥300

≥3

Total

≥800

≥15

*Side dishes

It is recommended that both a starchy carbohydrate side dish and a vegetable side dish be offered as part of the main course to provide at least 150kcal. Any carbohydrate and vegetable sides are suitable to be served with a higher energy main meal to create a higher energy main course, however side dishes should only be coded as higher energy on menus individually if they provide ≥150kcal per serve on their own.

Snacks

Snacks are considered a higher energy option if they provide ≥150kcal and ≥2g of protein per serve (5).

Source

Food Services Specialist Group (FSSG)

Recommended Menu Code

P or +

Recommended Menu Type

Standard – a la carte or cyclical menu

Patient Groups Suitability

Patients with a small or poor appetite

Patients with increased protein requirements, including critical care, major trauma, burns, cancer, malnutrition and older adults

These patients can make up to a third of hospital admissions (4).

Rationale for Diet

To improve general nutrition and meet or exceed DRVs.

To provide a diet which can meet increased protein requirements in modest portion sizes and presentations which are appealing and easy to eat.

Nutritional Criteria for Menu Coding

Lunch and dinner meals

The following criteria is recommended as best practice.

Aim for 27g protein per mealtime (lunch and dinner meals) to ensure the day part energy figures are met for nutritionally vulnerable patients.

Table 12.6: High Protein Suggested Coding Criteria:

Meal type

Protein (g/portion)

Starter

≥3

Main course

≥19

Recommended main course breakdown

Main meal: ≥15

Total side dishes*:  ≥4

Dessert (including accompaniments)

≥5

*Sides

It is recommended that both a starchy carbohydrate side dish and a vegetable side dish be offered as part of the main course to provide at least 4g protein. Any carbohydrate and vegetable sides are suitable to be served with a higher protein main meal to create a higher protein main course, however side dishes should only be coded as higher protein on menus if they provide ≥4g protein or more per serve on their own.

Snacks

Snacks are considered a higher protein option if they provide ≥4g protein per serve.

Source

Food Services Specialist Group (FSSG)

Recommended Menu Code

★ or L7 Easy to Chew or EC

Recommended Menu Type

Standard – a la carte or cyclical menu

Patient Groups Suitability

This menu code can be used to signpost patients to foods that are easy to chew within a regular texture as outlined by the International Dysphagia Diet Standardisation Initiative (IDDSI) (6), i.e., normal, everyday foods of a soft/tender texture.

People who are unsafe to eat without supervision are not considered suitable for this texture level.

Primarily, this menu code can be used on the standard menu but also included in cultural and therapeutic diet menus.

This level is for people with enough chewing ability to break down soft/tender foods into pieces without help, but who have difficulty chewing or coping with firm foods, due to problems such as:

• No or limited teeth
• Poor teeth condition
• Badly fitting dentures
• Sore mouths
• Fatigue (but alert enough to safely swallow foods)

It is only for patients who have no increased risk of choking and who are safe to eat unsupervised. It is possible to have a problem swallowing thin liquids, but still be able to manage a Level 7 Easy to Chew diet. 

Some patients with no clinical requirement, may simply prefer to choose Easy to Chew items which is why it is recommended to signpost suitable dishes on appropriate menus (as referred to above). Other patients may be prescribed Level 7 Easy to Chew by a Speech and Language Therapist, but it should only be used for people who are safe to eat without supervision and who have not been clinically identified as at risk of choking.

Rationale for Diet

It is imperative we have only one system for describing food and drink texture modification. IDDSI have developed a standard terminology with a colour and numerical index to describe texture modification for food and drink (6). Easy to Chew foods are softer food choices that fall within Level 7 regular and are intended for those who do not require particle size restriction to help reduce choking risk.

Since the NHS Improvement Patient Safety Alert in 2018 (7), there has been a directive not to use the imprecise term ‘soft diet’ due to confusion about what this means and the subsequent risk to patient safety.

A clinical decision will have been made by Speech and Language Therapist regarding any patients who need a texture modified diet based on their assessment. Healthcare assistants and catering staff must not make decisions about which patients have dysphagia or what level they require. They should also not assess food textures themselves as this should be done by a multidisciplinary team when menu planning.

Guidance for Menu Coding

Everyday foods of soft/tender texture that break apart or squash easily (and do not regain shape) or that can be cut using the side of a fork or spoon.

Food piece size is not restricted in a Level 7 Easy to Chew diet; therefore, foods may be a range of sizes. The following list of the description/characteristics of Level 7 Easy to Chew Foods is specified by IDDSI as a guide: “Do not include: hard, tough, chewy, fibrous, stringy, crunchy, or crumbly foods. This includes any foods with pips, seeds, fibrous parts of fruit or vegetables, husks or bones.” However, please note that whether any item is suitable for a Level 7 Easy to Chew diet is determined by the IDDSI tests on the final product, detailed in the full framework, not by the listed ingredients.

Details of the IDDSI Framework, Descriptor and Testing Method documents can be found on the IDDSI website as well as resources to describe all the levels including Level 7 Regular Easy to Chew (8).

Source

http://iddsi.org/

[Last accessed: 10.06.22]

Recommended Menu Code

V

Recommended Menu Type

Standard - a la carte or cyclical menu

Patient Groups Suitability

Lacto-ovo vegetarians - those who eat dairy and eggs

Rationale for Diet

This is the most common type of vegetarian diet.

Guidance for Menu Coding

Excludes all meat, poultry, fish, shellfish, crustaceans and ingredients or products derived from these e.g. gelatine and rennet.

Eggs, milk and dairy products are suitable.

Care should be taken to identify hidden ingredients that may contain animal by-products such as rennet or gelatine when coding vegetarian menus. This can be done by careful checking of food labels. Items to be aware of include:

• Desserts (especially cheesecakes, other set desserts and ice cream)
• Yoghurts
• Cheeses
• Soups
• Condiments and other table sauces.

Ensure meals contain adequate and varied protein. Good protein sources for vegetarians include (9):

• Beans, legumes and lentils
• Peas
• Nuts
• Tofu and tempeh
• Meat substitutes such as soya protein and mycoprotein
• Eggs
• Dairy products
• Wholemeal cereal products, such as wholemeal pasta, rice, quinoa, bread and breakfast cereals.

Source

Food Services Specialist Group (FSSG)