Why a Global Standard for Texture-Modified Foods and Drinks?
Dysphagia, or swallowing difficulties, affects millions of people worldwide. Managing dysphagia may include careful modification of food textures and drink thicknesses to support safe swallowing. However, inconsistent terminology and varying standards across different regions and healthcare settings can lead to confusion and potential risks for people with dysphagia. A global standard is essential to address these challenges and ensure consistency in dysphagia management.
Understanding the IDDSI Levels
The International Dysphagia Diet Standardisation Initiative (IDDSI) framework was developed to create a unified approach to describing texture-modified foods and thickened liquids. This standardised framework helps healthcare professionals, caregivers, and food service providers communicate effectively and ensure that people with dysphagia receive appropriate and safe meals.
The IDDSI framework standardises the description of food textures and drink thicknesses for individuals with dysphagia, or swallowing difficulties. It comprises 8 levels, ranging from 0 to 7:
- Levels 0-4 apply to drinks.
- Levels 3-7 apply to foods.
Each level is identified by a unique number, a descriptive text label (e.g., “Moderately Thick,” “Pureed”), and a specific colour code for ease of identification and reference.
A Detailed Examination of the Food Levels (3-7):
While all levels are important, a more in-depth understanding of the food-specific levels is crucial, particularly in relation to products like Shape It:
- Level 3: Liquidised / Moderately Thick: This level can be consumed from a cup or with a spoon. It exhibits flow, albeit at a slower rate than thinner liquids. Note: foods and drinks should be of the same consistency at this level.
- Level 4: Pureed / Extremely Thick: This level represents a classic puree – smooth in consistency, with no lumps present. It maintains its shape on a spoon and is typically not suitable for consumption from a cup. Examples include very smooth mashed potatoes or thick, smooth yoghurt.
- Level 5: Minced & Moist: This food category features small, visible particles (approximately 4mm in size for adults, 2mm for paediatrics), but remains very soft and moist. Minimal chewing is needed to eat this texture. An example would be finely minced meat served in a thick, smooth sauce.
- Level 6: Soft & Bite-Sized: These foods are soft, tender, and moist but need a greater degree of chewing. Pieces should be no larger than 1.5cm x 1.5cm (for adults). Examples include tender, small pieces of chicken served with gravy.
- Level 7: Regular / Easy to Chew: This encompasses everyday foods of various textures; however, the “Easy to Chew” sub-category specifies that the food remains soft and tender.
The IDDSI Framework provides detailed descriptions for each level, supported by practical and readily implemented testing methods. These tests are designed to verify the flow properties or textural characteristics of a food or fluid, particularly at the intended serving temperature. Clinicians, such as speech pathologists and dietitians, utilise these tests in conjunction with a comprehensive clinical assessment to make informed recommendations regarding appropriate dietary modifications.
A Guide to Testing IDDSI Levels 4 and 5
Accurate determination of IDDSI levels requires practical testing. Here are the established methods for verifying Levels 4 and 5, using readily available utensils:
Level 4: Pureed / Extremely Thick
- Fork Drip Test: Place a sample of the puree onto a fork. It should form a stable mound or pile above the fork tines. A minimal amount may flow through and create a short tail below the fork, but continuous dripping should not occur.
- Spoon Tilt Test: Place a sample of the puree onto a spoon. Upon tilting the spoon, the entire sample should slide off cleanly and readily, leaving minimal residue. Adherence to the spoon is indicative of an inappropriate texture.
- Absence of Lumps: This is a critical criterion. The puree must be completely homogenous and free of any lumps or granular texture.
- Piping, Layering, or Moulding (Generally Not Possible): A true Level 4 puree, while thick, typically lacks the cohesive properties to maintain intricate shapes. (Products like Shape It Powder enhance cohesiveness to address this.)
Level 5: Minced & Moist
- Fork Drip Test: Place a sample of the food onto a fork. It should remain on the fork, with small amounts potentially flowing slowly between the tines, but without continuous dripping.
- Particle Size: The defining characteristic is the size of the minced particles. For adults, these should not exceed 4mm (approximately the width of a standard fork tine). For children, the maximum particle size is 2mm.
- Spoon Tilt Test: Similar to Level 4, the food should slide off the spoon relatively easily when tilted; however, a small amount of residue is acceptable.
- Ease of Mashing: The small particles should be easily mashed with minimal pressure from a fork.
- Moisture Content: The food must be moist and incorporated with a thick, smooth sauce or gravy. Dry, crumbly textures are unacceptable.
Important Note: These tests should be conducted at the intended serving temperature of the food, as temperature can significantly influence texture and thickness.
Shape It: Your Partner in Achieving IDDSI Levels 4 and 5
Shape It powder is designed to help achieve IDDSI Levels 4 and 5 by thickening and shaping pureed foods. It provides a consistent texture and enhances the visual appeal of meals, making them more enjoyable for individuals with dysphagia.
Benefits of Using Shape It for Texture-Modified Foods
When prepared according to the provided instructions, Shape It powder offers several key advantages for individuals requiring pureed foods:
- Consistent Texture: Ensures that pureed foods meet IDDSI Level 4 or 5 requirements.
- Improved Appearance: Transforms pureed foods into visually appealing shapes.
- Enhanced Nutrition: Encourages better consumption and improves nutritional intake.
Resources and Further Learning
The Official IDDSI Website
For more information about the IDDSI framework, visit the official IDDSI website.
Other Helpful Organisations and Resources
BSpPath (Hons), GCHEd, PhD CPSP
Dr Rebecca Parker does not work for or own shares in Flavour Creations, has received no funding or financial gain from reviewing this article, and has disclosed no relevant affiliations beyond their academic appointment.