Send to

Choose Destination
Dysphagia. 2018 Feb;33(1):26-32. doi: 10.1007/s00455-017-9827-x. Epub 2017 Aug 30.

The Criteria of Thickened Liquid for Dysphagia Management in Japan.

Author information

Department of Molecular Nutrition, Institution of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan.
Department of Health Sciences, Prefectural University of Hiroshima, 1-1-71 Ujina-Higashi, Minami-ku, Hiroshima, 734-8558, Japan.
Department of Rehabilitation Medicine, National Center for Global Health and Medicine, Tokyo, Japan.
Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, Shizuoka, Japan.
Division of Oral Rehabilitation Medicine, Department of Special Needs Dentistry, School of Dentistry, Showa University, Tokyo, Japan.
Department of Biochemistry School of Dentistry, Showa University, Tokyo, Japan.
Faculty of Human Sciences and Design, Japan Women's University, Tokyo, Japan.
Division of Medical Nutrition, Faculty of Healthcare, Tokyo Healthcare University, Tokyo, Japan.
Department of Rehabilitation Medicine, Seirei Yokohama General Hospital, Kanagawa, Japan.
Department of Dysphasia Rehabilitation, Nihon University of Dentistry, Tokyo, Japan.
Department of Health Sciences, Prefectural University of Hiroshima, 1-1-71 Ujina-Higashi, Minami-ku, Hiroshima, 734-8558, Japan.


In Japan, the viscosity of thickened liquids is different among hospitals and nursing homes. In order to standardize viscosity of thickened liquids, the dysphagia diet committee of the Japanese Society of Dysphagia Rehabilitation developed the Japanese Dysphagia Diet 2013 (JDD2013). To decide on a definition of thickened liquids, 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 thickened water with thickeners using xanthan gum were performed, and the JDD2013 (Thickened Liquid) was determined. The JDD2013 (Thickened Liquid) 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 viscometer to 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 dysphagia to 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.


Deglutition; Deglutition disorders; Dysphagia; Swallowing; Thickened liquids; Viscosity

[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Springer
Loading ...
Support Center