Development of International Terminology and Definitions for Texture-Modified Foods and Thickened Fluids Used in Dysphagia Management: The IDDSI Framework

Abstract

Dysphagia is estimated to affect ~8% of the world’s population (~590 million people). Texture-modified foods and thickened drinks are commonly used to reduce the risks of choking and aspiration. The International Dysphagia Diet Standardisation Initiative (IDDSI) was founded with the goal of developing globally standardized terminology and definitions for texture-modified foods and liquids applicable to individuals with dysphagia of all ages, in all care settings, and all cultures. A multi-professional volunteer committee developed a dysphagia diet framework through systematic review and stakeholder consultation. First, a survey of existing national terminologies and current practice was conducted, receiving 2050 responses from 33 countries. Respondents included individuals with dysphagia; their caregivers; organizations supporting individuals with dysphagia; healthcare professionals; food service providers; researchers; and industry. The results revealed common use of 3–4 levels of food texture (54 different names) and ≥3 levels of liquid thickness (27 different names). Substantial support was expressed for international standardization. Next, a systematic review regarding the impact of food texture and liquid consistency on swallowing was completed. A meeting was then convened to review data from previous phases, and develop a draft framework. A further international stakeholder survey sought feedback to guide framework refinement; 3190 responses were received from 57 countries. The IDDSI Framework (released in November, 2015) involves a continuum of 8 levels (0–7) identified by numbers, text labels, color codes, definitions, and measurement methods. The IDDSI Framework is recommended for implementation throughout the world.

Developing Viscosity Modelling for Traditional Liquids in Egypt

“…Although the equipment is simple, it is already internationally standardized, and the IDDSI Flow Test has been found to categorize a wide range of liquids reliably, in agreement with currently existing laboratory tests and expert judgement. It has been found to be sensitive enough to demonstrate small changes in thickness associated with changes in the serving temperature and other variables [14]. Although the LST is a quick empirical test for comparing relative consistencies of various comparable products, it requires specialized templates and measuring devices that are not commonly available without modifications, its testretest reliability is poor [14], and it does not differentiate liquids with very different viscosities [20][21][22].…”

“…At 10 s, 1 finger is replaced over the nozzle, stopping the liquid flow. The remaining liquid in the syringe is measured to determine the volume that has exited the syringe, and the IDDSI Flow Test scoring method classifies the tested liquids into 5 levels (from 0 to 4) based on the liquid remaining after 10 s [14].…”

Swallowing in Patients With Laryngitis

“…The liquid was given to the subjects by graduated syringe and the paste bolus by spoon. The solid bolus was a soft 2.2 g cookie coated with liquid barium, which needed to be chewed before swallowing, and classified as level 6 in the category of transitional foods of the IDDSI classification (13) . The following time parameters were assessed: (1) time the complete bolus volume was inside the mouth; (2) onset of the propulsive movement of the tongue tip at the maxillary incisors; (3) passage of the bolus head through the tongue base; (4) Statistical analysis was performed by a linear model with mixed effects (random and fixed effects), in which the responses of the same subject were grouped and the assumption of independence between observations within the same group was not appropriate (14) .…”

“…The liquid bolus was 100% liquid barium sulfate and the paste bolus was prepared with 50 mL of liquid barium and 4 g of food thickener (starch and maltodextrin). The liquid bolus consistency was classified as level 3 (moderately thick) and the paste bolus as level 4 (extremely thick) in the IDDSI flow test proposed by the International Dysphagia Diet Standardization Initiative (IDDSI) (13) . The liquid was given to the subjects by graduated syringe and the paste bolus by spoon.…”

Effects of Maneuvers on Breathing-Swallowing Coordination and Swallowing Kinetics in Dysphagia Patients

“…We adopted the 'Level' system of the Japanese Society of Dysphagia Rehabilitation [12] to describe the specification of test foods. Test foods we used were Level 0 soft jelly, Level 2 hard jelly, Level 3 purée, and water.…”