Diet Quality, Food Insecurity, and Chronic Kidney Disease: Insights From the US National Health and Nutrition...

Healthy eating patterns may prevent development of chronic kidney disease (CKD). Food insecurity is a known barrier to high diet quality. We examine the association of diet quality with CKD prevalence and food insecurity in a nationally representative population.

Cross-sectional analysis of data was conducted among eligible adults (n = 5,974) in the 2017-2020 National Health and Nutrition Examination Survey. Multivariable linear and logistic regression models were used to examine the association between diet quality, assessed using the Healthy Eating Index (HEI)-2020, and CKD prevalence and between food insecurity, assessed using a 10-item questionnaire, and diet quality. CKD was defined as an estimated glomerular filtration rate <60 mL/min per 1.73 m² or urine albumin-to-creatinine ratio ≥30 mg/g. Models adjusted for sociodemographic and health characteristics were conducted in the general population, among people with diabetes, and those with hypertension.

Diet quality was not significantly associated with CKD prevalence in the general population (adjusted odds ratio [aOR] per 10-point increase = 0.88; 95% confidence interval (CI): 0.78, 1.01). However, a 10-point higher HEI-2020 score was associated with 24% lower odds of CKD in those with diabetes (aOR = 0.76; 95% CI: 0.61, 0.95) and 20% lower odds in those with hypertension (aOR = 0.80; 95% CI: 0.69, 0.99). In adjusted models, no statistically significant association was observed between diet quality and food insecurity.

Poorer diet quality was associated with a higher prevalence of CKD among individuals with diabetes and/or hypertension. Addressing barriers to healthy eating is essential among individuals at risk for CKD.