Changing food supply for patients with ckd

Just as cellophane was used to make an artificial kidney in the early days, it also changed the way food items were packaged and distributed in the United States. After World War II, the boom in packaged foods stemmed largely from the widespread introduction of new transparent wrappers that kept food fresh and allowed customers to see exactly what they were purchasing. In the 1950s and 1960s, patients with kidney disease tried these new foods, but continued to prepare most meals in their home kitchens. Canned foods were utilized and many of them were preserved by the homemaker; home-baking remained popular. When patients ate in restaurants or were a guest in another's home, food was prepared fresh, using mainly fresh ingredients. Patients with kidney disease were encouraged to ask for special preparation methods when eating away from home.

In the next two decades, a large array of new items arrived on grocery store shelves and the supermarket industry flourished. Frozen food cases at stores were now filled with a large array of products. An increasing number of meals were eaten away from home, and what we know as "fast food" restaurants today increased in popularity. The sodium content of prepared foods increased, and food labeling laws were updated to make this information available to the consumer. Renal dietitians met the challenge by publishing dining out guides and organizing classes on the topic of food selection at restaurants.

In the 1990s, the American public changed their food habits, which included more restaurant meals, in-car meals, and vending machine meals and snacks. Portion sizes increased. Foods eaten at home included a large amount of commercially prepared frozen items, restaurant carryout meals, and quick-to-fix snacks. Renal dietitians were challenged to educate their patients about the nutrient content of these new foods and to try to fit them into their patient's diet. Cooking skills and home food preparation habits declined by the end of the 1990s.

As the new millennium dawned, renal dietitians were faced with new challenges. Food manufacturers increased their reliance on phosphorus-containing food additives to enhance shelf life, to further decrease cooking or preparation time, to improve food textures, and to improve flavor acceptability (52). The bioavailability of these additives is also higher than natural food sources of phosphorus. Unfortunately, there is no requirement that the phosphorus content of these products be listed on the food label. Therefore, patients with kidney disease must decipher the small print of the ingredient list to determine the suitability of a particular product. It is estimated that processed foods may contribute up to 1000 mg of phosphorus daily and this exceeds the dietary phosphorus recommendations for most patients with kidney disease. Renal dietitians continue to petition the Food and Drug Administration to make further changes in label requirements that will assist patients with CKD in making informed choices in the grocery store, especially with an increasing array of fortified and enhanced food products.

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