Steamed Fish and Tofu Cake | IDDSI Level 4 Recipe

IDDSI Level 4 (Pureed) | 30 minutes | Easy

Fresh fish fillet provides complete protein and Omega-3 fatty acids, while silken tofu contributes calcium in a smooth, steamed cake that suits dysphagia patients needing a high-protein diet. No frying — steaming preserves maximum nutrients. Each serving provides approximately 18g of protein and 180mg of calcium, making this an excellent daily protein and calcium supplement.

Ingredients (serves 2)

Main ingredients:

• Fresh fish fillet 150g (skinless, boneless — tilapia, sea bass, or cod)
• Silken tofu 150g
• Egg 1
• Potato starch or cornstarch 1 tbsp

Seasoning:

• Salt ¼ tsp
• Ginger juice ½ tsp
• Light soy sauce ½ tsp
• Sesame oil, a few drops

Method

1. Cut fish fillet into small pieces; marinate with ginger juice for 5 minutes to remove fishiness. Pat tofu dry with kitchen paper to remove excess moisture.
2. Place fish, tofu, egg, starch, and all seasoning into a blender; process until completely smooth.
3. Pass through a fine sieve to ensure no bone fragments or tofu lumps remain.
4. Pour into a lightly oiled shallow dish (about 2cm deep); smooth the surface.
5. Steam over high heat for 10–12 minutes until set (a skewer inserted in the centre comes out clean).
6. Remove; portion into small pieces or serve by spoon. Drizzle with a little steamed fish soy sauce if desired.

Texture Testing

Fork-pressure test: Passes Level 4 — easily crushed under light fork pressure; no chewing required, can be mashed with tongue against palate.

Particle check: Surface and cross-section uniform; no bone fragments, tofu lumps, or air pockets.

Cohesion check: Does not stick to bowl; holds shape when cut with a spoon but does not spring back.

Safety Notes

⚠️ Bone check is critical — Before blending, run your fingers carefully along every centimetre of the fish to locate all bones. Choose farmed white fish (sea bass, tilapia) which have fewer pin bones. Still sieve after blending.

⚠️ Tofu moisture — Excess moisture in tofu will make the cake too soft to maintain Level 4 shape. Pat dry thoroughly before blending and avoid extra-soft or water-packed tofu.

⚠️ Portion size — Cut into pieces no larger than 1.5cm before serving to ensure manageable bites without chewing burden.

Purchasing in Hong Kong

• Fresh fish fillet: Wet market fish stalls; choose tilapia or sea bass fillet. Frozen cod fillet from supermarkets also works well.
• Silken tofu: ParknShop or Wellcome — choose “silken” or “soft” tofu (絹豆腐/嫩豆腐); do not use firm tofu.

Nutrition Notes

Per serving (approx 170g): ~165 kcal, protein 18g, calcium 180mg, Omega-3 fatty acids ~0.8g. Fish protein has high bioavailability; tofu calcium helps prevent osteoporosis in elderly patients. Recommend 2–3 servings per week, paired with vegetable puree or soup for a complete meal.