Knowledge Does Not Correspond to Adherence of Renal Diet Restrictions in Patients With Chronic Kidney Disease Stage 3-5.

OBJECTIVES: Nutrition plays a critical role in delaying the progression of chronic kidney disease (CKD); however, adherence to nutrition recommendation in patients with non-dialysis-dependent CKD (NDD-CKD) has been underexplored. The objective of this research is to determine patients with NDD-CKD adherence to nutrition recommendation, and whether knowledge of dietary recommendations impacts adherence. DESIGN AND METHODS: Patients with NDD-CKD and a glomerular filtration rate <45 mL/min were recruited from an urban, outpatient nephrology clinic. To assess adherence, patients completed an online Food Frequency Questionnaire. Knowledge of renal diet restrictions and food sources of sodium, potassium, and phosphorus was assessed by a CKD Knowledge Questionnaire. RESULTS: A total of 63 patients completed both the Food Frequency Questionnaire and CKD Knowledge Questionnaire. Patients were consuming excess protein (average intake of 1.16 g/kg; 65-81% of patients' intake above goal), sodium (average intake of 3,117 mg, 67-91% of patients' intake above goal), and phosphorus (average intake of 1,153 mg, 59-70% of patients' intake above goal). In patients without hyperkalemia, only 32-43% of patients consumed adequate potassium. People with hyperkalemia did not consume less potassium than those without hyperkalemia (2,327 vs. 2,564 mg, P = .36). Awareness of diet restriction was not associated with reduced intake of phosphorus (785 vs. 907 mg, P = .21), protein (54.4 vs. 57.0 g, P = .71), or potassium (1,793 vs. 2,076 mg, P = .27). Greater knowledge of nutrient food sources did not correlate to reduced intake of sodium (r = -0.078, P = .54) or phosphorus (r = -0.053, P = .68), or potassium in people with hyperkalemia (r = 0.025, P = .92). CONCLUSIONS: Patients with NDD-CKD consume excess sodium, phosphorus, and protein, whereas potassium intake is inadequate in people without hyperkalemia. Greater knowledge of the renal diet was not associated with increased adherence to dietary restrictions. Instruction efforts should go beyond providing nutrient-based diet information, and instead emphasize healthy food patterns and incorporate counseling to promote behavior change.

Experiences of Community Violence Among Adults with Chronic Conditions: Qualitative Findings from Chicago.

BACKGROUND: Community violence is an important social determinant of health in many high-poverty, urban communities. OBJECTIVE: The purpose of this study was to explore and characterize self-described experiences of community violence among adults with chronic health conditions. DESIGN: Qualitative study design was implemented in 2017 using in-depth, semi-structured focus groups and interviews; data were collected from two clinical sites located in geographic epicenters of high violent crime in Chicago. PARTICIPANTS: Adult patients, ages 35 years and older, who had at least one chronic condition. APPROACH: Data were analyzed using grounded theory and the constant comparison method. KEY RESULTS: The overall sample (N = 51) was predominantly female (67%) and black non-Hispanic (75%); a large proportion had hypertension (65%), arthritis (55%), obesity (53%), and/or diabetes (45%). The majority reported that a close friend or family member was seriously injured or killed due to community violence (71%); a similar proportion had never discussed their experiences of community violence with a healthcare provider (73%). Several major themes emerged: (1) perceived risk of being targeted, (2) chronic stress and worry, (3) hypervigilance, (4) social breakdown, (5) chronic isolation, (6) constrained choice (loss of freedom), (7) limited access to material resources, and (8) inadequate healthcare responses. CONCLUSIONS: Patients often struggled to balance the challenges imposed by community violence with the demands of living with and managing their chronic conditions. Emergent themes may inform practical targets for addressing community violence as a social determinant of health in vulnerable populations.

Power-up: a collaborative after-school program to prevent obesity in African American children.

BACKGROUND: Schools represent a key potential venue for addressing childhood obesity. OBJECTIVE: To assess the feasibility of Power-Up, an after-school program to decrease obesity risk among African American children, using community-based participatory research (CBPR) principles. METHODS: Teachers led 14 weekly nutrition and physical activity sessions during afterschool care at the Woodlawn Community School on Chicago's South Side. Forty African American children ages 5 to 12 participated; their 28 parents discussed similar topics weekly at pickup time, and families practiced relevant skills at home. Pre- and post-intervention anthropometrics, blood pressure, dietary measures, and health knowledge and beliefs for children and parents were compared in univariate analysis. RESULTS: At baseline, 26% of children were overweight; 28% were obese. Post-intervention, mean body mass index (BMI) z scores decreased from 1.05 to 0.81 (p<.0001). Changes were more pronounced for overweight (-0.206 z-score units) than for obese children (-0.062 z-score units; p=.01). Girls decreased their combined prevalence of overweight/obesity from 52% to 46%; prevalence across these categories did not change for boys. The prevalence of healthful attitudes rose, including plans to "eat more foods that are good for you" (77% to 90%; p=.027) and "planning to try some new sports" (80% to 88%; p=.007). CONCLUSION: Children in the Power-Up program reduced mean BMI z scores significantly. The after-school venue proved feasible. The use of CBPR principles helped to integrate Power-Up into school activities and contributed to likelihood of sustainability. Engaging parents effectively in the afterschool time frame proved challenging; additional strategies to engage parents are under development. Plans are underway to evaluate this intervention through a randomized study.