Phosphate diet - low

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

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.