International dysphagia diet guidelines are here

Global guidelines to standardise dysphagia diets have finally reached Australia. The IDDSI framework, while not mandatory, came into effect 1 May, 2019.

Here’s a brief recap followed by insights into what to expect.


Older adults are at high risk for swallowing difficulties, otherwise known as dysphagia. Estimates suggest dysphagia affects up to one in five older people living in the community and around half of those in assisted living facilities.

It’s a serious concern that can result in choking or suffocation if food or drinks go down the wrong way. Managing the condition, while some swallowing ability is still present, involves the use of texture-modified foods and thickened liquids.

The International Dysphagia Diet Standardisation Initiative (IDDSI) lays down food guidelines to ensure that people with dysphagia can eat safely.

Viscosity is tailored according to dysphagia severity, ranked from soft and bite-sized to pureed food, and thin to extremely thick drinks. Proportion Foods’ SmartserveTM passed the test last year when it was classified as Level 4 Puree.

Australia has used its own dysphagia diet guidelines since 2007, but research has grown since then.

IDDSI aims to standardise the terminology and testing of these rankings around the world, for people of all ages in all care facilities. Australia is joining more than 20 other countries including New Zealand, the US, Canada, and several European nations in implementing it.

Making the transition

It will take time and organisation for health care providers and institutions to complete the transition – in the meantime both old and new frameworks will both be used so it’s important to be familiar with each of them.

The Australian Standards for Texture Modified Foods and Fluids – to be phased out – classifies fluids as mildly, moderately and extremely thick and food as soft, minced and moist, and smooth pureed.

IDDSI categorises foods as regular, soft and bite-sized, minced and moist, pureed and liquidised. Drinks go from thin to slightly, mildly, moderately and extremely thick. Pureed and liquidised food overlap with extremely thick and moderately thick fluid, respectively.

It’s apparent when comparing these standards that there is some overlap between them. But it is important to note differences. For instance, Level 6 of the IDDSI, which aligns with Texture A – Soft Diet, specifies that foods must be in ‘bite-sized’ pieces.

To adopt the new guidelines, organisations will need to review and overhaul policy and documentation, educate staff (IDDSI workshops will support this), and review menu items.

All relevant team members – including speech pathologists and dietitians – and external stakeholders – GPs, local hospitals – will also need to be informed and involved in the process.

Speech Pathology Australia, the primary body for speech pathologists, has made a statement in support of the new guidelines that can be accessed on their website below.

The site also provides supporting material including information on old and new standards and educational posters.


The International Dysphagia Diet Standardisation Initiative 2016 @

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