Abstract
The use of the dietary phosphorus-to-protein ratio (PPR) to reduce dietary phosphorus while maintaining protein intake is valuable for nutritional management in the dialysis population, but the actual PPR values in hospital meals have not been determined. We aimed to determine the accuracy of a nutrient database for estimating the PPR in low-phosphate hospital diets compared with the accuracy of chemical analysis and produce hospital diets with low-phosphate content by boiling meat for 30 minutes before cooking. The phosphorus and protein content of 26 cooked dishes selected from the hospital menu was estimated using a food composition table (FCT) and sent for chemical analysis. Comparisons of FCT-based estimated values with measured values for every 100 g of tested foods revealed an overestimation for the PPR both in plant-based dishes (mean difference ± SD, 4.1 ± 14.6 mg/g, P = 0.06), and in meats (2.1 ± 2.3 mg/g, P = 0.06). By boiling meats, we crafted diets with PPR as low as 8 mg/g. Caution should be exercised in estimating the PPR using a FCT in hospital diets and boiling should be used to prepare hospital meals. Such diets will be promoted for dialysis patients in both inpatient and outpatient settings.
Highlights
There is growing evidence that eating during hemodialysis treatment can improve nutritional status, quality of life and survival[10,11]
This is the first study to assess the accuracy of nutrient database in estimating the dietary phosphorus-to-protein ratio (PPR) and produce low-phosphate hospital meals using boiling meats with PPR as low as 8 mg/g
food composition table (FCT)-based estimation for both plant-based dishes and meats overestimated the actual value of the PPR in natural foods chosen from a low-phosphate hospital menu
Summary
There is growing evidence that eating during hemodialysis treatment can improve nutritional status, quality of life and survival[10,11]. Low-phosphate hospital diet is one of the useful candidates to provide foods during hemodialysis treatment. The amount of phosphorus and the PPR of currently used low-phosphate meals for dialysis patients in our hospital are estimated based on a food composition table (FCT)[12], and their actual content has not been determined. The FCT is essential for estimating nutrient intake in clinical practice, but estimation of
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