Division of Nephrology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, Md., USA.
Am J Nephrol. 2014;39(1):27-35. doi: 10.1159/000357595. Epub 2014 Jan 8.
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.
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.
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.
Food insecurity may contribute to disparities in kidney disease, especially among persons with diabetes or hypertension, and is worthy of further study.
食物不安全（无法获得营养充足和安全的食物）与慢性肾脏病（CKD）之间的关系尚不清楚。我们研究了在一般美国成年人群体和城市人群中，食物不安全是否与低收入个体中普遍存在的 CKD 相关。
我们对国家健康和营养调查（NHANES）2003-2008 年（n=9126）和多样性在生命跨度中的邻里健康老龄化（HANDLS）研究（n=1239）中的低收入参与者进行了横断面分析。根据问卷定义食物不安全，通过估算肾小球滤过率降低或蛋白尿定义 CKD；使用多变量逻辑回归进行调整。
在 NHANES 中，CKD 的年龄调整患病率分别为高、边缘和无食物不安全组的 20.3%、17.6%和 15.7%。在调整社会人口统计学和吸烟状况后，仅在患有糖尿病（OR=1.67，95%CI：1.14-2.45 比较高与无食物不安全组）或高血压（OR=1.37，95%CI：1.03-1.82）的参与者中，高食物不安全与 CKD 的更高几率相关。在 HANDLS 中，有和没有食物不安全的参与者的年龄调整 CKD 患病率分别为 5.9%和 4.6%（p=0.33）。食物不安全与 CKD 几率增加呈趋势相关（OR=1.46，95%CI：0.98-2.18），在糖尿病、高血压或肥胖亚组中没有证据表明存在效应修饰。
食物不安全可能导致肾脏疾病的差异，尤其是在患有糖尿病或高血压的人群中，值得进一步研究。
