Table 3 Initiative for mitigating the Diet-Environment-Renal Health trilemma in Japan
From: Renal health benefits of sustainable diets in Japan: a review
| Â | Initiatives | Promoters and Inhibitors | Reported scientific evidence |
|---|---|---|---|
Diet-environment axis | Local production for local consumption to reduce GHGE (reduce transport costs) Switch to plant-based diet Prevent overconsumption of processed foods Prevent energy loss from food processing and food preparation processes Prevent food waste Green agricultural management and land use | Requires changes to the food industry Considerations for import/export industries and existing industries (e.g., food processing industry, dairy farming) Policy incentives for going carbon free | Diet → Environment: Conclusive Plant-based diets have a far lower environmental impact than animal-based diets Environment → Diet: Conclusive Global warming reduces crop, livestock, and fishery yield |
Renal health-diet axis | Switch to plant-based diet Protect renal glomerular function with low-salt, low-protein diet Avoid excessive consumption of processed foods and prevent hyperphosphatemia Avoid inappropriate nutritional treatment in advanced renal disease (overconsumption of potassium, over-restriction of protein) | Promotes appropriate intervention by dietitians for CKD Rethinking and popularization of traditional Japanese diets Promotes understanding of vegetarianism in Japan | Renal health → Diet: Conclusive Renal dysfunction requires food restriction Diet → Renal health: Partly inconclusive Plant-based diets are mostly effective for early-stage CKD. some guideline recommends for patients with CKD that at least half of their daily protein intake from animal sources. Caution is required for advanced CKD. Salt reduction is effective. Low protein may be effective, but the mechanism is partially unclear. The epidemiology of vegetarianism in Japan and effects on the kidneys are unclear |
Environment-renal health axis | Reduce the need for necessary treatment by preventing aggravation of CKD Popularize green medical practices and behavior modification of patients Avoid drug waste Avoid over-prescription (including for dialysis) Pharmaceutical production with low environmental impact Establish and popularize non-drug treatment to protect renal function | Improvement of preventive medicine and people’s health literacy Considerations for existing pharmaceutical companies and production lines People’s understanding of the ethical question of intentionally changing prescriptions for environmental benefits | Environment → Renal health: Mostly conclusive CKD caused by global warming Loss of healthy life expectancy due to global warming in various ways Renal health → Environment: Indirect, inconclusive Increased prevalence of CKD and end-stage kidney disease has a monetary impact (but no direct quantifiable effects on the environment). environmental impact of dialysis treatment is larger than that of general medical care. lack of evidence on effects of non-drug treatment on renal function protection |