Understanding the IDDSI Framework
The International Dysphagia Diet Standardisation Initiative (IDDSI) established a global framework to standardize the description of food textures and drink thicknesses for individuals with dysphagia. This framework uses eight levels (0-7) to help ensure individuals receive appropriate consistencies, reducing the risk of aspiration and choking. It is important for all involved in care to understand these levels for safety.
The 8 IDDSI Levels
The IDDSI framework spans eight levels, with drinks classified from Level 0 to Level 4:
- Level 0 (Thin): Similar to water and most standard liquid nutritional supplements like Ensure.
- Level 1 (Slightly Thick): Thicker than water, flowing slightly slower.
- Level 2 (Mildly Thick): Pours from a spoon slower than water.
- Level 3 (Moderately Thick): Pours slowly and can be drunk from a cup, but not easily through a straw.
- Level 4 (Extremely Thick): Holds its shape and must be eaten with a spoon.
What IDDSI Level is Standard Ensure?
Most standard liquid Ensure products, such as Ensure Original or Ensure Life, are thin, corresponding to IDDSI Level 0 when served at room temperature or chilled. This consistency flows quickly and is not safe for individuals requiring thickened fluids. A Speech-Language Pathologist or other clinician should advise on the appropriate thickness for these individuals.
Product-Specific IDDSI Levels for Ensure Variations
Ensure products vary in consistency. Abbott Nutrition provides IDDSI classifications for specific formulations. Some are designed to be naturally thicker. For instance, Ensure Plus Crème is described as a creamy, yogurt-like texture and has been classified at IDDSI Level 4 (Extremely Thick/Pureed) according to tests conducted for Abbott.
How to Achieve a Specific IDDSI Level with Ensure
To modify standard (IDDSI Level 0) Ensure, a commercial thickening agent is typically used. Accurate measurement and testing are essential to achieve the correct consistency.
General steps for thickening Ensure include:
- Measure the Ensure and the recommended amount of thickener for the desired IDDSI level according to the thickener's instructions.
- Mix briskly for at least 30 seconds.
- Let it sit for 1 to 5 minutes to reach final thickness.
- Use an IDDSI Flow Test to confirm the correct consistency before serving.
- If too thick, discard and start again.
Comparison of Ensure Product Consistencies
This table summarizes the IDDSI classification for different Ensure products and their modified states.
| Product | Natural IDDSI Level | Notes |
|---|---|---|
| Ensure® Original/Life | 0 (Thin) | Water-like consistency at room temperature; requires thickening for those needing thicker fluids. |
| Ensure® Plus Crème | 4 (Extremely Thick) | Naturally pudding-like; suitable for those requiring a very thick fluid. |
| Ensure® (Thickened) | Varies | Depends on thickener type and amount used according to clinical advice. |
The Crucial Role of Clinical Assessment
Knowledge of IDDSI levels is important, but it does not replace professional medical advice. A healthcare professional, such as a Speech-Language Pathologist or dietitian, must conduct a comprehensive assessment to determine the appropriate IDDSI level for an individual based on their specific needs and swallowing abilities. Providing the wrong consistency can lead to serious health issues like aspiration. Always consult a clinician before changing a prescribed IDDSI level.
Conclusion
Standard liquid Ensure products are IDDSI Level 0 (Thin). However, some variants like Ensure Plus Crème are naturally thicker, classifying as IDDSI Level 4. For individuals requiring a thicker consistency than Level 0, standard Ensure must be thickened accurately using commercial thickeners and verified with an IDDSI Flow Test. Crucially, a healthcare professional must always determine the safest and most appropriate IDDSI level for anyone with swallowing difficulties. For further information, visit the official International Dysphagia Diet Standardisation Initiative (IDDSI) website.
