University of San Carlos

School of Health Care Professions

Department of Nutrition and Dietetics

ND 3104 Medical Nutrition Therapy I

Laboratory # 3
International Dysphagia Diet Standardisation Initiative (IDDSI)

Name: Jess Aeron B. Sandalo Date: 09/21/2023

BSND – 3 Mr. Rey Francis M. Erana, RND

I. Objectives
1. To prepare the different levels of food textures as part of the International
Dysphagia Diet Standardisation Initiative.
2. To differentiate the characteristics of IDDSI Levels.
3. To evaluate the prepared sample food and dishes which are appropriate for every
level.

II. IDDSI Introduction

The IDDSI or International Dysphagia Diet Standardisation Initiative is a framework
launched in healthcare settings primarily to improve patients or individuals with dysphagia
through the initiative of providing clear terminologies in describing textures in food and
thickness of liquids. This allows healthcare professionals to better understand and meet the
specific needs of patients with swallowing difficulties. The framework is classified into food and
drinks depicting two triangles with varying levels identified by numbers, colors and text labels, 5
levels (0-4) for drinks and 3 levels (5-7) for food. Each of these levels are defined by specific
criteria that prescribes a level to each identified food or drink, which include meticulous
measurements, visual, and textural descriptions depending on their viscosity, making it easier to
determine whether or not individuals with dysphagia can tolerate a particular food and/or drink.
III. Levels of IDDSI

LEVELS DESCRIPTIONS

Level 0: Thin Liquids at this level are characterized by their

very low viscosity and ability to flow easily,
allowing them to quickly adapt to the shape of
their container freely. This quality allows
them to flow out of the syringe after 10
seconds.

Milk

Level 1: Slightly Thick At this level liquids have been modified to

significantly achieve a moderately much
thicker consistency than Level 0. Liquids at
this level are primarily designed to reduce the
risk of aspiration, wherein fast-flowing liquids
enter the airway. With this, slightly thick
liquid allows for slowing down their flow and
making them easier to control during
swallowing.

Strained Cream Soup

Level 2: Mildly Thick Mildly thick liquids are fluids with a slightly
increased viscosity compared to thin or
regular liquids. These are modified to have a
mild thickening consistency, making them
suitable for individuals with mild to moderate
dysphagia. At this level, liquids flow more
slowly but are still relatively easy to pour and
manage. It has a smoother or creamier texture
compared to thin which still retains a
drinkable quality while depicting slightly
more resistance to flow.

Gravy
Level 3: Liquidised | Moderately Thick
Yogurt
Level 4: Pureed | Extremely Thick
Sieved Creamy Mashed Potatoes
Level 5: Minced & Moist
Oatmeal, Scrambled Eggs, Baked Beans
Moderately thick liquids, as defined by the
IDDSI Framework, are fluids with a
noticeably increased viscosity. These liquids
exhibit a notable increase in viscosity, giving
them a visibly thicker consistency. The
heightened viscosity can be achieved to have
a creamy or custard like texture due to their
increased viscosity.
Extremely thick liquids are characterized by
an exceptionally high level of viscosity,
resulting in an extremely thick and almost
pudding-like consistency. They are
significantly thicker than moderately thick
liquids and offer substantial resistance to flow.
These liquids flow extremely slowly, do not
pour or drop easily and may adhere to the
utilization of utensils, cups or containers.
Their texture is noticeably dense and
cohesive.
Minced and Moist, also known as Level 5
foods in the IDDSI Framework, are
specifically prepared meals for individuals to
ensure that they are safe and manageable for
those with swallowing difficulties. The
components of foods at these levels include
solid but moist foods that are finely chopped
or minced to create small uniform pieces that
are easily manageable in the mouth. It is
intended to be moistened to make them easier
to chew and swallow making it more
comfortable for individuals with dysphagia to
consume. These foods typically resemble
finely minced or ground textures.
 Level 6: Soft & Bite- Sized Soft & Bite-Sized also referred to as the 6th
Level in the IDDSI Framework, modified to
ensure safe and manageable swallowing. Soft
& Bite-Sized are prepared to be tender and
easy to chew. The texture of these foods is
soft and pliable, allowing individuals with
dysphagia to break them down into smaller
pieces with minimal effort.
Lugaw, Soft Meatball, Blanched Potato and
Carrot Cubes

Level 7: Regular Regular or easy to chew characterized by its

7th Level in the IDDSI Framework, are those
that have minimal to no modifications to
special textures and are typically applicable to
individuals with mild chewing challenges.
They have natural texture, meaning to say that
they are not finely minced, pureed, or
significantly altered in texture. Generally soft
but maintain their inherent textures, such as
the firmness of corn or tenderness of cooked
porkchop.

Pan-fried porkchop, Sweet & Sour Peppers,

Corn Kernels, & Apple

IV. Guide Questions

1. What are the target population and conditions that IDDSI can be applied for?

IDDSI is used for people or groups of individuals that can’t consume a full diet or foods

that can be consumed by normal and/or healthy individuals. It is intended for the specific

population with swallowing difficulties. The primary target populations for IDDSI are

individuals of all ages who have dysphagia, regardless of the underlying cause and conditions

such as but not limited to stroke, aging- related, post- surgery, traumatic brain injury, and

neurological disease.
 2. How does IDDSI help clinicians in providing a diet for transition food?

IDDSI plays a significant role in assisting clinicians in providing safe and appropriate

transition diets for individuals with swallowing difficulties. IDDSI provides specific

terminologies in describing textures-modified diets and thickened liquids. It classifies foods and

liquids into specific levels based on their texture and thickness, ranging from Level 0 to Level 7.

This enables clinicians and healthcare professionals to communicate clearly about dietary

recommendations and transitions. Clinicians utilize IDDSI guidelines in assessing and evaluating

a patient’s swallowing function. Through the comprehension of the patient’s current level of

dysphagia severity, clinicians can make informed recommendations for transition food or diets.

3. How does IDDSI differ from your traditional Dysphagia Diets?

The Dysphagia Diet or referred to as the National Dysphagia Diet (NDD) of 2002 is

depicted to be generalized, subjective, and undefined, characterized by its limited evaluation

tools for modified food and liquid consistencies while the IDDSI is deeply specific, objective

measurements of food or liquid and built-in testing methods and tools for evaluation of modified

food and liquid consistencies. NDD one level is termed as “Pureed” which has a similar name

and texture definition to Pureed Level 4 of IDDSI. Some food levels of NDD are named as

Mechanically Altered which is hard to interpret. Overall, NDD and IDDSI have varying

terminologies including thin, nectar-thick, honey-thick, spoon-thick, dysphagia pureed,

dysphagia mechanically altered, dysphagia advanced and regular for NDD which is slightly

complex and unclear as compared to IDDSI terminologies.

V. Conclusion

The International Dysphagia Diet Standardisation Initiative (IDDSI) ensures that those

with chewing and swallowing problems are protected from choking and aspiration. The

understanding of each level and its varying descriptions and characteristics is of prime

importance as future nutritionist-dietitians in order to come up with cohesive and accurate

recommendations.

The execution of cooking according to prescribed levels is challenging given the fact that

each level has slight differences when it comes to consistencies and textures. Some of our

prepared food items at a specific level are too thick for that level primarily because of slight

mishaps and adjustments of ingredients used primarily in the gravy. The levels in the IDDSI

frameworks starts from liquid with varying thickness and slowly transitions to solids from foods

with different textures appropriate for IDDSI tests. The tests includes the usage of common

kitchen tools such as spoon testing if the sample hold its shape when tilted, fork to determine the

thickness of the liquid and testing the presence of lumps and granulation, and a medical tool used

to determine the viscosity of liquids through letting it flow in a syringe without the plunger and

needle.

Overall, the applications of methods in creating food appropriate for a particular level is

crucial with careful consideration to its varying and increasing consistencies. Moreover, IDDSI

is a versatile framework that can be applied to a broad range of individuals with dysphagia and in

various healthcare and caregiving settings. Its standardized terminology and guidelines

contribute to improved safety, nutrition, and quality of life for individuals living with dysphagia

and support professionals who care for them.