Iddsi Framework Headline Large July2020 Scaled

Dysphagia has been closely associated with dehydration, malnutrition, upper respiratory infections, and even risk for death. While it is not an uncommon diagnosis, with an estimated 8% of the population being affected by it across the globe, dysphagia is seen in all age groups, with those in the elderly and very young populations having increased rate of adverse impact on their health.

Across the globe countries have continued to provide dysphagia diets with modified textures and liquid consistencies to aid in the prevention of potential adverse impacts on resident health.  However, there has not been consistent terminology used across the board, which can lead to confusion and potentially incorrect diet and fluid orders. Starting in 2013, a new dysphagia diet program, called the International Dysphagia Diet Standardisation Initiative (IDDSI) was launched. This international program was developed to provide consistent terminology for all texture modified foods and fluids to meet the needs of individuals with dysphagia across all age spans, all care setting, and across all cultures.

The IDDSI dysphagia diet standard is called the International Dysphagia Diet Framework and will replace terminology from the National Dysphagia Diet (NDD). Key Elements of the IDDSI Framework include:

  • Continuum of 8 levels (0-7)
    • Drinks – levels 0-4
    • Foods- levels 3-7
    • Overlap at levels 3 and 4 for food and drinks (for moderately thick liquids and liquidized foods, extremely thick liquids and pureed foods, respectively)
    • Transitional foods (for levels 5-7)
  • Levels are identified by text labels, numbers, and color codes to improve safety and identification
  • Specific and practical testing methods for both liquids and food consistencies, including the IDDSI Flow Test, Fork Drip and Spoon Tilt
  • Many companies in the food service industry have already started transitioning to IDDSI terminology and have added dual labeling to both food and fluid products

Implementation of IDDSI will involve several phases and coordination with staff through awareness and training, as well as implementation and monitoring. Registered Dietitians play an important role in the success of the IDDSI program. The dietitian along with the speech therapist and other team members should facilitate training to assure proper interventions are in place. Your Registered Dietitian can also assist with utilizing the IDDSI website and resources to provide a tailored plan for action and execution at your building.


International Dysphagia Diet Standardisation Initiative. Complete IDDSI Framework Detailed definitions.

Academy of Nutrition and Dietetics. (2017). Academy of Nutrition and Dietetics, What is the International Dysphagia Diet Standardisation Initiative?

Carlson, D. (2018). A Clinical Dietitian’s Guide To IDDSI. Retrieved August 31, 2020, from