title: A practical approach to a low protein diet in Brazil.
abstract: Chronic kidney disease (CKD) is an emerging health public problem in Brazil. Nutritional counseling with focus on protein restriction is a promising strategy to treatment of nondialysis CKD patients due its effects on slowing renal loss. However, Brazilian people have high protein intake, which is a challenge when low protein diet (LPD) should be prescribed. This review describes a practical approach to the dietetic management of nondialysis CKD patients in Brazil.
  
  
  
  Although Brazilian cuisine varies greatly by region, Brazil has current trends of incorporating Western dietary habits, including high intake of red meat. Traditional plant-based foods, such as rice and beans, are also important contributors to the high protein content to the Brazilian diet. Thus, a successful implementation of LPD requires adaptation of these dietary habits, with reduction of portion sizes and adequate food substitution options. Intensive nutritional counseling with specialized renal dietitians is also important to improve compliance to the LPD. Moreover, the precarious health system organization and economic problems are barriers to nutritional care, which could be solved with intensive and specialized perspectives of treatment. The adherence to protein restriction is important for better metabolic and clinical control of nondialysis CKD patients. Early dietetic attention, nutrition education strategies and intensive specialized nutritional counseling are essential to achieve diet habits that promote adherence to the LPD without excluding cultural characteristics of the Brazilian diet.
authors.affiliation: Graduate Program in Medical Sciences and Graduate Program in Cardiovascular Sciences, Federal Fluminense University (UFF), Niterói, RJ, Brazil. dmafra30@gmail.com.br.|Graduate Program in Cardiovascular Sciences, Federal Fluminense University (UFF), Niterói, RJ, Brazil. dmafra30@gmail.com.br.
authors.forename: Denise
authors.initials: D
authors.lastname: Mafra
authors.affiliation: Graduate Program in Cardiovascular Sciences, Federal Fluminense University (UFF), Niterói, RJ, Brazil.
authors.forename: Viviane O
authors.initials: VO
authors.lastname: Leal
mesh_terms: D001938:Brazil; D018753:Diet, Protein-Restricted / Q000379:methods*; D004044:Dietary Proteins / Q000008:administration & dosage; D037001:Directive Counseling; D002149:Energy Intake; D005247:Feeding Behavior; D006801:Humans; D062407:Meals; D010349:Patient Compliance; D051436:Renal Insufficiency, Chronic / Q000178:diet therapy*
chemical_list: D004044:Dietary Proteins
keywords: Adherence; Brazilians; Chronic kidney disease; Low protein diet