Swallow Aware Day – The International Dysphagia Diet Standardisation Initiative

The International Dysphagia Diet Standardisation Initiative, or 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.

All staff involved with meal preparation in hospitals and care homes in select parts of the world must implement this framework by April 2019, to ensure consistency in description and texture of food and liquid prepared for those in care. The IDDSI descriptions of food texture and characteristics, food texture requirements and restrictions have been generated from existing national terminologies and the literature describing properties that increase risk for choking.

Drinks and liquids such as gravy and sauces are best assessed using the IDDSI Flow Test. 

Thick drinks and fluid foods can be tested by assessing whether they flow through the slots/prongs of a fork and comparing against the detailed descriptions of each level.

For hard or firm food, the fork has been chosen as it can uniquely be used for assessment of mechanical properties associated with hardness, in addition to assessment of shape attributes such as particle size. As such, a Fork Pressure Test is best used to assess foods in Levels 4-7 and transitional foods. The slots/gaps between the tines/prongs of a standard metal fork typically measure 4 mm, which provides a useful compliance measure for particle size of foods at Level 5 – Minced & Moist.

Download the full framework here:

For more information on the initiative, to download resources, and for a list of countries implementing the IDDSI, click here.