Understanding the IDDSI Framework
The International Dysphagia Diet Standardisation Initiative (IDDSI) provides a global framework for classifying food textures and drink thickness across a continuum of eight levels, numbered 0-7. This standardization was created to improve safety for individuals with dysphagia, or swallowing difficulties, by removing the ambiguity of older, non-standardized descriptions like 'soft' or 'nectar-thick'. Levels range from thin liquids (Level 0) to regular-textured foods (Level 7), with each level having distinct characteristics and simple testing methods to ensure accuracy. A clinician determines the appropriate level for a patient based on a comprehensive clinical assessment.
What is a Level 7 Food? Defining the IDDSI's Final Stage
Level 7 is the final food texture level in the IDDSI framework and is split into two important sub-categories: Regular and Regular Easy to Chew. This level is for individuals who do not have an increased risk of choking and have a strong ability to chew and swallow safely.
Level 7 Regular: The Standard Diet
IDDSI Level 7 Regular refers to normal, everyday foods with no texture restrictions. This diet is suitable for individuals with no problems with chewing or swallowing. It includes a variety of textures, from hard and crunchy to naturally soft, and allows for foods of any size. For most healthy adults and children with typical eating abilities, this is their standard, unrestricted diet. The key requirement for a Regular diet is the ability to bite, chew, and form a cohesive bolus (a soft mass of food) without tiring easily or experiencing pain.
Level 7 Regular Easy to Chew: A Softer Option
IDDSI Level 7 Regular Easy to Chew is a sub-category that offers a softer version of the regular diet. It is specifically for people who find hard, firm, or chewy foods difficult or uncomfortable to eat but do not have a significant choking risk. This could be due to factors like dental issues, fatigue, or recovery from illness. While food piece size is not restricted at this level, all items must be soft and tender.
How to Test for a Level 7 Easy to Chew Texture
To ensure a food item meets the Level 7 Easy to Chew criteria, a simple fork pressure test can be performed.
- Press with a fork: Apply gentle pressure to the food item with the side of a fork until your thumbnail blanches (turns white).
- Observe the result: The food should break apart and squash easily, leaving an impression. When the pressure is released, the food should not return to its original shape.
- Test on a variety of foods: This test is especially useful for meat, fish, and vegetables to confirm they are tender enough.
Navigating Level 7: What to Eat and What to Avoid
For those on an IDDSI Level 7 Easy to Chew diet, selecting the right foods is crucial for comfort and safety. Here is a guide to help.
Recommended foods for Level 7 Easy to Chew
- Proteins: Tender, slow-cooked meats, boneless fish that flakes easily, moist meatballs, and eggs (scrambled, poached, or omelettes).
- Fruits: Soft, peeled fresh fruits like bananas, mangoes, peaches, and melons (being careful of excess water content). Canned or stewed fruits are also excellent choices.
- Vegetables: Well-cooked or boiled vegetables such as carrots, squash, cauliflower, and sweet potatoes that can be easily mashed with a fork.
- Grains and Starches: Well-moistened cereals like porridge, soft cooked pasta, moist sandwiches with soft fillings, and potatoes (baked without skin, mashed, or soft roasted).
- Dairy and Desserts: Yogurt, milk puddings, custards, cottage cheese, and soft cakes with cream or custard.
Foods to avoid for Level 7 Easy to Chew
- Hard and Dry Foods: Nuts, dry cakes, hard raw vegetables (carrots, apples), and dry bread or toast.
- Chewy and Fibrous Foods: Steak, pineapple, celery, fibrous parts of fruit, chewing gum, and sticky candies.
- Crunchy and Crispy Foods: Popcorn, potato chips, corn chips, crispy bacon, and flaky pastries.
- Foods with High Choking Risk: Whole grapes, seeds, pips, and small bones or gristle in meat.
- Mixed Consistencies: Foods with a mix of solid and thin liquids, like soup with large chunks of vegetables or thin milk with hard cereal.
Comparing Food Levels: IDDSI Level 6 vs. Level 7
Understanding the distinction between Level 6 (Soft and Bite-Sized) and Level 7 is critical for patient safety, especially regarding choking risk. Below is a comparison of their key features.
| Feature | IDDSI Level 6 (Soft & Bite-Sized) | IDDSI Level 7 (Regular & Easy to Chew) |
|---|---|---|
| Chewing Requirement | Requires chewing; minimal effort needed. | Regular: No restriction. Easy to Chew: Chewing required, but softer textures are preferred. |
| Swallowing Ability | For individuals with adequate tongue control and minimal swallowing problems. | For individuals with no swallowing problems or increased risk of choking. |
| Food Texture | Soft and tender pieces; cohesive, but no separate thin liquid. | Regular: All textures, including hard, chewy, and crunchy. Easy to Chew: Soft and tender only. |
| Particle Size | Specific particle size restriction: 1.5 cm for adults and 8 mm for children. | No particle size restriction. |
| Choking Risk | Reduced risk due to controlled particle size. | Regular: No identified risk. Easy to Chew: Lower risk than Regular, but particle size is not controlled, unlike Level 6. |
Nutritional Considerations and Safety for a Level 7 Diet
Following a texture-modified diet, even a softer one like Easy to Chew, requires careful attention to nutritional intake. People on these diets may unintentionally reduce their calorie and protein intake if they struggle with food consumption. It is essential to ensure meals are nutrient-dense. For example, adding full-fat dairy, sauces, or gravy can increase calories and moisture. Monitoring weight and consulting with a dietitian can help ensure nutritional needs are met. Always serve Level 7 foods with the appropriate drink thickness level, as prescribed by a health professional, to manage any combined swallowing issues. Supervision during meals may still be necessary for individuals with specific behaviors that increase choking risk, such as eating too quickly.
Conclusion: Making Informed Nutritional Choices
Knowing what is a level 7 food is key to understanding the IDDSI framework and providing safe, appropriate nutrition. Whether it's the unrestricted Regular diet or the softer Easy to Chew variant, Level 7 is for individuals with competent chewing and swallowing abilities. This classification standardizes terminology, reducing confusion and enhancing safety in health care settings. By following these guidelines and consulting with a healthcare professional, individuals can maintain a nutritious and enjoyable diet adapted to their specific needs. For more details, visit the official website of the International Dysphagia Diet Standardisation Initiative (IDDSI).
