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AUDREY WILLIAMS, CHRISTI MACKEY, & ALYSSA FLEMING

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These are NOT official IDDSI resources, educational materials or education programs and they are NOT meant to replace materials and resources on www.IDDSI.org

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IDDSI Overview1

  • The International Dysphagia Diet Standardization Initiative (IDDSI) utilized an evidence-based method of guideline development to produce new global standardized 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 culture.

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https://pbs.twimg.com/profile_images/600550280892026880/rO9uJkQU_400x400.jpg

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IDDSI History2

Began with goal of developing international standardized terminology and descriptors

2013

Published the IDDSI Framework and Level Descriptors and IDDSI Testing Methods

2015

Academy of Nutrition and Dietetics will DDSI will be the only texture-modified diet recognized by NCM®.

2021

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IDDSI Mission2

Standardized way of naming and describing texture modified foods and thickened liquids for improved patient safety and better dysphagia treatment outcomes.

Person-focused, rather than profession focused.

Common language for technical, cultural, professional and non-professional uses.

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Dysphagia2

  • Affects 8% population: 590 million people worldwide
  • Can occur at any time during lifespan 
  • Can be long term or short term
  • Signs/Symptoms - trouble with
    • Swallowing food or drinks
    • Chewing
    • Sucking
    • Controlling saliva
    • Taking medication
    • Protecting airway from choking

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The IDDSI Framework

  • Provides a common terminology to describe food textures and drink thickness.
  • Consists of a continuum of 8 levels (0-7)
    • Drinks are measured from levels 0-4
    • Foods are measured from levels 3-7

https://iddsi.org/getattachment/Framework/Framework/IDDSI_Framework_whitebackground_Headline_small_July2020-(1).png.aspx

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https://iddsi.org/IDDSI/media/images/Posters/IDDSI_Whole_Framework_A3_Poster_INT_VERSION_May_16_2020_no_bleed.pdf

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IDDSI Testing Methods

  • Intended to confirm the flow or textural characteristics of a particular product at the time of testing.
    • Testing should be done on foods and drinks under the intended serving conditions (especially temperature). 

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Drink Testing Methods:�Flow Test �

  • When evaluating drinks and liquidized foods, IDDSI chose a gravity flow test using a 10ml syringe, as a simple, easy to use, practical objective measure to classify drinks based on their rate of flow.
    • It has been found to be sensitive enough to demonstrate small changes in thickness associated with change in serving temperature.

https://iddsi.org/IDDSI/media/images/Testing_Methods_IDDSI_Framework_Final_31_July2019.pdf

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Now it’s Your Turn to do the Flow Test

https://iddsi.org/IDDSI/media/images/FlowTestCards/IDDSI_Flow_Test_Cards_USA_vers_89x51mm_July17_2020_bleed.pdf

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Food Testing Methods

Fork Drip Test

Spoon Tilt Test

Fork/Spoon Pressure Test

https://iddsi.org/IDDSI/media/images/Posters/IDDSI_Framework_Poster_A3_A_P_Food_only_FINAL_with_bleed_Jan2020.pdf

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Fork Drip Test

  • Thick drinks and fluid foods (Levels 3 and 4) can be tested by assessing whether they flow through the tines/prongs of a fork and comparing against the detailed descriptions of each level.

https://iddsi.org/IDDSI/media/images/Complete_IDDSI_Framework_Final_31July2019.pdf

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Spoon Tilt Test

  • The Spoon Tilt Test is used predominantly for measures of samples in levels 4 and 5.
  • The sample should:
    • Be cohesive enough to hold its shape on the spoon
    • A full spoonful must plop off the spoon if the spoon is titled or turned sideways; a very gentle flick (using only fingers and wrist) may be necessary to dislodge the sample from the spoon, but the sample should slide off easily with very little food left on the spoon.
      • A scooped mound may spread or slump very slightly on a plate

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https://iddsi.org/IDDSI/media/images/Testing_Methods_IDDSI_Framework_Final_31_July2019.pdf

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Fork/Spoon Pressure Test

  • A fork can be applied to the food sample to observe its behavior when pressure is applied.
  • Pressure applied to the food sample has been quantified by assessment of the pressure needed to make the thumb nail blanch noticeably to white

https://iddsi.org/IDDSI/media/images/ConsumerHandoutsAdult/6_Soft_Bite_Sized_Adult_consumer_handout_30Jan2019.pdf

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RG7/EC7

  • All foods are fine to have- RG7
  • EC7
    • Dentition issues

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https://iddsi.org/IDDSI/media/images/ConsumerHandoutsAdult/7_Easy_to_Chew_Adult_consumer_handout_30Jan2019.pdf

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SB6

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https://iddsi.org/IDDSI/media/images/ConsumerHandoutsAdult/6_Soft_Bite_Sized_Adult_consumer_handout_30Jan2019.pdf

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MM5

https://iddsi.org/IDDSI/media/images/ConsumerHandoutsAdult/5_Minced_Moist_Adults_consumer_handout_30Jan2019.pdf

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PU4/EX4

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https://iddsi.org/IDDSI/media/images/ConsumerHandoutsAdult/4_Extremely_Thick_Adults_consumer_handout_30Jan2019.pdf

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LQ3/MO3

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https://iddsi.org/IDDSI/media/images/ConsumerHandoutsAdult/3_Liquidised_Adults_consumer_handout_30Jan2019.pdf

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Terminology Changes

Mechanical moist → Minced and Moist (MM5)

Liquid diet → Liquidized (LQ3)

Pudding thick → Extremely thick (EX4)

Honey thick → Moderately thick (MO3)

Nectar thick → Mildly thick (MT2)

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Test Your Knowledge- MM5 Menu 

Ground chicken with celery and thick gravy

White rice with pineapple tidbits

Mechanicalized corn 

Cake

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Importance of Standardization

With the movement of both patients and health professionals around the world, the use of globally recognized terms for foods and liquids has clear advantages for facilitating the delivery of safe and quality therapeutic products to individuals with dysphagia.

For researchers to accurately determine which texture-modified diets or thickened fluids provide the greatest therapeutic benefit to our patients, it is critical that we all use the same terms, definitions and measurable characteristics.

Standardized terminology and definitions will allow for consistent communication among health professionals, care providers, researchers and industry partners to improve quality of care and safety for patients.

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References 

  1. Cichero, J.A.Y., Steele, C., Duivestein, J. et al. The need for international terminology and definitions for texture-modified foods and thickened liquids used in dysphagia management: foundations of a global initiative. Curr Phys Med Rehabil Rep. 2013; 1:280–291. doi: /10.1007/s40141-013-0024-z
  2. The International Dysphagia Diet Standardisation Initiative 2019. IDDSI about us. https://iddsi.org/About-Us/History. IDDSI. Accessed September 28, 2021.
  3. IDDSI - Home. Iddsi.org. https://iddsi.org/. Published 2021. Accessed September 25, 2021.