Neighborhood Food Outlet Access and Dietary Intake among Adults with Chronic Kidney Disease: Results from the Chronic Renal Insufficiency Cohort Study

Published:March 04, 2020DOI:https://doi.org/10.1016/j.jand.2019.12.013

      Abstract

      Background

      Healthy diet is essential in the management of chronic kidney disease (CKD) and preventing related comorbidities. Food outlet access has been studied in the general population; however, the influence of the local food environment on dietary intake among people with CKD has not been evaluated.

      Objectives

      This study examined the associations of food outlet density and type of outlets with dietary intake in a multicenter cohort of racially and ethnically diverse patients with CKD.

      Methods

      The Chronic Renal Insufficiency Cohort Study is a multicenter prospective study of patients with CKD that used a validated food frequency questionnaire to capture dietary intake at the baseline visit. This is a cross-sectional analysis of 2,484 participants recruited in 2003-2006 from seven Chronic Renal Insufficiency Cohort Study centers. Food outlet data were used to construct a count of the number of fast-food restaurants, convenience stores, and grocery stores per 10,000 population for each geocoded census block group. Multivariable linear and logistic regression models were used to evaluate the associations between measures of food outlet availability and dietary factors.

      Results

      The proportion of participants living in zero–, low–, and high–food outlet density areas differed by gender, race or ethnicity, and income level. Among male subjects, living in areas with zero or the highest number of outlets was associated with having the highest caloric intakes in multivariable models. Male subjects living in areas with zero outlets consumed the highest levels of sodium and phosphorous. Female subjects living in areas with zero outlets had the lowest average intake of calories, sodium, and phosphorous. Among low-income female subjects, close proximity to more outlets was associated with higher calorie consumption. Among all participants, access to fast-food restaurants was not associated with an unhealthy diet score, and access to grocery stores was not associated with a healthy diet score.

      Conclusions

      Average caloric and nutrient intakes differed by outlet availability; however, there were no strong associations with type of food outlet. This should be considered when developing food-focused public health policies.

      Keywords

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      Biography

      J. M. Madrigal is a doctoral candidate, Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago.

      Biography

      A. C. Ricardo is an associate professor of medicine, Division of Nephrology, Department of Medicine, University of Illinois at Chicago, Chicago.

      Biography

      E. Cedillo-Couvert is a nephrologist, South Texas Renal Care Group, San Antonio.

      Biography

      L. J. Appel is a professor, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.

      Biography

      C. A. M. Anderson is a professor, Department of Family Medicine and Public Health, University of California San Diego School of Medicine, La Jolla.

      Biography

      R. Deo is an associate professor, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia.

      Biography

      D. Sha is a biostatistician, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia.

      Biography

      J. Y. Hsu is an assistant professor of biostatistics, Center for Clinical Epidemiology and Biostatistics and Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia.

      Biography

      L. L. Hamm is dean, Tulane University School of Medicine, New Orleans, LA.

      Biography

      D. Cornish-Zirker is a clinical research project manager, University of Michigan, Ann Arbor.

      Biography

      T. C. Tan is a senior research project manager, Kaiser Permanente Northern California, Division of Research, Oakland.

      Biography

      S. N. Zenk is a professor, Department of Health Systems Science, College of Nursing, University of Illinois at Chicago, Chicago, IL.

      Biography

      V. Persky is a professor, Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL.

      Biography

      J. P. Lash is a professor of medicine, Division of Nephrology, Department of Medicine, University of Illinois at Chicago, Chicago, IL.

      Biography

      M. R. Saunders is assistant professor of medicine, Section of General Internal Medicine, University of Chicago Medicine, Chicago, IL.