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The Diet For Chronic Kidney Disease-CKD PowerPoint Presentation

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Description : Check out this medical PowerPoint presentation titled "The Diet for Chronic Kidney Disease (CKD)”.

This medical PowerPoint presentation is about a proper diet for Chronic Kidney Disease (CKD).

Chronic Kidney Disease (CKD) is a condition that affects the kidneys ability to filter waste and excess fluids from the blood. In addition to medical treatment, following a proper diet can help manage the symptoms and slow down the progression of CKD.

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Slide 1-

Module 4: The Diet for Chronic Kidney Disease (CKD) Healthy eating patterns may be beneficial in CKD
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This professional development opportunity was created by the National Kidney Disease Education Program (NKDEP), an initiative of the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health. With the goal of reducing the burden of chronic kidney disease (CKD), especially among communities most impacted by the disease, NKDEP works in collaboration with a range of government, nonprofit, and health care organizations to: raise awareness among people at risk for CKD about the need for testing; educate people with CKD about how to manage their disease; provide information, training, and tools to help health care providers better detect and treat CKD; and support health system change to facilitate effective CKD detection and management. To learn more about NKDEP, please visit: http://www.nkdep.nih.gov. For additional materials from NIDDK, please visit: http://www.niddk.nih.gov. Slide 2 of 89
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Meet our Presenters Slide 3 of 89 Theresa A. Kuracina, M.S., R.D., C.D.E., L.N. Ms. Kuracina is the lead author of the Academy of Nutrition and Dietetics’ CKD Nutrition Management Training Certificate Program and NKDEP’s nutrition resources for managing patients with CKD. Ms. Kuracina has more than 25 years of clinical dietetics experience focused on diabetes and CKD with the Indian Health Service (IHS). Until her retirement in 2017, she served as a co-coordinator for a diabetes self-management education program at the IHS Albuquerque Indian Health Center in New Mexico. For more than 9 years, she has supported NKDEP with expertise regarding medical nutrition therapy for diabetes and CKD patients, first as a member of the NKDEP’s Coordinating Panel and more recently as a senior clinical consultant for the Program.
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Slide 4 of 89 Andrew S. Narva, M.D., F.A.C.P. Dr. Narva is the Director of the National Kidney Disease Education Program (NKDEP) at the National Institutes of Health. Prior to joining the NKDEP in 2006, he served as Director of the Kidney Disease Program for the Indian Health Service (IHS). Dr. Narva continues to serve as the Chief Clinical Consultant for Nephrology for IHS and to provide care for patients at Zuni Pueblo through a telemedicine clinic. Dr. Narva is a member of the American Board of Internal Medicine Nephrology Subspecialty Board. He has served as a member of the Eighth Joint National Committee (JNC 8) Expert Panel, the National Quality Forum Renal Steering Committee, the Kidney Disease Outcomes Quality Initiative Work Group on Diabetes in Chronic Kidney Disease, and the Medical Review Board of End Stage Renal Disease Network 15. Meet our Presenters
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Participants will be able to: Slide 5 of 89 Identify vegetables and fruits as the food groups consistently associated with positive health outcomes. Identify food preparation techniques for vegetables and fruits when hyperkalemia is present. Identify national trends in intakes of sodium and protein.
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Slide 6 of 89 Brief Review Blood pressure control may slow CKD progression. Limit sodium to 2,300 milligrams. Diabetes control early may lower CKD risk. Target A1c is individualized, based on age, comorbid conditions, and frequency of hypoglycemia. In people with lower GFRs, hypoglycemia may be a sign that kidney disease has progressed.
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Brief Review Slide 7 of 89 Urine albumin is a marker of kidney damage. Higher levels are associated with more rapid progression of CKD. Weight loss, sodium restriction, certain blood pressure medications, avoidance of excessive protein intake, and tobacco cessation may reduce urine albumin. CKD increases risk of cardiovascular disease (CVD). Nontraditional risk factors for CVD include certain complications seen in CKD including phosphate retention.
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Slide 8 of 89 Review: Complications may increase as kidney function declines
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Slide 9 of 89 HEALTHY EATING PATTERNS
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Slide 10 of 89 U.S. Healthy Eating Pattern (2015) INCLUDES Variety of vegetables (dark green, red & orange, legumes, starchy and other) Fruits, especially whole Grains, at least half whole grains Fat-free or low-fat dairy (milk, yogurt, cheese and/or fortified soy beverages) A variety of protein (seafood, lean meats, poultry, eggs, legumes and nuts, seeds and soy-products) Oils LIMITS Saturated fats Less than 10% total calories Trans fats Added sugar Less than 10% total calories Sodium Less than 2,300 milligrams/day If alcohol is consumed, consume in moderation (by adults of drinking age): Up to 1 drink/day for women Up to 2 drinks/day for men
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Slide 11 of 89 https://ndb.nal.usda.gov/ndb/ Use Food Search for an individual food Use Nutrients List for a detailed report which can include lists with Up to three nutrients for one to ten food groups in household measures. https://ndb.nal.usda.gov/ndb/nutrients/index
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Dietary carbohydrate (CHO) and protein are the nutrients used for microbiota growth and maintenance. The ratio of dietary fiber (indigestible complex CHO) to protein affects type of bacteria and resultant metabolites. Without dietary fiber, proteolytic bacteria dominate, and higher levels of potentially toxic end-products are produced. Fiber plus protein means more saccharolytic bacteria (healthier type) and more short chain fatty acids. Fiber is prebiotic = nondigestible food ingredients that benefit certain microbiota. Slide 12 of 89 What we feed the gut matters References: Sabatino et al. Curr Diab Rep 2017; 17:16; Conlon et al. Nutrients 2015;7:17-44
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Slide 13 of 89 Healthy eating patterns, food groups and impact on health outcomes Health outcomes include lower risks of obesity, cardiovascular disease, hypertension, type 2 diabetes and certain cancers Reference: USDA Scientific Report of the 2015 Dietary Guidelines
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ARIC study: High intakes of red and processed meat may increase risk of developing CKD; and nuts, low-fat dairy or legumes may lower risk (excluded DM). Haring et al. JRN 2017; 27:233-242 NIH-AARP Diet and Health Study: A healthier diet with less sodium and higher potassium was associated with reduced risk of mortality or self-reported dialysis initiation. Smyth et al. JRN 2016; 26:288-298 Healthy eating patterns with adequate vegetable and fruits and limited alcohol may delay CKD progression and improve survival. Wai et al. JRN 2017;27175-182 Meta-analysis found higher fruit and vegetable, fish, legume, whole grain and fiber intake and reduced red meat, sodium and refined sugar intake is associated with lower mortality in CKD. Kelly et al, Clin J Am Soc Nephrol 2017;12:273-279 Healthy eating patterns and kidney disease Slide 14 of 89
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Slide 16 of 89 Healthy Eating Patterns for 2,000 calories *Scientific Report DGA 2015 ** DASH diet brief
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What counts as one equivalent? Slide 17 of 89
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Dietary Reference Intake: The Essential Guide to Nutrient Requirements. http://ww.nap.edu/catalog/11537.html UL = Tolerable Upper Intake Level (highest level of nutrient intake that is likely to pose no risk of adverse health effects). RDA = Recommended Dietary Allowance (average daily intake sufficient to meet nutrient requirements for 97-98% of healthy individua ls in a group). AI = Adequate Intake (Not enough scientific evidence available to determine RDA). GOOD NEWS: Dietary Reference Intakes for chronic disease are being discussed by the National Academies of Sciences, Engineering and Medicine. Slide 18 of 89
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Slide 19 of 89 Nutrient profiles of the eating patterns Adapted from: Scientific Report of the 2015 Dietary Guidelines
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Slide 20 of 89 Nutrient digestion and absorption Food composition data provide estimates of nutrient contents in a specific amount of food. Bioavailability can be defined as the amount of a nutrient that is digested, absorbed and utilized in metabolism. Factors affecting bioavailability include individual variability, physiologic state, dose and presence of other components in the meal. Reference: Parada and Aguilera. Journal of Food Science. 2007;72:R21-R32; Palafox-Carlos et al. Journal of Food Science 2011; 76:R6-R15.
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Slide 21 of 89 Sodium is almost completely absorbed (≈ 98 percent). About 85 percent of potassium is absorbed. 55-70 percent of phosphorus is absorbed. The majority of phosphorus is absorbed passively and active absorption requires Vitamin D. Not all the minerals in food are bioavailable Reference: IOM, 1997 DRIEssentialGuideNutrientsRequirements
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Phosphorus bioavailability varies Slide 22 of 89 Phytic acid is the storage form of phosphorus found in plant seeds (beans, peas, cereals, nuts). Absorption of phytate requires phytase, found in some foods and some colonic bacteria. Phytates are thought to be poorly absorbed. Phytates in leavened whole grain breads are hydrolyzed by yeast and the phosphorus is more bioavailable than in unleavened bread or breakfast cereals. Reference: DRIEssnetialGuide Nutrients at www.nap.edu/catalog/11537.html;
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Slide 23 of 89 Urinary phosphorus excretion may differ based on food source Urinary excretion of phosphorus by source varies: ≈ 40 - 50% of plant phosphorus may be excreted ≈ 40 - 70% of animal phosphorus may be excreted Sodium-based phosphate additives may be absorbed at much higher rates (almost completely). Phosphate additives which have calcium, magnesium or aluminum may not be as readily absorbed. Phosphoric acid is absorbed. “PHOS” still identifies foods with added phosphorus; however, how much is absorbed is not known. Reference: St-Jules et al. JRN. 2017;27:78-83
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Phosphorus in foods and serum phosphorus Slide 24 of 89 References: Moore et al. Am J Clin Nutr 2015; 102:444-453. Moe et al. C J Am Soc Nephrol; Sullivan et al. JAMA 2009;301:629-635. In NHANES 2003-2006 population, Moore et al. controlled for eGFR, BMI, and UACR and found: Dairy with PHOS additives may have greater effect on serum phosphorus than with dairy without additives. Cereals and grains with PHOS additives may have greater effect than those without additives. In CKD (average GFR 32), Moe et al. found that a week of vegetarian diet led to lower serum phosphorus and decreased FGF-23 compared to the meat (casein) diet. In hemodialysis, people who read labels to avoid PHOS additives had modestly lower serum phosphorus levels.
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SODIUM Slide 25 of 89 A healthy eating pattern limits sodium to 2,300 mg a day https://health.gov/dietaryguidelines/2015/
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Slide 26 of 89 Food sources of sodium Scientific Report of the 2015 Dietary Guidelines
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Slide 27 of 89 NKDEP - Tips for Eating Right with CKD - SODIUM https://www.niddk.nih.gov/health-information/kidney-disease/chronic-kidney-disease-ckd/eating-nutrition
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Slide 28 of 89 CAUTION: Lower sodium items may use potassium chloride to replace sodium chloride Read ingredient lists on lower sodium items for potassium chloride (KCl).
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*Also Available in Spanish https://www.niddk.nih.gov/health-information/kidney-disease/chronic-kidney-disease-ckd/eating-nutrition Slide 29 of 89
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Slide 30 of 89 Potassium will be listed on new food labels. This new version was scheduled to be in place in July 2018. The FDA proposed extending compliance dates depending on manufacturer’s annual sales: > $10 million – in 2020 < $10 million – in 2021 https://www.fda.gov/downloads/food/guidanceregulation/guidancedocumentsregulatoryinformation/labelingnutrition/ucm501643.pdf
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Slide 31 of 89 https://www.fda.gov/downloads/Food/GuidanceRegulation/UCM265446.pdf UL = Tolerable Upper Intake Level (highest level of nutrient intake that is likely to pose no risk of adverse health effects). RDA = Recommended Dietary Allowance (average daily intake sufficient to meet nutrient requirements for 97-98% of healthy individuals in a group). AI = Adequate Intake (Not enough scientific evidence available to determine RDA).
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Slide 32 of 89 VEGETABLES https://health.gov/dietaryguidelines/2015-scientific-report/
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Slide 33 of 89 The eating patterns include a variety of vegetables each week One cup equivalent = 1 cup raw or cooked vegetables, 1 cup vegetable juice, 2 cups leafy salad greens, or ½ cup dried vegetable Adapted from: Scientific Report of the 2015 Dietary Guidelines
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Slide 34 of 89 Examples of vegetable subgroups
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Nutrient Profiles for vegetable subgroups Slide 35 of 89 Adapted from: www.cnpp.usda.gov/USDAFoodPatterns Consumption-weighted average nutrient content, based on NHANES 2009-2010 consumption data for 2 days of food intake
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Dark Green Vegetables Slide 36 of 89 FOOD PHOTOS https://www.choosemyplate.gov/myplate/vegetables/gallery Potassium in 1 c. raw: arugula < watercress < green leafy < romaine < mixed greens < spinach Potassium in ½ c. fresh cooked : collards < mustard < turnip < bok choy < swiss chard
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Dark Green Vegetables Slide 37 of 89 Vegetables are cooked without salt
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Red-Orange Vegetables Slide 38 of 89 FOOD PHOTOS https://www.choosemyplate.gov/myplate/vegetables/gallery
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Red-Orange Vegetables Slide 39 of 89
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Starchy Red-Orange Vegetables Slide 40 of 89
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Starchy Vegetables Slide 41 of 89 FOOD PHOTOS https://www.choosemyplate.gov/myplate/vegetables/gallery
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Starchy Vegetables Slide 42 of 89
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Slide 43 of 89 Other Vegetables
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Slide 44 of 89 Other Vegetables NAS = No Added Salt
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Slide 45 of 89 SUMMARY: Preparation may impact potassium content of vegetables Generally speaking, potassium contents vary, when cooking: Canned < boiled < baked Frozen boiled < fresh boiled Boiled < microwaved Smaller pieces < larger pieces (chopped vs. spears) Generally speaking, for raw vegetables: Smaller pieces < larger pieces (grated vs. chopped) Juice has more based on comparable serving size (how many pieces does it take to make one half cup?)
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A few tips for vegetables when someone has hyperkalemia Slide 46 of 89 Choose lower potassium vegetables. Buy frozen vegetables without added sauces or seasoning. Some frozen Asian stir fry mixes may have added soy sauce. Boil vegetables instead of microwaving them. Choose no-added salt canned vegetables, drain and rinse. Drain and rinse regular canned vegetables to lower sodium (and maybe some potassium). Top sandwiches with veggies such as green leaf lettuce, sliced cucumbers, grated carrots, and others. Add grated carrots and zucchini to meatloaf or meatballs. Top tacos with green cabbage and lettuce.
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Fruit Slide 47 of 89 https://health.gov/dietaryguidelines/2015-scientific-report/
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Healthy eating patterns include fruit; whole fruit is preferred Slide 48 of 89 Adapted from: : www.cnpp.usda.gov/USDAFoodPatterns One cup equivalent = 1 cup raw or cooked, 1 cup fruit juice, ½ cup dried fruit One-half cup has: Recommended intakes per day for selected calorie levels
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FRUIT and FIBER < 100 mg potassium per serving Slide 49 of 89 One serving: ½ cup fresh, canned, cooked or frozen (frz) or ¼ cup dried*
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Fruit and Fiber 101-200 mg potassium per serving Slide 50 of 89 Canned peaches, solids and liquids (potassium in one half cup) extra light syrup 90 mg heavy syrup 120 mg juice pack 160 mg water pack 120 mg One serving: ½ cup fresh, canned (cnd), cooked or frozen (frz)
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Fruit and Fiber201-300 mg potassium per serving Slide 51 of 89 One serving: ½ cup fresh, canned, cooked or frozen; or ¼ cup dried* 301 mg plus potassium per serving
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Size and processing makes a differencein potassium content Slide 52 of 89 PEACHES
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Slide 53 of 89 Tips for fruit when someone has hyperkalemia Choose lower potassium fruits. If a higher potassium fruit is preferred, eat a small amount. Canned fruits have less potassium than fresh. Drain and rinse. Use peeled fruit for fruit salad. Although the fruit “nectars” are lower in potassium, they have added sugar and are lower in fiber.
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Slide 54 of 89 Whole Grains
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Most “bread” has salt; phosphorus in whole grain yeast bread may be more bioavailable Slide 55 of 89
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May need to recommend different cold cereal; read the labels Slide 56 of 89 Phosphorus in plant foods not completely absorbed
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Some instant hot cereals may be higher in sodium Slide 57 of 89
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Slide 58 of 89 Dietary protein transiently increases the GFR PROTEIN
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Protein and the kidneys Slide 59 of 89 Amino acids are the source of nitrogen in the diet. We do not store extra nitrogen, the kidneys excrete excess as urea. Glucagon secretion is stimulated by dietary protein. Glucagon stimulates urea excretion by the kidneys and the GFR increases for a few hours after eating protein. Protein-rich foods are a source of phosphorus and potassium. Sulfur amino acids (in animal protein) are thought to increase acid load. For people with CKD, a lower protein diet reduces nitrogenous waste, and decrease intakes of phosphorus and potassium. Smaller amounts of animal protein may lower acid load. Reference: Bankir et al. Am J Physiol Renal Physiol. 2015;309:F2-F23.
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Which type of protein is best for CKD? Slide 60 of 89 Animal protein May contribute to acidosis (due to sulfur-amino acids) and uremic toxins in CKD. More than half of dietary phosphorus is from animal protein in our diets. High intakes of processed and red meat may be associated with CVD. Plant protein May contribute to bicarbonate levels. May be associated with fewer uremic toxins. May improve lipid levels. May be associated with lower mortality in CKD. Reference:. Chen et al. Am J Kidney Dis 2016;67:423-430.
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High protein diets are not recommended for people with CKD Slide 61 of 89 Protein contributes to phosphorus and potassium intake. Animal protein intake may increase acidemia. Most Americans eat more protein than needed, averaging 1.2 to 1.4 grams/kilogram per day. Some protein foods have salt added to them.
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Which weight should be used to estimate protein needs? Slide 62 of 89 The best weight to use in CKD is unknown. No one weight or method is best. Examples include: Ideal body weight (life insurance data) Standard body weight (NHANES data) Hamwi method (based on height and gender) Body Mass Index (BMI) Adjusted body weight: theoretical estimation using ([actual weight – ideal weight] +/- 25%); subtract in obese and add in underweight
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Use your clinical judgment Slide 63 of 89 When using current body weight you may: Overestimate dietary needs with obesity Underestimate dietary needs with underweight No adjustment method is better than any other.
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The healthy eating patterns include a variety of proteins each week Slide 64 of 89 For 2,000 calories pattern One ounce equivalent = 1 ounce lean meat, poultry or fish; 1 egg; ¼ cup cooked dry beans or tofu; 1 tablespoon peanut butter; ½ ounce nuts or seeds Adapted from: Scientific Report of the 2015 Dietary Guidelines
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Nutrient Profiles for protein subgroups Slide 65 of 89 Consumption-weighted average nutrient content, based on NHANES 2009-2010 consumption data for 2 days of food intake n3 = long chain fatty acids (such as EPA, DHA) Adapted from: www.cnpp.usda.gov/USDAFoodPatterns
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For females, most of the protein comes from meat, poultry and eggs Slide 66 of 89 Meat, Poultry, Eggs Seafood Nuts, Seeds & Soy Adapted from: health.gov/dietaryguidelines/2015/guidelines Ounce equivalents
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Many adult men eat more meat, poultry and eggs than recommended Slide 67 of 89 Adapted from: health.gov/dietaryguidelines/2015/guidelines Meat, Poultry, Eggs Seafood Nuts, Seeds & Soy
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Slide 68 of 89 Convenience items contribute to mineral intakes
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Cow’s milk has more phosphorus compared to soy; all contribute potassium Slide 69 of 89
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Slide 70 of 89 Processed cheese has more sodium than natural cheeses One ounce equivalent for dairy = 2 ounces of processed cheese or 1 ½ ounces of natural cheese
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Seafood can be part of a healthy eating pattern; intake is low for many Slide 71 of 89 www.fda.gov/downloads/Food/GuidanceRegulation/ucm063478.pdf Higher sodium choices (> 200 mg sodium/ 3 oz.) Blue crabs, lobster, oysters, scallops and shrimp Lower potassium choices (<300 mg potassium/ 3 oz.) Catfish, ocean perch, oysters and shrimp
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Source may impact nutrient content Slide 72 of 89 https://ndb.nal.usda.gov/ndb/nutrients/index
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For salmon, type and preparation may make a small difference in phosphorus Slide 73 of 89 https://ndb.nal.usda.gov/ndb/nutrients/index
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Legumes: fiber, potassium and phosphorus Slide 74 of 89 https://ndb.nal.usda.gov/ndb/nutrients/index
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Nuts and seeds: fiber, potassium and phosphorus Slide 75 of 89 https://ndb.nal.usda.gov/ndb/nutrients/index
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ACTIVITY Slide 76 of 89 Compare sodium(Na), potassium (K) and phosphorus (P) contents in one cup of various canned vegetable soups. http://www.nal.usda.gov/fnic/foodcomp/search/
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ACTIVITY: ANSWERS Slide 77 of 89 Compare sodium(Na), potassium (K) and phosphorus (P) contents in one cup of various canned vegetable soups. http://www.nal.usda.gov/fnic/foodcomp/search/
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What about beverages? Slide 78 of 89 Water should be the preferred choice. Milk and fruit juice should be consumed within recommended food group amounts and calorie needs. Beverages with added sugars should be reduced and not replaced with low-calorie versions; drink water instead. Currently, sweetened beverages account for 35% of calories from beverages in the diet. For adults who choose to drink alcohol, per day, up to 1 drink for women and up to 2 drinks for men. U.S Dietary Guidelines 2015
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Beverages may contribute to phosphorus, potassium and sodium – read ingredient list Slide 79 of 89 Nutrient analysis from USDA National Nutrient Database for Standard Reference http://ndb.nal.usda.gov/ndb/search/list
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Tips for eating healthy in CKD Slide 80 of 89 Prepare foods from scratch. Choose foods without food additives. Prepare foods without salt, and if needed, add a small amount at the table. Use liquid vegetable oil instead of solid fats. Use less meat, poultry, or fish in recipes. Increase vegetable intake.
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Online Resources including Cookbooks Slide 81 of 89
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Brief Summary Slide 82 of 89 Healthy eating patterns may be beneficial in CKD. Foods rich in fiber are important for gut health. Food composition data provide estimates about nutrient content but do not provide information about nutrient bioavailability (e.g. phosphorus). Limiting sodium is part of a healthy eating pattern. Preparation of vegetables and fruit impacts potassium content (canned < frozen < fresh). Vegetables and fruit generate bicarbonate. Foods rich in protein contribute to phosphorus and potassium intake. Some have added sodium. Animal proteins contribute to acid load.
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References Slide 83 of 89 American Dietetic Association evidence analysis library. Recommendations summary: CKD anthropometric assessment options 2010. American Dietetic Association website. https://www.andeal.org/template.cfm?template=guide_summary&key=2412&highlight=CKD&home=1 Accessed July 3, 2017. Bankir L, Roussel R, Bouby N. Protein- and diabetes-induced glomerular hyperfiltration: role of glucagon, vasopressin, and urea. American Journal of Physiology Renal Physiology. 2015;309:F2–F23. Chan M, Kelly J, Tapsell L. Dietary modeling of foods for advanced CKD based on general healthy eating guidelines: what should be on the plate? American Journal of Kidney Diseases. 2016; 69(3):436–450. Chen X, Wei G, Jalili T, et al. The associations of plant protein intake with all-cause mortality in CKD. American Journal of Kidney Diseases. 2016;67(3):423–430. Conlon MA, Bird AR. The impact of diet and lifestyle on gut microbiota and human health. Nutrients. 2015;7:17–44. Cupisti A, Kalantar-Zadeh K. Management of natural and added dietary phosphorus burden in kidney disease. Seminars in Nephrology. 2013;33(2):180-190.
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Slide 84 of 89 Haring B, Selvin E, Liang M, et al. Dietary protein sources and risk for incident chronic kidney disease: results from the atherosclerosis risk in communities (ARIC) study. Journal of Renal Nutrition. 2017; 27(4):233–242. Institute of Medicine. Dietary Reference Intakes: The Essential Guide to Nutrient Requirements. Washington, D.C.: National Academy Press; 2006. https://www.nap.edu/catalog/11537/dietary-reference-intakes-the-essential-guide-to-nutrient-requirements Accessed August 1, 2017. Kelly JT, Palmer SC, Wai SN, et al. Healthy dietary patterns and risk of mortality and ESRD in CKD: a meta-analysis of cohort studies. Clinical Journal of the American Society of Nephrology. 2017; 12: 272–279. Kelly JT, Rossi M, Johnson DW, Campbell KL. Beyond sodium, phosphate and potassium: potential dietary interventions in kidney disease. Seminars in Dialysis. 2017; 30(3): 197–202. Moe SM, Zidehsarai MP, Chambers MA, et al. Vegetarian compared with meat dietary protein sources and phosphorus homeostasis in chronic kidney disease. Clinical Journal of the American Society of Nephrology. 2011; 6: 257–264. References
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Slide 85 of 89 Moore LW, Nolte JV, Gaber AO, Suki WN. Association of dietary phosphate and serum phosphorus concentration by levels of kidney function. American Journal of Clinical Nutrition. 20015;102:444–453. Moorthi RJ, Vorland CJ, Hill Gallant KM. Diet and diabetic kidney disease: plant versus animal protein. Current Diabetes Reports. 2017;17:15. National Academies of the Sciences, Engineering, and Medicine, 2017. Guiding principles for developing dietary reference intakes for chronic disease. Washington, DC: The National Academies Press, doi:https:doi.org/10.17226.24828. Palafox-Carlos H, Ayala-Zavala JF, Gonzalez-Aguilar GA. The role of dietary fiber in the bioaccessibility and bioavailability of fruit and vegetables antioxidants. Journal of Food Science.2011; 76:R6–R15. Parada J, Aguilera JM. Food microstructure affects the bioavailability of several nutrients. Journal of Food Science. 2007;72:R21–R32. Sabatino A, Regolisti G, Cosola C, Gesualdo L, Fiaccodori E. Intestinal microbiota in type 2 diabetes and chronic kidney disease. Current Diabetes Reports. 2017;17:16. References
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Slide 86 of 89 Smyth A, Griffin M, Yusuf S, et al. Diet and major renal outcomes: a prospective cohort study. The NIH-AARP diet and health study. Journal of Renal Nutrition. 2016;26(5):288–298. St-Jules DE, Jagannathan R, Gutekunst L, Kalantar-Zadeh K, Sevick MA. Journal of Renal Nutrition. 2017; 27(20):78–83. Sullivan C, Sayre SS, Leon JB, et al. Effect of food additives on hyperphosphatemia among patients with end-stage renal disease. Journal of the American Medical Association. 2009;301(6):629–635. U.S. Department of Agriculture. Agricultural Research Service. 2016. USDA National Nutrient Database for Standard Reference, Release 28. U.S. Department of Agriculture website. https://ndb.nal.usda.gov/ndb/ United States Department of Agriculture Center for Nutrition Policy and Promotion. USDA Food Patterns. https://www.cnpp.usda.gov/sites/default/files/usda_food_patterns/NutrientProfiles.pdf References
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Slide 87 of 89 U.S. Department of Agriculture. Scientific Report of the 2015 Dietary Guidelines Advisory Committee. February 2015. https://health.gov/dietaryguidelines/2015-scientific-report/PDFs/Scientific-Report-of-the-2015-Dietary-Guidelines-Advisory-Committee.pdf U.S. Department of Health and Human Services and U.S. Department of Agriculture. 2015-2020 Dietary Guidelines for Americans 8th edition. http://health.gov/dietaryguidelines/2015/guidelines. U.S. Food and Drug Administration. Guidance for industry: a food labeling guide. 14. Appendix F: Calculate the percent daily value for the appropriate nutrients. January 2013. https://www.fda.gov/downloads/Food/GuidanceRegulation/UCM265446.pdf Accessed August 1, 2017. Wai SN, Kelly JT, Johnson DW, Campbell KL. Dietary patterns and clinical outcomes in chronic kidney disease: the CKD.QLD Nutrition study. Journal of Renal Nutrition. 2017;27(3): 175–182. References
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Slide 88 of 89 National Kidney Disease Education Program. Eating right for kidney health: Tips for people with chronic kidney disease (CKD). Revised June 2014. NIH publication 14–7405. National Kidney Disease Education Program website. https://www.niddk.nih.gov/-/media/Files/Health-Information/Communication-Programs/NKDEP/eating-right-508.pdf National Kidney Disease Education Program. How to read a food label: Tips for people with chronic kidney disease. June 2010. NIH publication 10–7407. National Kidney Disease Education Program website. https://www.niddk.nih.gov/-/media/Files/Health-Information/Communication-Programs/NKDEP/nutrition-food-label-508.pdf National Kidney Disease Education Program. Phosphorus: Tips for people with chronic kidney disease (CKD). April 2010. NIH publication 10–7407. National Kidney Disease Education Program website. https://www.niddk.nih.gov/-/media/Files/Health-Information/Communication-Programs/NKDEP/nutrition-phosphorus-508.pdf National Kidney Disease Education Program. Potassium: Tips for people with chronic kidney disease (CKD). April 2010. NIH publication 11–7407. National Kidney Disease Education Program website. https://www.niddk.nih.gov/-/media/Files/Health-Information/Communication-Programs/NKDEP/nutrition-potassium-508.pdf References
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Slide 89of 89 National Kidney Disease Education Program. Protein: Tips for people with chronic kidney disease (CKD). April 2010. NIH publication 10–7407. National Kidney Disease Education Program website. https://www.niddk.nih.gov/-/media/Files/Health-Information/Communication-Programs/NKDEP/nutrition-protein-508.pdf National Kidney Disease Education Program. Sodium: Tips for people with chronic kidney disease (CKD). June 2014. NIH publication 14–7407. National Kidney Disease Education Program website. https://www.niddk.nih.gov/-/media/Files/Health-Information/Communication-Programs/NKDEP/nutrition-sodium-508.pdf U.S. Food and Drug Administration. New Label What’s Different https://www.fda.gov/downloads/food/guidanceregulation/guidancedocumentsregulatoryinformation/labelingnutrition/ucm501643.pdf U.S. Food and Drug Administration. Seafood Nutrition Facts. January 2008. https://www.fda.gov/downloads/Food/GuidanceRegulation/ucm063478.pdf References
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