Is IDDSI an Evidence-Based Framework? A Relevant Question for the Frail Older Population

Abstract

To delay impacts of aging, optimal nutritional status is essential. Several factors can reduce food intake, such as isolation, income, and cognitive/physical decline. Additionally, chewing and swallowing difficulties, or dysphagia, often disrupt the ability to consume life-long favorite dishes. Food and liquids could require modification of texture or consistency to ensure a comfortable or safe swallow. The food industry, foodservices facilities, and caregivers need quality control benchmarks to provide adequate nourishment and meet these new feeding challenges. The International Dysphagia Diet Standardisation Initiative (IDDSI) is proposing the IDDSI framework and testing methods to describe food used in nutritional care plans to circumvent dysphagia and improve communication among caregivers. This systematic review assesses the validity and reliability of the IDDSI testing methods using the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN). Two publications presented content validity whereas 19 publications looked at construct validity or reliability for the IDDSI testing methods. One study was conducted in older adults presenting dysphagia. This review concludes that there is insufficient evidence to recommend the IDDSI testing methods. Further research, conducted with robust methodological design and reporting, is needed to develop and assess nutritious adapted food for frail older populations.

Nutritional Intake and Meal Composition of Patients Consuming Texture Modified Diets and Thickened Fluids: A Systematic Review and Meta-Analysis

“…Due to this challenging terminology mapping, there is insufficient overlap in classifications to warrant the pooling of data. Although IDDSI provides an instructed audit tool and specification for each level of TMDs and TFs, it is still a recently introduced framework and requiring more work on validating the testing methods [ 81 ]. To minimize the confusion in terminologies and provide quantitative comparisons, robust study designs with detailed description of categorization and testing methods are required to study the various levels of TMDs and TFs.…”

Instrumental and sensory techniques to characterize the texture of foods suitable for dysphagic people: A systematic review

“…Furthermore, it is a tool developed by the IDDSI framework to categorize liquid foods. But because no correlations or comparisons with foods for dysphagia have been made, validating the method using quantitative and validated tools is necessary (Côté et al., 2020; Ng et al., 2021).…”

“…Côté et al. (2020) reported the lack of validation of this method according to the “funnel post‐humus.” This study highlighted the lack of documentation of the metrological qualities of the method, whose rationale appear only in one article (Cichero, 2019). In addition, the IDDSI syringe method has a number of limitations.…”

“…However, the Fork Drip and Spoon Tilt tests are quick and useful for characterizing and establishing IDDSI levels for OD‐oriented foods (Trček Kavčič et al., 2020). Although some authors point out it is an adequate method in the clinical setting to evaluate foods with consistency higher than level 4 (Barewal et al., 2020; Dick et al., 2020), others note there is insufficient evidence to recommend the IDDSI methods for assessing foods oriented to frail older people (Côté et al., 2020).…”

Institutionalized elderly are able to detect small viscosity variations in thickened water with gum-based thickeners: should texture classifications be reviewed?

“…Currently, the latest initiative of the IDDSI consists of the creation of four new ranges of liquids textures but uses qualitative methods with a syringe, instead of quantitative methods like rheological measurements [28]. However, this testing methods still needs more evidence before to be to recommend, as suggested by a recent review [29]. There are few studies that perform rheological tests of the IDDSI classification [28,30,31].…”