Field Notes

Review Suggests Long-Term Harm of High-Protein Diets

High-protein diets may lead to long-term kidney damage among those suffering from chronic kidney disease (CKD), according to research led by nephrologist Kamyar Kalantar-Zadeh, MD, PhD, MPH, of the University of California (UC), Irvine.

The review article, “Nutritional Management of Chronic Kidney Disease,” was recently published in the New England Journal of Medicine and examines the role nutrition plays in managing CKD, a condition that affects approximately 10% of the world’s adult population. The article release coincided with the opening of the annual Kidney Week Congress, the world’s premier nephrology meeting, in New Orleans.

“The high-protein diet that has been used increasingly in recent years to control weight gain and obesity may have deleterious impacts on kidney health in the long term,” according to Kalantar-Zadeh, director of the Harold Simmons Center of Kidney Disease Research and Epidemiology, and chief of the division of nephrology and hypertension at UC Irvine School of Medicine. Colleague Denis Fouque, MD, PhD, of the University Claude Bernard Lyon in France, also contributed to this work.

CKD is defined as evidence of structural or functional renal impairment for three or more months and generally is progressive and irreversible. The potential benefits of nutritional management of the condition have remained underutilized in the United States and many other countries, according to Kalantar-Zadeh.

“There’s an exceptionally high cost and burden of maintenance dialysis therapy and kidney transplantation,” Kalantar-Zadeh says. “Thus, dietary interventions and nutritional therapy may be increasingly chosen as a management strategy for CKD, helping to increase longevity and delaying the need for the onset of dialysis for millions of people worldwide.”

The research also indicates that a low-protein, low-salt diet not only may slow the progression of CKD as an effective adjunct therapy but also can be used for the management of uremia, or high levels of urea and other uremic toxins in the blood, in late-stage or advanced CKD and help patients defer the need to initiate dialysis. (For more information, read “High-Protein Diets and Weight Loss“ in the December 2017 issue of Today’s Dietitian.)

— Source: University of California, Irvine


Moms of Obese Children Use Different Words to Restrict Eating

It’s a familiar scene at a birthday party: As a child goes back for a second cupcake or piece of cake, a parent says he or she has had enough sweets.

But the rebuke may differ family to family. In a small new study, researchers found caregivers of children with a higher weight may be more likely to use direct statements to restrict a child’s eating.

A research team led by University of Michigan C.S. Mott Children’s Hospital videotaped 237 mothers and children who were seated alone in a room and presented with different types of foods, including chocolate cupcakes. Direct commands such as “only eat one” were more often used among mothers of children with a higher weight while eating dessert, according to the findings published in the Journal of Nutrition Education and Behavior.

Meanwhile, mothers of children with a lower weight were more likely to guide children with indirect comments, such as, “That’s too much. You haven’t had dinner.”

“Current child obesity guidelines remain silent on how parents should talk to their children about limiting food intake,” says lead author Megan Pesch, MD, a developmental and behavioral pediatrician at Mott.

“There’s some conflicting advice on the best approach. On one hand, overly restricting food could backfire and actually lead to overeating. But parents also want to encourage healthful habits. We wanted to study these family dynamics to see how adults try to get kids to eat less junk food.”

Pesch notes that in most other areas of child development, such as discipline and sleep, direct and firm imperatives are linked with improved child compliance and behaviors. But when it comes to food, expert advice is more mixed.

“Indirect or subtle statements don’t seem to work as well in general parenting,” she says. “Direct messages are usually easier for kids to interpret and understand where the limits are. But there’s more sensitivity around how to talk to children about eating and weight. To our knowledge, there are also no studies that have examined the impact of parental direct imperatives in restricting a child’s intake of unhealthful food,” Pesch adds.

The study included low-income, female primary caregivers with children ranging from ages 4 to 8. Ninety-five percent of caregivers were biological mothers, with the remainder mostly including grandmothers and stepmothers.

Pesch says there’s sometimes a stereotype that parents of children with a high weight are less conscious of their child’s eating habits, but the observational study helps debunk some of those misconceptions.

“There’s often this perception that parents of children with obesity let their kids eat voraciously and don’t manage their child’s diet,” she says. “But the mothers we observed were on it. They were attentive and actively trying to get their children to eat less junk food. These mothers may be quite invested in wanting their children to have the best possible health outcomes.”

Pesch says the University of Michigan developmental and behavioral research team plans to further study what language and communication tactics are most effective in encouraging healthful eating among children.

“The finding that mothers of children with obesity used more direct imperatives to restrict eating may have important implications for practice guidelines and future research,” she says.
“Direct imperatives may in fact have a healthful, adaptive role in approaches to feeding to prevent childhood obesity, but we have to do more work to understand the nuances.”

“So many of the guidelines are focused on what not to do,” Pesch adds. “There’s a lot of emphasis on what parents shouldn’t be doing and what doesn’t work. We hope to find better answers to the ultimate question of what parents should do to help set their child up for healthful eating long term.”

— Source: Michigan Medicine — University of Michigan