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An approach to protein restriction in children with renal insufficiency
N G Raymond1, J T Dwyer, P Nevins
1Frances Stern Nutrition Center, New England Medical Center Hospitals, Boston, Massachusetts 02111.
Insights
Low protein diets (LPD) may benefit children with kidney insufficiency by slowing disease progression. Careful planning, counseling, and supplements are crucial for safe LPD implementation in pediatric patients.
Area of Science:
- Pediatric Nephrology
- Nutritional Science
Background:
- Children with mild to moderate renal insufficiency face risks of glomerulosclerosis and renal failure.
- Low protein diets (LPD) show promise in animal models and adults for slowing renal disease progression.
Purpose of the Study:
- To review protein and caloric needs in growing children.
- To discuss the potential benefits and harms of LPDs in pediatric renal insufficiency.
- To explore challenges in dietary adherence and LPD design for children.
Main Methods:
- Literature review of pediatric protein and caloric requirements.
- Analysis of potential effects of LPDs on pediatric renal insufficiency.
- Discussion of practical considerations for implementing LPDs in children.
Main Results:
- LPDs may offer benefits but require careful planning and supplementation.
- Reducing protein to the recommended daily allowance (RDA) is feasible.
- Nutritional assessment, counseling, and monitoring are essential.
Conclusions:
- A carefully planned LPD, not below the RDA, can be safe for children with renal insufficiency.
- Extensive counseling, dietary supplements, and ongoing monitoring are vital.
- Successful LPD implementation requires a multidisciplinary approach.
Abstract:
Children with mild to moderate renal insufficiency may be at an increased risk for developing glomerulosclerosis and subsequent renal failure. Low protein diets (LPD) have been shown to delay the progression of renal insufficiency in laboratory animals and may be of benefit in adult humans. The nutritional costs of a LPD in adults are reportedly minimal. We review the protein and caloric requirements of growing children and discuss the potential harmful effects and benefits of an LPD in this population. We also discuss dietary adherence and the difficulty of designing an LPD for children. We conclude that the protein content of a typical American diet can safely be reduced to, but not below, the recommended daily allowance for protein if diets are carefully planned, patients and their parents extensively counseled, and if dietary supplements are given to help meet the caloric and vitamin-mineral nutrient needs of growing children. In addition, ongoing nutritional assessment, counseling, and frequent monitoring of growth, diet and biochemical indicators of protein status are essential for maintaining the health of these children.