IDDSI: The International Dysphagia Diet Standardisation Initiative framework

NEW: Joint statement from the BDA and RCSLT on the implementation process 

The International Dysphagia Diet Standardisation Initiative (IDDSI) have published international standardised terminology and definitions for texture modified foods and thickened liquids for people with dysphagia. 

The framework consists of a continuum of eight levels (0-7) and includes descriptors, testing methods and evidence for both liquid thickness and food texture levels. IDDSI: The International Dysphagia Diet Standardisation Initiative framework

Benefits of IDDSI

a) The framework has been developed after much research and collaboration across the world and each level is based on evidence. The current UK descriptors are based on a consensus of expert opinion not research evidence.

b) The framework is a continuum and contains levels for fluids as well as foods. This means that the safety of patients when both eating and drinking is accounted for an d assured. Fluids are not included in the UK descriptors.

c) The framework is being adopted across the world and countries currently implementing it include: USA, Australia, Canada, New Zealand, Germany and China to name but a few. This means that when healthcare workers and patients travel from country to country there will be no confusion about the dysphagia descriptors being used and this in turn means that patient safety is assured.

d) If more countries use the same descriptors then the ability to do larger research studies and systematic reviews is much greater and this means that we will be able to generate more robust evidence about the care of patients with dysphagia.

e) The final benefit of implementing the framework is that it gives professionals the opportunity to raise the profile of the care of patients with dysphagia.

UK IDDSI Expert Reference Group

The BDA belongs to a UK Expert Reference Group which was initially set up by NHS England. Subsequently the chairmanship of the group was transferred to both the BDA and the Royal College of Speech and Language Therapists. The group comprises: BDA, RCSLT, dietitians from England, Wales, Northern Ireland, and Scotland, representatives from nursing homes, HCA, NACC, BSNA, manufacturers of thickening agents and products designed specifically for people with dysphagia and manufacturers of modified texture pre-prepared meals.

The group has spent over a year gathering evidence to determine whether or not to adopt the framework and this work has included literature reviews, pilots, a pros and cons exercise and surveys of healthcare professionals. In August 2017, the BDA surveyed dietitians to find out their views on the possible adoption of IDDSI and the RCSLT did a similar exercise with its membership.

Following the comprehensive analysis of this evidence, the results were presented to the BDA and RCSLT. Both the RCSLT and BDA have independently and formally announced that they support the adoption of the framework. 

Letter of confirmation of the BDA's adoption of the framework

The BDA and RCSLT see the adoption of the framework as of great benefit to patients and carers alike for the following reasons:

  • Improvement of patient safety (e.g. when patients, carers and /or healthcare professionals travel from one country to another there will be common international terminology which should mean that patients continue to receive the correct textures and hence remain safe; product labels will also be international).
  • Greater opportunities to collect and evaluate treatment outcomes (due to international standardised terminologies, larger cohorts of patients can be compared in research to evaluate the effects of existing and new treatments).
  • The combination, within one framework or continuum, of descriptors for both texture modified food and fluids – the latter are not currently addressed by the UK descriptors.

Implementation of the IDDSI framework

What is the timeframe for implementation?

The UK Expert Reference group has agreed the following timeframe for implementation:


Implementation Toolkit

The UK Expert Reference group has developed an implementation toolkit to assist healthcare professionals to implement the framework safely and efficiently in their local settings.

The toolkit (below) is being added to in real time and so do check this webpage regularly to find any new items.

The toolkit comprises:

The IDDSI website has a number of resources that local implementation teams may find useful including: 

  • published research articles
  • reports
  • posters
  • a general FAQ section
  • Information about drink and food testing methods with accompanying videos are available.

Keep up-to-date with the latest developments

There is a monthly e-newsletter providing the latest information about the Framework. To receive the latest news please subscribe here.

If you have any questions directly related to the Framework, please contact

If you have any other questions, please email Joanna Instone.