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Ethnic Foods and PD Patients: What to Be Aware

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Ethnic Foods and PD Patients: What to Be Aware February 7th-9th, 2013 EthnicEthnic FoodsFoods andand PDPD Patients:Patients: whatwhat toto bebe awareaware of?of? JiakJiak ChinChin KohKoh RD,RD, MScMSc.. [email protected]@providencehealth.bc.ca FebFeb 9,9, 20132013 Background:Background: Personal background: - Grew up in Malaysia (early exposure to 3 different cultures) - Traveled to over 50 countries - Renal dietitian in Vancouver for 10 yrs Presentation background: - Focus will be on: * Understanding the role of culture in food preferences * Recognizing challenges integrating some ethnic foods in the PD diet * Learning practical strategies to support consumption of healthy foods that are culturally acceptable to our patients. - Unique feature of this talk: interviewed RDs from various cultural backgrounds LearningLearning toto cookcook whilewhile travelingtraveling “Berber Omelete” at the edge of Sahara Desert in Morocco “Cactus” in Oaxaca, Mexico “Pizza” on lava bed in Hawaii ““GroceryGrocery shoppingshopping”” whilewhile travelingtraveling Fresh Dates orchard in Tunisia Bargaining for Red Bananas in Tanzania Fresh fruit on the street in Barbados StatisticsStatistics CanadaCanada 20062006 CensusCensus DataData 200200 differentdifferent ethnicethnic originsorigins reportedreported ~16.2%~16.2% totaltotal populationpopulation isis ofof visiblevisible minorityminority ProjectsProjects byby 2031,2031, 28%28% ofof CanadianCanadian populationpopulation willwill bebe foreignforeign--bornborn SubstantialSubstantial increaseincrease inin Chinese,Chinese, FilipinoFilipino andand SouthSouth AsianAsian immigrationimmigration DemographicsDemographics inin BCBC && YukonYukon PDPD andand AllAll DialysisDialysis PD Patients All Dialysis Patients 2002 2007 2012 2002 2007 2012 # Patients 591 704 841 2050 2578 3071 (28.8%) (27.3%) (27.4 %) (100%) (100%) (100%) Age Mean ± SD 57 ± 16 61 ± 16 63 ± 15 61 ± 16 64 ± 16 66 ± 15 Median [IQR] 58 [47-70] 64 [50-74] 65 [54-75] 63 [50-74] 66 [54-76] 68 [56-77] Male 56% 56% 61% 59% 59% 60% Source: BC Patient Records & Outcome Management Information System (PROMIS) database EthnicEthnic groupsgroups ofof PDPD patientspatients inin BCBC (%(% consistentconsistent withwith ““AllAll DialysisDialysis””)) 70 62% (2012) 60 50 40 2002 30 2007 16% 2012 20 8% 5% 3% 3% 3% 10 0 Caucasian Asian East Indian Filipino First Nation Others Unknow n Orie ntal Source: BC PROMIS database Ethnicity,Ethnicity, Culture,Culture, andand RelationshipRelationship ofof CultureCulture withwith FoodFood andand DiseaseDisease EthnicityEthnicity oftenoften refersrefers toto ““asas aa commoncommon ancestry,ancestry, nationality,nationality, socialsocial customscustoms andand religionreligion””.. OneOne ofof thethe waysways ethnicethnic groupsgroups maintainmaintain theirtheir culturalcultural identitiesidentities isis throughthrough foodfood practices,practices, valuesvalues andand beliefs.beliefs. CultureCulture determinesdetermines howhow aa personperson definesdefines health,health, recognizesrecognizes illness,illness, andand seeksseeks treatment.treatment. CultureCulture andand FoodFood FoodFood andand languagelanguage areare thethe culturalcultural habitshabits humanhuman learnlearn firstfirst –– thereforetherefore greatestgreatest reluctancereluctance toto change.change. EvenEven wherewhere socialsocial attitudesattitudes becomebecome homogenized,homogenized, culturalcultural foodfood practicespractices tendtend toto maintainmaintain theirtheir ethnicethnic features.features. AreAre traditionaltraditional culturalcultural foodsfoods healthful,healthful, oror atat leastleast compatiblecompatible withwith modernmodern dietarydietary goals?goals? GoalGoal isis toto supportsupport patientspatients inin maintainingmaintaining theirtheir culturalcultural foodfood practicespractices asas muchmuch asas possible.possible. CulturalCultural CompetenceCompetence Means recognizing and forming one’s attitudes, beliefs, skills, values, and level of awareness to provide culturally appropriate, respectful, and relevant care and education (Campinha-Bocate Model) Complex integration of: - Attitudes (open-minded, value diversity), - Knowledge (understanding the language, culture, behaviours) and - Skills to enhance cross-cultural interactions, to work effectively with and to make appropriate recommendations for individuals from different backgrounds. CulturalCultural CompetenceCompetence Cultural competence exists on a continuum from incompetence to proficiency - Developing awareness - Acquiring knowledge and - Developing and maintaining cross-cultural skills (Requires long-term commitment of active learning and practicing). Culturally competent health care fosters: - favourable clinical outcomes results - positive and rewarding interpersonal experiences, - promotes patient/client satisfaction PDPD DietDiet Requirements:Requirements: Nutrient Amount Protein Emphasize High Biological Value (HBV) Protein Stable state: 1.2-1.3 g/kg (e.g.: 70 kg: 7-8 oz + 1 glass dairy) Peritonitis: 1.5 g/kg Sodium (Na+) < 2300 mg/d Potassium (K+) Typically 3000-4000 mg/d 2- Phosphorus (PO4 ) 800-1200 mg/d Fluid Typically 6-8 glasses/d ChineseChinese (Protein)(Protein) LessLess Often:Often: BetterBetter Choices:Choices: Organ meats, bone marrow, Lean meats, poultry, sardines, dried shrimps fish, eggs ChineseChinese (Vegetarian(Vegetarian Protein)Protein) SoyaSoya BeanBean ProductsProducts (High(High Phosphorus):Phosphorus): Tofu,Tofu, BeanBean curds,curds, BeanBean CurdCurd Sheets,Sheets, TofuTofu dessertsdesserts ChineseChinese (Noodles)(Noodles) LessLess Often:Often: BetterBetter Choices:Choices: InstantInstant NoodlesNoodles –– RiceRice noodles,noodles, vermicellivermicelli -- 800800--2000mg2000mg NaNa+/packet!/packet! butbut checkcheck NaNa+ contentcontent too.too. ChineseChinese (Soups)(Soups) SoupSoup basebase –– AvoidAvoid usingusing bonesbones (phosphorus(phosphorus leachingleaching intointo soups).soups). UseUse meatmeat oror vegetablesvegetables instead.instead. Bone-based soups (Higher phosphorus) Vegetable / meat-based soup (Lower phosphorus) ChineseChinese (Sauces(Sauces && Spices)Spices) LessLess Often:Often: BetterBetter Choices:Choices: Oyster, Hoisin, Plum, Ginger, garlic, onion, chives, Char-Siu sauces green onion, sesame oil, Chinese five spice ChineseChinese (Beverages)(Beverages) LessLess Often:Often: BetterBetter Choices:Choices: Milo,Milo, OvaltineOvaltine,, HorlickHorlick,, GreenGreen tea,tea, LemonLemon tea,tea, SoyaSoya milkmilk WaterWater withwith lemon/lime,lemon/lime, RiceRice beveragebeverage ChineseChinese (Beliefs)(Beliefs) Yin/YangYin/Yang (Cold/Hot)(Cold/Hot) FoodsFoods ““YinYin ”” (Cold)(Cold) foodsfoods (e.g.:(e.g.: manymany fruits)fruits) avoidedavoided whenwhen sicksick –– maymay bebe challengingchallenging toto raiseraise KK level.level. MayMay needneed toto considerconsider KK--supplement.supplement. PostPost surgerysurgery –– avoidingavoiding ““toxictoxic”” foodsfoods suchsuch asas somesome proteinprotein foods.foods. ComfortComfort foodfood –– CongeeCongee (rice(rice porridge).porridge). ChineseChinese YangYang // HotHot vsvs YinYin // ColdCold Lunar/ChineseLunar/Chinese NewNew YearYear CelebratedCelebrated forfor 1515 daysdays JapaneseJapanese (( SeasonalSeasonal Eating)Eating) JapanJapan’’ss traditionaltraditional cultureculture oftenoften describeddescribed asas thethe seasonalseasonal culture.culture. TheThe sensesense ofof seasonseason isis highlyhighly valued.valued. PremiumPremium placedplaced uponupon freshnessfreshness andand naturalnatural flavourflavour .. EatingEating foodfood atat theirtheir ““ShunShun”” oror ““NowNow--inin SeasonSeason”” –– believedbelieved toto bebe goodgood forfor health.health. Spring: Bamboo shoots, tuna, herring Early summer: Bonito (fish) Autumn: Matsutake (a type of mushroom), chestnuts JapaneseJapanese ((““JapanJapan--izedized”” andand TrendyTrendy Foods)Foods) JapaneseJapanese cuisinecuisine hashas alsoalso takentaken upup manymany otherother cultureculture ’’ss foodsfoods e.g.:e.g.: JapaneseJapanese currycurry (block(block currycurry roux)roux) JapandogJapandog (Japanese(Japanese stylestyle hothot dogs)dogs) TrendyTrendy foodsfoods promotedpromoted onon TV/MediaTV/Media (e.g.(e.g. mucousymucousy seaweed)seaweed) JapaneseJapanese (Condiments)(Condiments) WasabiWasabi PickledPickled GingerGinger (Japanese(Japanese horseradishhorseradish fromfrom wasabiwasabi root)root) Pickled in salt, sugar & vinegar – usually don’t eat much 30g = 275 mg Na+ Tube, paste form – Salt may be added Powder form (need to add water) – No salt JapaneseJapanese (Soup(Soup && RiceRice Accompaniments)Accompaniments) Miso Soup • Dark brown miso paste ~2000mg/tbsp • Light brown miso paste tends to be lower in Na ~1000mg/tbsp Tsukemono (Pickled vegetables -salty) JapaneseJapanese (Rice(Rice Accompaniments)Accompaniments) Furikake (Salty sprinkles on rice)- Iriko/Chirimen-jako (Salt preserved/dried many contain Nori (seaweed) anchovies Fish roes - Tobiko, Kazunoko (herring roe), Mentaiko (cod roe) – all salt cured JapaneseJapanese (Cooking)(Cooking) UsesUses quitequite aa bitbit ofof sugarsugar –– e.g.:e.g.: teriyakiteriyaki && sukiyakisukiyaki sauces,sauces, basicallybasically sugarsugar && soyasoya saucesauce (Watch(Watch ifif havehave diabetes).diabetes). SushiSushi ricerice –– hashas salt,salt, sugarsugar andand vinegar.vinegar. ThereforeTherefore alreadyalready quitequite saltysalty eveneven withoutwithout soyasoya sauce.sauce. JapaneseJapanese (Sauces)(Sauces) LessLess Often:Often: (Na mg/Tbsp) BetterBetter
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