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      Effect of Food Insecurity on Chronic Kidney Disease in Lower-Income Americans

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          Abstract

          Background: The relation of food insecurity (inability to acquire nutritionally adequate and safe foods) and chronic kidney disease (CKD) is unknown. We examined whether food insecurity is associated with prevalent CKD among lower-income individuals in both the general US adult population and an urban population. Methods: We conducted cross-sectional analyses of lower-income participants of the National Health and Nutrition Examination Survey (NHANES) 2003-2008 (n = 9,126) and the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study (n = 1,239). Food insecurity was defined based on questionnaires and CKD was defined by reduced estimated glomerular filtration rate or albuminuria; adjustment was performed with multivariable logistic regression. Results: In NHANES, the age-adjusted prevalence of CKD was 20.3, 17.6, and 15.7% for the high, marginal, and no food insecurity groups, respectively. Analyses adjusting for sociodemographics and smoking status revealed high food insecurity to be associated with greater odds of CKD only among participants with either diabetes (OR = 1.67, 95% CI: 1.14-2.45 comparing high to no food insecurity groups) or hypertension (OR = 1.37, 95% CI: 1.03-1.82). In HANDLS, the age-adjusted CKD prevalence was 5.9 and 4.6% for those with and without food insecurity, respectively (p = 0.33). Food insecurity was associated with a trend towards greater odds of CKD (OR = 1.46, 95% CI: 0.98-2.18) with no evidence of effect modification across diabetes, hypertension, or obesity subgroups. Conclusion: Food insecurity may contribute to disparities in kidney disease, especially among persons with diabetes or hypertension, and is worthy of further study.

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          A comparison of treating metabolic acidosis in CKD stage 4 hypertensive kidney disease with fruits and vegetables or sodium bicarbonate.

          Myeong Chan Jo, Nimrit Goraya, Jan Simoni … (2013)
          Current guidelines recommend Na(+)-based alkali for CKD with metabolic acidosis and plasma total CO2 (PTCO2) < 22 mM. Because diets in industrialized societies are typically acid-producing, we compared base-producing fruits and vegetables with oral NaHCO3 (HCO3) regarding the primary outcome of follow-up estimated GFR (eGFR) and secondary outcomes of improved metabolic acidosis and reduced urine indices of kidney injury. Individuals with stage 4 (eGFR, 15-29 ml/min per 1.73 m(2)) CKD due to hypertensive nephropathy, had a PTCO2 level < 22 mM, and were receiving angiotensin-converting enzyme inhibition were randomly assigned to 1 year of daily oral NaHCO3 at 1.0 mEq/kg per day (n=35) or fruits and vegetables dosed to reduce dietary acid by half (n=36). Plasma cystatin C-calculated eGFR did not differ at baseline and 1 year between groups. One-year PTCO2 was higher than baseline in the HCO3 group (21.2±1.3 versus 19.5±1.5 mM; P<0.01) and the fruits and vegetables group (19.9±1.7 versus 19.3±1.9 mM; P<0.01), consistent with improved metabolic acidosis, and was higher in the HCO3 than the fruits and vegetable group (P<0.001). One-year urine indices of kidney injury were lower than baseline in both groups. Plasma [K(+)] did not increase in either group. One year of fruits and vegetables or NaHCO3 in individuals with stage 4 CKD yielded eGFR that was not different, was associated with higher-than-baseline PTCO2, and was associated with lower-than-baseline urine indices of kidney injury. The data indicate that fruits and vegetables improve metabolic acidosis and reduce kidney injury in stage 4 CKD without producing hyperkalemia.
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            Neighborhood characteristics and availability of healthy foods in Baltimore.

            Manuel Franco, Ana V. Diez Roux, Thomas A. Glass … (2008)
            Differential access to healthy foods may contribute to racial and economic health disparities. The availability of healthy foods has rarely been directly measured in a systematic fashion. This study examines the associations among the availability of healthy foods and racial and income neighborhood composition. A cross-sectional study was conducted in 2006 to determine differences in the availability of healthy foods across 159 contiguous neighborhoods (census tracts) in Baltimore City and Baltimore County and in the 226 food stores within them. A healthy food availability index (HFAI) was determined for each store, using a validated instrument ranging from 0 points to 27 points. Neighborhood healthy food availability was summarized by the mean HFAI for the stores within the neighborhood. Descriptive analyses and multilevel models were used to examine associations of store type and neighborhood characteristics with healthy food availability. Forty-three percent of predominantly black neighborhoods and 46% of lower-income neighborhoods were in the lowest tertile of healthy food availability versus 4% and 13%, respectively, in predominantly white and higher-income neighborhoods (p<0.001). Mean differences in HFAI comparing predominantly black neighborhoods to white ones, and lower-income neighborhoods to higher-income neighborhoods, were -7.6 and -8.1, respectively. Supermarkets in predominantly black and lower-income neighborhoods had lower HFAI scores than supermarkets in predominantly white and higher-income neighborhoods (mean differences -3.7 and -4.9, respectively). Regression analyses showed that both store type and neighborhood characteristics were independently associated with the HFAI score. Predominantly black and lower-income neighborhoods have a lower availability of healthy foods than white and higher-income neighborhoods due to the differential placement of types of stores as well as differential offerings of healthy foods within similar stores. These differences may contribute to racial and economic health disparities.
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              Association of dietary patterns with albuminuria and kidney function decline in older white women: a subgroup analysis from the Nurses' Health Study.

              Julie Lin, Gary Curhan, Frank Hu … (2011)
              Dietary patterns have been linked to such chronic diseases as cardiovascular disease, but sparse data currently are available for associations between dietary patterns and microalbuminuria or kidney function decline. Subgroup analysis from a prospective observational cohort study. Female participants in the Nurses' Health Study who had dietary pattern data from food frequency questionnaires returned in 1984, 1986, 1990, 1994, and 1998 and urinary albumin-creatinine ratios from 2000 (n = 3,121); estimated glomerular filtration rate (eGFR) change between 1989 and 2000 was available for 3,071. Prudent (higher intake of fruits, vegetables, legumes, fish, poultry, and whole grains), Western (higher intake of red and processed meats, saturated fats, and sweets), and Dietary Approach to Stop Hypertension (DASH)-style dietary patterns (also greater intake of vegetables, fruits, and whole grains). Microalbuminuria (albumin-creatinine ratio, 25-354 μg/mg) in 2000 and change in kidney function using eGFR between 1989 and 2000. After multivariable adjustment, the highest quartile of Western pattern score compared with the lowest quartile was associated directly with microalbuminuria (OR, 2.17; 95% CI, 1.18-3.66; P for trend = 0.01) and rapid eGFR decline ≥3 mL/min/1.73 m(2)/y (OR, 1.77; 95% CI, 1.03-3.03). Women in the top quartile of the DASH score had decreased risk of rapid eGFR decline (OR, 0.55; 95% CI, 0.38-0.80), but no association with microalbuminuria. These associations did not vary by diabetes status. The prudent dietary pattern was not associated with microalbuminuria or eGFR decline. Study cohort included primarily older white women and generalizability of results would benefit from validation in nonwhites and men. A Western dietary pattern is associated with a significantly increased odds of microalbuminuria and rapid kidney function decrease, whereas a DASH-style dietary pattern may be protective against rapid eGFR decline. Copyright © 2011 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.
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                Author and article information

                Journal
                Journal ID (publisher-id): AJN
                Journal ID (nlm-ta): Am J Nephrol
                Journal ID (doi): 10.1159/issn.0250-8095
                Title: American Journal of Nephrology
                Publisher: S. Karger AG
                ISSN (Print): 0250-8095
                ISSN (Electronic): 1421-9670
                Publication date Subscription-year: 2014
                Publication date (Print): February 2014
                Publication date (Electronic): 08 January 2014
                Volume: 39
                Issue: 1
                Pages: 27-35
                Affiliations
                aDivision of Nephrology, Department of Medicine, bWelch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Md., cDepartment of Behavioral Health and Nutrition, University of Delaware, Newark Del., dDivision of Nephrology, Department of Medicine, University of California, San Francisco, Calif., eDivision of Nephrology, Department of Medicine, University of Michigan, Ann Arbor, Mich., fNational Institute on Aging, National Institutes of Health, Baltimore, Md., gDivision of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Ga., and hDepartment of Medicine, San Francisco General Hospital, University of California, San Francisco, Calif., USA
                Author notes
                *Deidra C. Crews, MD, ScM, Division of Nephrology, Johns Hopkins University School of Medicine, Johns Hopkins Bayview Medical Center, 301 Mason F. Lord Drive, Suite 2500, Baltimore, MD 21224 (USA), E-Mail dcrews1@jhmi.edu
                Article
                Publisher ID: 357595 Pmcid ID: PMC3952065 Other ID: Am J Nephrol 2014;39:27-35
                DOI: 10.1159/000357595
                PMC ID: PMC3952065
                PubMed ID: 24434743
                SO-VID: 804457c9-226f-45af-9512-2cae9ba392c6
                Copyright © © 2014 S. Karger AG, Basel
                License:

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                History
                Date received : 23 September 2013
                Date accepted : 24 November 2013
                Page count
                Figures: 2, Tables: 3, Pages: 9
                Categories
                Subject: Original Report: Patient-Oriented, Translational Research

                ScienceOpen disciplines: Cardiovascular Medicine,Nephrology
                Keywords: Nutrition,Disparity,Socioeconomic status
                Data availability:
                ScienceOpen disciplines: Cardiovascular Medicine, Nephrology
                Keywords: Nutrition, Disparity, Socioeconomic status

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