Development of the South African renal exchange lists

Objective: The objective of this developmental study was the development of renal exchange lists for the South African population with renal failure.Subjects and design: A questionnaire was circulated to South African renal dietitians to establish the format and composition of the proposed exchange lists. Foodfinder 3 was used for assessment of nutrient composition of foods; and the NRIND Food Quantities Manual was used for assessment of portion sizes. Results from the Food Consumption Study were used to identify food items frequently consumed by the South African population; and dietitians with knowledge of the eating habits of Moslem; Indian; white; black and coloured groups were consulted regarding the inclusion of cultural foods. Portion sizes were determined by protein content of foods. The preliminary exchange lists were circulated for comment and tested for a period of 1 year. Results: Many new food items were added during revision of the exchange lists. Portion sizes were adapted to be more realistic; and in some cases additional sub-groups were added. Foodfinder 3 and renal exchange list values for all food items included in the exchange lists were then compared; and this showed highly significant correlations for all nutrients concerned. There was no significant difference between mean nutrient values for the two methods; with the exception of protein; the content of which was consistently and significantly underestimated by a mean of 0.1 g per food item. This underestimation is not considered to be of clinical importance. Conclusion: In this study renal exchange lists were developed for use in South African persons with renal failure. Despite the small but significant underestimation of protein content; the lists appear to be of sufficient precision for use in clinical practice

Nutritional management of chronic renal failure by dietitians - the South African experience

Objective: The objective of this descriptive study was to assess the practices of South African dietitians regarding the dietary treatment of patients with chronic renal failure. Subjects and design: A questionnaire was mailed to 600 randomly selected dietitians registered with the Health Professions Council of South Africa. Practices were compared to international standards for pre-dialysis; haemodialysis (HD) and peritoneal dialysis (PD) patients. Results: A 26 response rate was obtained; with only 28 of these dietitians indicating that they counsel renal patients. The majority of dietitians met the international dietary recommendations; but a substantial number deviated from them. This was especially evident in PD patients; where the deviation ranged from 20 (4 dietitians) in the case of energy and phosphate; to 55 (11 dietitians) in the case of calcium. Parameters used for the assessment of nutritional status included body mass index (45of dietitians); serum albumin (44); clinical examinations (43); bioelectrical impedance (37) and diet history (36). Methods used to monitor dietary compliance included biochemistry; dietary history; anthropometric measurements and clinical investigation. The most frequently used approaches in the management of protein-energy malnutrition included supplemental drinks (86) and dietary enrichment at household level (76). Conclusion: Although the majority of dietitians met international standards for most nutrients; there was some variation and uncertainty. Ongoing education will enable South African dietitians to treat renal patients competently and with confidence