#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

A practical approach to low protein diets for patients with chronic kidney disease in Cameroon


Cameroon is a low–middle income country with a rich diversity of culture and cuisine. Chronic kidney disease (CKD) is common in Cameroon and over 80 % of patients present late for care, precluding the use of therapies such as low protein diets (LPDs) that slow its progression. Moreover, the prescription of LPDs is challenging in Cameroon because dieticians are scarce, there are no renal dieticians, and people often have to fund their own healthcare. The few nephrologists that provide care for CKD patients have limited expertise in LPD design. Therefore, only moderate LPDs of 0.6 g protein per kg bodyweight per day, or relatively mild LPDs of 0.7–0.8 g protein per kg bodyweight per day are prescribed. The moderate LPD is prescribed to patients with stage 3 or 4 CKD with non-nephrotic proteinuria, no evidence of malnutrition and no interrcurrent acute illnesses. The mild LPD is prescribed to patients with stage 3 or 4 CKD with nephrotic proteinuria, non-symptomatic stage 5 CKD patients or stage 5 CKD patients on non-dialysis treatment. In the absence of local sources of amino and keto acid supplements, traditional mixed LPDs are used. For patients with limited and sporadic access to animal proteins, the prescribed LPDs do not restrict vegetable proteins, but limit intake of animal proteins (when available) to 70 % of total daily protein intake. For those with better access to animal proteins, the prescribed LPDs limit intake of animal proteins to 50–70 % of total daily protein intake, depending on their meal plan. Images of 100 g portions of meat, fish and readily available composite meals serve as visual guides of quantities for patients. Nutritional status is assessed before LPD prescription and during follow up using a subjective global assessment and serum albumin. In conclusion, LPDs are underutilised and challenging to prescribe in Cameroon because of weakness in the health system, the rarity of dieticians, a wide diversity of dietary habits, the limited nutritional expertise of nephrologists and the unavailability of amino and keto acid supplements.

Keywords:
Low protein diets, Chronic kidney disease, Cameroon, Africa


Autoři: Gloria Enow Ashuntantang 1*;  Hermine Fouda 2;  Francois Folefack Kaze 3;  Marie-Patrice Halle 4;  Crista Tabi-Arrey 5;  Magloire Biwole-Sida 6
Působiště autorů: Yaounde General Hospital & Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon. 1;  Douala General Hospital & Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon. 2;  University Teaching Hospital Yaounde & Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon. 3;  Douala General Hospital & Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon. 4;  Yaounde Central Hospital, Yaounde, Cameroon. 5;  Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon. 6
Vyšlo v časopise: BMC Nefrol 2016, 17:126
Kategorie: Correspondence
prolekare.web.journal.doi_sk: https://doi.org/10.1186/s12882-016-0340-5

© 2016 The Author(s).

Open access
This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
The electronic version of this article is the complete one and can be found online at: http://bmcnephrol.biomedcentral.com/articles/10.1186/s12882-016-0340-5

Souhrn

Cameroon is a low–middle income country with a rich diversity of culture and cuisine. Chronic kidney disease (CKD) is common in Cameroon and over 80 % of patients present late for care, precluding the use of therapies such as low protein diets (LPDs) that slow its progression. Moreover, the prescription of LPDs is challenging in Cameroon because dieticians are scarce, there are no renal dieticians, and people often have to fund their own healthcare. The few nephrologists that provide care for CKD patients have limited expertise in LPD design. Therefore, only moderate LPDs of 0.6 g protein per kg bodyweight per day, or relatively mild LPDs of 0.7–0.8 g protein per kg bodyweight per day are prescribed. The moderate LPD is prescribed to patients with stage 3 or 4 CKD with non-nephrotic proteinuria, no evidence of malnutrition and no interrcurrent acute illnesses. The mild LPD is prescribed to patients with stage 3 or 4 CKD with nephrotic proteinuria, non-symptomatic stage 5 CKD patients or stage 5 CKD patients on non-dialysis treatment. In the absence of local sources of amino and keto acid supplements, traditional mixed LPDs are used. For patients with limited and sporadic access to animal proteins, the prescribed LPDs do not restrict vegetable proteins, but limit intake of animal proteins (when available) to 70 % of total daily protein intake. For those with better access to animal proteins, the prescribed LPDs limit intake of animal proteins to 50–70 % of total daily protein intake, depending on their meal plan. Images of 100 g portions of meat, fish and readily available composite meals serve as visual guides of quantities for patients. Nutritional status is assessed before LPD prescription and during follow up using a subjective global assessment and serum albumin. In conclusion, LPDs are underutilised and challenging to prescribe in Cameroon because of weakness in the health system, the rarity of dieticians, a wide diversity of dietary habits, the limited nutritional expertise of nephrologists and the unavailability of amino and keto acid supplements.

Keywords:
Low protein diets, Chronic kidney disease, Cameroon, Africa


Zdroje

1. Cameroon GDP and Economic Data. Available from: https://www.gfmag.com/global-data/ 282country-data/cameroon-gdp-country-report. Accessed 27 Jan 2016.

2. Cameroon: Index-AHO. Available from http://www.aho.afro.who.int/profiles_ information/index.php/Cameroon:Index. Accessed 26 Jan 2016

3. Kaze FF, Meto DT, Halle M-P, Ngogang J, Kengne A-P. Prevalence and determinants of chronic kidney disease in rural and urban Cameroonians: a cross-sectional study. BMC Nephrol. 2015;16:117.

4. Kaze FF, Kengne AP, Choukem SP, Dzudie A, Halle MP, Dehayem MY, et al. Dialysis in Cameroon. Am J Kidney Dis. 2008;51:1072–4.

5. Halle MP, Takongue C, Kengne AP, Kaze FF, Ngu KB. Epidemiological profile of patients with end stage renal disease in a referral hospital in Cameroon. BMC Nephrol. 2015;16:59.

6. Halle MPE, Kengne AP, Ashuntantang G. Referral of patients with kidney impairment for specialist care in a developing country of sub-Saharan Africa. Ren Fail. 2009;31:341–8.

7. Mennen LI, Mbanya JC, Cade J, Balkau B, Sharma S, Chungong S, et al. The habitual diet in rural and urban Cameroon. Eur J Clin Nutr. 2000;54:150–4.

8. Nolla NP, Sop MMK, Djeukeu WA, Tetanye EA, Gouado I. Assessment of nutritional status and food consumption in Makepe Missoke, Douala, Cameroon. J Med Sci. 2013;4:1–7.

9. Elie F, Roger P, Honoris TDP, Brice DKH, Blonde TL, Bih AM, et al. Methods of preparation and nutritive value of some dishes consumed in the West Region of Cameroon. Pak J Nutr. 2009;8:1190–5.

10. Kouebou CP, Achu M, Nzali S, Chelea M, Bonglaisin J, Kamda A, et al. A review of composition studies of Cameroon traditional dishes: Macronutrients and minerals. Food Chem. 2013;140:483–94.

11. Ponka R, Fokou E, Leke R, Fotso M, Souopgui J, Achu Bih M, et al. Methods of preparation and nutritional evaluation of dishes consumed in a malaria endemic zone in Cameroon (Ngali II). Afr J Biotechnol. 2005;4:273–8.

12. Mawouma S, Ponka R, Mbofung CM. Composition of 13 different traditional sauces prepared from moringa olifera leaves in the far-north region of cameroon. Int J Innov Appl Stud. 2014;7:1129–36.

13. Ejoh RA, Nkonga DV, Inocent G, Moses MC. Nutritional components of some non-conventional leafy vegetables consumed in Cameroon. Pak J Nutr. 2007;6:712–7.

14. Bouba AA, Njintang NY, Foyet HS, Scher J, Montet D, Mbofung CMF. Proximate Composition, Mineral and Vitamin Content of Some Wild Plants Used as Spices in Cameroon. Food Nutr Sci. 2012;03:423–32.

15. Achu MB, Fokou E, Tchiégang C, Fotso M, Tchouanguep FM. Nutritive value of some Cucurbitaceae oilseeds from different regions in Cameroon. Afr J Biotechnol. 2005;4:1329–34.

16. Yadang G, Tchatchueng JB, Tchiegang C. Protein, carbohydrate, fat and energy content of “ready-to-eat foods” in Cameroonian Sahel’s region. J Food Technol. 2009;7:1–4.

17. Nkongho GO, Achidi AU, Ntonifor NN, Numfor FA, Dingha BN, Jackai LE, et al. Sweet potatoes in Cameroon: Nutritional profile of leaves and their potential new use in local foods. Afr J Agric Res. 2014;9:1371–7.

18. Ponka R, Fokou E, Fotso M, Achu MB, Tchouanguep FM, et al. Methods of preparation and the energy, protein and mineral values of three Cameroonian dishes: Corn chaff, Nnam Owondo/Ebobolo and Nnam Ngon/Ebobolo. Afr J Food Agric Nutr Dev. 2005;5:1–13.

19. Yang R-Y, Keding GB. Nutritional contributions of important African indigenous vegetables. In: Shackleton CM, Pasquini MW, Drescher AW, editors. African indigenous vegetables in urban agriculture. London: Earthscan; 2009. p. 105–44.

20. Fokou E, Achu MB. Preliminary nutritional evaluation of five species of egusi seeds in Cameroon. Afr J Food Agric Nutr Dev (AJFAND). 2004;4:1–11.

21. Sharma S, Claude Mbanya J, Cruickshank K, Cade J, Tanya AK, Cao X, et al. Nutritional composition of commonly consumed composite dishes from the Central Province of Cameroon. Int J Food Sci Nutr. 2007;58:475–85.

22. Sop MMK, Fotso M, Gouado I, Tetanye E, Zollo PA. Nutritional survey, staple foods composition and the uses of savoury condiments in Douala, Cameroon. Afr J Biotechnol. 2008;7:1339–43.

23. Koppert GJ, Dounias E, Froment A, Pasquet P. Food consumption in three forest populations of the southern coastal area of Cameroon: Yassa-Mvae- Bakola. In: Hladik CM, Hladik A, Linares O, Pagezy H, Semple A, Hadley M, editors. Tropical Forest, People and Food: Biocultural Interactions and Applications to Development. Paris: UNESCO; 1993. p. 295–310.

24. Acho-Chi C. The mobile street food service practice in the urban economy of Kumba, Cameroon. Singap J Trop Geogr. 2002;23:131–48.

25. Piccoli GB, Vigotti FN, Leone F, Capizzi I, Daidola G, Cabiddu G, et al. Lowprotein diets in CKD: how can we achieve them? A narrative, pragmatic review. Clin Kidney J. 2015;8:61–70.

Štítky
Detská nefrológia Nefrológia
Prihlásenie
Zabudnuté heslo

Zadajte e-mailovú adresu, s ktorou ste vytvárali účet. Budú Vám na ňu zasielané informácie k nastaveniu nového hesla.

Prihlásenie

Nemáte účet?  Registrujte sa

#ADS_BOTTOM_SCRIPTS#