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International Dysphagia Diet Standardisation Initiative (IDDSI) Framework and Rationale, Part 1

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1.  The National Dysphagia Diet Proposed 10 textural food properties Proposed 6 textural food properties Proposed 8 textural food properties Proposed 5 levels which included food and liquids

2.  The National Dysphagia Diet included NDD Level 1 – dysphagia advanced NDD Level 3 – puree NDD Level 4–pudding like NDD Level 2 – mechanical altered

3.  The National Dysphagia Diet Taskforce included ranges for thickened liquids such as Nectar like – 250-700 cP Honey like – 351-1750 cP Thin–1-250cP Spoon thick – anything higher than 2000 cP

4.  In preparation for new standardizations, a survey conducted found Common use of 4-5 levels of food texture which created confusion More than 5 levels of liquid thickness which created confusion Common use of 3-4 levels of food texture with 54 different names More than 30 different names for levels of thickened liquids

5.  The IDDSI Framework Identified levels 0-6 only for measuring liquids Found it would be impossible to test foods or liquids because of the cost/availability of equipment necessary to ensure accurate results Determined that foods and drinks should be tested under the serving conditions, especially temperature Identified levels 5 -7 only for measuring foods

6.  Systematic Literature Review findings identified Thicker liquids reduce risk of penetration, aspiration and decrease the risk of post swallow residue in the pharynx During normal chewing, the tongue and jaw can result in biting of the tongue and cheek Particles of chewed food rarely collect in the vallecular space during oral preparation Solid, hard and adhesive or sticky foods require increased chewing rate, longer chewing and muscle effort

7.  Examples of bias found in the systematic literature review included Very small samples Incomplete protocols Insufficient detail, data All of the above

8.  IDDSI: Did not agree with a level to identify thickened infant milk Stated that syringe-based flow test allowed the ability to evaluate liquids not typically considered drinks, such as sauces, soups, nutritional supplements and liquids meds Recommends using the line spread test to evaluate the thickness of liquids based on cP Recommends the use of only gum thickeners based on their liquid testing

9.  Which of the following statements is true? The IDDSI found that the term “honey” and “nectar” were understood and recognized around the world as descriptors for liquid consistencies The IDDSI felt there would be confusion of the “food" honey with the liquid consistency “honey” and chose not to use the term as a descriptor The IDDSI found that there was a universal understanding of the term meltable/dissolvable The IDDSI welcomed the participation of sponsors to help develop/design the framework and levels for the new standardization effort

10.  IDDSI believed it was necessary to identify physiological contradictions for advancing to Level 7. This included: Drooling Lack of back molars for chewing Difficulty managing mixed textures COPD