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Abstract: TH-PO191

Associations of Food Environment with Bone Mineral Disorders in the Chronic Renal Insufficiency Cohort (CRIC) Study

Session Information

Category: Bone and Mineral Metabolism

  • 402 Bone and Mineral Metabolism: Clinical

Authors

  • Madrigal, Jessica M., University of Illinois at Chicago, Chicago, Illinois, United States
  • Cedillo-Couvert, Esteban A., South Texas Renal Care Group, San Antonio, Illinois, United States
  • Ricardo, Ana C., University of Illinois at Chicago, Chicago, Illinois, United States
  • Appel, Lawrence J., Johns Hopkins Medical Institutions, Baltimore, Maryland, United States
  • Anderson, Cheryl A., University of California San Diego, La Jolla, California, United States
  • Deo, Rajat, University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Hamm, L. Lee, Tulane University School of Medicine, New Orleans, Louisiana, United States
  • Sha, Daohang, University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Hsu, Jesse Yenchih, University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Zenk, Shannon, University of Illinois at Chicago, Chicago, Illinois, United States
  • Saunders, Milda Renne, University of Chicago, Chicago, Illinois, United States
  • Persky, Victoria, University of Illinois at Chicago, Chicago, Illinois, United States
  • Lash, James P., University of Illinois at Chicago, Chicago, Illinois, United States

Group or Team Name

  • CRIC Investigators
Background

Access to fast food outlets may influence eating behaviors and contribute to disordered mineral metabolism through increased consumption of phosphates. The influence of food outlet density on mineral disorders has not been studied in chronic kidney disease (CKD).

Methods

Baseline cross-sectional analysis of the association between food outlet density (within 1 km of census block group) and phosphate ≥5.3 mg/dL, fibroblast growth factor 23 (FGF23) ≥100 RU/mL, and parathyroid hormone (PTH) ≥100 pg/mL using multivariable logistic regression. Data on food outlets included a count of fast food restaurants (unhealthy), convenience stores (unhealthy), and grocery stores (healthy). A food outlet index was categorized as no food outlets; only unhealthy outlets; few healthy food outlets (a ratio of healthy to unhealthy ≤0.2); or mostly healthy (a ratio of >0.2).

Results

The study included 2,484 participants with CKD (mean age 58 years, 46% female, 42% white, 39% black, and mean eGFR 44 ml/min/1.73 m2). A total of 455 (18%) participants had no food outlets within 1 km, 973 (39%) had only unhealthy food, 716 (29%) had few healthy food outlets, and 340 (14%) had mostly healthy outlets. Hyperphosphatemia was rare (n=50, 2%); 73% and 41% of participants had excess FGF23 and PTH, respectively. The table summarizes analyses. Compared to persons living in an area with only unhealthy food, increased availability of healthy food outlets was significantly associated with increased odds of hyperphosphatemia [OR=2.3 (1.1, 4.9)].

Conclusion

Our results highlight the possibility that changes to the food environment at the neighborhood level may impact important health indicators in CKD. Increased food availability may influence behaviors, and access to healthy food may not prevent unhealthy choices.

Multivariable Logistic Regression for Association* Between Food Outlet Density and Markers of Mineral Disorders
VariablesOnly unhealthy food outletsNo food outletsFew healthy food outletsMany healthy food outlets
Median (IQR)OR (95% CI)Median (IQR)OR (95% CI)Median (IQR)OR (95% CI)Median (IQR)OR (95% CI)
Phosphate ≥5.3 mg/dL3.7 (3.3-4.2) mg/dL1.0 (ref)3.6 (3.2-4.1) mg/dL0.75 (0.23, 2.5)3.7 (3.3-4.2) mg/dL0.92 (0.42, 2.0)3.7 (3.3-4.2) mg/dL2.3 (1.1, 4.9)
FGF23 ≥100 RU/mL152 (99-243) RU/mL1.0 (ref)137 (92-216) RU/mL0.93 (0.70,1.2)155 (95-252) RU/mL0.93 (0.72, 1.2)163 (105-279) RU/mL1.1 (0.79, 1.2)
PTH ≥100 pg/mL57 (37-95) pg/mL1.0 (ref)47 (33-78) pg/mL1.2 (0.92,1.5)55 (36-90) pg/mL1.0 (0.80, 1.3)60 (38-97) pg/mL1.1 (0.80, 1.4)

*Adjusted for center, age, sex, race/ethnicity, income, eGFR, diabetes, activated vitamin D and phosphorus binder use.

Funding

  • NIDDK Support