Comparison of National Dysphagia Diet and International Dysphasia Diet Standardization Initiative Levels for Thickened Drinks Prepared with a Commercial Xanthan Gum-Based Thickener Used for Patients with Dysphagia

Abstract

The thickness levels of fluids for patients with dysphagia are established according to the guidelines of the National Dysphagia Diet (NDD) and International Dysphagia Diet Standardization Initiative (IDDSI). The nectar- (level 2), honey- (level 3), and pudding-like (level 4) fluids in NDD are consistent with the mildly (level 2), moderately (level 3), and extremely (level 4) thick fluids in IDDSI, respectively. In this study, NDD levels were compared with IDDSI levels by estimating both the apparent viscosity (η_a,50) and the residual volume (mL) in the IDDSI syringe flow test of thickened drinks prepared with a commercial xanthan gum-based thickener at different concentrations (0.1∼3.1%, w/w). The concentration range of the thickener in thickened drinks at each IDDSI and NDD level increased in the following order: water> orange juice> milk. A small difference was noted in the range of thickener concentration in the same NDD and IDDSI levels for thickened milk when compared with other thickened drinks. These results indicate that the thickener concentration ranges of thickened drinks for the classification of NDD levels differed from those of IDDSI levels, and they appeared to be greatly influenced by the type of drink. These findings could provide useful information for practically indi-cating the reliable thickness levels by the IDDSI flow test in clinical practice.

Keywords: International Dysphagia Diet Standardization Initiative; National Dysphagia Diet; dysphagia; thickened drink.

Fig. 1

Comparison of National Dysphagia Diet (NDD) and International Dysphagia Diet Standardization Initiative (IDDSI) levels for drinks. Adapted from the framework of International Dysphagia Diet Standardisation Initiative (2019).

Fig. 2

Fork drip test results of the extremely thick level (level 4) in the International Dysphagia Diet Standardization Initiative for thickened drinks. (A) Water at 3.0% concentration, (B) orange juice at 2.2% concentration, and (C) milk at 1.8% concentration.