title: Food Access, Chronic Kidney Disease, and Hypertension in the U.S.
abstract: BACKGROUND
  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.
authors.affiliation: Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida; Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Jonathan J
authors.initials: JJ
authors.lastname: Suarez
authors.affiliation: Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Tamara
authors.initials: T
authors.lastname: Isakova
authors.affiliation: Department of Preventive and Family Medicine, University of California San Diego, San Diego, California.
authors.forename: Cheryl A M
authors.initials: CA
authors.lastname: Anderson
authors.affiliation: Department of Medicine.
authors.forename: L Ebony
authors.initials: LE
authors.lastname: Boulware
authors.affiliation: Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Myles
authors.initials: M
authors.lastname: Wolf
authors.affiliation: Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida; Department of Medicine; Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina. Electronic address: julia.scialla@duke.edu.
authors.forename: Julia J
authors.initials: JJ
authors.lastname: Scialla
mesh_terms: D000328:Adult; D005260:Female; D005523:Food Supply; D006801:Humans; D006973:Hypertension / Q000453:epidemiology*; D016013:Likelihood Functions; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys; D009752:Nutritional Status; D011203:Poverty; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology