Implementing the International Dysphagia Diet Standardization Initiative Framework in Dietetic Curriculum: A Pilot Study

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Journal of the Academy of Nutrition and Dietetics







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Learning Outcome
Upon completion, participant will be able to articulate key features of the International Dysphagia Diet Standardization Initiative Framework, and how it improves upon the previously accepted National Dysphagia Diet.
Dysphagia affects 4%- 8% of the general population. Standard practice in the U.S. is based on the National Dysphagia Diet (nectar/honey/pudding thick). However, thickening liquids to subjective descriptors is difficult to do properly; incorrect thickness can lead to aspiration pneumonia. The International Dysphagia Diet Standardization Initiative (IDDSI) uses an objective, culture-neutral framework to evaluate and classify thickened liquids. Different consistencies are identified by rate of flow through a 10 ml syringe, then classified using numbers (0 for thin, up to 4 for extremely thick). IDDSI was endorsed by the Academy of Nutrition and Dietetics in January 2017. This experimental study used a convenience sample of 21 senior dietetics students to examine whether hands-on lab training (n=11) or classroom lecture (n=10) would improve students' performance in evaluating thickened liquids. The average percent of samples correctly identified in the lecture group was 61% ± 21%, and 70% ± 22% in the lab training group. No difference was found between training methods in percent of samples correctly identified (p = 0.985), or number of samples evaluated (p = 0.197). A significant relationship was found between type of liquid thickened (water, juice, or coffee) and percent correct, (p = 0.011), but the percent correct was independent of level of thickness, (p = 0.149). In this small sample, lecture and hands-on lab training were equally effective in disseminating the IDDSI guidelines. To our knowledge this is the first study to evaluate methods for implementing the newly adopted IDDSI Framework into U.S. dietetic student curriculum.

Funding Sponsor

San Jose State University Circle of Friends Research Grant


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Nutrition, Food Science and Packaging