- Email: [email protected]
Where Can I Find Information on the Oxalate Content of Foods?
NEW IN REVIEW PRACTITIONER’S BOOKSHELF Food Service Manual for Health Care Institutions, Third Edition By: Ruby P. Puckett, MA, RD; San Francisco, CA: Jossey-Bass; 2004; $75.00; paperback; 784 pp; ISBN: 0-7879-6468-9 The third edition of Food Service Manual for Health Care Institutions provides the most up-to-date information on the management of daily operations in health care food service departments. The book is divided into two major categories: the management of a health care food service and the operation of a health care food service. Each chapter contains an introduction, summary, and reference list, as well as figures, tables, and Web site addresses where appropriate. Part One focuses on management, and provides specific information on leadership, marketing, quality management, planning and decision making, organization and time management, communication, human resource management, clinical nutrition care management, and management information systems. Part Two, which is greatly expanded and updated in this new edition, deals with operations and covers environmental issues and waste management; food safety, sanitation, and hazard analysis critical control points (HACCP); safety, security, and emergency preparedness; menu planning; product selection; purchasing; receiving, storage, and inventory control; food production; distribution and service; and facility
design and equipment selection. Both parts contain forms, formulas, policies, and techniques to assist anyone involved with food service in an institutional environment. Overall, Food Service Manual for Health Care Institutions offers a current and comprehensive review of both the management and operation of health care food service that is appropriate for students, directors, and managers alike.
SITES IN REVIEW National Eating Disorders Association http://www.nationaleatingdisorders.org In the United States, an estimated 10 million females and one million males are struggling with a severe eating disorder that is associated with a high mortality rate, according to the National Eating Disorders Association (NEDA). This organization also reports that these statistics are just the tip of the iceberg because millions of other Americans have anorexia or bulimia that eludes proper medical diagnosis and treatment. Established in 2001, NEDA is the largest nonprofit organization dedicated to eating disorders in the United States. The focus of its mission is the provision of materials that educate Americans about the prevention and treatment of anorexia, bulimia, and other types of disordered eating. NEDA also sponsors programs, research projects, and a tollfree helpline for individuals with eat-
ing disorders and their family members. NEDA is supported by public and corporate donations. The Web site of NEDA (available at www.nationaleatingdisorders.org) is full of resources that discuss a wide array of topics on eating disorders. In the Eating Disorders Info section of the site, over 50 different subcategories are listed that address issues related to anorexia and bulimia in males and females from childhood through adulthood, disordered eating among athletes and other special populations, health complications associated with eating disorders, and prevention strategies. Topics are written for specific target audiences: the affected individual with an eating disorder, family members, health professionals, or the general public. The material is available in both English and Spanish. The Treatment Referral section is another valued feature of the NEDA site. Nationwide inpatient/outpatient treatment centers, support groups, and research studies related to eating disorders are listed by state. Links to all treatment facilities provide a detailed description of therapy options, staffing credentials, population(s) treated, and insurance reimbursement issues. Although the NEDA Web site is dense with text, its easy navigation, relevant material, and other strengths are prized by 50 million users who visit the site each year. This site is a goldmine of timely information about eating disorders directed at the general public, press, and health professionals.
QUESTION OF THE MONTH
Where Can I Find Information on the Oxalate Content of Foods?
I
t is thought that our modern lifestyle and dietary habits promote the development of kidney stones (1). In the United States, an increase of 37% in stone disease has been observed over the last 20 years (1).
This article was written by Wendy Marcason, RD, of the ADA’s Knowledge Center Team in Chicago, IL. Contact: [email protected] doi: 10.1016/j.jada.2006.02.023
Approximately 75% of stones are made from calcium oxalate (2). Only a small amount of ingested oxalate is absorbed; approximately 6% to 14% in normal individuals. People who have hyperoxaluria—so-called “super absorbers”— can absorb 50% more oxalate than non–stone formers (2). Hyperoxaluria can be caused by genetic disorders that result in excessive endogenous production, excessive absorption caused by compromised bowel function, or from high intake of oxalate from food.
April 2006 ● Journal of the AMERICAN DIETETIC ASSOCIATION
627
NEW IN REVIEW Nutrition management is the cornerstone of any plan to reduce risk of stone formation. Up to 85% of all stone patients could lower their risk of recurrence with simple dietary and lifestyle changes (3). The following are general guidelines for reducing the risk of urolithiasis/urinary stones from the American Dietetic Association’s Nutrition Care Manual, which also includes a list of low-, moderate-, and high-oxalate foods (4): ● ●
● ● ● ● ●
Protein: normalize intake to 0.8 to 1.0 g/kg of body weight/day; not to exceed the Dietary Reference Intake Calcium: normalize intake to 800 mg/day for men; 1,200 mg/day for women; do not restrict and balance intake of calcium throughout the day Fluids: 12 to 16 cups to produce a urine volume ⬎2.5 L Oxalate: ⬍40 to 50 mg/day Sodium: lower intake to 100 to 150 mEq/day (2,300 to 3,450 mg/day) Calories: level to maintain a healthful weight Vitamin/mineral supplement: B-vitamins have not been shown to be harmful; vitamin C should be limited to the Dietary Reference Intake
The oxalate content of foods may vary depending on soil conditions, time of harvest, and processing. In addition, differences in analysis methodology also add to the complexity of determining an absolute value for a food.
References 1. Straub M, Hautmann RE. Developments in stone prevention. Curr Opin Urol. 2005;15:119-126. 2. Reynolds TM. ACP Best Practice No 181: Chemical pathology clinical investigation and management of nephrolithiasis. J Clin Pathol. 2005;58:134-140. 3. Holmes RP, Assimos DG. The impact of dietary oxalate on kidney stone formation. Urol Res. 2004;32: 311-316. Epub June 17, 2004. 4. Nutrition Care Manual. Urolithiasis/urinary stones. ADA Nutrition Care Manual. 2005. Available at: http:// www.nutritionacaremanual.org. Accessed February 2, 2006.
Additional Resources Because of the many factors that influence the oxalate content in food, there is not one best resource. The Knowledge Center has compiled a list of resources: Brzezinski E, Durning AM. The Oxalate Content of Selected Foods with Recipes and Menu Suggestions. San Diego, CA: University of California; 2002. To order call 800/520-7323. Mahan LK, Escott-Stump S. Krause’s Food, Nutrition, &
628
April 2006 Volume 106 Number 4
Diet Therapy. Philadelphia, PA: Saunders; 2004. Chart of oxalate content of foods, pp 1242-1243. Pennington JAT, Douglass JS. Bowes & Church’s Food Values of Portions Commonly Used. Baltimore, MD: Lippincott Williams & Wilkins; 2005. Chart of oxalate content of foods, p 351. Pronsky ZM. Food–Medication Interactions. Birchrunville, PA: Food–Medication Interactions; 2004. Chart of oxalate food source, p 378. Shils ME, Shike M, Ross AC, Caballero B, Cousins RJ. Modern Nutrition in Health and Disease. Baltimore, MD: Lippincott Williams & Wilkins; 2006. Chart of oxalate content of foods, pp 2014-2015. Oxalic Acid Content of Selected Vegetables. http:// www.ars.usda.gov/Services/docs.htm?docid⫽9444 Oxalosis & Hyperoxaluria Foundation-Diet. http://www. ohf.org/diet.html. Accessed February 2, 2006. Massey LK, Kynast-Gales SA. Diets with either beef or plant proteins reduce risk of calcium oxalate precipitation in patients with a history of calcium kidney stones. J Am Diet Assoc. 2001;101:326-331. Available at: http://www. adajournal.org/article/PIIS0002822301000852/fulltext. Accessed February 2, 2006. Massey LK. Effects of ascorbate supplements on urinary oxalate and risk of kidney stones. J Am Diet Assoc. 2000;100:516. Available at: http://www.adajournal.org/ article/PIIS0002822300001589/fulltext. Accessed February 2, 2006. Massey LK, Kynast-Gales SA. Substituting milk for apple juice does not increase kidney stone risk in most normocalciuric adults who form calcium oxalate stones. J Am Diet Assoc. 1998;98:303-308. Available at: http://www. adajournal.org/article/PIIS0002822398000716/fulltext. Accessed February 2, 2006. Massey LK, Sutton RA. Modification of dietary oxalate and calcium reduces urinary oxalate in hyperoxaluric patients with kidney stones. J Am Diet Assoc. 1993;93: 1305-1307. Available at: http://www.adajournal.org/ article/PII000282239391961O/fulltext. Accessed February 2, 2006. Massey LK, Roman-Smith H, Sutton RA. Effect of dietary oxalate and calcium on urinary oxalate and risk of formation of calcium oxalate kidney stones [review]. J Am Diet Assoc. 1993;93:901-906. Available at: http://www.adajournal.org/ article/PII0002822393915304/fulltext. Accessed February 2, 2006. From The National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC), a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK): What I Need to Know about Kidney Stones. http://kidney.niddk.nih.gov/kudiseases/pubs/ stones_ez/. Kidney Stones in Adults. http://kidney. niddk.nih.gov/kudiseases/pubs/stonesadults/. Accessed February 2, 2006.
design and equipment selection. Both parts contain forms, formulas, policies, and techniques to assist anyone involved with food service in an institutional environment. Overall, Food Service Manual for Health Care Institutions offers a current and comprehensive review of both the management and operation of health care food service that is appropriate for students, directors, and managers alike.
SITES IN REVIEW National Eating Disorders Association http://www.nationaleatingdisorders.org In the United States, an estimated 10 million females and one million males are struggling with a severe eating disorder that is associated with a high mortality rate, according to the National Eating Disorders Association (NEDA). This organization also reports that these statistics are just the tip of the iceberg because millions of other Americans have anorexia or bulimia that eludes proper medical diagnosis and treatment. Established in 2001, NEDA is the largest nonprofit organization dedicated to eating disorders in the United States. The focus of its mission is the provision of materials that educate Americans about the prevention and treatment of anorexia, bulimia, and other types of disordered eating. NEDA also sponsors programs, research projects, and a tollfree helpline for individuals with eat-
ing disorders and their family members. NEDA is supported by public and corporate donations. The Web site of NEDA (available at www.nationaleatingdisorders.org) is full of resources that discuss a wide array of topics on eating disorders. In the Eating Disorders Info section of the site, over 50 different subcategories are listed that address issues related to anorexia and bulimia in males and females from childhood through adulthood, disordered eating among athletes and other special populations, health complications associated with eating disorders, and prevention strategies. Topics are written for specific target audiences: the affected individual with an eating disorder, family members, health professionals, or the general public. The material is available in both English and Spanish. The Treatment Referral section is another valued feature of the NEDA site. Nationwide inpatient/outpatient treatment centers, support groups, and research studies related to eating disorders are listed by state. Links to all treatment facilities provide a detailed description of therapy options, staffing credentials, population(s) treated, and insurance reimbursement issues. Although the NEDA Web site is dense with text, its easy navigation, relevant material, and other strengths are prized by 50 million users who visit the site each year. This site is a goldmine of timely information about eating disorders directed at the general public, press, and health professionals.
QUESTION OF THE MONTH
Where Can I Find Information on the Oxalate Content of Foods?
I
t is thought that our modern lifestyle and dietary habits promote the development of kidney stones (1). In the United States, an increase of 37% in stone disease has been observed over the last 20 years (1).
This article was written by Wendy Marcason, RD, of the ADA’s Knowledge Center Team in Chicago, IL. Contact: [email protected] doi: 10.1016/j.jada.2006.02.023
Approximately 75% of stones are made from calcium oxalate (2). Only a small amount of ingested oxalate is absorbed; approximately 6% to 14% in normal individuals. People who have hyperoxaluria—so-called “super absorbers”— can absorb 50% more oxalate than non–stone formers (2). Hyperoxaluria can be caused by genetic disorders that result in excessive endogenous production, excessive absorption caused by compromised bowel function, or from high intake of oxalate from food.
April 2006 ● Journal of the AMERICAN DIETETIC ASSOCIATION
627
NEW IN REVIEW Nutrition management is the cornerstone of any plan to reduce risk of stone formation. Up to 85% of all stone patients could lower their risk of recurrence with simple dietary and lifestyle changes (3). The following are general guidelines for reducing the risk of urolithiasis/urinary stones from the American Dietetic Association’s Nutrition Care Manual, which also includes a list of low-, moderate-, and high-oxalate foods (4): ● ●
● ● ● ● ●
Protein: normalize intake to 0.8 to 1.0 g/kg of body weight/day; not to exceed the Dietary Reference Intake Calcium: normalize intake to 800 mg/day for men; 1,200 mg/day for women; do not restrict and balance intake of calcium throughout the day Fluids: 12 to 16 cups to produce a urine volume ⬎2.5 L Oxalate: ⬍40 to 50 mg/day Sodium: lower intake to 100 to 150 mEq/day (2,300 to 3,450 mg/day) Calories: level to maintain a healthful weight Vitamin/mineral supplement: B-vitamins have not been shown to be harmful; vitamin C should be limited to the Dietary Reference Intake
The oxalate content of foods may vary depending on soil conditions, time of harvest, and processing. In addition, differences in analysis methodology also add to the complexity of determining an absolute value for a food.
References 1. Straub M, Hautmann RE. Developments in stone prevention. Curr Opin Urol. 2005;15:119-126. 2. Reynolds TM. ACP Best Practice No 181: Chemical pathology clinical investigation and management of nephrolithiasis. J Clin Pathol. 2005;58:134-140. 3. Holmes RP, Assimos DG. The impact of dietary oxalate on kidney stone formation. Urol Res. 2004;32: 311-316. Epub June 17, 2004. 4. Nutrition Care Manual. Urolithiasis/urinary stones. ADA Nutrition Care Manual. 2005. Available at: http:// www.nutritionacaremanual.org. Accessed February 2, 2006.
Additional Resources Because of the many factors that influence the oxalate content in food, there is not one best resource. The Knowledge Center has compiled a list of resources: Brzezinski E, Durning AM. The Oxalate Content of Selected Foods with Recipes and Menu Suggestions. San Diego, CA: University of California; 2002. To order call 800/520-7323. Mahan LK, Escott-Stump S. Krause’s Food, Nutrition, &
628
April 2006 Volume 106 Number 4
Diet Therapy. Philadelphia, PA: Saunders; 2004. Chart of oxalate content of foods, pp 1242-1243. Pennington JAT, Douglass JS. Bowes & Church’s Food Values of Portions Commonly Used. Baltimore, MD: Lippincott Williams & Wilkins; 2005. Chart of oxalate content of foods, p 351. Pronsky ZM. Food–Medication Interactions. Birchrunville, PA: Food–Medication Interactions; 2004. Chart of oxalate food source, p 378. Shils ME, Shike M, Ross AC, Caballero B, Cousins RJ. Modern Nutrition in Health and Disease. Baltimore, MD: Lippincott Williams & Wilkins; 2006. Chart of oxalate content of foods, pp 2014-2015. Oxalic Acid Content of Selected Vegetables. http:// www.ars.usda.gov/Services/docs.htm?docid⫽9444 Oxalosis & Hyperoxaluria Foundation-Diet. http://www. ohf.org/diet.html. Accessed February 2, 2006. Massey LK, Kynast-Gales SA. Diets with either beef or plant proteins reduce risk of calcium oxalate precipitation in patients with a history of calcium kidney stones. J Am Diet Assoc. 2001;101:326-331. Available at: http://www. adajournal.org/article/PIIS0002822301000852/fulltext. Accessed February 2, 2006. Massey LK. Effects of ascorbate supplements on urinary oxalate and risk of kidney stones. J Am Diet Assoc. 2000;100:516. Available at: http://www.adajournal.org/ article/PIIS0002822300001589/fulltext. Accessed February 2, 2006. Massey LK, Kynast-Gales SA. Substituting milk for apple juice does not increase kidney stone risk in most normocalciuric adults who form calcium oxalate stones. J Am Diet Assoc. 1998;98:303-308. Available at: http://www. adajournal.org/article/PIIS0002822398000716/fulltext. Accessed February 2, 2006. Massey LK, Sutton RA. Modification of dietary oxalate and calcium reduces urinary oxalate in hyperoxaluric patients with kidney stones. J Am Diet Assoc. 1993;93: 1305-1307. Available at: http://www.adajournal.org/ article/PII000282239391961O/fulltext. Accessed February 2, 2006. Massey LK, Roman-Smith H, Sutton RA. Effect of dietary oxalate and calcium on urinary oxalate and risk of formation of calcium oxalate kidney stones [review]. J Am Diet Assoc. 1993;93:901-906. Available at: http://www.adajournal.org/ article/PII0002822393915304/fulltext. Accessed February 2, 2006. From The National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC), a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK): What I Need to Know about Kidney Stones. http://kidney.niddk.nih.gov/kudiseases/pubs/ stones_ez/. Kidney Stones in Adults. http://kidney. niddk.nih.gov/kudiseases/pubs/stonesadults/. Accessed February 2, 2006.