The International Dysphagia Diet Standardisation Initiative (IDDSI)
The International Dysphagia Diet Standardisation Initiative, or IDDSI, is a global framework created to standardize terminology for texture-modified foods and thickened liquids used for individuals with dysphagia, or swallowing problems. Before its adoption, different healthcare settings often used their own classification systems, leading to potential confusion and patient safety risks. The IDDSI framework uses a numerical scale from 0 to 7 for food textures and liquid thicknesses. A Type 7 regular diet sits at the top of this scale, signifying the least restrictive food texture level and representing a standard, everyday diet.
What is a Type 7 regular diet?
A Type 7 regular diet, also known as IDDSI Level 7, is intended for individuals who can safely chew and swallow all types of food textures and sizes. It is the normal, unrestricted diet that most people consume daily. There are no modifications required for food thickness, particle size, or moisture content. This diet is appropriate for patients who have no increased risk of choking and are able to bite and chew foods with varying firmness, without tiring easily. The diet includes mixed-consistency foods, which are combinations of solids and liquids, such as cereal with milk or soups with noodles.
Examples of foods included:
- Proteins: All types of meat (including steak), poultry, and fish, cooked in any manner.
- Fruits and Vegetables: Raw, cooked, fibrous, and tough varieties, including those with seeds or peels, such as apples, raw carrots, and pineapples.
- Grains and Starches: All types of bread, crusty rolls, rice, pasta, and cereals.
- Snacks: Crunchy, crispy, or chewy foods like nuts, popcorn, and chips.
The distinction of IDDSI Level 7 Easy to Chew
While Level 7 is often referred to as a regular diet, it's important to differentiate between the standard Type 7 Regular and the Level 7 Easy to Chew variant. The Easy to Chew version is a sub-category designed for individuals who do not have swallowing problems but may have difficulty with certain harder or tougher foods due to weaker chewing muscles, fatigue, or dental issues. This variant requires specific food preparation to ensure items are soft and tender.
Foods restricted in the Easy to Chew variant include:
- Hard, tough, or dry foods (e.g., nuts, raw vegetables)
- Chewy foods (e.g., tough meat, dried fruit)
- Crispy or crunchy items (e.g., cornflakes, crisp bacon)
- Fibrous or stringy foods (e.g., pineapple, rhubarb)
- Foods with pips, seeds, bones, or gristle
Nutritional considerations for a Type 7 diet
For most individuals, a Type 7 regular diet is nutritionally adequate and requires no special considerations beyond a balanced meal plan incorporating a variety of foods from all major food groups. However, if a patient is transitioning from a modified texture diet (such as pureed or minced) to a Type 7 diet, healthcare professionals may monitor their intake to ensure adequate nutrition and weight stability, especially if they have experienced weight loss. The ability to consume a full range of food textures generally improves caloric and nutrient intake significantly. Patients on a Level 7 Easy to Chew diet should still ensure they are receiving all necessary nutrients, as some foods may be off-limits. Their diet can be fortified with nutrient-dense options if needed.
IDDSI Level 7: Regular vs. Easy to Chew
| Feature | IDDSI Level 7 (Regular) | IDDSI Level 7 (Easy to Chew) |
|---|---|---|
| Food Texture | All textures, including hard, tough, and chewy. | Soft, tender, and moist textures only. |
| Food Size | Any size; no restrictions. | Any size, but food must break apart easily. |
| Chewing Ability | Normal, strong chewing ability. | Ability to chew soft/tender food without tiring easily. |
| Associated Risks | No increased risk of choking. | No increased risk of choking, but certain food characteristics are avoided for comfort and safety. |
| Who It's For | General population, no dysphagia. | Individuals with weaker chewing ability or dental issues, but no swallowing problems. |
| Food Restrictions | No food restrictions based on texture or size. | Avoids hard, tough, chewy, crunchy, and stringy foods. |
Conclusion
In the International Dysphagia Diet Standardisation Initiative, a Type 7 regular diet is the standard classification for a normal, everyday diet that includes all types of food textures and sizes. It is suitable for individuals with fully functional chewing and swallowing abilities. Understanding this classification, including its distinction from the Level 7 Easy to Chew variant, is crucial for healthcare professionals and patients alike to ensure safe, enjoyable, and nutritionally adequate eating. For more detailed resources on the IDDSI framework and food texture levels, you can visit the official IDDSI website.
