International Dysphagia Diet Standardisation Initiative (IDDSI)

IDDSI is an international collaboration of professionals who developed a standardized framework for labeling texture-modified foods and thickened liquids. The framework is designed to avoid the confusion created by variable terminology and definitions to describe modified diets around the world. The effort is expected to improve the safety and care for all individuals with dysphagia, across all cultures.

History of IDDSI

In 2012, an international collaboration of a multidisciplinary group of volunteers from a variety of settings—including nutrition and dietetics, medicine, speech-language pathology, occupational therapy, nursing, patient safety, engineering, and food science and technology—came together to develop international standardized terminology and definitions for texture-modified foods and thickened liquids for persons with dysphagia.

The first steps of IDDSI involved completing international reviews of literature. The first, completed in 2013, looked at published literature and existing national standards. The next project took place in 2014, which was a systematic review of modified food texture and liquid consistency. Next, IDDSI conducted surveys of four stakeholder groups—health professionals, patients and caregivers, industry, and researchers—throughout 2014 and 2015. More than 5,000 responses yielded overwhelmingly positive support for the initiative and a standardized international framework.

In May 2019, IDDSI officially launched for implementation in the United States, with multiple food manufacturers changing their package labeling by this date to reflect the IDDSI framework. While the number of facilities around the country adopting IDDSI continued to grow, the need for increasing structure and guidance for implementation led to the creation of reference groups (volunteer-led work groups). The United States IDDSI Reference Group (USIRG) was formed in November 2020 with the goal of facilitating and supporting implementation of IDDSI in the United States and Territories over the following 1–2 years.

ASHA Supports the IDDSI

The Academy of Nutrition and Dietetics (AND), the Association of Nutrition & Foodservice Professionals (ANFP), and ASHA support ongoing interprofessional collaborative practice to implement the IDDSI since its official launch in May 2019 in the United States.

Recognizing that total IDDSI implementation will take time and effort, these three organizations—AND, ANFP, and ASHA—are committed to supporting their members during their transition. Representatives from AND, ANFP, and ASHA engage with the USIRG in ongoing implementation efforts across the country.

Note: The National Dysphagia Diet (NDD) was formerly part of the full Nutrition Care Manual (NCM)® established by the AND. The AND announced that beginning in October 2021, IDDSI will be the only texture-modified diet recognized by NCM®. Therefore, after October 2021, the NDD and its associated resources are no longer being included in the NCM®.

ASHA's Involvement With IDDSI

2022: August: The ASHA Board of Directors passes a resolution (BOD 16-2022) to continue support of the IDDSI Framework, including exhibiting at the annual ASHA Convention.; June: ASHA, The Academy of Nutrition and Dietetics (AND), and the Association of Nutrition & Foodservice Professionals (ANFP) reiterate their coordinated support for ongoing interprofessional collaborative practice to implement IDDSI in the United States.
2021: ASHA begins working with the USIRG volunteers to create resources that will support best practice for the implementation of IDDSI.
2020: ASHA commits to participating in the USIRG, specifically for the development of Utilization/Guidance/Best Practice relating to implementation of IDDSI.
2018: ASHA and the Academy of Nutrition and Dietetics announce IDDSI's official launch date of May 1, 2019, and support for implementation in the United States.
2017: ASHA and the Academy of Nutrition and Dietetics announce their support of the global initiative in a joint press release.
2016: The ASHA Board of Directors passes a resolution (BOD 42-2016) to support the IDDSI Framework.
2013: ASHA agrees to be listed as a supporter of this initiative and surveys ASHA members to solicit information for the project.

Additional Resources

Disclaimer: ASHA supports the IDDSI Framework, and ASHA is one of the organizations that is sharing it with members who assess and treat individuals with dysphagia. ASHA does not endorse any product, program, or procedure. For specific questions and more information on the framework, testing methods, FAQs, and implementation resources, please visit the IDDSI website. Read ASHA’s guidance related to dysphagia diets.