The International Dysphagia Diet Standardisation Initiative (IDDSI) was created to provide a universal framework for describing modified food textures and thickened liquids. This initiative ensures that patients with swallowing disorders (dysphagia) or other issues affecting eating receive safe, consistent, and nutritious meals. The framework is divided into eight levels, from Level 0 (Thin Liquids) to Level 7 (Regular), each with specific characteristics and testing methods. Our focus is on the highest level of this scale, explaining what is level 7 consistency and its important sub-categories.
Deconstructing IDDSI Level 7
IDDSI Level 7 is represented by the color black and is the destination for individuals who have progressed through texture-modified diets or who only require slight modifications to a normal diet. This level is unique because it encompasses two different textures: Regular and Easy to Chew. The determination of which Level 7 diet is appropriate is made by a healthcare professional, such as a speech-language pathologist or dietitian, based on a person’s chewing and swallowing ability. The key distinction lies in the firmness and tenderness of the food.
IDDSI Level 7 Regular (RG7)
This is a standard diet for individuals with no chewing or swallowing difficulties. It includes normal, everyday foods of all textures and sizes. People on this diet can chew and swallow with ease and can handle a variety of consistencies, including hard, crunchy, fibrous, or mixed-texture foods. There are no restrictions on the size of food pieces, and individuals can safely consume items like crisp vegetables, nuts, and tough meats. This is the texture level most people are accustomed to eating.
IDDSI Level 7 Easy to Chew (EC7)
This sub-category is designed for individuals who have some difficulty with tough or hard textures but are not at an increased risk of choking. It's often recommended for people recovering from an illness, experiencing fatigue, or with dental issues. Foods at this level are normal, but they must be soft and tender enough to be broken apart easily with the side of a fork or spoon. Tough, chewy, or fibrous foods are avoided. It's crucial for patients on this diet to be able to regulate their own bite size and not demonstrate unsafe eating behaviors. A key test for this texture is the fork pressure test, where food should completely squash when pressure is applied with a fork.
Foods Suitable for a Level 7 Easy to Chew Diet
- Tender Cooked Meats: Slow-cooked stews, casseroles, or tender fish fillets that flake easily.
- Soft Vegetables: Boiled or steamed vegetables like carrots, cauliflower, or sweet potatoes that are soft and mashed easily.
- Soft Fruits: Ripe bananas, stewed fruits with skins removed, or tinned peaches.
- Well-Cooked Pasta and Rice: Soft-cooked pasta dishes like macaroni and cheese or risotto.
- Soft Dairy Products: Smooth yogurt, cottage cheese, and soft cheeses.
- Moistened Cereals: Porridge or breakfast cereals softened with milk.
- Soups: Cream-based or broth-based soups without large, tough pieces.
Foods to Avoid on a Level 7 Easy to Chew Diet
- Hard or Dry Foods: Nuts, dry toast, crackers, hard candies, and crisp vegetables like raw carrots.
- Tough or Fibrous Foods: Steak, pineapple, and some varieties of beans.
- Chewy or Sticky Foods: Dried fruit, chewing gum, sticky sweets, and some types of cheese.
- Crunchy Foods: Popcorn, crispy bacon, and flaky pastries.
- Foods with Bits: Seeds, nuts, pips, or bones that could be difficult to chew or pose a choking risk.
- Mixed Consistencies: Soups with large pieces of meat or vegetables, or cereal with milk that doesn't soften completely.
Comparing IDDSI Levels: A Texture Guide
To better understand how Level 7 fits into the broader framework, here is a comparison with other common food texture levels for dysphagia.
| Feature | IDDSI Level 4 (Pureed) | IDDSI Level 5 (Minced & Moist) | IDDSI Level 7 (Easy to Chew) |
|---|---|---|---|
| Texture | Smooth, lump-free, 'pudding-like' | Soft and moist with small, visible lumps | Soft and tender, normal everyday foods |
| Particle Size | No lumps, smooth texture | Lumps no bigger than 4mm for adults | No restriction on particle size |
| Chewing Required | None | Minimal chewing required | Required, but food is soft and tender |
| Fork Test | Falls easily off a tilted fork | Easily squashed with a fork, does not regain shape | Breaks apart easily with side of fork |
| Appearance | Holds its shape on a spoon but not firm or sticky | Small, soft lumps in a moist sauce or gravy | Normal, everyday food appearance |
The Role of a Nutritionist in Managing Level 7 Diets
While the guidelines for Level 7 are clear, determining the right texture level for an individual requires professional assessment. A nutritionist or dietitian plays a vital role in this process, ensuring that the diet meets all nutritional needs while remaining safe. They can help in the following ways:
- Personalized Planning: Creating a meal plan that is both safe and enjoyable, with a wide variety of foods.
- Preventing Malnutrition: People on modified diets may consume less and risk malnutrition. A nutritionist can provide strategies for adding extra calories and protein.
- Transitioning Diets: When moving from a more restricted diet, such as Level 5, to Level 7, a professional can guide the transition to ensure safety.
- Recipe Modification: Offering guidance on how to modify recipes to make them suitable for the Easy to Chew diet.
Conclusion: Ensuring Safety and Nutrition
By clearly defining food textures, the IDDSI framework has significantly improved safety for individuals with swallowing or chewing issues. Understanding what is level 7 consistency provides clarity for both caregivers and patients, distinguishing between the standard Regular diet and the Easy to Chew sub-category. Whether an individual needs softer, tender foods or can handle a full range of textures, consulting with a healthcare professional ensures they receive the right nutritional support to meet their specific health needs. The focus is always on providing the safest and most enjoyable food options to support overall well-being.
