Fact sheetDiet specifications

Published on 1 Nov 2012


Phosphate diet - low

This document is part of the ACI Diet Specifications for Paediatric Inpatients. It is not to be used for patient education.

Aim

To provide a diet that is low in phosphate: approximately 400-800mg per day depending on the age of the child.

Characteristics

Restricts processed meats in favour of unprocessed cuts of meat to lower phosphate intake while maintaining high biological protein sources. Restricts foods with additives high in phosphorus such as packaged foods and bakery goods. Milk cheese, soy and soy alternatives are limited to 1-2 serves per day.

High energy, nutritious foods are encouraged to help meet energy and nutrient needs.

Indications

  • haemodialysis/peritoneal dialysis
  • renal failure
  • Hyperphosphataemia
  • secondary hyperparathyroidism
  • chronic renal disease.

Nutritional adequacy

Nutritionally adequate.

Precautions

Protein intake needs to be maintained for growth requirements and increased needs due to losses for patients on dialysis. Patients requiring low phosphate tend to have poor appetite due to underlying condition. Choice of high biological value protein in place of processed products assists in meeting all nutrient goals.

Meat should be limited to 2 serves per day. Milk products should be limited to 1-2 serves per day.

Phosphate binders are usually used in conjunction with a low phosphorus diet. These need to be taken with meals and snacks containing phosphate.

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). Age of child will determine phosphate tolerance and thus restriction required.

Specific menu planning guidelines

Allowed Not allowed
Hot main dishes

<300mg phosphate per full serve

Unprocessed meats such as lamb/beef/ chicken – all roasted/grilled/braised/casseroled

Fish grilled/steamed

Canned salmon, tuna and sardines

Eggs

Legumes, baked beans

Tofu

Processed meats (e.g. bacon, corned beef/silverside, devon, frankfurts, ham, sausage, salami)

Preserved fish (e.g. smoked salmon, smoked tuna)

Offal (e.g. brains, liver)

Crumbed meats/fish/chicken

Dishes containing cheese (e.g. cheese sauce, cheese mornay, white sauce)

Sauces, gravies All others Cheese and white sauces
Starchy vegetables/pasta/rice

White rice

White pasta

Potato

Brown rice

Wholemeal pasta

Dishes with cheese or white sauce

Vegetables

All others

Legumes, baked beans

Mixed beans, mushrooms

Vegetables served with cheese or white sauce

Soups All others Cream soups made with milk
Sandwiches

All on white bread

Salad, roast meats, egg, tuna, salmon

Hard cheese limited to 20-30g per day

Wholegrain/wholemeal bread

Processed meats, smoked fish, ham

Salads, dressings

All others, including cottage cheese

Hard cheese limited to 20-30g per day

Ham, processed meats and corned beef
Breads, cereals

All white bread, rice cakes

Rolled oats made on water

Weet-Bix™

All others

Bran-based and high fibre cereals

Muesli, rolled oats made on milk

Oat bran

Spreads Margarine, butter, jam, honey Peanut butter, Vegemite™, Marmite™
Hot breakfast choices All others (e.g. egg, baked beans, creamed corn, tomato, mushrooms, canned spaghetti) Sausages, bacon
Fruit All other fresh and canned fruit Dried fruit
Yoghurt None All
Desserts All others, including ice-cream and jelly

Custard, milk puddings

Desserts made with dried fruit

Chocolate cake or pudding

Fruit cake

Bakery goods such as commercial cakes, croissants, pastries

Milk and cheese

Dairy limited to 1-2 serves per day including milk on cereal and depending on age

May include hard cheese limited to 1 serve per day (20-30g)

Cottage and ricotta cheese

Cream cheese

Cream

Custard
Beverages

All others, including non-cola based soft drinks, juice, cordial

Milk and soy beverage as part of dairy allowance (1-2 serves per day)

Milo®, Aktavite®, Ovaltine®, cocoa and cola based soft drinks
Biscuits

Plain refined flour biscuits (e.g. Milk Arrowroot™, Milk Coffee™)

Rice cakes

Chocolate biscuits, Shredded Wheatmeal™ biscuits
Miscellaneous Cream, sugar, herbs and spices Nuts, seeds, coconut, dried fruit, chocolate

References

  1. Agency for Clinical Innovation. Nutrition standards for paediatric inpatients in NSW hospitals. Sydney 2011.
  2. Agency for Clinical Innovation. Nutrition standards for adult inpatients in NSW hospitals. Sydney 2011.
  3. Dietitians Association of Australia. 2009. Nutrition Manual 8th ed. Canberra: DAA.
  4. American Dietetic Association. Paediatric Nutrition Care Manual. Chicago: ADA.
  5. Food Standards Australia New Zealand. 2010. NUTTAB 2006 Online version. Food that contain phosphorus.
  6. Kariyawasam D. Phosphate management – a dietitian’s perspective. J Renal Care 2009;35(Supp 1):79-83.
  7. 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.
  8. Heart Foundation Healthy Eating.
  9. NHMRC 2003 Dietary Guidelines for Children and Adolescents in Australia.
  10. ANZRGT evidence based practice guidelines for nutrition management of CKD in adults.
  11. Caring for Australians with Renal Impairment Guidelines.
  12. National Kidney Foundation Kidney Disease Outcome Quality Initiative.
  13. Shaw V and Lawson M. 2007. Clinical Paediatric Dietetics. 3rd Edition. Blackwell Publishing.
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