Assessment of dietary intake of children with chronic kidney disease

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.

Keywords: Children; Chronic kidney disease; Dietary assessment; Nutrient intake.

Conflict of interest statement

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

Figures

Figure 1

Flow chart for data collection

Figure 2. Distribution of estimated daily potassium intake by age and glomerular filtration rate (GFR)

Lower and upper bound denote 25th and 75th percentiles respectively. Square denotes median. Recommended daily intake for a normal child [33]: 1–3 years: 3000mg / 4–8 years: 3800mg / 9–13 years: 4500mg / 14–18 years: 4700mg

Figure 3. Distribution of energy intake (kcal) by age and sex

Shaded regions show intake above the recommended daily caloric values in the respective age groups (1000kcal, 1400kcal, 1800kcal and 2200kcal for male and 1000kcal, 1200kcal, 1600kcal and 1800kcal for girls [33]).

Figure 4

Distribution of energy intake (kcal) by glomerular filtration rate (GFR)