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)

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.

Is It Possible to Include Potato in the Diet of Chronic Kidney Disease Patients? New Culinary Alternatives for Limiting Potassium Content.

OBJECTIVE(S): Despite the nutritional benefits of potato tuber, patients with chronic kidney disease (CKD) should limit the consumption because of its high potassium content. Some culinary treatments have previously been suggested to reduce the final content of this mineral; however, these are either not effective enough or involve very long procedures that affect the final flavor of the food. The aim of this work was to analyze the effect of culinary treatments on the reduction in potassium content in potatoes, offering new alternatives for minimizing the final content of this mineral to allow the increase of potato intake by patients with CKD. DESIGN AND METHODS: Fresh potatoes, canned potatoes, and frozen french fried potatoes were submitted to three different culinary treatments: soaking, normal cooking, and frying. Two types of cut were studied: strips and dice. Initial and final potassium content and % humidity in each cooking treatment applied on the three types of potatoes were analyzed. Potassium content was analyzed using flame photometry. RESULTS: Results show that potato soaking was ineffective for fresh raw potato, while normal cooking achieved insufficient reduction of potassium. However, when a soaking procedure was applied after normal cooking, it was found to be possible to leach up to 70% of the potassium, to final values of under 130 mg/100 g edible portion in both cut types studied. Subsequent frying did not leach potassium but rather increased potassium content; however, without reaching the 150 mg/100 g edible portion threshold. Similar results were observed for canned potatoes and frozen french fries. CONCLUSIONS: With this new proposed culinary method, the potassium content of potatoes is reduced to an acceptable limit. Additionally, the technique maintains a low-potassium content even after frying potatoes, thus allowing potatoes to be incorporated into the CKD dietary pattern.

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.

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.