title: Development of International Terminology and Definitions for Texture-Modified Foods and Thickened Fluids Used in Dysphagia Management: The IDDSI Framework.
abstract: Dysphagia is estimated to affect ~8% of the world's population (~590 million people). Texture-modified foods and thickened drinks are commonly used to reduce the risks of choking and aspiration. The International Dysphagia Diet Standardisation Initiative (IDDSI) was founded with the goal of developing globally standardized terminology and definitions for texture-modified foods and liquids applicable to individuals with dysphagia of all ages, in all care settings, and all cultures. A multi-professional volunteer committee developed a dysphagia diet framework through systematic review and stakeholder consultation. First, a survey of existing national terminologies and current practice was conducted, receiving 2050 responses from 33 countries. Respondents included individuals with dysphagia; their caregivers; organizations supporting individuals with dysphagia; healthcare professionals; food service providers; researchers; and industry. The results revealed common use of 3-4 levels of food texture (54 different names) and ≥3 levels of liquid thickness (27 different names). Substantial support was expressed for international standardization. Next, a systematic review regarding the impact of food texture and liquid consistency on swallowing was completed. A meeting was then convened to review data from previous phases, and develop a draft framework. A further international stakeholder survey sought feedback to guide framework refinement; 3190 responses were received from 57 countries. The IDDSI Framework (released in November, 2015) involves a continuum of 8 levels (0-7) identified by numbers, text labels, color codes, definitions, and measurement methods. The IDDSI Framework is recommended for implementation throughout the world.
authors.affiliation: International Dysphagia Diet Standardisation Initiative (IDDSI) Working Committee, Brisbane, QLD, Australia. j.cichero@uq.edu.au.|School of Pharmacy, Pharmacy Australia Centre of Excellence (PACE), The University of Queensland, 20 Cornwall St, Brisbane, QLD, 4102, Australia. j.cichero@uq.edu.au.
authors.forename: Julie A Y
authors.initials: JA
authors.lastname: Cichero
authors.affiliation: International Dysphagia Diet Standardisation Initiative (IDDSI) Working Committee, Brisbane, QLD, Australia.|Faculty of Land and Food Systems, University of British Columbia, Vancouver, BC, Canada.|Peter Lam Consulting, Vancouver, BC, Canada.
authors.forename: Peter
authors.initials: P
authors.lastname: Lam
authors.affiliation: International Dysphagia Diet Standardisation Initiative (IDDSI) Working Committee, Brisbane, QLD, Australia.|Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.|Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
authors.forename: Catriona M
authors.initials: CM
authors.lastname: Steele
authors.affiliation: International Dysphagia Diet Standardisation Initiative (IDDSI) Working Committee, Brisbane, QLD, Australia.|Department of Mechanical Engineering, University College London, London, UK.
authors.forename: Ben
authors.initials: B
authors.lastname: Hanson
authors.affiliation: International Dysphagia Diet Standardisation Initiative (IDDSI) Working Committee, Brisbane, QLD, Australia.|Zhejiang Gongshang University, Hangzhou, China.
authors.forename: Jianshe
authors.initials: J
authors.lastname: Chen
authors.affiliation: International Dysphagia Diet Standardisation Initiative (IDDSI) Working Committee, Brisbane, QLD, Australia.|Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil.
authors.forename: Roberto O
authors.initials: RO
authors.lastname: Dantas
authors.affiliation: International Dysphagia Diet Standardisation Initiative (IDDSI) Working Committee, Brisbane, QLD, Australia.|Access Community Therapists, Vancouver, BC, Canada.|Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Janice
authors.initials: J
authors.lastname: Duivestein
authors.affiliation: International Dysphagia Diet Standardisation Initiative (IDDSI) Working Committee, Brisbane, QLD, Australia.|Department of Health Sciences, Prefectural University of Hiroshima, Hiroshima, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Kayashita
authors.affiliation: International Dysphagia Diet Standardisation Initiative (IDDSI) Working Committee, Brisbane, QLD, Australia.|National Health Service Improvement, London, UK.
authors.forename: Caroline
authors.initials: C
authors.lastname: Lecko
authors.affiliation: International Dysphagia Diet Standardisation Initiative (IDDSI) Working Committee, Brisbane, QLD, Australia.|Ann Arbor Veterans Affairs, Ann Arbor, MI, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Murray
authors.affiliation: International Dysphagia Diet Standardisation Initiative (IDDSI) Working Committee, Brisbane, QLD, Australia.|Speech Pathology, School of Health Sciences, University of KwaZulu-Natal, Westville Campus, Durban, South Africa.|Manchester Metropolitan University, Manchester, UK.
authors.forename: Mershen
authors.initials: M
authors.lastname: Pillay
authors.affiliation: International Dysphagia Diet Standardisation Initiative (IDDSI) Working Committee, Brisbane, QLD, Australia.|Department of Speech-Language Pathology, New York Medical College, Valhalla, NY, USA.|Barrique Speech-Language Pathology at Center for Swallowing & Speech-Language Pathology, New York Methodist Hospital, Brooklyn, NY, USA.
authors.forename: Luis
authors.initials: L
authors.lastname: Riquelme
authors.affiliation: International Dysphagia Diet Standardisation Initiative (IDDSI) Working Committee, Brisbane, QLD, Australia.|Swallowing and Speech Pathology, Hospital zum Heiligen Geist, Kempen, Germany.
authors.forename: Soenke
authors.initials: S
authors.lastname: Stanschus
mesh_terms: D000268:Adhesiveness; D001628:Beverages; D032921:Consensus; D003245:Consensus Statements as Topic; D003680:Deglutition Disorders / Q000178:diet therapy*; D005502:Food; D006244:Hardness; D006801:Humans; D010316:Particle Size; D012196:Review Literature as Topic; D011795:Surveys and Questionnaires; D009626:Terminology as Topic; D014783:Viscosity
keywords: Deglutition; Deglutition disorders; Dysphagia diet; Food and fluid standards; Swallowing; Texture-modified food; Thickened fluid