Vegetarian diet helps CKD patients stay healthy - The Clinical Advisor

Vegetarian diet helps CKD patients stay healthy - The Clinical Advisor

Vegan Diet for Chronic Kidney Disease in Adult Patients

VEGAN DIET FOR CHRONIC KIDNEY DISEASE IN ADULT PATIENTS

(New Nutrition Perspective on CKD in Indonesia - as an Alternative and  Challenge)

Intan Laila

Introduction.Chronic kidney disease (CKD) is defined as having some type of kidney abnormality or "marker" such as protein in the urine, and having decreased kidney function for three months or longer. There are many causes of chronic kidney disease such as diabetes and high blood pressure, glomerulonephritis, kidneystones, repeated urinary tract infection, polycystic kidney disease, drugs and toxin. Sometimes, chronic kidney disease may progress to kidney failure, which requires dialysis or kidney transplantation to maintain life. Many kidney diseases can be treated successfully. Careful control of diseases like diabetes and high blood pressure can help prevent kidney disease or keep it from getting worse. The glomerular filtration rate (GFR) is an indicator of kidney function; it estimates how well the kidneys are cleansing the blood.

Nowdays, in many countries , most of their  people  follow the food balance diet in their healthy- daily foods (consists of  carbohydrates sources, animal protein and vegetable protein sources, fats sources, vegetables and fruits sources), as in a food guidelines. In Indonesia, we called “Menu Seimbang”.  Especially for  CKD patients in Indonesia,  the standard diet  for CKD patients is using  the RDA with 35 calories/BW/day and  0.60-0.75 grams protein/BW/day , consists of 50% of  animal protein and 50% of vegetable protein.

 This article aims to review some studies comparing the different effects of vegetarian low-protein diet and animal-low protein diet on CKD.

Method. Reviews some articles and studies.

Results.Is Plant-Based Diet (Vegan Diet) safe for kidney function? There are limited studies to date comparing the different effects of animal vs vegetable protein on kidney function. However, Adam M.Bernstein, et al, in their review of literature reveals several important early findings (J Am Diet Assoc. 2007), such as a) In people with normal renal function, there are dynamic changes in renal function following consumption of a single meal high in animal protein but not after vegetable protein, b) Substitution of vegetable protein for animal protein may protect against the development of proteinuria in patients with diabetes, c) Long-term consumption of high-protein diets, composed of either predominantly animal or vegetable protein, by persons with normal renal function may cause renal injury.

Soroka N, Silverberg D, et el (1998), Department of Nephrology, Tel Aviv Medical Center, have compared the effect of a soya-based vegetarian low-protein diet and an animal-based low-protein diet in 15 patients with predialysis Chronic Renal Failure (CRF). Cupisti, et al (2002), Department of Internal Medicine, University of Pisa, Italia studied a dietary management program, consisting of the alternation between a vegetarian low-protein diet (VD) and an animal-based conventional low-protein diet (CLPD), aims to increase foods choices and to improve compliance with dietary prescriptions, psychological aspects, and the quality of life of twenty renal patients.

Is a vegan diet healthy? In fact, it was stated by the ADA (American Dietetic Association) – J Am Diet Assoc. 2009; 109:1266-128, ”It is the position of the American Dietetic Association that appropriately planned vegetarian or vegan diets are healthful, nutritionally adequate, and may provide health benefits in the prevention and treatment of certain diseases. Well-planned vegetarian diets are appropriate for individuals during all stages of the lifecycle, including pregnancy, lactation, infancy, childhood, and adolescence, and for athletes. The results of an evidence-based review showed that a vegetarian diet is associated with a lower risk of death from ischemic heart disease. Vegetarians also appear to have lower low-density lipoprotein cholesterol levels, lower blood pressure, and lower rates of hypertension and type 2 diabetes than nonvegetarians. Furthermore, vegetarians tend to have a lower body mass index and lower overall cancer rates.”

Nutrition Education is needed on how to design adequate diet, and Dietetics Counseling is strongly recommended for Chronic Kidney Disease patients at the clinics and hospitals. By Nutrition Education and Dietetics Counseling, a dietitian has responsibility to evaluate the daily food intake and body weight, nutritional status, discuss them and convey some suggestions to the doctor if it is needed; and the other hands, patients should be encouraged to  ask everything  about his/her diet in order to obtain nutritional adequacy.

The roles of the family as/and a care taker is important to prepare the meals at home and make sure that the foods can be eaten by the patients. It is also good to suggest the care taker to take a note as food diary of what foods did patient eat per day.  A varied vegan diet can meet their needs.

Conclusion.Vegan diet for CKD patients could be as an alternative diet and on the other hands, it will be as a challenge for the health professionals, especially the doctors and Indonesian dietitians at the clinics and hospitals and the experts who concern about vegan, as well.       

Future studies should continue to explore differences between animal and vegetable protein on renal function among in and out- patients, especially in Indonesia. Areas for investigation may include the long-term effects of exclusively vegetarian diets, especially vegan diet on CKD. Furthermore, studies in human beings of the adequacy of vegetable protein diets for people with Chronic Kidney Disease will also be benefit.      

                                                                                                                        

Patients’ Satisfaction Level on Nutrition Service Quality based on Five Quality Dimensions

Patients’ Satisfaction Level on  Nutrition Service Quality based on Five Quality Dimensions (Tangibles, Reliability, Responsiveness, Assurance, and Empathy) at X Hospital, Jakarta, Indonesia

I. Laila

Dietitian

ABSTRACT

The purpose of this study is to evaluate inpatients’ satisfaction level on quality of nutrition service. The study was held at the third class wards of X Hospital on June 2006. Using a Servqual method by Parasuraman, the variables used to measure the nutrition service quality were based on five quality dimensions (tangibles, reliability, responsiveness, assurance, and empathy).

This study was conducted to 98 respondents. It is a quantitative cross sectional design and data used in this study was a primary data.

The results of this study showed that the mean of total inpatients’ satisfaction on nutrition service quality was 85.49%, while the mean of general inpatients’ satisfaction on nutrition service quality was 67.4%. There was a relationship with different strength association between each quality dimension towards general inpatients’ satisfaction on nutrition service quality. Empathy was the most dominant dimension factor correlated to overall satisfaction. Educational background, one of respondent’s characteristics, was a confounding factor interfered the relationship between quality dimensions and the level of overall satisfaction.

It is suggested to X hospital management and related departments to improve nutrition service quality regarding the problems and the positive things found in this study.

Key words:  Patients’ Satisfaction, Quality, Hospital Nutrition Service.