Nutrition and Kidney Stone Disease

The prevalence of kidney stone disease is increasing worldwide. The recurrence rate of urinary stones is estimated to be up to 50%. Nephrolithiasis is associated with increased risk of chronic and end stage kidney disease. Diet composition is considered to play a crucial role in urinary stone formation. There is strong evidence that an inadequate fluid intake is the major dietary risk factor for urolithiasis. While the benefit of high fluid intake has been confirmed, the effect of different beverages, such as tap water, mineral water, fruit juices, soft drinks, tea and coffee, are debated. Other nutritional factors, including dietary protein, carbohydrates, oxalate, calcium and sodium chloride can also modulate the urinary risk profile and contribute to the risk of kidney stone formation. The assessment of nutritional risk factors is an essential component in the specific dietary therapy of kidney stone patients. An appropriate dietary intervention can contribute to the effective prevention of recurrent stones and reduce the burden of invasive surgical procedures for the treatment of urinary stone disease. This narrative review has intended to provide a comprehensive and updated overview on the role of nutrition and diet in kidney stone disease.     

Nutrition and the Culinary Professional

This paper discusses the results of a survey of culinary professionals taken jointly by faculty at the University of New Hampshire and members of the Educational Institute of the American Culinary Federation. The purpose was to assess the current attitudes and behavior of foodservice professionals regarding the incorporation of nutritional guidelines into their foodservice operations. An additional objective was to determine which topics, educational formats, and media choices would most likely be of value to the respondents in the future in order to meet their professional nutrition goals.     

Medical Nutrition Therapy in Adults with Chronic Kidney Disease: Integrating Evidence and Consensus into Practice for the Generalist Registered Dietitian Nutritionist

Chronic kidney disease is classified in stages 1 to 5 by the National Kidney Foundation's Kidney Disease Outcomes Quality Initiative depending on the level of renal function by glomerular filtration rate and, more recently, using further categorization depending on the level of glomerular filtration rate and albuminuria by the Kidney Disease Improving Global Outcomes initiative. Registered dietitian nutritionists can be reimbursed for medical nutrition therapy in chronic kidney disease stages 3 to 4 for specific clients under Center for Medicare and Medicaid Services coverage. This predialysis medical nutrition therapy counseling has been shown to both potentially delay progression to stage 5 (renal replacement therapy) and decrease first-year mortality after initiation of hemodialysis. The Joint Standards Task Force of the American Dietetic Association (now the Academy of Nutrition and Dietetics), the Renal Nutrition Dietetic Practice Group, and the National Kidney Foundation Council on Renal Nutrition collaboratively published 2009 Standards of Practice and Standards of Professional Performance for generalist, specialty, and advanced practice registered dietitian nutritionists in nephrology care. The purpose of this article is to provide an update on current recommendations for screening, diagnosis, and treatment of adults with chronic kidney disease for application in clinical practice for the generalist registered dietitian nutritionist using the evidence-based library of the Academy of Nutrition and Dietetics, published clinical practice guidelines (ie, National Kidney Foundation Council on Renal Nutrition, Renal Nutrition Dietetic Practice Group, Kidney Disease Outcomes Quality Initiative, and Kidney Disease Improving Global Outcomes), the Nutrition Care Process model, and peer-reviewed literature.     

Medical Nutrition Therapy for Patients with Osteoporosis

Osteoporosis is a disease of bone fragility that afflicts more than 25 million Americans and costs the economy of the United States approximately $13.8 billion per year. In addition to direct economic costs, osteoporosis frequently costs patients their independence and a decrease in quality of life. Patients with osteoporosis, particularly those with hip fractures, are often older, malnourished persons in need of nutrition assessment and intervention. Such intervention in persons with hip fractures has been shown to be effective in reducing medical costs by decreasing hospital stays and morbidity. We review here a working practice of care at our osteoporosis research center for the medical nutrition therapy of patients with osteoporosis. Medical nutrition therapy includes an evaluation of the patient's health history, social status, and nutrient intake. On the basis of the assessment, a nutrition care plan can be developed and implemented with the goals of improving clinical outcomes and the quality of life for patients and saving health care dollars. J Am Diet Assoc. 1997:97:414–417.     

原发性小肠淋巴管扩张症的营养支持治疗

目的探讨原发性小肠淋巴管扩张症营养支持治疗和综合治疗改善营养状况的方法。方法对6例临床确诊原发性小肠淋巴管扩张症发生营养不良的患者给予营养支持治疗为基础的综合治疗。结果经过充足能量、高蛋白、低脂肪、低纤维、低盐的中链甘油三酯饮食的营养支持治疗后，患者的营养状况有改善的趋势，住院阶段体重平均增加（4．5±1．9）kg，血清白蛋白由（19．8±2．9）g／L升至（32．7±2．2）g／L（P=0．056），血清总蛋白由（41．5±5．9）g／L升至（56．0±7．1）g／L（P=0．08），前白蛋白由（189．7±24．7）mg／L升至（275．3±42．8）mg／L（P=0．26）。结论以充足能量、高蛋白、低脂肪、低纤维、低盐的中链甘油三酯饮食的营养支持治疗为基础的综合治疗方法可能使原发性小肠淋巴管扩张症患者的营养状况得到改善。     

基于证据的糖尿病营养治疗推荐标准

营养治疗是糖尿病综合治疗的基础。美国糖尿病学会于2002年提出基于证据的糖尿病营养推荐量标准和治疗原则。改善患者代谢状况，包括控制体重、血糖、血脂、血压及肾功能等，是确保治疗成功的关键。