Mineral / electrolyte diet - phosphate - low
This document is part of the ACI Diet Specifications for Adult Inpatients. It is not to be used for patient education.
Aim
To limit phosphate intake to 1200mg per day.
Characteristics
Limits foods high in phosphate.
Indications
- renal failure
- hyperphosphataemia
- secondary hyperparathyroidism
- chronic kidney disease.
Nutritional adequacy
Nutritionally adequate.
Precautions
Meat should be limited to two serves per day. Milk products should be limited to two serves per day.
Phosphate binders are usually used in conjunction with a low-phosphate diet. In some cases a low-phosphate diet is needed together with a high-protein diet, and the dietitian may then prescribe higher levels of protein foods than normally allowed on this diet (e.g. including eggs at breakfast). The specified levels of phosphate per serve for hot main dishes are a guide, but the actual content may not be known for many products and the examples of allowed and not allowed items should guide menu plans.
Paediatrics
Not suitable for use in paediatrics.
Specific menu planning guidelines
| Allowed | Not allowed | |
|---|---|---|
| Hot main dishes | < 300mg phosphate per serve (e.g. plain roasted meats, poultry, steamed fish and eggs) Limit to two serves per day | ≥ 300mg phosphate per serve (e.g. brains, liver, corned beef, crumbed fish, sardines, bacon, cheese, mornays, sausages, legumes) |
| Sauces, gravies | All others | Cheese sauces and white sauces |
| Starchy vegetables / pasta / rice | All others | Brown rice Wholemeal pasta |
| Vegetables | All others | Mixed beans Vegetables served with cheese sauce or white sauce |
| Soups | All others | Cream soups made with milk Soups with added legumes (e.g. lentil soup, minestrone) |
| Sandwiches | All breads All sandwiches < 300mg phosphate and replacing a main meal | - |
| Salads, dressings | All salads < 350mg phosphate | - |
| Breads, cereals | All breads Rice cakes Rolled oats made with water Most lower-fibre breakfast cereals (e.g. Weet-Bix™, Corn Flakes®, Rice Bubbles®) | Bran-based and high-fibre cereals Muesli Rolled oats made with milk Oat bran |
| Spreads | All others, e.g.jam, honey | Peanut butter, Vegemite™, Marmite™ |
| Hot breakfast choices | All others, e.g. eggs, creamed corn, tomatoes, mushrooms, canned spaghetti | Baked beans, sausages, bacon |
| Fruit | All other fresh and canned fruit | Dried fruit |
| Yoghurt | Yoghurt (one serve per day) | - |
| Desserts | All other desserts <70mg phosphate per serve, including ice-cream, chocolate mousse | Milk-based desserts, e.g. custards, milky rice Desserts made with dried fruit Chocolate cake or pudding Fruit cake |
| Milk and cheese | Milk for cereal, tea and coffee Cottage cheese and ricotta | All milk (including soy milk), other than for cereal, tea and coffee Semi-hard and hard cheeses |
| Beverages | All others, including coffee, tea, non-cola-based soft drinks | Milk drinks, Milo®, Aktavite®, Ovaltine®, cocoa and cola-based soft drinks |
| Biscuits | Plain refined flour biscuits (e.g. Milk Arrowroot™, Milk Coffee™) | Chocolate biscuits Wheatmeal biscuits |
| Miscellaneous | Cream, sugar, herbs and spices | Nuts, coconut, dried fruit, chocolate |
References
- Food Standards Australia New Zealand. NUTTAB Online searchable database: foods that contain phosphorus.
- Dietitians Association of Australia. Nutrition manual. 8th ed. Canberra: DAA; 2009.
- American Dietetic Association. Nutrition care manual. Chicago: ADA; 2009. [accessed 26 April 2010].
- Kariyawasam D. Phosphate management: a dietitian’s perspective. J Renal Care 2009;35 Suppl 1:79-83.
- National Kidney Foundation. K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease. Am J Kidney Dis 2003;42(4) Suppl 3:S1-201.