Rheological Properties and Stability of Thickeners for Clinical Use.

The adaptation of liquids for patients with dysphagia requires precision and individualization in the viscosities used. We describe the variations of viscosity in water at different concentrations and evolution over time of the three compositions of commercial thickeners that are on the market (starch, starch with gums, and gum). By increasing the concentration in water, the viscosity of gum-based thickeners increases linearly, but it did not reach pudding texture, whereas the viscosity of the starch-based thickeners (alone or mixed with gums) rapidly reaches very thick textures. We modeled the viscosity at different concentrations of the four thickeners using regression analysis (R2 > 0.9). We analyzed viscosity changes after 6 h of preparation. The viscosity of gum-based thickeners increased by a maximum of 6.5% after 6 h of preparation, while starch-based thickeners increased by up to 43%. These findings are important for correct handling and prescription. Gum-based thickeners have a predictable linear behavior with the formula we present, reaching nectar and honey-like textures with less quantity of thickener, and are stable over time. In contrast, starch thickeners have an exponential behavior which is difficult to handle, they reach pudding-like viscosity, and are not stable over time.

Mediterranean Diet and Chronic Kidney Disease (CKD): A Practical Approach.

Chronic kidney disease has become a serious public health issue, as well as others health problems such as hypertension, DM, and obesity. Mediterranean diet (MD) can reduce the risk of cardiovascular disease and cancer and can lead to weight loss in obesity. There are studies that suggest that MD could be the diet of choice for patients with CKD for its influence on endothelial function, inflammation, lipid profile and blood pressure. There are few studies that tell us how to adapt MD to this group of patients. This review aims to offer a practical approach to Mediterranean diet adaptation as nutritional treatment in CKD patients.

Institutionalized elderly are able to detect small viscosity variations in thickened water with gum-based thickeners: should texture classifications be reviewed?

BACKGROUND: The prevalence of dysphagia is very high in institutionalized elderly. Knowledge of the rheological and sensory characteristics of the various thickeners in elderly is limited, although it has been seen that there are differences between the rheological behaviors of gum-based thickeners with different composition. Moreover, we have not found sensory studies of viscosity in institutionalized elderly. Our hypothesis was that viscosity ranges established by the scientific societies, such as the National Dysphagia Diet Task Force (NDD), seem to be very wide and individuals might be able to detect small differences within the same texture range. The objectives of our study were 1) comparing the rheological characteristics of two commercial gum-based thickeners with different composition, dissolved in water under standard conditions, and 2) perform a sensory analysis (with both adults and institutionalized elderly) to detect different viscosities within the same texture (nectar and honey). METHODS: Two commercial thickeners based on gums (NC and RC) were studied analyzing their viscosity in water with different concentrations (shear rate: 50 s- 1; temperature: 22-25 °C). A sensory analysis involving 26 elderly and 29 adult controls was carried out to evaluate whether differences within nectar and honey textures among gum-based thickeners could be distinguished. RESULTS: As the shear rate increases, viscosity decreases (non-Newtonian and pseudoplastic behavior). At the same concentration, each thickener produces a different viscosity (p < 0.05). Institutionalized elderly detected viscosity differences in nectar range of 49.9 (2.5) mPa·s (p < 0.05) and 102.2 (4.7) mPa·s (p < 0.0001). They also detected viscosity differences in honey texture range of 134.6 (9.7) mPa·s (p < 0.05) y 199.3 (9.2) mPa·s (p < 0.0001). Their caregivers also detected viscosity differences in both viscosity ranges (p < 0.0001) and with greater intensity than the elderly in honey texture (p: 0.016). CONCLUSIONS: Our results suggest that the accepted viscosity ranges by NDD for the different textures might be too wide because institutionalized elderly and their caregivers are able to discern small differences in viscosity in nectar and honey textures. Gum-based thickeners with different composition showed differences in viscosity capacity, so they are not interchangeable.

[Multidisciplinary nutritional consensus on assessment and nutritional dietary treatment in patients with chronic kidney disease and SARS-CoV-2 infection]. / Consenso multidisciplinar sobre la valoración y el tratamiento nutricional y dietético en pacientes con enfermedad renal crónica e infección por SARS-CoV-2. Consenso de nutrición en enfermedad renal crónica e infección por SARS-CoV-2.

The presence of malnutrition in patients with chronic kidney disease (CKD) is high, it can be made worse by SARS-CoV-2 infection.The nutritional assessment should be adapted to minimize the infection, recommending monitoring: weight loss percentage, body mass index (BMI), loss of appetite, analytical parameters and functional capacity using the dynamometer. As well as the sarcopenia assessment using the SCARF scale, and the possibility of using the GLIM criteria in those patients who have been tested positive by MUST.It is important to adapt the nutritional recommendations in the caloric and protein intake, to the CKD stage and to the SARS-CoV-2 infection stage. In patients with hypercatabolism, to prioritize preserving the nutritional status (35 kcal/kg weight/day, proteins up to 1.5 g/kg/day). The rest of the nutrients will be adapted to CKD stage and the analytical values.In the post-infection stage, a complete nutritional assessment is recommended, including sarcopenia. The energy and protein requirements in this phase will be adapted to the nutritional status, with special attention to the loss of muscle mass.Dietary recommendations need to be tailored to side effects of SARS-CoV-2 infection: anorexia, dysphagia, dysgeusia, and diarrhea.Anorexia and hypercatabolism makes it difficult to meet the requirements through diet, therefore the use of oral nutritional supplements is recommended as well as the enteral or parenteral nutrition in severe phases.

Impacto del consumo de alimentos ultraprocesados en la enfermedad renal crónica / Association between ultrapocessed food and chronic kidney disease

La alimentación moderna está estrechamente vinculada al consumo de alimentos procesados, originando un aumento en la ingesta de sal, azúcares simples, fósforo y potasio añadidos. Este aporte excesivo se asocia a un mayor riesgo de obesidad, diabetes, hipertensión y enfermedad renal crónica (ERC). La ERC, que según datos del estudio ENRICA afecta al 15% de la población, magnifica su repercusión por la mayor prevalencia de diabetes e hipertensión y por las limitaciones en el manejo del sodio y del fósforo. La ingesta de estos productos supera ampliamente las recomendaciones establecidas, suponiendo un 72% del sodio total, un 25-35% del fósforo, un 12-18% de potasio y más del 10% del aporte calórico en azúcares simples. Son necesarias medidas para disminuir su aporte a través de consejo nutricional, revisión del etiquetado, campañas de educación en hábitos saludables, tasas y actuaciones institucionales que impliquen a las agencias de seguridad alimentaria, industria, distribución y sociedades científicas. (AU)

The modern diet is closely linked to the consumption of processed foods, causing an increase in the intake of salt, simple sugars, phosphorus and added potassium. This excess intake is associated with an increased risk of obesity, diabetes, hypertension and chronic kidney disease (CKD). CKD, which according to data from the ENRICA study affects 15% of the population, magnifies its impact due to the higher prevalence of diabetes and hypertension and due to limitations in the management of sodium and phosphorus. The intake of these products far exceeds the established recommendations, assuming 72% of total sodium, 25-35% of phosphorus, 12-18% of potassium and exceeding 10% of the caloric intake in simple sugars. Measures are necessary to reduce their contribution through nutritional advice, labeling review, education campaigns on healthy habits, fees and institutional actions that involve food safety agencies, industry, distribution and scientific societies. (AU)

Consenso multidisciplinar sobre la valoración y el tratamiento nutricional y dietético en pacientes con enfermedad renal crónica e infección por SARS-CoV-2. Consenso de nutrición en enfermedad renal crónica e infección por SARS-CoV-2 / Multidisciplinary nutritional consensus on assessment and nutritional dietary treatment in patients with chronic kidney disease and SARS-CoV-2 infection

La presencia de malnutrición en pacientes con enfermedad renal crónica (ERC) es elevada, puede agravarse por la infección por SARS-CoV-2. La valoración nutricional se debe adaptar para minimizar contagios, recomendando monitorizar: porcentaje de pérdida de peso, índice de masa corporal (IMC), pérdida de apetito, parámetros analíticos y capacidad funcional mediante dinamometría. Así como valorar la sarcopenia mediante la escala SCARF, y la posibilidad de utilizar los criterios GLIM en aquellos pacientes que el cribado MUST ha dado positivo. Es importante adaptar las recomendaciones nutricionales en ingesta calórica y proteica, al estadio de la ERC y a la fase de infección por SARS-CoV-2. En pacientes hipercatabólicos priorizar preservar estado nutricional (35kcal/kg peso/día, proteínas hasta 1,5g/kg/día). El resto de nutrientes se adaptarán a estadio de ERC y valores analíticos. En la etapa postinfección, se recomienda realizar valoración nutricional completa, incluyendo sarcopenia. Los requerimientos energéticos y proteicos en esta fase se adaptarán a la afectación del estado nutricional, con especial atención a la pérdida de masa muscular. Es necesario adaptar las recomendaciones dietéticas a efectos secundarios de la infección por SARS-CoV-2: anorexia, disfagia, disgeusiay diarrea. La anorexia y el hipercatabolismo dificulta el cumplimiento de los requerimientos a través de la alimentación, por lo que se recomienda la utilización de soporte nutricional oral y en las fases severas la nutrición enteral o la parenteral. (AU)

The presence of malnutrition in patients with chronic kidney disease (CKD) is high, it can be made worse by SARS-CoV-2 infection. The nutritional assessment should be adapted to minimize the infection, recommending monitoring: weight loss percentage, body mass index (BMI), loss of appetite, analytical parameters and functional capacity using the dynamometer. As well as the sarcopenia assessment using the SCARF scale, and the possibility of using the GLIM criteria in those patients who have been tested positive by MUST. It is important to adapt the nutritional recommendations in the caloric and protein intake, to the CKD stage and to the SARS-CoV-2 infection stage. In patients with hypercatabolism, to prioritize preserving the nutritional status (35kcal/kg weight/day, proteins up to 1.5g/kg/day). The rest of the nutrients will be adapted to CKD stage and the analytical values. In the post-infection stage, a complete nutritional assessment is recommended, including sarcopenia. The energy and protein requirements in this phase will be adapted to the nutritional status, with special attention to the loss of muscle mass. Dietary recommendations need to be tailored to side effects of SARS-CoV-2 infection: anorexia, dysphagia, dysgeusia, and diarrhea. Anorexia and hypercatabolism makes it difficult to meet the requirements through diet, therefore the use of oral nutritional supplements is recommended as well as the enteral or parenteral nutrition in severe phases. (AU)

Multidisciplinary nutritional consensus on assessment and nutritional dietary treatment in patients with chronic kidney disease and SARS-CoV-2 infection.

The presence of malnutrition in patients with Chronic Kidney Disease (CKD) is high, it can be made worse by SARS-CoV2 infection. The nutritional assessment should be adapted to minimize the infection, recommending monitoring: weight loss percentage, body mass index (BMI), loss of appetite, analytical parameters and functional capacity using the dynamometer. As well as the sarcopenia assessment using the SCARF scale, and the possibility of using the GLIM criteria in those patients who have been tested positive by MUST. It is important to adapt the nutritional recommendations in the caloric and protein intake, to the CKD stage and to the SARS-CoV2 infection stage. In patients with hypercatabolism, to prioritize preserving the nutritional status (35 kcal/kg weight/day, proteins up to 1.5 g/kg/day). The rest of the nutrients will be adapted to CKD stage and the analytical values. In the post-infection stage, a complete nutritional assessment is recommended, including sarcopenia. The energy and protein requirements in this phase will be adapted to the nutritional status, with special attention to the loss of muscle mass. Dietary recommendations need to be tailored to side effects of SARS-CoV-2 infection: anorexia, dysphagia, dysgeusia, and diarrhea. Anorexia and hypercatabolism makes it difficult to meet the requirements through diet, therefore the use of oral nutritional supplements is recommended as well as the enteral or parenteral nutrition in severe phases.

Association between ultrapocessed food and chronic kidney disease.

The modern diet is closely linked to the consumption of processed foods, causing an increase in the intake of salt, simple sugars, phosphorus and added potassium. This excess intake is associated with an increased risk of obesity, diabetes, hypertension and chronic kidney disease (CKD). CKD, which according to data from the ENRICA study affects 15% of the population, magnifies its impact due to the higher prevalence of diabetes and hypertension and due to limitations in the management of sodium and phosphorus. The intake of these products far exceeds the established recommendations, assuming 72% of total sodium, 25%-35% of phosphorus, 12%-18% of potassium and exceeding 10% of the caloric intake in simple sugars. Measures are necessary to reduce their contribution through nutritional advice, labeling review, education campaigns on healthy habits, fees and institutional actions that involve food safety agencies, industry, distribution and scientific societies.

Recomendaciones dietéticas para pacientes con Enfermedad Renal Crónica e infección por SARS-CoV-2 / Dietary recommendations for patients with Chronic Kidney Disease and SARS-CoV-2 infection

La prevalencia de malnutrición en paciente con Enfermedad Renal Crónica es elevada, aumentando en pacientes con infección por SARS-CoV-2. La relación existente entre inflamación y nutrición es conocida en la enfermedad renal, por lo que la presencia previa de cuadros de malnutrición empeora el pronóstico de la infección. El objetivo del presente artículo es la creación de recomendaciones dietéticas específicas para pacientes con enfermedad renal crónica e infección o post-infección por SARS-CoV-2, adaptadas al estadio de enfermedad y a la etapa del proceso de infección. El abordaje nutricional comienza por la valoración del estado nutricional, para lo que se recomiendan minimizar el contacto físico mediante la utilización de los criterios Global Leadership Initiative on Malnutrition (GLIM), y el cuestionario rápido de sarcopenia (SARC-F). Las recomendaciones dietéticas deben considerar el estadio de enfermedad renal crónica, la etapa de infección por SARS-CoV-2 y las complicaciones surgidas que comprometan la ingesta oral, entre las más comunes se encuentran: anorexia, ageusia, disfagia y diarrea. En el presente documento se han elaborado tablas de raciones de ingestas diarias adaptadas a las diferentes situaciones. En aquellos pacientes que no cubran los requerimientos nutricionales se recomienda comenzar con la suplementación nutricional de manera precoz, considerando las consecuencias de la infección descrita. Debido al elevado riesgo de malnutrición en pacientes con enfermedad renal cónica e infección por SARS-CoV-2, se recomienda la adaptación de la valoración del estado nutricional y su tratamiento, así como realizar una monitorización tras la fase de infección activa

The prevalence of malnutrition in patients with Chronic Kidney Disease is high, increasing in patients with SARS-CoV-2 infection. The relationship between inflammation and nutrition in kidney disease is known, so the previous presence of malnutrition conditions worsens the prognosis of infection. The objective of this article is the creation of specific dietary recommendations for patients with chronic kidney disease and infection or post-infection by the SARS-CoV-2 virus, adapted to the stage of the disease and the stage of the infection process. The nutritional approach begins with the assessment of nutritional status, recommending minimizing physical contact through the use of the Global Leadership Initiative on Malnutrition (GLIM) criteria and the rapid sarcopenia questionnaire (SARC-F). The dietary recommendations should consider the stage of chronic kidney disease, the stage of infection by SARS-CoV-2 and the complications arising that compromise oral intake, among the most common are: anorexia, ageusia, dysphagia and diarrhea. In this document, tables of daily intakes have been prepared adapted to different situations. In those patients who do not meet the nutritional requirements, it is recommended to start with an early nutritional supplementation, considering the consequences of the infection described. Due to the high risk of malnutrition in patients with chronic kidney disease and SARS-CoV-2 infection, it is recommended to adapt the assessment of nutritional status and treatment, as well as to carry out monitoring after the active infection phase

Cooking Legumes: A Way for Their Inclusion in the Renal Patient Diet.

OBJECTIVE: It has been observed that the consumption of legumes within a varied and Mediterranean diet has beneficial effects in prevention and control of many diseases, including chronic kidney disease (CKD). Recently, legumes have also been considered a good source of protein for CKD patients. However, despite their benefits, guidelines still recommend a limit to their consumption by these patients because of legumes' high potassium and phosphorus content, which are minerals whose intake must be controlled. The aim of this work is to analyze and compare the effect of different cooking methods in the reduction and final content of minerals in legumes to evaluate a possible increase in the frequency of their consumption by CKD patients. METHODS: Dried and canned chickpeas and lentils were cooked using different cooking techniques: (1) soaking, (2) pressure cooking, and (3) normal cooking. Initial and final potassium and phosphorus content and the percentage of humidity in each cooking technique were determined in both legumes. Mineral content was analyzed using flame photometry and nitro-vanado-molybdate colorimetry. RESULTS: The results showed potassium content reductions of up to 80% after soaking and cooking with final values under 120 mg/100 g edible portion. The initial potassium content in canned legumes was low enough, 100 mg/100 g edible portion, but with the application of a subsequent culinary treatment, it was possible to leach up to 95% of the potassium to almost negligible values. Reductions in phosphorus content were not as marked as those of potassium, but culinary treatments reach a phosphorus/protein ratio,11. CONCLUSIONS: These results show that culinary processing of legumes is a very useful tool to reduce potassium and phosphorus content to acceptable levels for their consumption by renal patients, allowing an increase in intake frequency. But, this also reveals the need to update CKD dietary guidelines.

Adherence to Mediterranean Diet Pattern among Spanish Adults Attending a Medical Centre: Nondiabetic Subjects and Type 1 and 2 Diabetic Patients.

OBJECTIVE: To identify adherence to Mediterranean diet among two groups of Spanish adults: diabetic patients and nondiabetic subjects. METHODS: Adherence to Mediterranean diet was measured by a 14-item screener (scale: 0-14; ≤5: low, 6-9: moderate, and ≥10: high) in 351 volunteers. RESULTS: Mean age was 50.97 ± 12.58 in nondiabetics (n = 154) and 59.50 ± 13.34 in diabetics (n = 197). The whole sample scored 8.77 ± 1.82. Score was 9.19 ± 1.84 in nondiabetic females (n = 58) and 8.15 ± 1.79 in diabetic females (n = 85) (p = 0.003), due to lower consumption of olive oil (p = 0.005) and nuts (p = 0.000). Type 2 diabetic males (n = 79; 8.76 ± 1.88) consumed less olive oil than healthy males (n = 28; 9.36 ± 1.59) (p = 0.046). Up to 30-year-old nondiabetics scored lower than more than 60-year-old nondiabetics (8.40 ± 1.5 versus 9.74 ± 2.03; p = 0.047). The youngest ate less olive oil (p = 0.002) and more pastries (p = 0.007). CONCLUSIONS: The sample presented moderate adherence to Mediterranean diet in all subgroups. Scientific evidence about the benefits of Mediterranean diet, olive oil, and nuts supports the recommendation to increase consumption of olive oil and nuts in diabetic women and of daily olive oil in type 2 diabetic men, reducing consumption of red meat, butter, and pastries, and to promote Mediterranean diet among the youngest of the sample studied.

Reducción del contenido de potasio de las judías verdes y las acelgas mediante el procesado culinario. Herramientas para la enfermedad renal crónica / Reduction of potassium content of green bean pods and chard by culinary processing. Tools for chronic kidney disease

Introducción: Con el fin de prevenir una posible hiperpotasemia, los enfermos renales crónicos, especialmente en fases avanzadas, deben seguir una dieta baja en potasio. Para ello, las guías alimentarias para la enfermedad renal crónica recomiendan limitar el consumo de muchas verduras, así como aplicar laboriosas técnicas culinarias para reducir al máximo la cantidad de potasio. Objetivos: El objetivo de este trabajo es analizar el contenido de potasio de varios productos vegetales (frescos, congelados y en conserva), así como comprobar y comparar la efectividad en la reducción de potasio de distintos procesos culinarios, algunos de ellos recomendados en las guías alimentarias, como son el remojo o la doble cocción. Métodos: Se analizó el contenido de potasio de las muestras por triplicado mediante espectrometría de emisión atómica de llama. Resultados: Los resultados mostraron reducciones significativas en el contenido de potasio en todos los procesos culinarios estudiados. El grado de disminución varió según el tipo de verdura y el procesado al que fue sometida. En los productos congelados se alcanzaron mayores reducciones que en los frescos, y en algunos casos se lograron pérdidas de potasio superiores al 90%. Además, se observó como en muchos casos la simple aplicación de una cocción normal dio lugar a reducciones de potasio hasta niveles aceptables para la inclusión en la dieta del enfermo renal. Conclusión: Los resultados mostrados en este estudio son muy positivos, ya que aportan herramientas a los profesionales que tratan con este tipo de pacientes, lo que les permite adaptarse más fácilmente a las necesidades y preferencias de sus pacientes, así como incrementar la variedad en su dieta (AU)

Introduction: In order to prevent a possible hyperkalemia, chronic renal patients, especially in advanced stages, must follow a low potassium diet. So dietary guidelines for chronic kidney disease recommend limiting the consumption of many vegetables, as well as to apply laborious culinary techniques to maximize the reduction of potassium. Objective: The aim of this work is to analyze potassium content from several vegetable, fresh products, frozen and preserved, as well as check and compare the effectiveness in potassium reduction of different culinary processes, some of them recommended in dietary guidelines such as soaking or double cooking. Methods: Sample potassium content was analyzed by triplicate using flamephotometry. Results: The results showed significant reductions in potassium content in all culinary processes studied. The degree of loss varied depending on the type of vegetable and processing applied. Frozen products achieved greater reductions than the fresh ones, obtaining in some cases losses greater than 90%. In addition, it was observed how in many cases the single application of a normal cooking reached potassium reductions to acceptable levels for its inclusion in renal patient diet. Conclusion: The results shown in this study are very positive because they provide tools for professionals who deal with this kind of patients. They allow them to adapt more easily to the needs and preferences of their patients and increase dietary variety (AU)

Reduction of potassium content of green bean pods and chard by culinary processing. Tools for chronic kidney disease. / Reducción del contenido de potasio de las judías verdes y las acelgas mediante el procesado culinario. Herramientas para la enfermedad renal crónica.

INTRODUCTION: In order to prevent a possible hyperkalemia, chronic renal patients, especially in advanced stages, must follow a low potassium diet. So dietary guidelines for chronic kidney disease recommend limiting the consumption of many vegetables, as well as to apply laborious culinary techniques to maximize the reduction of potassium. OBJECTIVE: The aim of this work is to analyze potassium content from several vegetable, fresh products, frozen and preserved, as well as check and compare the effectiveness in potassium reduction of different culinary processes, some of them recommended in dietary guidelines such as soaking or double cooking. METHODS: Sample potassium content was analyzed by triplicate using flamephotometry. RESULTS: The results showed significant reductions in potassium content in all culinary processes studied. The degree of loss varied depending on the type of vegetable and processing applied. Frozen products achieved greater reductions than the fresh ones, obtaining in some cases losses greater than 90%. In addition, it was observed how in many cases the single application of a normal cooking reached potassium reductions to acceptable levels for its inclusion in renal patient diet. CONCLUSION: The results shown in this study are very positive because they provide tools for professionals who deal with this kind of patients. They allow them to adapt more easily to the needs and preferences of their patients and increase dietary variety.

Hidden sources of phosphorus: presence of phosphorus-containing additives in processed foods.

INTRODUCTION AND OBJECTIVES: An increased consumption of processed foods that include phosphorus-containing additives has led us to propose the following working hypothesis: using phosphate-rich additives that can be easily absorbed in processed foods involves a significant increase in phosphorus in the diet, which may be considered as hidden phosphorus since it is not registered in the food composition tables. MATERIALS AND METHOD: The quantity of phosphorus contained in 118 processed products was determined by spectrophotometry and the results were contrasted with the food composition tables of the Higher Education Centre of Nutrition and Diet, those of Morandeira and those of the BEDCA (Spanish Food Composition Database) Network. RESULTS: Food processing frequently involves the use of phosphoric additives. The products whose label contains these additives have higher phosphorus content and higher phosphorus-protein ratio. We observed a discrepancy with the food composition tables in terms of the amount of phosphorus determined in a sizeable proportion of the products. The phosphorus content of prepared refrigerated foods hardly appears in the tables. CONCLUSIONS: Product labels provide little information on phosphorus content. We observed a discrepancy in phosphorus content in certain foods with respect to the food composition tables. We should educate our patients on reviewing the additives on the labels and on the limitation of processed foods. There must be health policy actions to deal with the problem: companies should analyse the phosphorus content of their products, display the correct information on their labels and incorporate it into the food composition tables. Incentives could be established to prepare food with a low phosphorus content and alternatives to phosphorus-containing additives.

The impact of processing meat and fish products on phosphorus intake in chronic kidney disease patients.

INTRODUCTION AND OBJECTIVES: The use of phosphate additives in meat and fish processing leads to a phosphorus overload that we cannot quantify through labelling or food composition tables. We analysed this increase by measuring phosphorus content in these products by spectrophotometry. MATERIALS AND METHOD: We determined the phosphorus/protein ratio in fresh meat and fish products with varying degrees of processing by spectrophotometry (phosphorus) and the Kjeldahl method (proteins). We contrasted these results with those reflected in the food composition tables. RESULTS: The phosphorus/protein ratio was higher in processed meat products (15.83 mg/g) than in battered (11.04 mg/g) and frozen meat products (10.5mg/g), and was lower in fresh (8.41 mg/g) and refrigerated meat products (8.78 mg/g). Fresh white fish had a phosphorus/protein ratio of 8.58mg/g, while it increased by 22% (10.3mg/g) in frozen white fish and by 46% (12.54 mg/g) in battered fish. The information in the tables was poor and confusing, and no reference is made to the brands tested. CONCLUSIONS: Processing meat and fish products poses a serious obstacle to the reduction of phosphorus intake. The current regulatory framework does not assist us in the objective of reducing phosphorus additives, since it considers them safe for public consumption. Overcoming these barriers requires a coordinated effort to demonstrate that a high intake of these additives may be harmful to the general population and it should be more closely examined by regulators.