What does the IDDSI framework consist of?

November 19, 2025 •

3 min read

Created in 2013, the International Dysphagia Diet Standardisation Initiative (IDDSI) was formed by a global group of dysphagia experts to improve patient safety worldwide. The question, 'what does the IDDSI framework consist of?' is central to understanding this global standard for managing eating, drinking, and swallowing problems (dysphagia).

Quick Summary

The IDDSI framework comprises an 8-level, color-coded continuum classifying texture-modified foods and thickened liquids for individuals with swallowing difficulties. It provides standardized descriptors and simple, reliable testing methods to ensure food and drink consistency, promoting patient safety and clearer communication among healthcare providers.

Key Points

Continuum of Levels: The IDDSI framework uses an 8-level continuum (Levels 0-7) to classify foods and liquids for people with swallowing problems.
Unified Terminology: It provides a global, standardized set of labels, numbers, and colors to describe food texture and drink thickness, reducing confusion and improving safety.
Practical Testing Methods: Simple, reliable tests like the Flow Test (for liquids) and Fork Pressure Test (for foods) are included to help confirm the appropriate consistency level.
Integrated System: The framework places both foods and liquids on the same continuum, with Levels 3 and 4 covering both categories based on their similar properties.
Enhanced Patient Safety: By standardizing diet modifications, IDDSI reduces the risk of choking and aspiration, leading to better health outcomes for individuals with dysphagia.
Global Adoption: IDDSI is widely adopted internationally, which ensures consistent care and understanding of diet recommendations across different healthcare settings and countries.
Person-Centered Approach: The framework emphasizes clinical judgment and personalized recommendations to allow for the least restrictive diet options that can be safely managed by an individual.

Understanding the IDDSI Framework

The International Dysphagia Diet Standardisation Initiative (IDDSI) framework is a globally recognized system designed to standardize the language used for texture-modified foods and thickened liquids for people with dysphagia. This standardization is crucial because, historically, different regions used varied terminologies, which could lead to confusion and safety risks. The IDDSI framework offers a single, clear system with a continuum of 8 levels (0-7), each defined by specific characteristics, numbers, text labels, and colors.

The Levels of the IDDSI Framework

The framework categorizes both drinks and foods across its 8 levels. These levels are identified by numbers, text labels, and color codes for enhanced clarity. The continuum includes:

Level 0 (Thin): Thin liquids similar to water.
Level 1 (Slightly Thick): Thicker than water, requiring less effort to drink through a straw than Level 2 liquids.
Level 2 (Mildly Thick): Pourable, noticeably thicker than thin fluids; requires some effort with a standard straw.
Level 3 (Moderately Thick / Liquidised): Can be drunk from a cup but not eaten with a fork; smooth with no lumps.
Level 4 (Extremely Thick / Pureed): Holds its shape on a spoon; cannot be drunk from a cup.
Level 5 (Minced and Moist): Soft, moist food with small lumps (max 4mm adults, 2mm children) that are easily squashed.
Level 6 (Soft and Bite-Sized): Soft, moist, tender food cut into bite-sized pieces (max 1.5cm adults, 8mm children); requires chewing.
Level 7 (Regular / Easy to Chew): Normal everyday foods. The 'Easy to Chew' sub-category includes softer regular foods.

Simple and Reliable Testing Methods

A key aspect of the IDDSI framework is its set of practical tests to confirm food and drink consistency. These tests can be performed by various individuals, from clinicians to caregivers, ensuring safety and consistency. Notable methods include:

IDDSI Flow Test: Used for liquids (Levels 0-4) to measure flow rate through a syringe.
Fork Drip Test: For Levels 3 and 4, assesses how food behaves on a fork.
Fork Pressure Test: For Levels 5, 6, and Easy to Chew (Level 7), checks how easily food breaks apart under light fork pressure.
Spoon Tilt Test: Used for Levels 4 and 5 to evaluate food cohesiveness and stickiness.

The Importance of a Standardized Approach

The IDDSI framework has significantly improved patient safety by offering clear, consistent guidelines, reducing risks like choking and aspiration. It fosters better communication among healthcare teams and ensures consistent care globally, regardless of location. The framework aims to provide the safest options while improving the quality of life for individuals with dysphagia.

Comparing IDDSI with Previous Systems

Previous national guidelines often lacked standardized testing and clear definitions. IDDSI addresses this with an evidence-based system and practical tests. Key differences are highlighted below:


Feature	Previous National Guidelines (e.g., NDD)	IDDSI Framework
Number of Levels	Typically fewer	Continuum of 8 levels (0-7) for both foods and drinks
Terminology	Inconsistent and varied	Standardized, global terminology with numbers, labels, and colors
Consistency Testing	Often subjective	Specific, practical tests included
Food and Liquid Integration	Separate categories	Integrated continuum with levels 3 and 4 overlapping
Global Adoption	Limited	Adopted globally

Conclusion

In summary, the IDDSI framework provides a comprehensive, evidence-based system for managing dysphagia through standardized food textures and liquid thicknesses. Its 8 clear levels, simple testing methods, and distinct color codes enhance patient safety globally. It serves as a common language in clinical nutrition and dysphagia management, ensuring consistent and clear communication for healthcare providers and individuals with swallowing difficulties. For more details, consult the official IDDSI website.

International Dysphagia Diet Standardisation Initiative (IDDSI)

Frequently Asked Questions

The primary purpose of the IDDSI framework is to provide a global standard for describing modified food textures and thickened liquids for individuals with dysphagia, improving patient safety by creating consistent terminology and testing methods.

The IDDSI framework consists of a continuum of 8 levels, numbered from 0 to 7. Drinks are classified from Levels 0 to 4, while foods are classified from Levels 3 to 7.

The IDDSI Flow Test is a simple, standardized test used to determine the thickness level of liquids (Levels 0-4). It involves measuring the amount of liquid that flows out of a 10ml syringe over 10 seconds.

IDDSI Level 4 (Pureed) is a smooth, lump-free consistency that holds its shape, while Level 5 (Minced and Moist) contains soft, moist lumps up to 4mm in size for adults.

The framework benefits individuals with dysphagia across the lifespan, their caregivers, healthcare professionals (including dietitians, speech-language therapists, and nurses), and food service providers by ensuring safe and consistent diet preparation.

Yes, Level 7 of the IDDSI framework is for regular, everyday foods. It also includes a sub-category, 'Easy to Chew,' for individuals who can manage regular textures but may benefit from softer food options.

By eliminating inconsistent terminology and providing clear, evidence-based descriptors and testing methods, the framework significantly reduces the risk of misinterpretation, which can lead to life-threatening issues like choking and aspiration.