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Assessment of dietary intake of children with chronic kidney disease

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Abstract

Objective

Our aim was to characterize the nutrient intake of children with chronic kidney disease (CKD) relative to recommended intake levels.

Methods

We conducted a cross-sectional study of dietary intake assessed by Food Frequency Questionnaire (FFQ) in The North American Chronic Kidney Disease in Children (CKiD) prospective cohort study. Nutrient intake was analyzed to estimate the daily consumption levels of various nutrients and compared with national guidelines for intake.

Results

There were 658 FFQs available for analysis; 69.9 % of respondents were boys, with a median age [Interquartile range (IQR)] of 11 years (8–15). Median daily sodium, potassium, and phosphorus intake was 3089 mg (2294–4243), 2384 mg (1804–3076), and 1206 mg (894–1612) respectively. Sodium and phosphorus consumptions were higher than recommended in all age groups. Caloric intake decreased with dropping glomerular filtration rate (GFR) (p = 0.003). The median daily caloric intakes were 1307 kcal in male children 2–3 years old, 1875 kcal in children 4–8 years old, 1923 kcal in those 9–13 years old, and 2427 kcal in those 14–18 years old. Respective levels for girls were 1467 kcal, 1736 kcal, 1803 kcal, and 2281 kcal. Median protein intake exceeded recommended levels in all age groups, particularly among younger participants. Younger children were more likely than older children to exceed the recommended intakes for phosphorus (p < 0.001) and the age-specific recommended caloric intake (p < 0.001). Macronutrient distribution (carbohydrate:fat:protein) was consistent with recommendation.

Conclusions

Children in the CKiD cohort consumed more sodium, phosphorus, protein, and calories than recommended. The gap between actual consumption and recommendations indicates a need for improved nutritional counseling and monitoring.

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Abbreviations

ACEI:

Angiotensin-converting enzyme inhibitor

BMI:

Body mass index

CKD:

Chronic kidney disease

CKiD:

Chronic Kidney Disease in Children

EER:

Estimated energy requirement

eGFR:

Estimated glomerular filtration rate

ESRD:

End-stage renal disease

FFQ:

Food Frequency Questionnaire

IQR:

Interquartile range

NHANES:

National Health and Nutrition Examination Survey

uP/C:

Urine protein/creatinine ratio

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Acknowledgments

Data in this manuscript were collected by the Chronic Kidney Disease in Children prospective cohort study (CKiD) with clinical coordinating centers (Principal Investigators) at Children’s Mercy Hospital and the University of Missouri – Kansas City (Bradley Warady, MD) and Children’s Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania (Susan Furth, MD, Ph.D.), Central Biochemistry Laboratory (George Schwartz, MD) at the University of Rochester Medical Center, and data coordinating center at the Johns Hopkins Bloomberg School of Public Health (Alvaro Muñoz, Ph.D.). The CKiD Study is funded by the National Institute of Diabetes and Digestive and Kidney Diseases, with additional funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, and the National Heart, Lung, and Blood Institute (U01-DK-66143, U01-DK-66174, U01-DK-82194, U01-DK-66116). The CKiD website is located at http://www.statepi.jhsph.edu/ckid.

Support for the nutritional analysis of the FFQ was provided by the National Center for Research Resources, Grant UL1RR024134, and is now at the National Center for Advancing Translational Sciences, Grant UL1TR000003. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Author information

Authors and Affiliations

  1. Department of Pediatrics, The Children’s Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA, 19104, USA

    Wun Fung Hui, Jonathan D. Savant & Susan L. Furth

  2. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Aisha Betoko & Alison G. Abraham

  3. Emory University and Children’s Healthcare of Atlanta, Atlanta, GA, USA

    Larry A. Greenbaum

  4. Division of Pediatric Nephrology, Children’s Mercy Hospital, Kansas City, MO, USA

    Bradley Warady

  5. National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA

    Marva M. Moxey-Mims

Authors
  1. Wun Fung Hui
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  2. Aisha Betoko
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  3. Jonathan D. Savant
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  4. Alison G. Abraham
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  6. Bradley Warady
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  7. Marva M. Moxey-Mims
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  8. Susan L. Furth
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Corresponding author

Correspondence to Susan L. Furth.

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Conflict of interest

The authors have indicated they have no potential conflicts of interest to disclose.

Funding source

National Institute of Diabetes and Digestive and Kidney Diseases, with additional funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the National Heart, Lung and Blood Institute (grants U01-DK-66143, U01-DK-66174, U01DK-082194, and U01-DK-66116).

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all participants.

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Hui, W.F., Betoko, A., Savant, J.D. et al. Assessment of dietary intake of children with chronic kidney disease. Pediatr Nephrol 32, 485–494 (2017). https://doi.org/10.1007/s00467-016-3491-5

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  • DOI: https://doi.org/10.1007/s00467-016-3491-5

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