title: Effect of food insecurity on chronic kidney disease in lower-income Americans.
abstract: BACKGROUND
  The relation of food insecurity (inability to acquire nutritionally adequate and safe foods) and chronic kidney disease (CKD) is unknown. We examined whether food insecurity is associated with prevalent CKD among lower-income individuals in both the general US adult population and an urban population.
  
  
  METHODS
  We conducted cross-sectional analyses of lower-income participants of the National Health and Nutrition Examination Survey (NHANES) 2003-2008 (n = 9,126) and the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study (n = 1,239). Food insecurity was defined based on questionnaires and CKD was defined by reduced estimated glomerular filtration rate or albuminuria; adjustment was performed with multivariable logistic regression.
  
  
  RESULTS
  In NHANES, the age-adjusted prevalence of CKD was 20.3, 17.6, and 15.7% for the high, marginal, and no food insecurity groups, respectively. Analyses adjusting for sociodemographics and smoking status revealed high food insecurity to be associated with greater odds of CKD only among participants with either diabetes (OR = 1.67, 95% CI: 1.14-2.45 comparing high to no food insecurity groups) or hypertension (OR = 1.37, 95% CI: 1.03-1.82). In HANDLS, the age-adjusted CKD prevalence was 5.9 and 4.6% for those with and without food insecurity, respectively (p = 0.33). Food insecurity was associated with a trend towards greater odds of CKD (OR = 1.46, 95% CI: 0.98-2.18) with no evidence of effect modification across diabetes, hypertension, or obesity subgroups.
  
  
  CONCLUSIONS
  Food insecurity may contribute to disparities in kidney disease, especially among persons with diabetes or hypertension, and is worthy of further study.
authors.affiliation: Division of Nephrology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, Md., USA.
authors.forename: Deidra C
authors.initials: DC
authors.lastname: Crews
authors.forename: Marie Fanelli
authors.initials: MF
authors.lastname: Kuczmarski
authors.forename: Vanessa
authors.initials: V
authors.lastname: Grubbs
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Hedgeman
authors.forename: Vahakn B
authors.initials: VB
authors.lastname: Shahinian
authors.forename: Michele K
authors.initials: MK
authors.lastname: Evans
authors.forename: Alan B
authors.initials: AB
authors.lastname: Zonderman
authors.forename: Nilka Rios
authors.initials: NR
authors.lastname: Burrows
authors.forename: Desmond E
authors.initials: DE
authors.lastname: Williams
authors.forename: Rajiv
authors.initials: R
authors.lastname: Saran
authors.forename: Neil R
authors.initials: NR
authors.lastname: Powe
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D005502:Food; D005523:Food Supply; D005919:Glomerular Filtration Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009749:Nutrition Surveys; D011203:Poverty; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology* / Q000209:etiology*; D012111:Residence Characteristics; D011795:Surveys and Questionnaires; D014481:United States; D014505:Urban Population; D055815:Young Adult