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Level 3 Moderately Thick
Prep: 60 min Difficulty: Easy Main ingredient: rice
#level-3#congee#high-calorie#fortified#medical-nutrition#undernutrition#protein-powder#olive-oil#liquidised#smooth

High-Calorie Congee Base | IDDSI Level 3 Recipe

IDDSI Level 3 (Liquidised) | 60 minutes | Easy | Medical Nutrition — 400 kcal/bowl

Undernutrition in elderly care home residents is a clinical problem of significant prevalence and serious consequence. Studies in Hong Kong and internationally consistently show that 20–50% of care home residents are malnourished or at risk of malnutrition — defined as insufficient caloric intake relative to needs. The compounding factors are well-documented: reduced appetite, dysphagia reducing oral intake, depression, cognitive decline, and the simply lower caloric density of texture-modified foods compared to their regular counterparts. This high-calorie congee base is designed as a standardised fortification protocol for IDDSI Level 3 congee — adding 150–180 kcal above a standard congee serving without increasing the volume the resident must eat, without significantly altering the familiar taste and texture, and without requiring specialised medical foods. The key fortification agents are extra-virgin olive oil (approximately 40 kcal per teaspoon, neutral in flavour at low doses, anti-inflammatory) and unflavoured protein powder (whey or soy, approximately 20g protein per scoop, no significant flavour impact). The result is a 400 kcal bowl of flowing Level 3 congee providing 22g protein — comparable in caloric density to a standard hospital supplement drink, but in a culturally familiar and genuinely appetising form.

Ingredients (1 large serving — approximately 350ml)

High-calorie congee base:

Fortification additions (per serving, added at time of serving):

Method

Congee base (makes approximately 4 standard servings — fortify each at time of serving):

  1. Rinse rice and soak for 30 minutes. Bring stock or water to a boil, add rice and salt. Reduce to a low simmer, cover with lid slightly ajar, and cook 40–45 minutes, stirring every 10 minutes until the rice has fully dissolved and the base flows freely. If the base is too thick, add hot stock or water until Level 3 flow is achieved.
  2. Keep the base warm over very low heat, or store in a covered container and reheat as needed. The base itself provides approximately 160–180 kcal per serving (280ml) and 4g protein — standard rice congee.

Fortification at time of serving: 3. Ladle approximately 280ml of the warm Level 3 congee base into a serving bowl. 4. Add 1 tablespoon of extra-virgin olive oil. Stir gently to incorporate — the oil will blend into the congee, adding richness and a slight sheen. At this quantity, the oil does not separate noticeably. 5. In a small cup, combine the protein powder scoop with 2 tablespoons of warm water (from the congee pot). Stir vigorously until completely dissolved — there should be no lumps or dry powder visible. Pour this protein liquid into the congee bowl and stir to incorporate. 6. If using MCT oil, add at this point and stir in. 7. Consistency check after fortification: Adding the protein powder can slightly increase the viscosity of the congee. Stir and assess — the fortified congee must still flow freely from a tilted spoon. If too thick, stir in 1–2 tablespoons of hot stock to restore Level 3 flow. 8. Serve immediately — the fortified congee is best consumed within 20 minutes as the protein powder can continue to thicken it slightly over time.

Texture Test

Flow test: Passes Level 3 — flows continuously from a tilted spoon; settles flat within 5 seconds; the olive oil integrates without creating floating oil droplets at the surface.

Consistency after fortification: The protein powder addition adds slight body but must not cause the congee to hold a mound or peak. Verify after each fortification that Level 3 flow is maintained.

Safety Notes

⚠️ Protein powder must be fully dissolved — undissolved protein powder can create lumpy particles in the congee that are not appropriate for Level 3. Always pre-dissolve in warm water before adding to the congee bowl.

⚠️ Consistency check after every fortification — different protein powder brands vary in their thickening effect. Always verify Level 3 flow after fortification before serving to residents.

⚠️ Olive oil quantity — 1 tablespoon per serving is the recommended dose for flavour neutrality. Adding more than 1.5 tablespoons may result in noticeable oiliness and potential resident refusal.

⚠️ Allergen check — whey protein is dairy-derived. For residents with lactose intolerance or dairy allergy, use soy protein isolate or pea protein instead.

⚠️ Sodium content — if using chicken stock rather than water as the base, monitor sodium contribution for residents on sodium-restricted diets. Use low-sodium or homemade stock.

Sourcing Outside Hong Kong

For international care kitchens and home cooks outside Hong Kong, Cantonese ingredients are widely available at East and Southeast Asian grocery stores:

Jasmine rice: universally available. Glutinous rice (糯米): Wing Yip, H Mart, T&T, Sheng Siong.

If a specific ingredient is unavailable in your region, the recipe notes alternative substitutions in the Ingredients section. For dishes requiring fresh Cantonese-specific ingredients (e.g. preserved century egg, fresh rice noodle rolls), check with your local East Asian grocer before substituting — texture compliance for IDDSI levels may require specific products.

Nutrition

Per serving after fortification (approximately 350ml):

This fortified congee provides caloric density comparable to standard oral nutritional supplements (e.g., Ensure, Complan — typically 300–400 kcal per 220ml serving) while being delivered in a familiar, appetising cultural food format. For residents who consistently refuse supplement drinks, this protocol offers a clinically meaningful alternative. To achieve 1500 kcal/day intake from congee alone, three servings per day of this fortified base would be required, along with additional nutritional contributions from other meals and snacks.

Clinical Context

This recipe was developed for care home kitchen use with input from the IDDSI framework and general dysphagia nutrition guidance. It is not a replacement for dietitian-prescribed supplementation for residents with confirmed severe malnutrition — those cases require clinical assessment. It is designed for kitchen-level fortification of standard congee meals to improve the nutritional baseline of all Level 3 residents, particularly those showing early signs of weight loss or reduced intake.

Variation

⚠️ This recipe is for reference only. Texture varies by technique and ingredients. A speech therapist should confirm the appropriate IDDSI level.
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