Testing 4Mar2017 IDDSI Framework updated ZS Edit final

1 !"#$%&''(&%)*+, *0%+12%'-$3*#45/*$%+*-%6#3-1$-2%712-*%5" -%%8*-+5#9-8/,,/1$%:55*#;75#/1<("+*-+6#0-%=>?%&15-*1+5#/1+6%@#3-1$-%%"554$ABB3*-+5#9 -3/,,/1$>/*CB6#3-1$-$B;D<$+B=>?B%E+*3"%=F%G?HI%! &''(&%)*+, *0%!-$5#1C%E-5"/2$%The IDDSI Framework and Descriptors are licensed under the CreativeCommons Attribution- Sharealike International License March 4, 2017 2 INTRODUCTION The International Dysphagia Diet Standardisation Initiative ( IDDSI ) was founded in 2013 with the goal of developing new global standardised terminology and definitions to describe texture modified foods and thickened liquids used for individuals with dysphagia of all ages, in all care settings, and all cultures. Three years of ongoing work by the International Dysphagia Diet Standardisation Committee has culminated in a final dysphagia diet Framework consisting of a continuum of 8 levels (0- 7).)

2 Levels are identified by numbers, text labels and colour codes. This document provides details regarding Testing Methods for use with the IDDSI Framework . This document is to be read in conjunction with the Complete IDDSI Framework , IDDSI Evidence and IDDSI Frequently Asked Questions (FAQs) documents ( ). The IDDSI Committee would like to acknowledge the interest and participation of the global community including patients, caregivers, health professionals, industry, professional associations and researchers. We would also like to thank our sponsors for their generous support. Please visit the for further information The IDDSI Committee: Co- Chairs: Peter Lam (CAN) & Julie Cichero (AUS); Committee Members: Jianshe Chen (CHN), Roberto Dantas (BRA), Janice Duivestein (CAN), Ben Hanson (UK), Jun Kayashita (JPN), Caroline Lecko (UK), Mershen Pillay (ZAF), Luis Riquelme (USA), Soenke Stanschus (GER), Catriona Steele (CAN).

3 Past Committee Members: Joe Murray (USA) The International Dysphagia Diet Standardisation Initiative Inc. ( IDDSI ) is an independent, not- for - profit entity. IDDSI is grateful to a large number of agencies, organizations and industry partners for financial and other support. Sponsors have not been involved with the design or development of the IDDSI Framework . Development of the IDDSI Framework (2012- 2015) IDDSI would like to thank and acknowledge the following sponsors for their generous support in the development of the IDDSI Framework : Nestl Nutrition Institute (2012- 2015) Nutricia Advanced Medical Nutrition (2013- 2014) Hormel Thick & Easy (2014- 2015) Campbell s Food Service (2013- 2015) apetito (2013- 2015) Trisco (2013- 2015) Food Care Co.

4 Ltd. Japan (2015) Flavour Creations (2013- 2015) Simply Thick (2015) Lyons (2015) Implementation of the IDDSI Framework is in progress. IDDSI is extremely grateful to all sponsors supporting implementation us/sponsors/ IDDSI Framework and Descriptors are licensed under the CreativeCommons Attribution- Sharealike International License March 4, 2017 4 IDDSI Flow Test The IDDSI Flow test uses a 10 mL slip tip hypodermic syringe, as shown in the image below. Although 10 mL syringes were initially thought to be identical throughout the world based on reference to an ISO standard (ISO 7886- 1), it has subsequently been determined that the ISO document refers only to the nozzle of the syringe and that variability in barrel length and dimensions may exist between brands.

5 Specifically the IDDSI Flow test uses a reference syringe with a measured length of mm from the zero line to the 10 mL line (BDTM syringes were used for the development of the tests manufacturer code 301604). IDDSI is aware that there are some syringes that are labeled as 10 mL, but in fact have a 12 mL capacity. Results using a 12 mL syringe will be different to those from a true 10 mL syringe. As a result it is important to check the barrel length as shown on the diagram below. Details for conducting the test are shown below. Videos showing the IDDSI Flow Test can also be viewed at: Testing - methods/ Drinks and liquids such as gravy, sauces and nutritional supplements are best assessed using the IDDSI Flow Test (Levels 0- 3).

6 For extremely thick drinks (Level 4), that do not flow through a 10 mL syringe in 10 seconds and are best consumed with a spoon, the IDDSI Fork Test and/or Spoon Tilt Test are recommended as methods for determining consistency. The IDDSI Framework and Descriptors are licensed under the CreativeCommons Attribution- Sharealike International License March 4, 2017 5 @!%+12%&*#$"%N75*#5#/1%P%'#-5-5#3%&1$5#5 75-%G??hS%N+5#/1+6%L+5#-15%(+J-5D%:C-13D F%U/D+6%8/66-C-%(4--3"%P%@+1C7+C-%!"-*+4 #$5$F%V*#5#$"%'#-5-5#3%:$$/3#+5#/1F%N+5# /1+6%N7*$-$%N75*#5#/1%Z*/74F%T/$4#5+6%8+ 5-*-*$%:$$/3#+5#/1%G?HHO>%%%&,+C-$%J/*%@ @ @!%+12%&*#$"%N75*#5#/1%P%'#-5-5#3%&1$5#5 75-%G??hS%N+5#/1+6%L+5#-15%(+J-5D%:C-13D F%U/D+6%8/66-C-%(4--3"%P%@+1C7+C-%!))))

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8 "-%-15#*-%.#25"%/J%+%$5+12+*2%J/*0%+6$/% ,-+$7*-$%+44*/a#,+5-6D%H>]3,%+$%$"/.1%#1 %5"-%#,+C-$%;-6/.>%H>]%a%H>]%3,%4+*5#36- %$#\-%#$%*-3/,,-12-2%J/*%@-9-6%f < !"-%$+,46-%"+$%;--1%$Y7+$"-2%+12%2#$#15-C*+5-2%+12%1/%6/1C-*%6//0$%6#0-%#5$%/*#C#1+6%$5+5-%."-1%5"-%J/*0%#$%6#J5-2% !"-%$+,46-%3+1%;-%-+$#6D%;*/0-1%+4+*5%7$#1C%3"/4$5#30$%.#5"%,#1#,+6%4*-$$7*->% !"-%$+,46-%;*-+0$%+4+*5%3/,46-5-6D%;D%*7 ;;#1C%5"-%$+,46-%; "-%5"7,;%+12%#12-a%J#1C-*%+12%2/-$%1/5%* -57*1%5/%#5$%#1#5#+6%$"+4->% b*%#5%"+$%,-65-2%$#C1#J#3+156D%+12%1/%6/ 1C-*%6//0$%6#0-%#5$%/*#C#1+6%$5+5-%M->C> %#3-%3"#4$O>%%%%%%%%%%%%%)757*-%$572#-$% )7*5"-*%./*0%#$%*-Y7#*-2%5/%2-9-6/4%+1%# 1-a4-1$#9-%;75%+337*+5-%5//6%5/%+$$#$5%. #5"%J//2%5-a57*-%+1+6D$#$>%!!"7,;%1+#6%; 6+13"-2%5/%."#5-%(+,46-%$Y7+$"-$%+12%J*+ 357*-$F%+12%2/-$%1/5%*-57*1%5/%#5$%/*#C# 1+6%$"+4-%."-1%4*-$$7*-%#$%*-6-+$-2! :446D%H%,6%/J%.+5-*%5/%$+,46-% K+#5%H%,#175-% ):-4.

9 +70<)=*0051>>/::</?-@ @C>D1)!&''(&%!-$5#1C%E-5"/2$%!&''(&%[9#2-13 -%!&''(&%)*-Y7-156D%:$0-2%j7-$5#/1$%M):j $O%!The IDDSI Framework and Descriptors are licensed under the CreativeCommons Attribution- Sharealike International License March 4, 2017 11 References Ashida I, Iwamori H, Kawakami SY, Miyaoka Y, Murayama A. Analysis of physiological parameters of masseter muscle activity during chewing of agars in healthy young males. J Texture Stud. 2007;38:87 99. Atherton M, Bellis- Smith N, Cichero JAY, Suter M. Texture modified foods and thickened fluids as used for individuals with dysphagia: Australian standardised labels and definitions. Nutr Diet. 2007;64:53 76. Berzlanovich AM, Muhm M, Sim E et al.]

10 Foreign body asphyxiation an autopsy study. Am J Med 1999;107: 351 5. Centre for Disease Control and Prevention. Non- fatal choking related episodes among children, United States 2001. Morb Mortal Wkly Rep. 2002; 51: 945 8. Chapin MM, Rochette LM, Abnnest JL, Haileyesus, Connor KA, Smith GA. Nonfatal choking on food among children 14 years or younger in the United States, 2001- 2009,Pediatrics. 2013; 132:275- 281. Cichero JAY, Steele CM, Duivestein J, Clave P, Chen J, Kayashita J, Dantas R, Lecko C, Speyer R, Lam P. The need for international terminology and definitions for texture modified foods and thickened liquids used in dysphagia management: foundations of a global initiative.