Are we forgetting the importance of a healthy diet?

Date: 06/03/2013 - Posted by By Carla M Avesani, Rio de Janeiro State University, Department of Applied Nutrition, Brazil. - 4 Comments Are we forgetting the importance of a healthy diet?

Are we forgetting the importance of a healthy diet?

By Carla M Avesani, Rio de Janeiro State University, Department of Applied Nutrition, Brazil.


The ISRNM has just published a consensus statement about the etiology of protein energy wasting (PEW) in CKD patients (J RenNutr. 2013 Mar;23(2):77-90). As a renal dietitian and clinical researcher, I believe this article describes what we face in clinical practice and research; that is, that PEW does not come solely from poor energy and protein intake, but rather from a combination of this and a catabolic state leading to a gradual loss of body weight, both fat and lean body mass.


When reading it, one sentence made me think: …“many of the restrictions in renal diets contradict current recommendation for healthy eating”.... Sometimes I do see patients on dialysis or even on pre-dialysis clinic that are given so many dietary restrictions that their diets become monotonous, lifeless and specially rather poor in nutrients. We all know what to restrict, but we do not always advice on what to consume instead. As a dietitian, I strongly believe that before advising on food restrictions we need to evaluate whether those restrictions are worth it/necessary, and if other food alternatives to palliate these restrictions are affordable, accessible and possible for the patient. In pursuing this, we need time to listen to the patient needs and food habits, as well as to listen to his/her family members. It is of high importance to know and understand the patient’s food preferences, his/her ability to cook, and if this is not possible identify and instruct the person responsible for buying and preparing such food. But again, this takes time, which is something we usually lack.


When I worked with wasted patients on hemodialysis, I got the feeling that by simply paying attention and showing interest to the patient and family members, food intake was positively impacted and I could see an improvement in boththe quality of the diet and the amount of calories and protein intake. I believe in the potential of food supplements, exercise programs and anabolic agents in the treatment of PEW. This is a very important issue that deserves appropriate research studies and more clinical evidence on its benefits. Nevertheless, sometimes we forget and/or obviate the importance of everyday food intake, the role of a healthy home cooking and how can surely not only prevent and/improve symptoms of undernutrition, but also solve, at least in part, some of the metabolic complications of CKD patients. A healthy nutrition may not be the panacea to the PEW syndrome, but a first step to its prevention and treatment. And by the way… the ISRNM statement paper is very complete and good review. It is worth reading it!


I am curious for the thoughts from the readers of this blog regarding this issue; Do we restrict without advice? Do we forget the importance of adequate nutrition in favor of artificial nutrition, commercial products and drugs? Do we have time to listen to our patients anymore?

Simple initiatives could be implemented, such as the construction of a  food pyramid directed to CKD and dialyzed patients in order to improve the quality of their diet. Does any of you have something similar in your settings?


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zeid waleed, Wednesday, March 27 2013

Cuppari Lilian, Tuesday, March 12 2013
Thanks Carla for raising this important point.
I think that the starting point is to develop or to adapt simple tools to evaluate the quality of diet and not only the amount of calories or nutrients ingested.

Ikizler Alp, Monday, March 11 2013
Carla makes an important point regarding the dietary recommendations for CKD patients. This is an excellent example where nutrition research has not been able to translate into clinical practice. CRN, ISRNM and other similar socities should take the responsibility to produce high quality practical guidelines and documents, similar to the scholarly ones already published. Please note that ISRNM is interested in any kind of collaborative writing projects.

Avesani Carla, Tuesday, March 12 2013
Dear Alp
Thank you for your comment. It would be very good to focus on guidelines devoted to clinical practice. It could be an idea for ISRNM to work on in the near future.