What is the International Dysphagia Diet Standardisation Initiative (IDDSI)?
The IDDSI framework is a global standard for describing modified food textures and thickened liquids, used for individuals with dysphagia (eating, drinking, and swallowing problems). Developed by a committee of international healthcare professionals, the framework provides a common terminology to improve patient safety across different settings and cultures. It consists of a continuum of eight levels, from Level 0 (Thin liquids) to Level 7 (Regular food).
A Closer Look at What is Level 7 Food?
IDDSI Level 7 is the highest and least restrictive level in the framework, encompassing normal, everyday foods. It has two options: 'Regular' and 'Easy to Chew'. The choice depends on an individual's chewing and swallowing abilities, as determined by a healthcare professional.
Level 7 Regular
This subcategory is for individuals without chewing or swallowing problems that increase choking risk. It permits any food texture and piece size, requiring the ability to bite off and chew all types of food.
Level 7 Easy to Chew
This is a softer option for those who can chew but may have weaker chewing muscles. Foods are soft and tender, breaking apart easily with a fork. Hard, tough, fibrous, stringy, crunchy, or crumbly textures should be avoided. The IDDSI Fork Pressure Test can verify the food's softness.
Testing for Level 7 Easy to Chew Food
The Fork Pressure Test is used to ensure Level 7 Easy to Chew food is soft enough. To perform the test, apply pressure to a piece of cooked food (like a carrot or tender meat) with the side of a fork until your thumbnail blanches. The food should completely squash without returning to its original shape.
Examples of Level 7 Foods
Suitable Easy to Chew foods:
- Tender, well-cooked meat and fish.
- Soft, cooked vegetables and fruits.
- Soft desserts, eggs, and pasta dishes.
- Well-soaked cereals.
Foods to avoid in the Easy to Chew category:
- Hard or dry foods.
- Tough or chewy meats.
- Stringy or fibrous foods.
- Sticky foods.
- Crunchy foods.
- Foods with bones, seeds, or gristle.
Comparison of IDDSI Food Texture Levels
| Feature | IDDSI Level 7 (Regular) | IDDSI Level 7 (Easy to Chew) | IDDSI Level 6 (Soft & Bite-Sized) | IDDSI Level 5 (Minced & Moist) |
|---|---|---|---|---|
| Chewing Ability | Required for all textures. | Chewing required for soft/tender foods, minimal effort. | Moderate chewing required. | Minimal chewing required, lumps mashed by tongue. |
| Lump Size | No restriction. | No restriction, but food is tender. | Max 1.5 cm for adults. | Max 4 mm for adults. |
| Moisture | May include mixed consistencies. | Soft and tender, may include mixed textures. | Moist, with no thin liquids separating. | Moist and cohesive, no separate liquid. |
| Food Test | No specific test. | Fork Pressure Test confirms softness. | Fork Pressure Test confirms softness and size. | Fork Drip Test and Spoon Tilt Test for cohesiveness. |
| Who It's For | No chewing/swallowing problems. | Weakened chewing but good swallowing function. | Moderate chewing difficulty, reduced bite strength. | Significant chewing difficulty, poor tongue control. |
The Role of Professional Guidance
Selecting the correct IDDSI level is vital for preventing choking and aspiration, especially for individuals with dysphagia. A healthcare team, including a Speech-Language Pathologist and Dietitian, assesses individuals to determine the safest and most appropriate food texture. They provide personalized recommendations to ensure nutritional needs are met safely and enjoyably.
For more information and resources on the framework, visit the official website for the International Dysphagia Diet Standardisation Initiative (IDDSI).
Conclusion
Level 7 food is the final stage of the IDDSI continuum, representing regular foods for those without swallowing difficulties. The 'Easy to Chew' subcategory within Level 7 provides a safer option for individuals with mild chewing impairments, such as older adults or those recovering from illness. Following IDDSI guidelines and seeking professional advice is crucial for safe and effective nutrition for individuals with dysphagia.
