Eating Like a Rainbow: The Development of a Visual Aid for Nutritional Treatment of CKD Patients. A South African Project.

Cecile Verseput,Giorgina Piccoli

doi:10.3390/nu9050435

Cecile Verseput, Giorgina Piccoli

Open Access

https://doi.org/10.3390/nu9050435

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Journal: Nutrients	Publication Date: Apr 28, 2017
Citations: 7	License type: CC BY 4.0

Affiliation: University of Turin, Centre Hospitalier du Mans

Abstract

Providing nutritional education for chronic kidney disease (CKD) patients in South Africa is complicated by several conditions: the population is composed of diverse ethnic groups, each with its own culture and food preferences; eleven languages are spoken and illiteracy is common in the lower socio-economic groups. Food preparation and storage are affected by the lack of electricity and refrigeration, and this contributes to a monotonous diet. In traditional African culture, two meals per day are often shared “from the pot”, making portion control difficult. There is both under- and over-nutrition; late referral of CKD is common. Good quality protein intake is often insufficient and there are several misconceptions about protein sources. There is a low intake of vegetables and fruit, while daily sodium intake is high, averaging 10 g/day, mostly from discretionary sources. On this background, we would like to describe the development of a simplified, visual approach to the “renal diet”, principally addressed to illiterate/non-English speaking CKD patients in Southern Africa, using illustrations to replace writing. This tool “Five steps to improve renal diet compliance”, also called “Eating like a Rainbow”, was developed to try to increase patients’ understanding, and has so far only been informally validated by feedback from users. The interest of this study is based on underlining the feasibility of dietary education even in difficult populations, focusing attention on this fundamental issue of CKD care in particular in countries with limited access to chronic dialysis.

Highlights

Chronic kidney disease (CKD) is highly prevalent in South Africa, a country in which there is a double burden of under- and over-nutrition [1,2,3,4]
Once CKD stage 5 is diagnosed, before considering long-term renal replacement therapy, it has to be established whether the patient is a South African citizen and is eligible for transplantation according to government regulations
Patients usually think in terms of cooked food, while dietitians think in terms of nutrients

Summary

Introduction

Chronic kidney disease (CKD) is highly prevalent in South Africa, a country in which there is a double burden of under- and over-nutrition [1,2,3,4]. Hypertension, often combined with obesity, is the major cause of CKD in South Africa; salt-sensitive primary hypertension often presents at an early age in the native African population [1,2,3,4,7]. Type 2 diabetes, often combined with hypertension and obesity, is the second cause of CKD in South Africa. HIV affects 6% of the population and contributes to HIV-associated nephropathy, another leading cause of CKD [2,8,9]. As in many African countries with high numbers of poor people, late referral of CKD is common

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