Dietary Quality in Relation to Physical Functioning among Individuals with Chronic Kidney Disease in the United States Public
Cravens, Lauryn (Spring 2023)
Abstract
Dietary Quality in Relation to Physical Functioning among Individuals with Chronic Kidney Disease in the United States
By Lauryn Cravens
Background: Chronic kidney disease (CKD) is a growing health burden on individuals and populations across the world. The physiological changes that may occur from CKD can result in physical functioning impairments, including limitations in mobility and carrying out daily activities. Dietary patterns are important modifiable risk factors for those with CKD and for delaying functional impairments in older adults. While recent studies have focused on the associations between specific foods and micronutrients as they relate to CKD, the present study examined the associations between overall dietary patterns and physical functioning among those already living with the disease.
Objective: The objective of the study is to assess the association between dietary patterns using the 2015 Healthy Eating Index (HEI-2015) and physical functioning among those with CKD by examining data from a nationally representative sample of U.S. adults.
Methods: This study utilized data from the National Health and Nutrition Examination Study (NHANES) from1999-2016, a nationally representative sample of the US population, to assess the association between diet quality and physical functioning in individuals with chronic kidney disease (CKD). The study included 5,160 participants who met inclusion criteria, and dietary data were obtained via a 24-hour dietary recall interview and analyzed using the HEI-2015. The primary outcome of interest was physical functioning (grouped into two sets of participants: those with above and below the median number of reported physical functioning difficulties). A multivariable analysis was conducted to assess the association between dietary patterns using HEI-2015 and physical functioning. The HEI-2015 was categorized into tertiles, and the first model adjusted for age, gender, race/ethnicity, poverty, education, and marital status. The second model additionally adjusted for smoking, drinking, physical activity, and body mass index (BMI).
Results: The first model found that poorer diet was significantly associated with lower physical functioning (β=-0.077, p < 0.001), along with older age, female gender, greater poverty, and non-married states. The second model found that smoking, more infrequent physical activity, higher BMI, older age, female gender, and greater poverty were all significant predictors of lower physical functioning, while the associations between dietary patterns and physical functioning were no longer significant.
Conclusion: The study suggests that maintaining a healthy diet may have a positive impact on physical functioning in individuals with CKD, along with notable modifiable risk factors including smoking, physical activity, and BMI. Future studies should aim to investigate the associations between diet and physical functioning in individuals with CKD additionally adjusting for fasting glucose, systolic blood pressure, and total cholesterol, as well as the association between dietary patterns and physical functioning in individuals with CKD outside of the United States.
Table of Contents
Introduction and Rationale 1
Introduction 1
Purpose Statement 1
Research Question 2
Significance Statement 2
Literature Review 2
Materials and Methods 7
Data Source 7
Study Sample 8
Dietary Assessment 9
Outcomes 9
Potential Confounders 10
Statistical Analysis 11
Results 12
Baseline Characteristics 12
Multivariable Analysis 14
Discussion 17
References 21
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