Compromised Diet Quality is Associated with Decreased Renal Function in Children with Chronic Kidney Disease

Abstract

Nutritional status of children with chronic kidney disease (CKD) is important since it affects growth and development. This study was to investigate overall diet quality measured by nutrient intake adequacy, nutrient density, and several dietary habits in children with CKD and its relationship with clinical parameters according to glomerular filtration rate (GFR). Assessment of nutritional status and diet quality was conducted in nineteen children with CKD. Average Z-scores of height, weight and body mass index (BMI) in the participants were less than standard growth rate. Nutritional status, such as Z-scores of height (p < 0.05) and serum total protein (p < 0.05), were significantly lower in the children with GFR < 75 mL/min/1.73 m2 compared to those with GFR ≥ 75 mL/min/1.73 m2. Nutrition adequacy ratio of energy, thiamin, riboflavin, vitamin B6, folate, iron, and zinc and overall diet quality were significantly poorer in the children with GFR < 75 mL/min/1.73 m2. Poorer appetite and avoidance of food were observed in the children with higher blood urea nitrogen (BUN). Intakes of iron, zinc, thiamin, niacin, and vitamin B6 were positively correlated with GFR. Intakes of calcium, potassium and folate were positively correlated with BUN, while protein intakes were negatively correlated. Overall nutrient intakes were inadequate and diet quality was decreased as kidney function was decreased. Dietary habit and appetite were also related with kidney function in this study subjects. Systemic efforts of nutritional intervention are imperative to prevent deteriorating growth and development and improve the nutritional status in children with CKD.

Dietary calcium intake does not meet the nutritional requirements of children with chronic kidney disease and on dialysis

“…These findings are in agreement with the Growth Failure in Children with Renal Disease (GFRD) study [ 24 ], where children with CKD achieved a Ca intake of 80% of normal requirements for age. Other studies have described similar or even lower Ca intakes [ 25 – 27 ], even from CKD stage 3 [ 28 ]. It is likely that a poor appetite also contributes to the reduced Ca intake in those with CKD.…”

Evaluation of Nutritional Habits and Dietary Management in Children with Chronic Kidney Disease

“…A study conducted in Korea found that dietary habits and appetite status in children with CKD are associated with a decrease in kidney functions. In addition, the order of meals, frequency of main and break meals, having regular breakfast, excessive appetite and loss of appetite are recognized as determinants of diet quality (1). In this study, 87.5% of children with CKD have breakfast and dinner every day and skip the lunch.…”

“…In an extensive study of 5022 children conducted in North America, it was found that onethird of children with CKD had PEM and this rate was higher in the younger age group (7). The best known cause of PEM in chronic kidney disease is the inadequacy of nutrient storage of the body in response to an increase in nutritional requirements arising from rapid growth (1).…”

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

“…Studies of children with CKD have indicated that diet quality and nutrient intake decrease as kidney function declines [4]. Anorexia and poor appetite are common in children with CKD and contribute to inadequate nutrient and caloric intake [5, 6].…”