Ask the Dietitian: IDDSI adoption in Canada


What’s changing and what’s next as the implementation target date nears?

Healthcare communities are keeping watch as the January 1, 2019, target date approaches for implementing IDDSI—International Dysphagia Diet Standardisation Initiative. The goal of IDDSI is to develop globally recognized terminology and definitions for describing texture-modified foods and liquids.

About 8% of the world’s population—350 million people—have difficulty swallowing food and liquids. This condition is known as dysphagia, and is most often managed by modifying the texture of foods or drinks by chopping, mincing, mashing or puréeing foods and thickening liquids.

Such modifications reduce the possibility of someone with dysphagia choking, aspirating or inhaling food or fluid into the airway. Modified foods also help prevent people from becoming malnourished or developing symptoms of dehydration. These modifications are practiced around the world, but the names and thicknesses associated with modified food and liquid vary from one setting and country to another. Without having standardized definitions and descriptors, those with dysphagia may not receive food and drinks that are safe for them to consume, putting them at risk of medical problems.

Since the IDDSI framework was first published in 2015, professional associations, regulatory bodies and the foodservice industry have been working to support implementation. Here is the latest on the initiative:

Preparation is well underway

The goal of the IDDSI was to create a framework that would be recognized around the world and be used across all age groups and in a variety of healthcare settings. The framework represents a continuum of eight levels (levels 0-7) with seven levels involving texture modification. Both food and liquid textures are included in a single scale using a dual inverted pyramid design showing foods on the top with liquids on the bottom. Each level of the framework is identified by a colour, number and label designed to improve accuracy in prescribing, preparing and providing texture-modified dysphagia diets. There is an overlapping area in the middle of the framework because certain food textures share movement or flow characteristics with thickened liquids. Food and fluid levels are defined by characteristics/descriptions, physiological rationale for each level, and IDDSI-specific testing methods. For example, If you work in a healthcare kitchen and need to make lemonade to a particular thickness, there’s a fork test—dip a fork in the liquid and then clock how quickly the liquid falls from the fork’s tines to determine whether it meets “Liquid Level 3—Moderately Thick.”

Canada is in the “prepare” phase of the Monitor-Aware-Prepare-Adopt (MAPA) process outlined by IDDSI. IDDSI is actively supporting implementation of the framework at the organizational level through the development of new resources.

Providing the ability to move forward

Tools available on the IDDSI website ( have expanded to include audit sheets for each level of liquid and food based on testing methods and descriptions. There’s also IDDSI abbreviations for use with foodservice computer software and downloadable presentations to assist with educating staff.

For further help, there’s an IDDSI YouTube channel with food- and fluid-testing videos, as well as recorded webinars on IDDSI updates and experiences of implementing IDDSI in various healthcare settings.

Additionally, IDDSI has created implementation guides with a 12-month calendar of events to help healthcare providers as they monitor their progress with residents and patients.

The IDDSI site also offers publications, including research articles and reports, FAQs and access to all newsletters. Information also can be accessed via the free IDDSI app (available for iOS and Android devices) and by following IDDSI on Twitter @iddsi_org

Supporting the initiative

With the implementation target date just six months away in Canada, the industry sector is busy. Makers of commercially available texture-modified products have committed to labelling their products with IDDSI terminology and nomenclature beginning in 2019. This could include dual labelling on products or full transition to IDDSI terminology.

In Canada, many professional organizations and regulatory agencies are committed to supporting IDDSI implementation. These include the Canadian Society of Nutrition Management, Dietitians of Canada, Speech-Language and Audiology Canada and the Canadian Association of Occupational Therapists.

While organizations recognize the potential for IDDSI to have a positive impact on caring for people with dysphagia, they understand it will take time, energy and commitment to implement the framework.

What Gordon Food Service is doing

Gordon Food Service supports IDDSI. Our organization understands the importance of the initiative and its focus on safety for those living with dysphagia and their caregivers at all levels. The Nutrition Resource Centre will be focused on solutions to help operators through the implementation process. That may include educational webinar opportunities, training topics, videos, Idea Centre articles and support in Cycle Menu Management.

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