KDOQI (Kidney Disease Outcomes Quality Initiative)


KDOQI Clinical Practice Guideline for Nutrition in Children with CKD: 2008 Update

Glossary of Definitions

Acceptable Macronutrient Distribution Ranges (AMDR):     A range of intake for each energy source associated with reduced risk of chronic disease while providing adequate intake of essential nutrients. The AMDR is based on evidence that consumption greater or less than these ranges may be associated with nutrient inadequacy and increased risk of developing chronic diseases, such as coronary heart disease, obesity, diabetes, and/or cancer. The AMDR is expressed as a percentage of total energy intake because its requirement is not independent of other energy sources or of the individual's total energy requirement.

Adequate Intake (AI):        The recommended average daily nutrient intake level based on observed or experimentally determined approximations or estimates of nutrient intake by a group (or groups) of apparently healthy people who are assumed to be maintaining an adequate nutritional state. The AI is expected to meet or exceed the needs of most individuals in a specific life-stage and gender group. When a Recommended Dietary Allowance (RDA) is not available for a nutrient, the AI can be used as the goal for usual intake by an individual. The AI is not equivalent to an RDA.

Children:         Infants, children, and adolescents between the ages of birth and 19 years.

Dietary Reference Intakes (DRI):        Set of 4 nutrient-based values that apply to the apparently healthy general population consisting of RDA, Estimated Average Requirement (EAR), AI, and Tolerable Upper Intake Level (UL).

Enteral Nutrition*:     Nutrition provided through the gastrointestinal tract through a tube, catheter, or stoma that delivers nutrients distal to the oral cavity.

Estimated Energy Requirement (EER):          An EER is defined as the average dietary energy intake that is predicted to maintain energy balance in healthy normal-weight individuals of a defined age, sex, weight, height, and level of physical activity consistent with good health. In children, the EER includes the needs associated with growth at rates consistent with good health. Relative body weight (ie, loss, stable, or gain) is the preferred indicator of energy adequacy.

Fiber:  Combination of dietary fiber, the edible nondigestible carbohydrate and lignin components existing naturally in plant foods, and functional fiber, the isolated, extracted, or synthetic fiber that has proven health benefits. Fiber includes viscous or soluble forms that may decrease serum cholesterol levels (eg, oat bran and legumes/beans) and insoluble forms or bulking agents that prevent or alleviate constipation (eg, wheat bran, whole grains, vegetables, and fruits).

Height Age:     The age at which the child's height would be on the 50th percentile.

Ideal Body Weight:      The weight at the same percentile as the child's height percentile, for the same age and sex.

Macronutrients:          Dietary fat, carbohydrate, protein, and fiber.

Nutrition Care*:         Interventions and counseling of individuals on appropriate nutrition intake through the integration of information from the nutrition assessment.

Nutrition Care Plan*: A formal statement of the nutrition goals and interventions prescribed for an individual using the data obtained from a nutrition assessment. The plan, formulated by an interdisciplinary process, should include: statements of nutrition goals and monitoring parameters, the most appropriate route of administration of specialized nutrition support (oral, enteral, and/or parenteral), method of nutrition access, anticipated duration of therapy, and training and counseling goals and methods.

Nutrition Therapy*:    A component of medical treatment that includes oral, enteral, and parenteral nutrition.

Obesity:           Body mass index (BMI) for age at 95th percentile or greater.

Oral Nutrition*:          Nutrition taken by mouth.

Overweight:    BMI for age at 85th or greater and less than 95th percentiles.

Parenteral Nutrition*:            The administration of nutrients intravenously.

Physical Activity Level (PAL):           The ratio of total energy expenditure (TEE) to basal energy expenditure. PAL categories are defined as sedentary (PAL, 1.0 to 1.39), low active (PAL, 1.4 to 1.59), active (PAL, 1.6 to 1.89), and very active (PAL, 1.9 to 2.5). PAL should not be confused with the physical activity coefficient (PA values) used in the equations to estimate energy requirement.

Recommended Dietary Allowance (RDA):      The intake that meets the nutrient needs of almost all (97% to 98%) individuals in a group. It may be used as a goal for individual intake.

Tolerable Upper Intake Level (UL):   The highest average daily nutrient intake level likely to pose no risk of adverse health effects to almost all individuals in a given life-stage and sex group. The UL is not a recommended level of intake. As intake increases above the UL, the potential risk of adverse effects increases.

* Source: Teitelbaum et al.1



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