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IDDSI: What Every Dysphagia Patient and Caregiver Should Know

There are more than 590 million people worldwide living with dysphagia¹, yet the terms used to describe the dysphagia diet have been as varied as the individuals living with the swallowing disorder – until now. The International Dysphagia Diet Standardisation Initiative (IDDSI) is a global effort to improve the lives of all individuals with dysphagia – regardless of age, care setting or culture – by promoting standardized, common language terminology and definitions to describe texture modified foods and thickened liquids.

Currently, a dysphagia patient on a modified diet may find that his or her diet may be called one thing in the hospital, yet something different in the rehab or long-term care facility. The patient may also find various terms used on product packaging – all of which leave patients confused and at risk for consuming the wrong product, and therefore at increased risk of illness or even death. IDDSI has addressed this issue by developing a framework of dietary standards for people with swallowing disorders.

Several countries, including the United States, are in the process of implementing IDDSI this year, with the U.S. officially adopting the new standards in May. This means that as facilities and organizations implement these new standards, patients and caregivers will soon begin to hear new and consistent dysphagia diet terminology used by their doctors, speech language pathologists and dietitians, and see updated product packaging. This is being designed to distinctly communicate the product’s thickness level through standardized colors, numbers and descriptors.

Previously, the National Dysphagia Diet (NDD), which was developed in 2002 by the American Dietetic Association, classified food and drinks according to their textural properties and was based on subjective comparison. In other words, each patient, caregiver, healthcare provider, or foodservice professional could potentially interpret the levels differently and inadvertently mix food and drinks to an inappropriate thickness for the patient at hand.

Now, the evidence-based IDDSI framework, which is endorsed by both the Academy of Nutrition and Dietetics and the American Speech-Language-Hearing Association in the U.S., consists of eight levels (0 – 7), where drinks are measured from Levels 0 – 4 (thin to extremely thick) and foods are measured from Levels 3 – 7 (liquidized to regular). The framework is designed to be person-focused and easily understood, so each standardized level is objective, measurable, predictable, and has a corresponding number, descriptor and color associated with it, reducing the patient’s risk of misuse. Additionally, IDDSI provides five levels to classify both foods and liquids – offering more options to potentially improve quality of life and intake while still maintaining safety.

Below, the conversion charts show the comparison between NDD standards and the new IDDSI standards:

Charts courtesy of IDDSI.

IDDSI also provides simple testing methods for each level that can be completed at home and without expensive equipment. The IDDSI flow test is a practical, objective measure to classify drinks and liquidized foods based on their rate of flow. It requires only a 10ml syringe, a stopwatch and 10 seconds of your time – watch a video demonstration here. Similarly, IDDSI offers videos demonstrating the fork drip test, fork pressure and spoon pressure test, chopstick test, and finger test for evaluating foods. The new classifications and testing methods can eliminate confusion between diets and ensure consistency among patients, caregivers, healthcare professionals, foodservice professionals, countries and cultures alike.

Thick-It® is a gold sponsor of IDDSI, and later this month, consumers will be able to find updated, IDDSI-compliant packaging for Thick-It® Clear Advantage® ready-to-drink juices on store shelves, as well as updated packaging for ready-to-drink water and coffee, purées and food and beverage thickeners in the coming months. Our new ready-to-drink packaging will include the new IDDSI standards while also maintaining the previous honey and nectar descriptors to eliminate confusion. Consult with a healthcare team to determine which IDDSI level is most appropriate and safe for you.

You’ll also see a name change from Thick-It® AquaCareH2O ready-to-drink beverages to Thick-It® Clear Advantage® ready-to-drink beverages, which will help better differentiate our xanthan gum-based products from our starch-based products.

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[1] International Dysphagia Diet Standardisation Initiative

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