The Criteria of Thickened Liquid for Dysphagia Management in Japan

In Japan, the viscosity of thickenedliquids is different among hospitals and nursing homes. In order to standardize viscosity of thickenedliquids, the dysphagiadiet committee of the Japanese Society of DysphagiaRehabilitation developed the Japanese DysphagiaDiet 2013 (JDD2013). To decide on a definition of thickenedliquids, the committee reviewed categories from other countries. Especially, the criteria of the USA and Australia were used as references. The definition had three levels: mildly thick, moderately thick, and extremely thick. Then a sensory evaluation by health care workers was carried out to decide the viscosity range of each level, and a draft document was made. After collecting public comments, follow-up experiments using thickenedwater with thickenersusing xanthan gumwere performed, and the JDD2013 ( ThickenedLiquid) was determined. The JDD2013 ( ThickenedLiquid) evaluated the drinking properties, visual properties, and viscosity values of each level. The shear rate of 50 s−1 was adopted to measure the viscosity with a cone and plate type viscometerto duplicate the measurement criteria used by the USA. We also set the values of the JDD2013 with the Line Spread Test to promote the use of guidelines in clinical practice. We believe the JDD2013 standards help hospitals and other settings that care for people with dysphagiato use the same thickness level and the same labels. In the future, the JDD2013 levels will be compared with new international guidelines to help with international understanding of the JDD2013 levels.