title: Factors associated with adherence to the dietary protein intervention in the Modification of Diet in Renal Disease Study.
abstract: OBJECTIVE
  To determine the characteristics and behaviors associated with adherence to dietary protein interventions among participants with chronic renal disease in the Modification of Diet in Renal Disease (MDRD) Study.
  
  
  METHODS
  Participants were categorized as consistent adherers or nonadherers on the basis of urinary urea nitrogen excretion and dietary protein intake data from self-reports. Psychosocial and behavioral factors were compared between groups.
  
  
  METHODS
  Subgroups of consistently adherent and non-adherent participants in the MDRD Study.
  
  
  METHODS
  15 clinical centers in the United States.
  
  
  METHODS
  In the nutrition intervention program, participants were assigned randomly to a usual-, low-, or very-low-protein diet group. Each eating pattern also specified a phosphorus goal.
  
  
  METHODS
  Analysis of variance.
  
  
  RESULTS
  Psychosocial factors significantly related to adherence included participant knowledge, attitude, support, satisfaction, and self-perception of success. Behavioral strategies including participant self-monitoring of protein intake and the provision of feedback by the dietitian were also significantly related to adherence.
  
  
  CONCLUSIONS
  Nutrition interventions for patients with renal disease should focus on psychosocial factors and behavioral approaches. Such approaches can be successfully incorporated into treatment programs and will assist the dietitian in promoting adherence to usual-, low-, and very-low-protein eating patterns.
authors.affiliation: Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA 15213, USA.
authors.forename: N C
authors.initials: NC
authors.lastname: Milas
authors.forename: M P
authors.initials: MP
authors.lastname: Nowalk
authors.forename: L
authors.initials: L
authors.lastname: Akpele
authors.forename: L
authors.initials: L
authors.lastname: Castaldo
authors.forename: T
authors.initials: T
authors.lastname: Coyne
authors.forename: L
authors.initials: L
authors.lastname: Doroshenko
authors.forename: L
authors.initials: L
authors.lastname: Kigawa
authors.forename: D
authors.initials: D
authors.lastname: Korzec-Ramirez
authors.forename: L K
authors.initials: LK
authors.lastname: Scherch
authors.forename: L
authors.initials: L
authors.lastname: Snetselaar
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D003625:Data Collection; D018753:Diet, Protein-Restricted / Q000592:standards*; D004044:Dietary Proteins / Q000592:standards*; D005247:Feeding Behavior; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007674:Kidney Diseases / Q000178:diet therapy* / Q000523:psychology / Q000652:urine; D009584:Nitrogen / Q000652:urine; D010349:Patient Compliance; D017060:Patient Satisfaction; D016226:Phosphorus, Dietary / Q000592:standards; D012649:Self Concept; D014508:Urea / Q000652:urine
chemical_list: D004044:Dietary Proteins; D016226:Phosphorus, Dietary; D014508:Urea; D009584:Nitrogen