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:



      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.


      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.


      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.


      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.


      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.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of the Academy of Nutrition and Dietetics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Burgoine T.
        • Forouhi N.G.
        • Griffin S.J.
        • Wareham N.J.
        • Monsivais P.
        Associations between exposure to takeaway food outlets, takeaway food consumption, and body weight in Cambridgeshire, UK: Population based, cross sectional study.
        BMJ. 2014; 348: g1464
        • Thornton L.E.
        • Bentley R.J.
        • Kavanagh A.M.
        Fast food purchasing and access to fast food restaurants: A multilevel analysis of VicLANES.
        Int J Behav Nutr Phys Act. 2009; 6: 28
        • Moore L.V.
        • Diez Roux A.V.
        • Nettleton J.A.
        • Jacobs D.R.
        • Franco M.
        Fast-food consumption, diet quality, and neighborhood exposure to fast food: The multi-ethnic study of atherosclerosis.
        Am J Epidemiol. 2009; 170: 29-36
        • Ritz E.
        • Hahn K.
        • Ketteler M.
        • Kuhlmann M.K.
        • Mann J.
        Phosphate additives in food—a health risk.
        Dtsch Arztebl Int. 2012; 109: 49-55
        • French S.A.
        • Story M.
        • Jeffery R.W.
        Environmental influences on eating and physical activity.
        Annu Rev Public Health. 2001; 22: 309-335
        • Caspi C.E.
        • Lenk K.
        • Pelletier J.E.
        • et al.
        Food and beverage purchases in corner stores, gas-marts, pharmacies and dollar stores.
        Public Health Nutr. 2017; 20: 2587-2597
        • Fleischhacker S.E.
        • Evenson K.R.
        • Rodriguez D.A.
        • Ammerman A.S.
        A systematic review of fast food access studies.
        Obes Rev. 2011; 12: e460-e471
        • Jeffery R.W.
        • Baxter J.
        • McGuire M.
        • Linde J.
        Are fast food restaurants an environmental risk factor for obesity?.
        Int J Behav Nutr Phy Act. 2006; 3: 2
        • Satia J.A.
        • Galanko J.A.
        • Siega-Riz A.M.
        Eating at fast-food restaurants is associated with dietary intake, demographic, psychosocial and behavioural factors among African Americans in North Carolina.
        Public Health Nutr. 2004; 7: 1089-1096
        • Rose D.
        • Richards R.
        Food store access and household fruit and vegetable use among participants in the US Food Stamp Program.
        Public Health Nutr. 2004; 7: 1081-1088
        • Moore L.V.
        • Diez Roux A.V.
        • Nettleton J.A.
        • Jacobs Jr., D.R.
        Associations of the local food environment with diet quality—a comparison of assessments based on surveys and geographic information systems: The multi-ethnic study of atherosclerosis.
        Am J Epidemiol. 2008; 167: 917-924
        • Anderson C.A.
        • Nguyen H.A.
        • Rifkin D.E.
        Nutrition interventions in chronic kidney disease.
        Med Clin North Am. 2016; 100: 1265-1283
        • Kalantar-Zadeh K.
        • Fouque D.
        Nutritional management of chronic kidney disease.
        N Engl J Med. 2017; 377: 1765-1776
        • Chang A.R.
        • Anderson C.
        Dietary Phosphorus Intake and the Kidney.
        Annu Rev Nutr. 2017; 37: 321-346
        • Calvo M.S.
        • Uribarri J.
        Public health impact of dietary phosphorus excess on bone and cardiovascular health in the general population.
        Am J Clin Nutr. 2013; 98: 6-15
        • Block G.A.
        • Hulbert-Shearon T.E.
        • Levin N.W.
        • Port F.K.
        Association of serum phosphorus and calcium x phosphate product with mortality risk in chronic hemodialysis patients: A national study.
        Am j Kidney Dis. 1998; 31: 607-617
        • Kestenbaum B.
        • Sampson J.N.
        • Rudser K.D.
        • et al.
        Serum phosphate levels and mortality risk among people with chronic kidney disease.
        J Am Soc Nephrol. 2005; 16: 520-528
        • Darmon N.
        • Drewnowski A.
        Does social class predict diet quality?.
        Am J Clin Nutr. 2008; 87: 1107-1117
        • Darmon N.
        • Drewnowski A.
        Contribution of food prices and diet cost to socioeconomic disparities in diet quality and health: A systematic review and analysis.
        Nutr Rev. 2015; 73: 643-660
        • Li K.K.
        • Concepcion R.Y.
        • Lee H.
        • et al.
        An examination of sex differences in relation to the eating habits and nutrient intakes of university students.
        J Nutr Educ Behav. 2012; 44: 246-250
        • Li R.
        • Serdula M.
        • Bland S.
        • Mokdad A.
        • Bowman B.
        • Nelson D.
        Trends in fruit and vegetable consumption among adults in 16 US states: Behavioral Risk Factor Surveillance System, 1990-1996.
        Am J Public Health. 2000; 90: 777-781
        • Shimakawa T.
        • Sorlie P.
        • Carpenter M.A.
        • et al.
        Dietary intake patterns and sociodemographic factors in the atherosclerosis risk in communities study. ARIC Study Investigators.
        Prev Med. 1994; 23: 769-780
        • Block J.P.
        • Scribner R.A.
        • DeSalvo K.B.
        Fast food, race/ethnicity, and income: A geographic analysis.
        Am J Prev med. 2004; 27: 211-217
        • Nicholas S.B.
        • Kalantar-Zadeh K.
        • Norris K.C.
        Socioeconomic disparities in chronic kidney disease.
        Adv Chronic Kidney Dis. 2015; 22: 6-15
        • Vart P.
        • Gansevoort R.T.
        • Joosten M.M.
        • Bultmann U.
        • Reijneveld S.A.
        Socioeconomic disparities in chronic kidney disease: A systematic review and meta-analysis.
        Am J Prev Med. 2015; 48: 580-592
        • Neugarten J.
        • Acharya A.
        • Silbiger S.R.
        Effect of gender on the progression of nondiabetic renal disease: A meta-analysis.
        J Am Soc Nephrol. 2000; 11: 319-329
        • Neugarten J.
        • Golestaneh L.
        Gender and the prevalence and progression of renal disease.
        AdvChronic Kidney Dis. 2013; 20: 390-395
        • Silbiger S.
        • Neugarten J.
        Gender and human chronic renal disease.
        Gend Med. 2008; 5: S3-s10
        • Feldman H.I.
        • Appel L.J.
        • Chertow G.M.
        • et al.
        The Chronic Renal Insufficiency Cohort (CRIC) Study: Design and methods.
        J Am Soc Nephrol. 2003; 14: S148-153
        • Lash J.P.
        • Go A.S.
        • Appel L.J.
        • et al.
        Chronic Renal Insufficiency Cohort (CRIC) Study: Baseline characteristics and associations with kidney function.
        Clin J Am Soc Nephrol. 2009; 4: 1302-1311
        • Subar A.F.
        • Thompson F.E.
        • Kipnis V.
        • et al.
        Comparative validation of the Block, Willett, and National Cancer Institute food frequency questionnaires: The Eating at America’s Table Study.
        Am J Epidemiol. 2001; 154: 1089-1099
        • Lloyd-Jones D.M.
        • Hong Y.
        • Labarthe D.
        • et al.
        Defining and setting national goals for cardiovascular health promotion and disease reduction: The American Heart Association’s strategic Impact Goal through 2020 and beyond.
        Circulation. 2010; 121: 586-613
        • Ricardo A.C.
        • Anderson C.A.
        • Yang W.
        • et al.
        Healthy lifestyle and risk of kidney disease progression, atherosclerotic events, and death in CKD: Findings from the Chronic Renal Insufficiency Cohort (CRIC) Study.
        Am J Kidney Dis. 2015; 65: 412-424
        • Boone-Heinonen J.
        • Gordon-Larsen P.
        • Kiefe C.I.
        • Shikany J.M.
        • Lewis C.E.
        • Popkin B.M.
        Fast food restaurants and food stores: Longitudinal associations with diet in young to middle-aged adults: The CARDIA study.
        Arch Intern Med. 2011; 171: 1162-1170
        • Hollands S.
        • Campbell M.K.
        • Gilliland J.
        • Sarma S.
        A spatial analysis of the association between restaurant density and body mass index in Canadian adults.
        Prev Med. 2013; 57: 258-264
        • Yang Y.
        • Diez-Roux A.V.
        Walking distance by trip purpose and population subgroups.
        Am J Prev Med. 2012; 43: 11-19
        • Athens J.K.
        • Duncan D.T.
        • Elbel B.
        Proximity to fast-food outlets and supermarkets as predictors of fast-food dining frequency.
        J Acad Nutr Diet. 2016; 116: 1266-1275
        • He M.
        • Tucker P.
        • Gilliland J.
        • Irwin J.D.
        • Larsen K.
        • Hess P.
        The influence of local food environments on adolescents’ food purchasing behaviors.
        Int J Environ Res Public Health. 2012; 9: 1458-1471
        • Larsen K.
        • Gilliland J.
        Mapping the evolution of “food deserts” in a Canadian city: Supermarket accessibility in London, Ontario, 1961-2005.
        Int J Health Geogr. 2008; 7: 16
        • Centers for Disease Control and Prevention (CDC)
        Census Tract Level State Maps of the Modified Retail Food Environment Index (mRFEI).
        US Department of Health and Human Services, Atlanta, GA2011
        • Greer S.
        • Schieb L.
        • Schwartz G.
        • Onufrak S.
        • Park S.
        Association of the neighborhood retail food environment with sodium and potassium intake among US adults.
        Prev Chronic Dis. 2014; 11: E70
        • Levey A.S.
        • Stevens L.A.
        • Schmid C.H.
        • et al.
        A new equation to estimate glomerular filtration rate.
        Ann Intern Med. 2009; 150: 604-612
        • Khan L.K.
        • Sobush K.
        • Keener D.
        • et al.
        Recommended community strategies and measurements to prevent obesity in the United States.
        MMWR Recomm Rep. 2009; 58: 1-26
        • Story M.
        • Kaphingst K.M.
        • Robinson-O'Brien R.
        • Glanz K.
        Creating healthy food and eating environments: Policy and environmental approaches.
        Annu Rev Public Health. 2008; 29: 253-272
        • Cheadle A.
        • Cromp D.
        • Krieger J.W.
        • et al.
        Promoting policy, systems, and environment change to prevent chronic disease: Lessons learned from the King County Communities Putting Prevention to Work Initiative.
        J Public Health Manag Pract. 2016; 22: 348-359
        • Bowen D.J.
        • Barrington W.E.
        • Beresford S.A.
        Identifying the effects of environmental and policy change interventions on healthy eating.
        Annu Rev Public Health. 2015; 36: 289-306
        • Centers for Disease Control and Prevention (CDC)
        National Center for Chronic Disease Prevention and Health Promotion, Division of Nutrition, Physical Activity and Obesity (DNPAO). Nutrition: Strategies and Resources.
        (Published 2019. Accessed November 1, 2019)
        • Rolls B.J.
        • Fedoroff I.C.
        • Guthrie J.F.
        Gender differences in eating behavior and body weight regulation.
        Health Psychol. 1991; 10: 133-142
        • Millen B.E.
        • Quatromoni P.A.
        • Franz M.M.
        • Epstein B.E.
        • Cupples L.A.
        • Copenhafer D.L.
        Population nutrient intake approaches dietary recommendations: 1991 to 1995 Framingham Nutrition Studies.
        J Am Diet Assoc. 1997; 97: 742-749
        • Stevens P.E.
        • Levin A.
        Evaluation and management of chronic kidney disease: Synopsis of the kidney disease: Improving global outcomes 2012 clinical practice guideline.
        Ann Intern Med. 2013; 158: 825-830
      1. Academy of Nutrition and Dietetics Evidence Analysis Library. 2010 Chronic Kidney Disease (CKD) Evidence-Based Nutrition Practice Guideline. Published 2010. Accessed January 15, 2019.

        • Suarez J.J.
        • Isakova T.
        • Anderson C.A.
        • Boulware L.E.
        • Wolf M.
        • Scialla J.J.
        Food access, chronic kidney disease, and hypertension in the U.S.
        Am J Prev Med. 2015; 49: 912-920
        • Morland K.
        • Wing S.
        • Diez Roux A.
        The contextual effect of the local food environment on residents’ diets: The atherosclerosis risk in communities study.
        Am J Public Health. 2002; 92: 1761-1767
        • Zenk S.N.
        • Lachance L.L.
        • Schulz A.J.
        • Mentz G.
        • Kannan S.
        • Ridella W.
        Neighborhood retail food environment and fruit and vegetable intake in a multiethnic urban population.
        Am J Health Promot. 2009; 23: 255-264
        • Elbel B.
        • Mijanovich T.
        • Kiszko K.
        • Abrams C.
        • Cantor J.
        • Dixon L.B.
        The introduction of a supermarket via tax-credits in a low-income area.
        Am J Health Promot. 2017; 31: 59-66
        • Rogus S.
        • Athens J.
        • Cantor J.
        • Elbel B.
        Measuring micro-level effects of a new supermarket: Do residents within 0.5 mile have improved dietary behaviors?.
        J Acad Nutr Diet. 2018; 118: 1037-1046
        • Ghosh-Dastidar M.
        • Hunter G.
        • Collins R.L.
        • et al.
        Does opening a supermarket in a food desert change the food environment?.
        Health Place. 2017; 46: 249-256
        • United States Department of Labor
        Occupational Safety and Health Administration. Standard Industrial Classification (SIC) Division Structure.
        (Published 2019. Accessed October 28, 2019)


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


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


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


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


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


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


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


      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.


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


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


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


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


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


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


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