Food Safety Issues for CKD Patients

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Renal Nutrition Update
Food Safety Issues for CKD Patients
Debra Blair, MPH, RD, CSR
February 20, 2009

Like immunocompromised individuals, CKD patients are especially vulnerable to foodborne illnesses

Foodborne illness affects 76 million people annually in the United States, resulting in approximately 5,000 deaths, according to estimates by the Department of Health and Human Services and the CDC. CKD patients are especially vulnerable, along with older adults and individuals with compromised immune function. Although recent media attention has focused on an outbreak of salmonellosis caused by contaminated peanut butter, there are more than 250 identified types of foodborne illness. Educating patients regarding potential sources of foodborne illness as well as food safety strategies is important to improving outcomes. However, as circumstances of the latest Salmonella outbreaks reveal, there is no substitute for good manufacturing practices and oversight to ensure a safe food supply.

The Salmonella genus comprises a number of gram-negative anaerobic species. The bacteria are noted to be “widespread in the intestines of birds, reptiles, and mammals” and acknowledged as “the leading cause of foodborne illness in the United States, causing about 1.4 million infections annually”(Curr Gastroenterol Rep. 2008;10:424-431). Foods are almost universally at risk for Salmonella contamination, especially unpasteurized milk and juice, uncooked meat and eggs, and fruits and vegetables that are eaten raw. Bulk processing of foods from different sources (i.e., ground meats, eggs) can increase the likelihood of contamination. The recent extensive occurrence of salmonellosis related to peanut products prompted the FDA to set up a Web site of recalled products (www.accessdata.fda.gov/scripts/peanutbutterrecall/index.cfm, accessed February 2, 2009). Possible mechanisms of Salmonella infection are thought to include inadequate heat during peanut roasting or contamination after processing.

A current review (Emerg Med Clin North Am. 2008;26:475-497) details the three main causes of foodborne illness: “microscopic pathogens” (bacteria, parasites, fungi, viruses), “toxic contaminants” (heavy metals, chemicals, pesticides), and “toxic substances naturally present” (poisonous mushrooms and other plants, fish, shellfish). The author notes that viral or bacterial contaminants are by far the most common and cites recent CDC FoodNet—Foodborne Diseases Active Surveillance Network (www.cdc.gov/foodnet/) data which indicate that “while foodborne infections from a number of common pathogens continue to decline, including Campylobacter, Listeria, Shigella, and Yersinia, infections caused by Shiga toxin-producing Escherichia coli O157:H7 (STEC) and Vibrio infections have remained constant or increased.” Hemolytic uremic syndrome (HUS) caused by E. coli O157:H7 can result in potentially fatal acute renal failure, particularly in children. Outbreaks in recent years have been linked to undercooked ground beef, unpasteurized cider, and contaminated fresh spinach. Immunocompromised individuals, e.g., dialysis patients, transplant recipients, and those with liver disease, are especially susceptible to a sepsis syndrome caused by Vibrio, a bacterium that is found in contaminated water and carried by shellfish or crabs. Patients should be cautioned to avoid eating undercooked or raw shellfish, particularly oysters.

The CDC acknowledges that “making food safe in the first place is a major effort, involving the farm and fishery, the production plant or factory, and many other points from the farm to the table.” Pasteurization and wider use of food irradiation are highlighted as important technologic methods to this end. Although good manufacturing practices and regulatory oversight are essential, consumers can also take steps to improve food safety. Recommendations to reduce the risk of foodborne diseases outlined by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and the CDC include:

    * Wash hands with soap and warm water before and after food preparation.
    * Cook meat, poultry, and eggs thoroughly to kill harmful bacteria—to at least160ºF for ground beef (no pink in the middle) and until egg yolks are firm.
    * Separate foods to avoid cross-contamination. Wash preparation surfaces, utensils, and cutting boards after contact with raw foods and before using with other foods. Keep raw meat, poultry, fish, and their juices separate from foods that are ready-to-eat. Put cooked foods on clean platters, not back on those previously used for raw meats.
    * Chill leftovers promptly (within two hours or less) to inhibit the growth of bacteria. Place leftovers in shallow containers so that food will cool more quickly.
    * Clean fresh fruits and vegetables by rinsing them under running tap water. Remove and discard the outer leaves of cabbage and lettuce. Since the cut surface of produce promotes bacterial growth, avoid leaving cut fruits and vegetables at room temperature for long periods.
    * Buy foods that have been processed for safety (i.e., pasteurized milk and fruit juices/ciders).
    * Report suspected foodborne illness to your local health department.

Additional information is available at digestive.niddk.nih.gov/ddiseases/pubs/bacteria/ and www.cdc.gov/ncidod/dmd/diseaseinfo/files/foodborne_illness_FAQ.pdf, both accessed February 2, 2009.

http://www.renalandurologynews.com/Food-Safety-Issues-for-CKD-Patients/article/127671/