Development of International Terminology and Definitions for Texture-Modified Foods and Thickened Fluids Used in Dysphagia Management: The IDDSI Framework.
Julie A Y Cichero, Peter Lam, Catriona M Steele and 10 others
PMID 27913916WHAT IT FOUND
A shared IDDSI framework gives texture-modified foods and thickened drinks common names, colors, and simple syringe and fork tests.
Use it to reduce label confusion, not because each level has proven therapeutic thickness.
Key findings
01The final IDDSI framework assigns colors to Levels 0 through 7 and uses a transitional foods category instead of Level 7 Minus.
02Current practice survey found 27 different labels for drink thickness and 54 different labels for food texture in use.
03The systematic review found thicker liquids reduced penetration-aspiration risk but increased pharyngeal residue, and evidence was insufficient to define specific viscosity boundaries.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The paper does not test whether any IDDSI level improves swallowing safety or patient outcomes. The systematic review could not define specific viscosity boundaries, and it did not include terms related to choking, airway obstruction, or asphyxiation in its search strategy. The framework was not developed to address nutritional adequacy or patient acceptability of texture-modified foods or thickened fluids. The surveys were dominated by health professionals and English-speaking countries, while people with dysphagia and their caregivers were the smallest group. Communication impairment may have limited participation by people with dysphagia, and survey respondents were likely motivated responders.
Declared interests
Sponsors provided financial support for administration, research, and data analysis. The paper states sponsors were not involved in design or development of the IDDSI framework and were briefed at milestones. Industry sponsors were kept out of sub-project design, conduct, writing, and interpretation of results.
The easy way to misread this
Do not read the IDDSI levels as proof that a thicker liquid or softer food is safer for a patient. The framework standardizes descriptions and testing, but the systematic review could not define specific viscosity boundaries and did not show which levels reduce aspiration.