IDDSI

International Dysphagia Diet Standardisation Initiative

The International Dysphagia Diet Standardisation Initiative (IDDSI) was founded in 2013 with the goal of developing new global standardised terminology and definitions to describe texture modified foods and thickened liquids used for individuals with dysphagia of all ages, in all care settings, and all cultures.

Three years of ongoing work by the International Dysphagia Diet Standardisation Committee has culminated in a final dysphagia diet framework consisting of a continuum of 8 levels (0–‐7). Levels are identified by numbers, text labels and colour codes.

 

Our product Easy-Base+ covers levels 3, 4 and 5 of this pyramide. 

 

LEVEL 2 – MILDLY THICK

Description / Characteristics
  • Flows off a spoon
  • Sippable, pours quickly from a spoon, but slower than thindrinks
  • Effort is required to drink this thickness through standardbore straw (standard bore straw = 0.209 inch or 5.3 mm diameter)

Physiological rationale for this level of thickness
  • If thin drinks flow too fast to be controlled safely, these Mildly Thick liquids will flow at a slightly slower rate
  • May be suitable if tongue control is slightly reduced.

Testing method http://iddsi.org/framework/drink-testing-methods/

IDDSI Flow Test*

Test liquid flows through a 10 mL slip tip syringe leaving 4 to 8 ml in the syringe after 10 seconds (see IDDSI Flow Test instructions*)

 

LEVEL 3 – LIQUIDISED MODERATELY THICK

Description / Characteristics
  • Can be drunk from a cup
  •  Some effort is required to suck through a standardbore or wide bore straw (wide bore straw = 0.275inch or 6.9 mm)
  • Cannot be piped, layered or moulded on a plate
  • Cannot be eaten with a fork because it drips slowlyin dollops through the prongs
  • Can be eaten with a spoon
  • No oral processing or chewing required – can beswallowed directly
  • Smooth texture with no ‘bits’ (lumps, fibers, bits ofshell or skin, husk, particles of gristle or bone)

Physiological rationale for this level of thickness
  • If tongue control is insufficient to manage Mildly Thick drinks (Level 2), this Liquidised/Moderately thick level may be suitable
  • Allows more time for oral control
  • Needs some tongue propulsion effort
  • Pain on swallowing

Testing method http://iddsi.org/framework/food-testing-methods/

IDDSI Flow Test*

Test liquid flows through a 10 ml slip tip syringe leaving > 8 ml in the syringe after 10 seconds (see Syringe Test Guide*).

Fork Drip Test
  • Drips slowly in dollops through the prongs of a fork
  • Tines/prongs of a fork do not leave a clear pattern on the surface
  • Spreads out if spilled onto a flat surface

Spoon Tilt Test

Easily pours from spoon when tilted; does not stick to spoon

Chopstick Test

Chopsticks are not suitable for this texture

Finger Test

It is not possible to hold a sample of this food texture using fingers. However, this texture slides smoothly and easily between the thumb and fingers, leaving a coating.

Food specific or Other examples
(NB. this list is not exhaustive)

The following items may fit into IDDSI Level 3:

  • Infant “first foods” (runny rice cereal or runny pureed fruit)
  • Sauces and gravies
  • Fruit syrup

LEVEL 4 – PUREED EXTREMELY THICK

Description / Characteristics
  • Usually eaten with a spoon (a fork is possible)
  • Cannot be drunk from a cup
  • Cannot be sucked through a straw
  • Does not require chewing
  • Can be piped, layered or molded
  • Shows some very slow movement under gravity but cannot be poured
  • Falls off spoon in a single spoonful when tilted and continues to hold shape on a plate
  • No lumps
  • Not sticky
  • Liquid must not separate from solid

Physiological rationale for this level of thickness
  • If tongue control is significantly reduced, this category may be easiest to manage
  • Requires less propulsion effort than Minced & Minced (level 5), Soft & Bite-‐‐Sized (Level 6) and Regular (Level 7) but more than Liquidised/Moderately thick (Level 3)
  • No biting or chewing is required
  • Increased residue is a risk if too sticky
  • Any food that requires chewing, controlled manipulation or bolus formation are not suitable
  • Pain on chewing or swallowing
  • Missing teeth, poorly fitting dentures

Testing method http://iddsi.org/framework/food-testing-methods/

IDDSI Flow Test*

No flow or drip through a slip tip syringe after 10 sec (refer to IDDSI Flow test instructions)*

(*Source:http://iddsi.org/)