Research Article
Food Access, Chronic Kidney Disease, and Hypertension in the U.S.

https://doi.org/10.1016/j.amepre.2015.07.017Get rights and content

Introduction

Greater distance to full-service supermarkets and low income may impair access to healthy diets and contribute to chronic kidney disease (CKD) and hypertension. The study aim was to determine relationships among residence in a “food desert,” low income, CKD, and blood pressure.

Methods

Adults in the 2003–2010 National Health and Nutrition Examination Survey (N=22,173) were linked to food desert data (www.ers.usda.gov) by Census Tracts. Food deserts have low median income and are further from a supermarket or large grocery store (>1 mile in urban areas, >10 miles in rural areas). Weighted regression was used to determine the association of residence in a food desert and family income with dietary intake; systolic blood pressure (SBP); and odds of CKD. Data analysis was performed in 2014–2015.

Results

Compared with those not in food deserts, participants residing in food deserts had lower levels of serum carotenoids (p<0.01), a biomarker of fruit and vegetable intake, and higher SBP (1.53 mmHg higher, 95% CI=0.41, 2.66) after adjustment for demographics and income. Residence in a food desert was not associated with odds of CKD (OR=1.20, 95% CI=0.96, 1.49). Lower, versus higher, income was associated with lower serum carotenoids (p<0.01) and higher SBP (2.00 mmHg higher for income–poverty ratio ≤1 vs >3, 95% CI=1.12, 2.89), but also greater odds of CKD (OR=1.76 for income–poverty ratio ≤1 vs >3, 95% CI=1.48, 2.10).

Conclusions

Limited access to healthy food due to geographic or financial barriers could be targeted for prevention of CKD and hypertension.

Introduction

Chronic kidney disease (CKD) affects 26 million Americans with growing prevalence and impact nationally.1, 2 Hypertension is a major risk factor for CKD and a leading national risk factor for morbidity and mortality.2, 3 As a result, CKD and hypertension are deemed important public health priorities warranting surveillance in the U.S. by CDC.4 Both CKD and hypertension are associated with substantial ethnic/race, socioeconomic, and geographic disparities that suggest modifiable environmental risk factors that could be targeted.5, 6, 7, 8, 9

The roles of diet and food environments as contributors to chronic disease have gained increased attention in recent years,10, 11, 12 with dietary risk factors identified as the leading risk factor for death and disability in the U.S. and globally.2, 13 It is increasingly recognized that adverse dietary patterns may increase the risk of CKD and hypertension.14, 15, 16, 17, 18, 19, 20 Although the exact mechanisms through which diet promotes CKD and hypertension are not known, a number have been proposed, including high sodium and phosphate content,21, 22 increased diet acid load,23, 24 and high intake of saturated fats.16

Adverse dietary patterns, such as higher intake of processed meats and fats and limited intake of fruits and vegetables, are common in lower-income neighborhoods in the U.S. and may be influenced by the local availability of affordable, healthy foods.10, 12, 25, 26 The U.S. Department of Agriculture (USDA) has defined areas in the U.S. that are characterized by low income and limited access to large grocery stores or supermarkets as “food deserts.”27 Although food deserts have been linked to some diet-related illnesses such as obesity, data on CKD and hypertension are lacking.10, 12, 27 Furthermore, the higher prices of healthy foods, such as fresh fruits and vegetables, also make low family income a substantial barrier to healthy food access.28 Thus, this paper describes the associations of residence in a food desert and low family income with kidney function and hypertension using national data. The authors hypothesize that food deserts and poverty will associate with greater likelihood of CKD and higher blood pressure due to adverse impacts on diet.

Section snippets

Study Population

The study included adults aged ≥20 years who enrolled in the National Health and Nutrition Examination Survey (NHANES) between 2003 and 2010 and had information on Census Tract of residence (N=22,173).

Measures

The NHANES is a complex survey of the non-institutionalized U.S. population. Blood pressure was measured manually in triplicate by study physicians after 5 minutes at rest in the seated position. Blood and urine samples were obtained and tested for a variety of analytes, including serum

Results

The study included 22,173 participants representing 2,567 unique Census Tracts in the U.S., 259 of which were food deserts (Appendix Figure 1, available online). The weighted characteristics of the participants generally reflected those of the adult U.S. population (Table 1). A minority of the participants in the study self-reported a history of CKD (2.1%); diabetes (8.2%); or hypertension (30.1%), although awareness is known to be low.3, 35 Participants living in food deserts were more likely

Discussion

The authors found that adults living in Census Tracts classified as food deserts have higher SBP than adults in non-food desert Tracts in the U.S. A trend toward higher prevalence of CKD was also found in the primary analysis, but this was only significant among the fasting population who likely had more-reliable morning assessments of albuminuria.36 Sensitivity analyses also supported a possible relationship between food deserts and CKD. By contrast, adults with lower family income had both

Acknowledgments

This work was supported by K23DK095494 to J Scialla from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). This manuscript represents the opinions of the authors and does not necessarily reflect the views of the NIDDK, Research Data Center, National Center for Health Statistics, or CDC.

No financial disclosures were reported by the authors of this paper.

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