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Kidney-Friendly Label Reading for Chronic Kidney Disease Shoppers

      Intended Audience: Chronic Kidney Disease Stages 3 to 5 Patients

      The education tool and article that follow are intended for use by chronic kidney disease (CKD) Stages 3 to 5 grocery shoppers. The article presents an overview of a handout intended to provide a nutrition education tool to assist CKD Stages 3 to 5 shoppers in shopping for kidney-friendly items. The handout may be used with CKD shopping tours and with CKD Stages 3 to 5 Medical Nutrition Therapy, in-center and home therapy dialysis. Because of the wide variation in nutrient needs for CKD Stages 3 to 5, the Kidney-Friendly Tips for Reading Food Labels for CKD shoppers is modifiable to be individualized for the specific needs of the shopping tour or for the particular CKD stage. The nutritional recommendations presented in the handout are described in the following article.

      Nutrition Facts Label Basics

      The shopper making food or beverage selections with CKD in mind needs a basic understanding of how to read a nutrition facts label. Although this aspect may be discussed in the office setting, a review or brief overview before the grocery tour can lay ground work from which the Renal Registered Dietitian Nutritionist (RDN) can build. The shopper attendee can observe the nutrition facts label, both on a nutritional education resource, such as a handout or personal computer screen, and also on actual products found on supermarket shelves. Combining traditional nutrition education with the hands-on environment where the shopper often makes decisions about product selection provides the shopper with an opportunity to implement label reading skills with guidance from the dietitian.
      • Hill L.J.
      Chronic kidney disease supermarket tours: an intervention to promote healthful food choices.
      Shopping tours done in a group atmosphere also can provide support among participants themselves as they navigate the supermarket.

      Kidney-Friendly Label Reading: Sodium

      The National Kidney Foundation recommends ≤10% Daily Value of sodium or ≤240 milligrams (mg) sodium per serving.

      National Kidney Foundation: Your guide to the new food label. 2016. Available at: http://www.kidney.org/atoz/content/foodlabel. Accessed July 17, 2017.

      The percentage based on daily value for US food labeling is 2,400 mg of sodium. The Nutrition Facts Label lists sodium in milligrams, so this is an easier nutrient to start with when counseling on label reading to build the shopper's confidence. Label claims for reduced sodium can vary widely, so it is advised that milligrams of sodium are checked on the Nutrition Facts Panel. It is also important to inform the CKD shopper that low-sodium products may have potassium chloride added to replace salt.

      National Kidney Disease Education Program: How to read a food label–Tips for people with chronic kidney disease. 2010. Available at: https://www.niddk.nih.gov/health-information/health-communication-programs/nkdep/a-z/nutrition-food-label/Documents/nutrition-food-label-508.pdf. Accessed August 1, 2017.

      The RDN should direct the shopper to check the ingredient list for sources of added potassium. If low-sodium products are not purchased, the shopper should be advised to rinse regular canned products to reduce the sodium content.

      Best Food Facts: Should you rinse canned foods. 2015. Available at: http://www.bestfoodfacts.org/question/should-you-rinse-canned-foods. Accessed September 18, 2017.

      Kidney-Friendly Label Reading: Potassium

      The National Kidney Foundation recommends ≤6% or less Daily Value of potassium or ≤200 mg of potassium per serving.

      National Kidney Foundation: Your guide to the new food label. 2016. Available at: http://www.kidney.org/atoz/content/foodlabel. Accessed July 17, 2017.

      It is critical to inform the CKD shopper that potassium is not required to be listed on the Nutrition Facts Label Panel. The CKD shopper also needs to be informed that if potassium is not listed on the Nutrition Facts Label Panel, it does not mean that potassium is not in that food, fluid, or product. The CKD shopper is always advised to check with their RDN regarding their individualized potassium needs. Potassium is sometimes listed as milligrams or percent daily value. The percentage based on daily value for US food labeling is 3,500 mg.

      Kidney-Friendly Label Reading: Phosphorus

      The National Kidney Foundation recommends ≤15% Daily Value of phosphorus or ≤150 mg per serving of phosphorus.

      National Kidney Foundation: Your guide to the new food label. 2016. Available at: http://www.kidney.org/atoz/content/foodlabel. Accessed July 17, 2017.

      It is important to convey to the CKD shopper that phosphorus is not required to be listed on the Nutrition Facts Label. Even with phosphorus unlisted on the Nutrition Facts Label Panel, it does not mean that phosphorus is not found in that food, fluid, or product. The manufacturer may elect to add percent Daily Value of phosphorus. If the percent Daily Value is listed, a helpful tip for the CKD shopper is to advise the addition of a zero to the percent Daily Value listed on the Nutrition Facts Label Panel. This tip is based on the percentage of Daily Value for the US food labeling for phosphorus of 1,000 mg. The CKD shopper should further be educated on checking the ingredients listed for PHOS words. This search is likened to doing a word search puzzle. See NKF How to Be a Phosphorous Detective for more specific details.

      National Kidney Foundation: How to be a phosphorous detective. 2017. Available at: https://www.kidney.org/newsletter/how-to-be-phosphorous-detective. Accessed August 1, 2017.

      Label Reading Recommendation for Protein

      The CKD shopper is advised to check with their RDN on their daily goal for grams of protein. While shopping, participants are instructed to check the Nutrition Facts Label for grams of protein in a serving of the selected product. Inform the CKD shopper of high-protein sources including fresh, frozen, and canned sources. This is an opportunity to reinforce differences in the lower sodium content of fresh items versus potentially higher sodium content of canned and frozen products. Review of meat serving sizes with equivalent grams of protein content is recommended for further understanding.

      The Future of the New Food Label

      On May 20, 2016, the Food and Drug Administration announced the new Nutrition Facts Label for packaged foods will reflect new scientific information, including a requirement that manufacturers must declare the actual amount, in addition to percent Daily Value of vitamin D, calcium, iron, and potassium. In addition, the footnote is changing to better explain what percent Daily Value means. It will read, “the % Daily Value tells you how much a nutrient in a serving of food contributes to a daily diet. Two thousand calories a day is used for general nutrition advice.” The bolding and/or increase of text size is planned for calories, servings per container, and serving size declarations to better highlight the information, as well as other changes to help consumers have access to the information they need for making informed food choices. On June 13, 2017, the Food and Drug Administration announced its intention to extend the compliance date for the Nutrition Facts Label final rules to provide additional time for implementation.

      U.S. Food and Drug Administration: Changes to the nutrition facts label. 2017. Available at: https://www.fda.gov/Food/GuidanceRegulation/GuidanceDocumentsRegulatoryInformation/LabelingNutrition/ucm385663.htm#dates. Accessed July 27, 2017.

      The future looks brighter for RDNs wishing to educate shoppers with CKD on self-management of their condition through proper product selection for their individual needs while grocery shopping.

      References

        • Hill L.J.
        Chronic kidney disease supermarket tours: an intervention to promote healthful food choices.
        Renal Nutr Forum. 2014; 33: 7-9
      1. National Kidney Foundation: Your guide to the new food label. 2016. Available at: http://www.kidney.org/atoz/content/foodlabel. Accessed July 17, 2017.

      2. National Kidney Disease Education Program: How to read a food label–Tips for people with chronic kidney disease. 2010. Available at: https://www.niddk.nih.gov/health-information/health-communication-programs/nkdep/a-z/nutrition-food-label/Documents/nutrition-food-label-508.pdf. Accessed August 1, 2017.

      3. Best Food Facts: Should you rinse canned foods. 2015. Available at: http://www.bestfoodfacts.org/question/should-you-rinse-canned-foods. Accessed September 18, 2017.

      4. National Kidney Foundation: How to be a phosphorous detective. 2017. Available at: https://www.kidney.org/newsletter/how-to-be-phosphorous-detective. Accessed August 1, 2017.

      5. U.S. Food and Drug Administration: Changes to the nutrition facts label. 2017. Available at: https://www.fda.gov/Food/GuidanceRegulation/GuidanceDocumentsRegulatoryInformation/LabelingNutrition/ucm385663.htm#dates. Accessed July 27, 2017.