The IDDSI Framework: A Global Standard
The International Dysphagia Diet Standardisation Initiative (IDDSI) was developed to create a universal terminology for describing texture-modified foods and thickened liquids. This framework, consisting of a continuum of eight levels (0–7), is designed to enhance patient safety by eliminating the confusion caused by varied and subjective local descriptions like 'mechanical soft'. For food, the scale spans from Level 3 (Liquidised) to Level 7 (Regular), with Level 5 representing the 'Minced and Moist' category.
What are the Key Characteristics of IDDSI Level 5?
Level 5, or Minced and Moist (MM5), is defined by specific textural properties designed for individuals with moderate dysphagia. The food at this level is intended for people who may have difficulty chewing or forming a cohesive bolus for swallowing, but still have some basic tongue and minimal chewing ability.
- Particle Size: For adults, all food pieces must be no larger than 4mm in width. This is roughly the size of the gap between the tines of a standard dinner fork. For children, the particle size is even smaller, at no more than 2mm.
- Moisture: Food must be soft and moist throughout, with no separate thin liquid leaking or dripping from it. A cohesive texture is essential to ensure a single, manageable bolus for swallowing.
- Chewing: Biting is not required, but some minimal chewing may occur. The texture is soft enough that the food can be easily broken down by the tongue.
- Cohesion: When a sample is scooped with a fork, it should hold its shape without dripping. It should not be sticky or gummy, which could cause it to adhere to the mouth or throat.
Practical Preparation for Level 5 Foods
Achieving the precise Minced and Moist consistency requires careful preparation. Most everyday foods can be modified by cooking them longer to soften them, then mincing and moistening with thick sauces or gravies. A food processor can be a useful tool for this process.
Examples of Safe Level 5 Foods
- Protein: Finely minced or chopped, tender meats (e.g., chicken, fish, lamb) served in a thick, non-pouring sauce or gravy. Skinless, minced sausages are also suitable.
- Starch: Well-cooked pasta or rice, mashed and mixed with a thick sauce. Mashed potatoes with added butter or milk can also work.
- Vegetables: Cooked vegetables (e.g., carrots, squash, broccoli florets) that are finely mashed with a fork or blender until soft. All skins, tough fibres, and seeds must be removed.
- Fruit: Soft, mashed fruits like bananas or cooked, stewed fruit (e.g., apple, pear) with no skins or pips.
- Cereals: Fully softened, thick porridge or cereals like Weetabix soaked in milk, with all excess liquid drained off.
How to Test for Correct IDDSI Level 5 Consistency
To ensure food meets the Minced and Moist standard, IDDSI provides simple, practical testing methods that can be performed with standard kitchen utensils.
Fork Drip Test: Scoop a sample of the prepared food onto a standard dinner fork. The food should sit in a cohesive pile and hold its shape. It should not flow or drip continuously through the prongs. The minced particles should be small enough to pass between the fork tines when pressure is applied.
Spoon Tilt Test: Scoop a sample of the food onto a spoon and then tilt or lightly flick it sideways. The entire spoonful should slide off easily, leaving very little residue behind. The food should not be sticky or hold its shape so firmly that it sticks to the spoon.
Comparison of IDDSI Food Levels
| Feature | IDDSI Level 4 (Puréed) | IDDSI Level 5 (Minced and Moist) | IDDSI Level 6 (Soft and Bite-Sized) |
|---|---|---|---|
| Texture | Smooth, uniform, and lump-free. | Soft, moist, with small lumps (≤4mm for adults). | Soft, tender, and bite-sized pieces (≤15mm for adults). |
| Chewing | Not required. | Minimal chewing required. | Chewing is required. |
| Cohesion | Holds shape on a plate; does not pour. | Holds shape on a spoon, cohesive but not sticky. | Cohesive enough to stay together on a spoon. |
| Testing Method | Spoon Tilt Test and Fork Drip Test (doesn't pass easily). | Spoon Tilt Test and Fork Drip Test (passes through tines when pressed). | Fork Pressure Test (easily squashes with pressure). |
| Example | Smooth yogurt, lump-free mashed potato. | Minced beef with thick gravy. | Soft, diced vegetables or pasta. |
Conclusion
IDDSI Level 5, or Minced and Moist, is a crucial step in the dysphagia diet progression, offering a texture that is both safe and palatable for individuals with moderate swallowing challenges. By adhering to the specific particle size and moisture guidelines, caregivers and food service professionals can provide nourishing and enjoyable meals while minimizing the risk of choking and aspiration. This attention to detail, supported by the straightforward IDDSI testing methods, ultimately improves the safety, dignity, and quality of life for those with dysphagia. Adherence to these standards helps to ensure that individuals receive the correct texture diet for their needs, preventing potential health complications. For further information, the IDDSI website provides comprehensive resources on all levels and testing methods: IDDSI.org.
