60 - Food Insecurity and Kidney Dysfunction in Children

Household food insecurity (HFI) is associated with childhood obesity, hypertension, and insulin resistance. The national school lunch program (NSLP) is a food assistance program for children which has been associated with greater adiposity, hypertension, and dyslipidemia. In adults, HFI has been associated with greater odds of chronic kidney disease; this association has not been studied in children. We hypothesized that HFI and NSLP participation would be associated with greater likelihood of microalbuminuria, albuminuria, and eGFR < 90.


Objective: To investigate the associations between HFI/ child food insecurity (CFI) / NSLP participation and indicators of kidney dysfunction in children.

Design/Methods: This was a cross-sectional analysis of children ages 5-17 years enrolled NHANES from 2009-2018 (N=18,156). HFI and CFI were defined based on a Food Security Survey Module score ≥3 and ≥2 respectively, indicating low and very low food security. NSLP participation was determined by the Dietary Behavior and Nutrition questionnaire. NHANES laboratory and body measures data was utilized and eGFR was determined using the bedside Schwartz formula. Complex sample adjusted regression models examined associations of HFI/CFI/NSLP participation with microalbuminuria (urine albumin:creatinine [Alb:Cr] >30 mg/g), albuminuria (Alb:Cr >300 mg/g), and eGFR < 90. Model 1 was adjusted for age, gender, and race; Model 2 was adjusted for body mass index (BMI) z-score and presence of a diabetes diagnosis.

Results: Children with HFI and NSLP participation were younger, had a higher BMI z-score, and lived in lower income households. HFI was associated with greater Alb:Cr ratio in unadjusted (b=5.86, CI: 0.41-11.31, p=0.04) and Model 1 (b=6.15, CI: 1.13-11.17, p=0.02), and with increased odds of microalbuminuria in all models (M0: OR=1.25, CI: 1.08-1.45, p=0.004; M1: OR=1.26, CI: 1.10-1.46, p=0.002; M2: OR=1.18, CI: 1.02-1.37, p=0.03). HFI was associated with greater odds of eGFR < 90 in all models (M0: OR=1.23, CI: 1.04-1.47, p=0.02; M1: OR=1.37, CI: 1.14-1.66, p=0.001; M2: OR=1.38, CI: 1.14-1.67, p=0.01). NSLP was associated with increased odds of microalbuminuria in Model 1(OR=1.23, CI: 1.01-1.51, p=0.04). There were no statistically significant associations between measured variables and CFI.

Conclusion(s):

HFI was associated with microalbuminuria and eGFR< 90. NSLP participation was associated with microalbuminuria. CFI was not associated with kidney dysfunction. It may be beneficial to screen patients and families for HFI to identify patients at risk of kidney dysfunction.