Crews Deidra C, Kuczmarski Marie Fanelli, Miller Edgar R, Zonderman Alan B, Evans Michele K, Powe Neil R
Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland.
Department of Behavioral Health and Nutrition, University of Delaware, Newark, Delaware.
J Ren Nutr. 2015 Mar;25(2):103-10. doi: 10.1053/j.jrn.2014.07.008. Epub 2014 Sep 17.
Poverty is associated with chronic kidney disease (CKD) in the United States and worldwide. Poor dietary habits may contribute to this disparity.
Cross-sectional study.
A total of 2,058 community-dwelling adults aged 30 to 64 years residing in Baltimore City, Maryland.
Adherence to the Dietary Approaches to Stop Hypertension (DASH) diet. DASH scoring based on 9 target nutrients (total fat, saturated fat, protein, fiber, cholesterol, calcium, magnesium, sodium, and potassium); adherence defined as score ≥4.5 of maximum possible score of 9. Poverty (self-reported household income <125% of 2004 Department of Health and Human Services guideline) and nonpoverty (≥125% of guideline).
CKD defined as estimated glomerular filtration rate <60 mL/minute/1.73 m(2) (CKD epidemiology collaboration equation). Multivariable logistic regression was used to calculate adjusted odds ratios (AORs) for relation of DASH score tertile and CKD, stratified by poverty status.
Among 2,058 participants (mean age 48 years; 57% black; 44% male; 42% with poverty), median DASH score was low, 1.5 (interquartile range, 1-2.5). Only 5.4% were adherent. Poverty, male sex, black race, and smoking were more prevalent among the lower DASH score tertiles, whereas higher education and regular health care were more prevalent among the highest DASH score tertile (P < .05 for all). Fiber, calcium, magnesium, and potassium intake were lower, and cholesterol higher, among the poverty compared with nonpoverty group (P < .05 for all), with no difference in sodium intake. A total of 5.6% of the poverty and 3.8% of the nonpoverty group had CKD (P = .05). The lowest DASH tertile (compared with the highest) was associated with more CKD among the poverty (AOR 3.15, 95% confidence interval 1.51-6.56), but not among the nonpoverty group (AOR 0.73, 95% confidence interval 0.37-1.43; P interaction = .001).
Poor dietary habits are strongly associated with CKD among the urban poor and may represent a target for interventions aimed at reducing disparities in CKD.
在美国及全球范围内，贫困与慢性肾脏病（CKD）相关。不良饮食习惯可能导致这种差异。
横断面研究。
共有2058名年龄在30至64岁之间、居住在马里兰州巴尔的摩市的社区成年人。
遵循终止高血压饮食疗法（DASH饮食）。基于9种目标营养素（总脂肪、饱和脂肪、蛋白质、纤维、胆固醇、钙、镁、钠和钾）进行DASH评分；依从性定义为得分≥4.5（满分9分）。贫困（自我报告的家庭收入<2004年卫生与公众服务部指南的125%）和非贫困（≥指南的125%）。
CKD定义为估计肾小球滤过率<60 ml/分钟/1.73 m²（CKD流行病学协作方程）。采用多变量逻辑回归计算按贫困状况分层的DASH评分三分位数与CKD关系的调整比值比（AOR）。
在2058名参与者中（平均年龄48岁；57%为黑人；44%为男性；42%为贫困人口），DASH评分中位数较低，为1.5（四分位间距，1 - 2.5）。只有5.4%的人依从。在DASH评分较低的三分位数人群中，贫困、男性、黑人种族和吸烟更为普遍，而在DASH评分最高的三分位数人群中，高等教育和定期医疗更为普遍（所有P < 0.05）。与非贫困组相比，贫困组的纤维、钙、镁和钾摄入量较低，胆固醇摄入量较高（所有P < 0.05），钠摄入量无差异。贫困组中有5.6%的人患有CKD，非贫困组中有3.8%的人患有CKD（P = 0.05）。最低的DASH三分位数（与最高三分位数相比）与贫困人群中更多的CKD相关（AOR 3.15，95%置信区间1.51 - 6.56），但在非贫困组中不相关（AOR 0.73，95%置信区间0.37 - 1.43；P交互作用 = 0.001）。
不良饮食习惯与城市贫困人口中的CKD密切相关，可能是旨在减少CKD差异的干预措施的目标。
