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.

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:

• United Kingdom: Wing Yip (Birmingham, London, Manchester), See Woo (London), Loon Fung (London)
• United States: 99 Ranch Market (West Coast), H Mart (East Coast), local Chinatown grocers
• Canada: T&T Supermarket (national chain), local Asian markets
• Australia: Burlington Supermarket, Tang’s, local Chinese grocers in Chinatown precincts
• Singapore & Malaysia: Sheng Siong, NTUC FairPrice (Singapore); Tesco, Mydin (Malaysia)
• Online: Sous Chef (UK/EU), Amazon.com (US), Yami.com (US)

Fresh white fish fillets (tilapia, sea bass, cod): available at most East Asian fishmongers; frozen fillets at H Mart, T&T, and Wing Yip.

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 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.