BACKGROUND:Chronic kidney disease (CKD) is an emerging health public problem in Brazil. Nutritional counseling with focus on protein restriction is a promising strategy to treatment of nondialysis CKD patients due its effects on slowing renal loss. However, Brazilian people have high protein intake, which is a challenge when low protein diet (LPD) should be prescribed. This review describes a practical approach to the dietetic management of nondialysis CKD patients in Brazil. DISCUSSION:Although Brazilian cuisine varies greatly by region, Brazil has current trends of incorporating Western dietary habits, including high intake of red meat. Traditional plant-based foods, such as rice and beans, are also important contributors to the high protein content to the Brazilian diet. Thus, a successful implementation of LPD requires adaptation of these dietary habits, with reduction of portion sizes and adequate food substitution options. Intensive nutritional counseling with specialized renal dietitians is also important to improve compliance to the LPD. Moreover, the precarious health system organization and economic problems are barriers to nutritional care, which could be solved with intensive and specialized perspectives of treatment. The adherence to protein restriction is important for better metabolic and clinical control of nondialysis CKD patients. Early dietetic attention, nutrition education strategies and intensive specialized nutritional counseling are essential to achieve diet habits that promote adherence to the LPD without excluding cultural characteristics of the Brazilian diet.

译文

背景:慢性肾脏病(CKD)是巴西一个新兴的健康公共问题。专注于蛋白质限制的营养咨询是治疗非透析CKD患者的一种有前途的策略,因为它对减慢肾功能有影响。但是,巴西人的蛋白质摄入量很高,这在应规定低蛋白质饮食(LPD)的情况下是一个挑战。这篇综述描述了巴西非透析CKD患者饮食管理的实用方法。
讨论:尽管巴西的美食在不同地区之间差异很大,但巴西目前有融入西方饮食习惯的趋势,包括大量摄入红肉。传统的植物性食品,例如大米和豆类,也是导致巴西饮食中蛋白质含量高的重要原因。因此,LPD的成功实施需要适应这些饮食习惯,同时减少份量和适当的食物替代选择。专门的肾脏营养师进行强化营养咨询对于提高对LPD的依从性也很重要。此外,不稳定的卫生系统组织和经济问题是营养保健的障碍,可以通过深入和专业的治疗观点来解决。坚持蛋白质限制对于非透析CKD患者更好的代谢和临床控制很重要。早期的饮食注意,营养教育策略和强化的专业营养咨询对于实现饮食习惯,促进遵守LPD的饮食习惯(不排除巴西饮食的文化特征)至关重要。

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