Pediatric Nephrology

, Volume 32, Issue 7, pp 1233–1241 | Cite as

Dietary sources of energy and nutrient intake among children and adolescents with chronic kidney disease

  • Wen Chen
  • Kirstie Ducharme-Smith
  • Laura Davis
  • Wun Fung Hui
  • Bradley A. Warady
  • Susan L. Furth
  • Alison G. Abraham
  • Aisha Betoko
Original Article



Our purpose was to identify the main food contributors to energy and nutrient intake in children with chronic kidney disease (CKD).


In this cross-sectional study of dietary intake assessed using Food Frequency Questionnaires (FFQ) in the Chronic Kidney Disease in Children (CKiD) cohort study, we estimated energy and nutrient intake and identified the primary contributing foods within this population.


Completed FFQs were available for 658 children. Of those, 69.9% were boys, median age 12 (interquartile range (IQR) 8–15 years). The average daily energy intake was 1968 kcal (IQR 1523–2574 kcal). Milk was the largest contributor to total energy, protein, potassium, and phosphorus intake. Fast foods were the largest contributors to fat and sodium intake, the second largest contributors to energy intake, and the third largest contributors to potassium and phosphorus intake. Fruit contributed 12.0%, 8.7%, and 6.7% to potassium intake for children aged 2–5, 6–13, and 14–18 years old, respectively.


Children with CKD consumed more sodium, protein, and calories but less potassium than recommended by the National Kidney Foundation (NKF) guidelines for pediatric CKD. Energy, protein, and sodium intake is heavily driven by consumption of milk and fast foods. Limiting contribution of fast foods in patients with good appetite may be particularly important for maintaining recommended energy and sodium intake, as overconsumption can increase the risk of obesity and cardiovascular complications in that population.


Nutrient intake Food Children Adolescents Chronic kidney disease 



Adequate intake


Chronic Kidney Disease in Children


Chronic kidney disease


Dietary sources of nutrients


Estimated glomerular filtration rate


Estimated energy requirement


Food Frequency Questionnaire


Interquartile range


National Health and Nutrition Examination Survey


National Kidney Foundation


Recommended dietary allowance

Supplementary material

467_2017_3580_MOESM1_ESM.docx (44 kb)
ESM 1(DOCX 44 kb)


  1. 1.
    Norman LJ, Macdonald IA, Watson AR (2004) Optimising nutrition in chronic renal insufficiency--growth. Pediatr Nephrol 19:1245–1252CrossRefPubMedGoogle Scholar
  2. 2.
    Apostolou A, Printza N, Karagiozoglou-Lampoudi T, Dotis J, Papachristou F (2014) Nutrition assessment of children with advanced stages of chronic kidney disease-A single center study. Hippokratia 18:212–216PubMedPubMedCentralGoogle Scholar
  3. 3.
    KDOQI Work Group (2009) KDOQI Clinical Practice Guideline for Nutrition in Children with CKD: 2008 update. Executive summary. Am J Kidney Dis 53:S11–S104Google Scholar
  4. 4.
    Kim H, Lim H, Choue R (2014) Compromised diet quality is associated with decreased renal function in children with chronic kidney disease. Clin Nutr Res 3:142–149CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Cheung WW, Paik KH, Mak RH (2010) Inflammation and cachexia in chronic kidney disease. Pediatr Nephrol 25:711–724CrossRefPubMedGoogle Scholar
  6. 6.
    Mak RH, Cheung W, Cone RD, Marks DL (2005) Orexigenic and anorexigenic mechanisms in the control of nutrition in chronic kidney disease. Pediatr Nephrol 20:427–431CrossRefPubMedGoogle Scholar
  7. 7.
    Schwartz GJ, Munoz A, Schneider MF, Mak RH, Kaskel F, Warady BA, Furth SL (2009) New equations to estimate GFR in children with CKD. J Am Soc Nephrol 20:629–637CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Furth SL, Cole SR, Moxey-Mims M, Kaskel F, Mak R, Schwartz G, Wong C, Munoz A, Warady BA (2006) Design and methods of the Chronic Kidney Disease in Children (CKiD) prospective cohort study. Clin J Am Soc Nephrol 1:1006–1015CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Willett WC, Sampson L, Stampfer MJ, Rosner B, Bain C, Witschi J, Hennekens CH, Speizer FE (1985) Reproducibility and validity of a semiquantitative food frequency questionnaire. Am J Epidemiol 122:51–65CrossRefPubMedGoogle Scholar
  10. 10.
    Blum RE, Wei EK, Rockett HR, Langeliers JD, Leppert J, Gardner JD, Colditz GA (1999) Validation of a food frequency questionnaire in Native American and Caucasian children 1 to 5 years of age. Matern Child Health J 3:167–172CrossRefPubMedGoogle Scholar
  11. 11.
    Baer HJ, Blum RE, Rockett HR, Leppert J, Gardner JD, Suitor CW, Colditz GA (2005) Use of a food frequency questionnaire in American Indian and Caucasian pregnant women: a validation study. BMC Public Health 5:135CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Murphy SP YA, West Suitor C, Moats S (2011) Child and adult care food program: aligning dietary guidance for all. Food and Nutrition Board; Institute of Medicine, Washington DCGoogle Scholar
  13. 13.
    Rockett HR, Colditz GA (1997) Assessing diets of children and adolescents. Am J Clin Nutr 65:1116S–1122SPubMedGoogle Scholar
  14. 14.
    US Department of Agriculture ARS, Nutrient Data Laboratory. (September 2015) USDA National Nutrient Database for Standard Reference, Release 28Google Scholar
  15. 15.
    Keast DR, Fulgoni VL 3rd, Nicklas TA, O’Neil CE (2013) Food sources of energy and nutrients among children in the United States: National Health and Nutrition Examination Survey 2003-2006. Nutrients 5:283–301CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Kuczmarski RJ, Ogden CL, Guo SS, Grummer-Strawn LM, Flegal KM, Mei Z, Wei R, Curtin LR, Roche AF, Johnson CL (2002) 2000 CDC Growth Charts for the United States: methods and development. Vital Health Stat 11(246):1–190Google Scholar
  17. 17.
    Krebs-Smith SM, Kott PS, Guenther PM (1989) Mean proportion and population proportion: two answers to the same question? J Am Diet Assoc 89:671–676PubMedGoogle Scholar
  18. 18.
    Mastrangelo A, Paglialonga F, Edefonti A (2014) Assessment of nutritional status in children with chronic kidney disease and on dialysis. Pediatr Nephrol 29:1349–1358CrossRefPubMedGoogle Scholar
  19. 19.
    Apostolou A, Karagiozoglou-Lampoudi T (2014) Dietary adherence in children with chronic kidney disease: a review of the evidence. J Ren Care 40:125–130CrossRefPubMedGoogle Scholar
  20. 20.
    Reedy J, Krebs-Smith SM (2010) Dietary sources of energy, solid fats, and added sugars among children and adolescents in the United States. J Am Diet Assoc 110:1477–1484CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Dror DK, Allen LH (2014) Dairy product intake in children and adolescents in developed countries: trends, nutritional contribution, and a review of association with health outcomes. Nutr Rev 72:68–81CrossRefPubMedGoogle Scholar
  22. 22.
    Krebs-Smith SM, Guenther PM, Subar AF, Kirkpatrick SI, Dodd KW (2010) Americans do not meet federal dietary recommendations. J Nutr 140:1832–1838CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Navaneethan SD, Kirwan JP, Arrigain S, Schreiber MJ, Sehgal AR, Schold JD (2012) Overweight, obesity and intentional weight loss in chronic kidney disease: NHANES 1999-2006. Int J Obes 36:1585–1590CrossRefGoogle Scholar
  24. 24.
    Lu JL, Kalantar-Zadeh K, Ma JZ, Quarles LD, Kovesdy CP (2014) Association of body mass index with outcomes in patients with CKD. J Am Soc Nephrol 25:2088–2096CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Ikizler TA, Greene JH, Wingard RL, Parker RA, Hakim RM (1995) Spontaneous dietary protein intake during progression of chronic renal failure. J Am Soc Nephrol 6:1386–1391PubMedGoogle Scholar
  26. 26.
    Quan A, Baum M (1996) Protein losses in children on continuous cycler peritoneal dialysis. Pediatr Nephrol 10:728–731CrossRefPubMedGoogle Scholar
  27. 27.
    Kovesdy CP, Kalantar-Zadeh K (2016) Back to the future: restricted protein intake for conservative management of CKD, triple goals of renoprotection, uremia mitigation, and nutritional health. Int Urol Nephrol 48:725–729CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Wingen A-M, Fabian-Bach C, Schaefer F, Mehls O (1997) Randomised multicentre study of a low-protein diet on the progression of chronic renal failure in children. Lancet 349:1117–1123CrossRefPubMedGoogle Scholar
  29. 29.
    Grimes CA, Wright JD, Liu K, Nowson CA, Loria CM (2013) Dietary sodium intake is associated with total fluid and sugar-sweetened beverage consumption in US children and adolescents aged 2-18 y: NHANES 2005-2008. Am J Clin Nutr 98:189–196CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Cooke LJ, Wardle J (2005) Age and gender differences in children’s food preferences. Br J Nutr 93:741–746CrossRefPubMedGoogle Scholar
  31. 31.
    Alexy U, Kersting M, Remer T (2008) Potential renal acid load in the diet of children and adolescents: impact of food groups, age and time trends. Public Health Nutr 11:300–306CrossRefPubMedGoogle Scholar
  32. 32.
    Washi SA, Ageib MB (2010) Poor diet quality and food habits are related to impaired nutritional status in 13- to 18-year-old adolescents in Jeddah. Nutr Res 30:527–534CrossRefPubMedGoogle Scholar
  33. 33.
    Yang Q, Zhang Z, Kuklina EV, Fang J, Ayala C, Hong Y, Loustalot F, Dai S, Gunn JP, Tian N, Cogswell ME, Merritt R (2012) Sodium intake and blood pressure among US children and adolescents. Pediatrics 130:611–619CrossRefPubMedGoogle Scholar
  34. 34.
    McMahon EJ, Bauer JD, Hawley CM, Isbel NM, Stowasser M, Johnson DW, Campbell KL (2013) A randomized trial of dietary sodium restriction in CKD. J Am Soc Nephrol 24:2096–2103CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Nerbass FB, Pecoits-Filho R, McIntyre NJ, McIntyre CW, Taal MW (2015) High sodium intake is associated with important risk factors in a large cohort of chronic kidney disease patients. Eur J Clin Nutr 69:786–790CrossRefPubMedGoogle Scholar
  36. 36.
    Tian N, Zhang Z, Loustalot F, Yang Q, Cogswell ME (2013) Sodium and potassium intakes among US infants and preschool children, 2003-2010. Am J Clin Nutr 98:1113–1122CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Guenther PM, Dodd KW, Reedy J, Krebs-Smith SM (2006) Most Americans eat much less than recommended amounts of fruits and vegetables. J Am Diet Assoc 106:1371–1379CrossRefPubMedGoogle Scholar
  38. 38.
    McGuire S (2011) U.S. Department of Agriculture and U.S. Department of Health and Human Services, Dietary Guidelines for Americans, 2010. 7th Edition, Washington, DC: U.S. Government Printing Office, January 2011. Adv Nutr 2:293–294CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Cade J, Thompson R, Burley V, Warm D (2002) Development, validation and utilisation of food-frequency questionnaires - a review. Public Health Nutr 5:567–587CrossRefPubMedGoogle Scholar

Copyright information

© IPNA 2017

Authors and Affiliations

  • Wen Chen
    • 1
    • 2
  • Kirstie Ducharme-Smith
    • 3
  • Laura Davis
    • 3
  • Wun Fung Hui
    • 4
  • Bradley A. Warady
    • 2
  • Susan L. Furth
    • 4
    • 5
  • Alison G. Abraham
    • 6
    • 7
  • Aisha Betoko
    • 6
  1. 1.Department of Nutrition and Food Hygiene, School of Public HealthTianjin Medical UniversityTianjinChina
  2. 2.Division of Pediatric NephrologyChildren’s Mercy HospitalKansas CityUSA
  3. 3.Johns Hopkins HospitalBaltimoreUSA
  4. 4.Department of PediatricsThe Children’s Hospital of PhiladelphiaPhiladelphiaUSA
  5. 5.Perelman School of Medicine at the University of PennsylvaniaPhiladelphiaUSA
  6. 6.Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  7. 7.Department of OphthalmologyJohns Hopkins School of MedicineBaltimoreUSA

Personalised recommendations