I. Dietary principles of chronic kidney disease (non-dialysis patients)
1.High quality low protein diet
Low protein diet can reduce the amount of protein excreted in the urine, reduce the burden of renal protein and amino acid metabolism, delay the rate of renal decompensation and postpone the time to enter dialysis. The amount of protein intake should be determined according to age, gender, weight, height, renal function and the physiological and pathological state of the body. The protein intake should be reasonably distributed among three meals a day as much as possible, avoiding concentration on a particular meal. In the case of limiting protein intake, high quality protein should be chosen as the main protein, which contains a high proportion of essential amino acids. High quality protein mainly refers to animal protein, such as eggs, milk, lean meat, fish, shrimp and chicken, etc. Soy protein also belongs to high quality protein and can be consumed in small amounts. Rice, flour and its products, vegetables and fruits all contain a considerable amount of vegetable protein, which is low biomass protein and should be consumed as little as possible, in which case the staple food is mostly recommended to choose the wheat starch category. High-quality low-protein diet combined with compound a-keto acid preparation is currently the most important principle of dietary treatment for patients with renal insufficiency, and studies have shown that it has the effect of stabilizing renal function, improving disorders of lipid, calcium and phosphorus metabolism, and correcting abnormal amino acid metabolism. It should be noted that the compounded a-keto acid preparation contains calcium (50mg of calcium per tablet), if the dosage is large or taken simultaneously with active vitamin D, blood calcium should be monitored to prevent hypercalcemia from occurring.
2. Adequate carbohydrates
Due to the restriction of protein intake, caloric energy is mainly supplied by carbohydrates, so the carbohydrates in the diet should be raised appropriately, such as sugar foods (diabetic patients need to be restricted), in order to meet the body’s demand for caloric energy. Adequate supply of calories reduces the consumption of protein and reduces the burden on the kidneys. Insufficient caloric intake will consume body fat and even muscle tissue, leading to malnutrition. Excessive caloric intake can also lead to obesity and increased blood lipids. It is recommended that the caloric intake of patients with chronic kidney disease should be 30-35 kcal/kg?d. The weight here refers to the standard weight, standard weight = height (cm) – 105. Foods with higher caloric intake include vermicelli, vermicelli, potatoes, lotus root powder, etc.
3.Low salt diet
Patients with chronic kidney disease who do not have edema, hypertension or renal failure, generally do not need to strictly limit salt intake, 4-6g/d is appropriate, but eating should not be too salty, too spicy, to light is good, pay attention to avoid salt pickles and foods containing high alkali. Patients with nephritis edema or hypertension should limit salt intake, 2 to 3g/d is appropriate. In patients with high edema, salt intake should be controlled to less than 2g/d and gradually increased after the edema subsides. Note that even if blood pressure returns to normal, a light diet should be appropriate. When renal function is obviously declining, do not overly restrict salt intake to avoid aggravating renal declining with insufficient blood volume. Food rich in sodium are pickles, kimchi, puffed eggs, cured meat, seafood, noodles, etc.
4.Drink water properly
Patients with low urine volume, edema or cardiac insufficiency should control the amount of water intake, generally drinking 500 to 800 ml of water daily is more suitable. However, for patients with urine volume >1000 ml/d without edema, it is not appropriate to restrict water intake too much to facilitate the excretion of metabolites in the body, and orange juice, watermelon juice, orange juice, fruit water and vegetable juice can be consumed. However, the clinical condition should be closely observed and electrolytes should be checked when necessary. Patients with high blood potassium should not drink the above fruit juices.
5.Supplementation of vitamins
Patients with chronic kidney disease should eat more foods rich in vitamin A, B and C and iron-rich foods to meet the body’s needs, such as fresh green leafy vegetables, fruits and animal offal, with pig liver, eggs, tomatoes, red dates, peanuts, eggplant, fungus, watermelon, radish, cucumber, citrus, kiwi, natural fruit juices, etc., but those with high blood uric acid and blood lipids should not consume animal offal. Supplemental vitamin C is beneficial to the absorption of iron, can eat tomatoes, green leafy vegetables, fresh dates, watermelon, carrots, cucumbers, watermelon, tangerines, kiwis and natural fruit juices and other foods.
6.Low phosphorus
Chronic renal failure patients often have elevated blood phosphorus, so limiting the intake of phosphorus in the diet is extremely important to control blood phosphorus. Should develop a low-phosphorus diet program, try to avoid phosphorus-rich foods, such as yeast, whole grains, dry legumes, hard fruits, seafood, animal offal, brain marrow, etc.. Egg yolk is high in phosphorus, no more than 2 in 1 week. When cooking fish and lean meat, you can boil them in water first and then fish them out and fry them hot to reduce the phosphorus content in fish.
7, high calcium
When the kidney function is reduced, the kidney synthesis 1,25 (OH) 2D3 and phosphorus excretion ability is reduced, resulting in hypocalcemia, so chronic kidney failure patients should eat more calcium-rich foods, such as milk, sesame paste, green leafy vegetables, etc.
8.Potassium intake
When the urine volume >1000mL/d, the intake of potassium in the diet can be unrestricted. If the urine volume decreases (especially <500mL/d) then the intake of potassium in the diet should be restricted. Foods with high potassium content.
① Fruits: e.g. strawberries, bananas, dates, oranges, etc.
② Vegetables: such as kelp, nori, silver fungus, wood ear, shiitake mushroom, fresh mushroom, potato, etc.
③ Juices: such as orange juice, lemon juice, sports drinks, coffee, tea, etc.
④ Soups. In addition, when cooking, vegetables are first cut into small slices, then scalded with hot water and then fished up, then fried in oil, or mixed in oil, which can reduce the potassium content in food.
Second, the dietary principles of hemodialysis and peritoneal dialysis patients
1.Diet for hemodialysis patients
The protein intake of patients just entering hemodialysis treatment should be gradually increased from 0.5~1.0g/kg?d before dialysis to 1.2~1.5g/kg?d. The protein intake should also be adjusted according to the frequency of dialysis, if too much protein is consumed, dialysis may not achieve sufficient clearance, and further loss of residual renal function may occur. The caloric supply of hemodialysis patients should be 30-35kcal/kg?d. Calories are mainly provided by carbohydrates and fats, with attention to increasing the intake of unsaturated fatty acids and encouraging patients to use more vegetable oils to reduce atherosclerosis. The intake of water and salt should be strictly limited in hemodialysis patients. Excessive intake of water and salt may lead to edema of the limbs, poor blood pressure control, respiratory difficulties, pulmonary edema, and even life-threatening. The blood potassium of hemodialysis patients can be elevated, and high blood potassium can cause serious cardiac arrhythmias and even cardiac arrest. The diet should avoid foods containing high potassium, such as potatoes, bananas, oranges, etc. To reduce the amount of potassium in the diet, green leafy vegetables can be soaked for more than half an hour.
2, diet of peritoneal dialysis patients
The protein intake of maintenance peritoneal dialysis patients is mostly 1.2 to 1.3 g/kg?d abroad. Recent studies have shown that high protein intake that is not accompanied by a larger dialysis dose can lead to inadequate dialysis and instead fail to improve nutritional status. Studies have concluded that a protein intake of 0.8 to 1.0 g/kg?d is sufficient for patients on abdominal dialysis to maintain adequate dialysis and good nutritional status while using 6 to 8 L of dialysate per day. Patients with abdominal dialysis should also limit the intake of water and salt, and the daily salt intake should not exceed 6g. The amount of fluid intake can be determined according to the amount of fluid removed by the patient, i.e. fluid intake = urine volume + ultrafiltration volume + 500mL.
Third, the dietary principles of diabetic patients
1. Control the total daily calorie intake
Total daily calories (kJ) = standard body weight × calories needed per kilogram of body weight. Adults should have 105-126 kJ/kg?d of calories at rest, 127-147 kJ/kg?d for light physical labor, 147-168 kJ/kg?d for medium physical labor, 168 kJ/kg?d or more for heavy physical labor, and 21 kJ/kg?d for pregnant women, lactating mothers, malnourished patients and patients with wasting diseases on the basis of ideal body weight, and 21 kJ/kg?d for obese patients. 21kJ/kg?d.
2. Determine the ratio of various nutritional elements
In the daily caloric energy supply for adults with diabetes, carbohydrate accounts for 55%-60% of total calories, fat accounts for 25%-30%, and protein accounts for 15%-20% (1-1.5g/kg). To balance the diet, choose a variety of nutritionally reasonable food, must enter the cereals and potatoes, vegetables, fish, poultry and eggs, fats and oils every day, because diabetics need a more nutritious and comprehensive diet than normal people. Should choose more lean meat, poultry, and remove the outer skin and fat layer. Cooking with less oil and mainly vegetable oil, more boiling, stewing, steaming, mixing and other cooking methods, less or no frying methods. High fiber diet can increase gastrointestinal peristalsis, absorb water, laxative, increase the excretion of bile acid in the feces, lower blood cholesterol levels, and at the same time can delay the absorption of food in the gastrointestinal tract, control the magnitude of postprandial blood sugar rise, choose whole grains, whole wheat food, use coarse grains instead of refined flour and rice, must eat vegetables every day, with the leaves and stems of vegetables as the mainstay, and do not peel fruits when eating.
3.Reasonable calorie distribution
Patients with diabetes should have at least 3 meals a day, and should eat regularly and quantitatively. Patients who apply insulin or oral hypoglycemic drugs should pay more attention, otherwise they are prone to hypoglycemia, or blood sugar fluctuations. The more food you eat, the heavier the burden on your pancreas, the higher your blood sugar, and the more harmful it is to your body. The calories of three meals should be distributed by 1/3, 1/3, 1/3, or 1/5, 2/5, 2/5, and should be adjusted according to the intensity of physical work.
4.About food exchange
Food exchange is divided into 6 food groups according to the proportion of nutrients they contain, and each food group provides the same amount of calories (90 kcal), which is called 1 food exchange, i.e. each food group provides 90 kcal. 6 food groups include staple foods, vegetables, fruits, fish, meat, dairy, fats and oils. 1 staple food group includes 25 grams each of rice, noodles, dried beans and dried vermicelli. 1 serving of fresh vegetables: 500 grams of various green vegetables, eggplant, tomatoes, cucumbers, etc.; 200 to 350 grams of bell peppers, carrots, garlic; 100 grams of various root vegetables. 1 serving of fresh fruits: 200 grams of various fruits; 500 grams of watermelon. 1 serving of raw meat or eggs: 25 to 50 grams of various animal meat; 70 grams of poultry meat; 80 to 120 grams of fish and shrimp; 1 egg. 1 portion of dairy: about 170 g; 220 ml of skim milk; 240 ml of soy milk. 1 portion of fats and oils: 15 g of peanuts or walnuts; 25 g of sunflower seeds, pumpkin seeds; 40 g of watermelon seeds. By mastering food exchange portions, you can freely swap them in your daily life (between the same kind), your diet will no longer be monotonous, and you won’t have to worry about too much or too little calorie intake.
5.Diabetic nephropathy stage
From the onset of proteinuria, diabetic patients should reduce protein intake to 0.8g/kg?d. From the onset of GFR decline, a low-protein diet should be implemented with a protein intake of 0.6g/kg?d and supplementation with compounded alpha-keto acid preparations. The caloric intake of patients on low-protein diet therapy is basically similar to that of non-diabetic nephropathy. Caloric restriction is required for obese type 2 – diabetes, and the total caloric intake should be reduced by 250-500kcal/d compared to the above recommended amount until the standard weight is reached. Since protein intake (only about 10% of total calories) and fat intake (only about 30% of total calories) are both restricted, the calorie deficit can often only be supplemented by carbohydrates, and insulin should be injected if necessary to ensure carbohydrate utilization. Other nutrients are the same as those required for non-diabetic nephropathy.
Fourth, the dietary principles of gout patients
1.Limit purine intake
According to the classification of purine content in food, it can be divided into low purine food (25mg of purine per 100g of food), medium purine food (25mg-150mg of purine per 100g of food) and high purine food (150mg-1000mg of purine per 100g of food). Edible low purine foods such as rice, pasta products, milk, eggs, cola, soft drinks, soda, honey, cream, walnuts, and most vegetables such as cabbage, peppers, and onions. Moderate purine foods such as beans and products, chicken, goose, pork, beef, grass carp, carp, spinach, kelp, silver fungus, mushrooms, peanuts, cashew nuts, etc. can be consumed. Forbidden high purine foods such as soybeans, lentils, shiitake mushrooms, animal offal, thick gravy, sea fish, shellfish, sea cucumber, yeast powder, and various kinds of alcohol. Uric acid is the end product of purine metabolism. Eating large amounts of purine-containing foods can cause a rapid increase in the level of uric acid in the extracellular fluid, which is often the cause of acute attacks of gouty arthritis. However, it is not advisable to adopt a diet with strict purine restriction for a long time, because when purine restriction is applied, protein intake is also restricted, which will have an adverse effect on systemic nutrition. The normal purine intake is 600-1000 mg Md. In general, during the acute stage of gout, purine should be strictly limited to 150 mg Md or less, and foods that contain little or no purine should be used, mainly milk and its products, eggs, vegetables, fruits and fine grains. In the remission period of gout, in addition to low purine foods, foods containing medium amount of purine, such as coarse grains, beans and soy products, meat, spinach, mushrooms, etc., can be used, but in moderation, the amount of meat should not exceed 120g per day, and avoid eating too much meat in one meal. Whether in the acute or remission period, foods with high purine content should be avoided, such as animal offal, sardines, oysters, clams, small shrimps, thick gravy, hot pot soup, etc. Because purine has high hydrophilicity, 50% of purine can be dissolved in soup, so when using meat or fish food, it is recommended to cook and then discard the soup for cooking.
2.Drink water
It is advisable to drink more water in order to facilitate the discharge of uric acid.
① alkaline water is appropriate.
② Drink enough water, the daily liquid intake should reach 2500 ~ 3000mL.
③ Drinking water every day should be placed before three meals, before going to bed should also drink an appropriate amount of water.
3, eat more alkaline food, less acidic food
Eat more alkaline food, can effectively supplement calcium, potassium, magnesium, sodium, maintain the acid-base balance in the body. Alkaline foods are fresh vegetables, fruits, sweet potatoes, hair pasta products, etc. Gout patients with purine metabolism disorders, abnormally high uric acid, eating more acidic food will aggravate the disease, which is not conducive to recovery. Gout patients should not only avoid acidic food, but also acidic food, such as various kinds of meat, animal offal, seafood and vinegar, etc.
4.Limit calories
Gout patients mostly have obesity, hypertension and diabetes, etc. Gout patients with reduced glucose tolerance account for 7% to 24%, and those with hypertriglyceridemia account for 75% to 84%, so weight should be reduced and calories should be restricted, and weight should preferably be 10% to 15% lower than ideal weight; calories should be 6.28 to 7.53 MJMd depending on the condition, and weight loss should not be too fast, but should be gradual; too fast weight loss Promote fat decomposition, easy to induce acute attacks of gout.
5.Protein and fat
Moderate supply, the standard weight of protein can be supplied according to 0.8 ~ 1.0gMd, the whole day in 40 ~ 65g, mainly plant protein, animal protein can choose milk, eggs, because these substances have no cell structure, does not contain nucleoprotein, can be used within the allowed range of protein supply. Try not to choose meat, poultry, fish, etc., such as must be used, a small amount of lean meat, poultry, etc. can be boiled and discarded soup after consumption. Fat can reduce the normal excretion of uric acid, should be controlled at 50g / d.
6.Vitamins and minerals
Provide sufficient B vitamins and vitamin C. Supply more alkaline foods such as vegetables and fruits, because alkaline environment can improve the solubility of uric acid salts, and these substances are rich in vitamin C, which can promote the dissolution of uric acid salts in tissues, which is conducive to uric acid excretion. Generally eat 1000g/d of vegetables and 4 to 5 times of fruits. Gout patients often combined with hypertension and hyperlipidemia, etc., should limit sodium, to 2 to 5g / d is appropriate.
7.Prohibit stimulating food
Prohibit the use of alcohol and spicy condiments. In the past, coffee, tea and cocoa were banned because they contain caffeine, theophylline and theobromine, but caffeine, theophylline and theobromine do not produce uric acid salts in the metabolism of the body and are not deposited in the gout stone, so they can be used in moderation.