Community Nutrition and Lifestyle Medicine for Kidney Health: Awareness of the Social Determinants of Health in Renal Nutrition

Community nutrition is the practice of nutrition education and implementation among groups of persons with the goal of promoting health and wellness and preventing or managing diseases by means of nutritional and dietary interventions at community level.1Aranceta J. Community nutrition.Eur J Clin Nutr. 2003; 57: S79-S81Crossref PubMed Scopus (24) Google Scholar It involves identification of unmet nutritional needs in a given community in order to design and apply nutrition and diet-related approaches to improve public health nutrition and health outcomes. Target communities can be diverse with different settings including workplaces or education centers such as schools, specific racial/ethnic groups, or persons at high risk of certain disease states such as those at risk of chronic kidney disease (CKD). Nutrition education is the core component of community nutrition efforts and includes food preparation skills. This encompasses culinary medicine approaches and food preparation methods based on the concept of food as medicine.2Medeiros L.C. Butkus S.N. Chipman H. Cox R.H. Jones L. Little D. A logic model framework for community nutrition education.J Nutr Educ Behav. 2005; 37: 197-202Abstract Full Text PDF PubMed Scopus (34) Google Scholar Practice of Community nutrition is often aligned with strategies under the lifestyle medicine.3Rosenfeld R.M. Kelly J.H. Agarwal M. et al.Dietary interventions to treat type 2 diabetes in adults with a goal of remission: an expert consensus statement from the American College of lifestyle medicine.Am J Lifestyle Med. 2022; 16: 342-362Crossref PubMed Scopus (15) Google Scholar The latter is defined as a medicine specialty that promotes lifestyle modifications including nutritional and dietary approaches as preventive and therapeutic interventions to manage chronic conditions including obesity, metabolic syndrome, or diabetes mellitus. Cardiovascular and renal diseases are also among targets of lifestyle medicine.3Rosenfeld R.M. Kelly J.H. Agarwal M. et al.Dietary interventions to treat type 2 diabetes in adults with a goal of remission: an expert consensus statement from the American College of lifestyle medicine.Am J Lifestyle Med. 2022; 16: 342-362Crossref PubMed Scopus (15) Google Scholar The American College of Lifestyle Medicine has announced dietary lifestyle position for prevention (?), treatment and potential reversal of disease, stating that eating a plant-based diet is recommended predominantly on a variety of minimally processed vegetables, fruits, whole grains, legumes, nuts, and seeds.4Benigas S. American College of lifestyle medicine: vision, tenacity, transformation.Am J Lifestyle Med. 2020; 14: 57-60Crossref PubMed Scopus (2) Google Scholar Social determinants of health including equitable access to nutrition education and food security impact the field of community nutrition.5Bruening M. Perkins S. Udarbe A. Academy of nutrition and dietetics: revised 2022 standards of practice and standards of professional performance for registered dietitian nutritionists (Competent, Proficient, and Expert) in public health and community nutrition.J Acad Nutr Diet. 2022; 122: 1744-1763.e49Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar Registered dietitian interested in engaging in community nutrition practices can take advantage of standards of practice under the “Public Health and Community Nutrition Dietetic Practice Group” guided by the Academy of Nutrition and Dietetics Quality Management Committee using a toolkit that includes 4 steps consisting of assessment, diagnosis, intervention, and evaluation/monitoring in Community Nutrition.5Bruening M. Perkins S. Udarbe A. Academy of nutrition and dietetics: revised 2022 standards of practice and standards of professional performance for registered dietitian nutritionists (Competent, Proficient, and Expert) in public health and community nutrition.J Acad Nutr Diet. 2022; 122: 1744-1763.e49Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar This and other toolkits can align the scope of expertise of dietitians including in medical nutrition therapy (MNT) to expand to the field of community nutrition.6Kalantar-Zadeh K. Mattix-Kramer H.J. Moore L.W. Culinary medicine as a core component of the medical nutrition therapy for kidney health and disease.J Ren Nutr. 2021; 31: 1-4Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar, 7Kalantar-Zadeh K. Rhee C.M. Joshi S. Brown-Tortorici A. Kramer H.M. Medical nutrition therapy using plant-focused low-protein meal plans for management of chronic kidney disease in diabetes.Curr Opin Nephrol Hypertens. 2022; 31: 26-35Crossref PubMed Scopus (10) Google Scholar, 8Kalantar-Zadeh K. Saville J. Moore L.W. Unleashing the Power of renal nutrition in value-based Models of kidney care choices: Leveraging dietitians' expertise and medical nutrition therapy to delay dialysis initiation.J Ren Nutr. 2022; 32: 367-370Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar, 9Rhee C.M. Kalantar-Zadeh K. Moore L.W. Medical nutrition therapy for diabetic kidney disease.J Ren Nutr. 2021; 31: 229-232Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar Proper nutrition and lifestyle choices play a crucial role in maintaining kidney health and preventing the onset or progression of CKD. Community nutrition initiatives and lifestyle medicine approaches have gained recognition as effective strategies to promote kidney health within populations. Practical tips for individuals and communities to adopt healthier habits can start with understanding the concept of a kidney health–friendly lifestyle and nutrition. Community nutrition education can start by providing an overview on the impact of poor lifestyle choices, such as unhealthy diets on kidney function.10Pourghazi F. Mohammadi S. Eslami M. et al.Association between childhood obesity and later Life kidney disorders: a systematic review.J Ren Nutr. 2023; 33: 520-528Abstract Full Text Full Text PDF Scopus (1) Google Scholar Community nutrition initiatives include discussing the significance of community-based nutrition programs in promoting kidney health with emphasis diet quality index,11Boaz M. Kaufman-Shriqui V. Moore L.W. Kalantar-Zadeh K. Diet quality index in kidney health and kidney disease.J Ren Nutr. 2023; 33: 1-3Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar management of diabetes and obesity with concurrent CKD,9Rhee C.M. Kalantar-Zadeh K. Moore L.W. Medical nutrition therapy for diabetic kidney disease.J Ren Nutr. 2021; 31: 229-232Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar culinary medicine and food as medicine,6Kalantar-Zadeh K. Mattix-Kramer H.J. Moore L.W. Culinary medicine as a core component of the medical nutrition therapy for kidney health and disease.J Ren Nutr. 2021; 31: 1-4Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar precision nutrition approaches in community nutrition,12Kalantar-Zadeh K. Moore L.W. Precision nutrition and personalized diet plan for kidney health and kidney disease management.J Ren Nutr. 2020; 30: 365-367Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar accurate estimates of renal function,13Kalantar-Zadeh K. Norris K.C. Moore L.W. Overcoming vestiges of structural racism in kidney care and renal nutrition and revisiting Cockcroft-Gault creatinine clearance and its weight index.J Ren Nutr. 2022; 32: 1-4Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar use of plant dominant diets,14Joshi S. Moore L.W. Kalantar-Zadeh K. The future of nutrition in kidney disease: plant-based diets, Gut Microbiome, and beyond.J Ren Nutr. 2021; 31: 97-99Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar nutrition in living kidney donors,15Moore L.W. Waterman A. Kalantar-Zadeh K. Nutrition therapy as a critical component for protecting the health of living donors.J Ren Nutr. 2022; 32: 265-267Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar role of dietitians in medical nutrition therapy to slow CKD progression,6Kalantar-Zadeh K. Mattix-Kramer H.J. Moore L.W. Culinary medicine as a core component of the medical nutrition therapy for kidney health and disease.J Ren Nutr. 2021; 31: 1-4Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar,8Kalantar-Zadeh K. Saville J. Moore L.W. Unleashing the Power of renal nutrition in value-based Models of kidney care choices: Leveraging dietitians' expertise and medical nutrition therapy to delay dialysis initiation.J Ren Nutr. 2022; 32: 367-370Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar,9Rhee C.M. Kalantar-Zadeh K. Moore L.W. Medical nutrition therapy for diabetic kidney disease.J Ren Nutr. 2021; 31: 229-232Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar health literacy and nutrition literacy in kidney care,16Moore L.W. Wang A.Y.M. Kalantar-Zadeh K. Global kidney nutrition care and health literacy: overcoming the disparities in renal nutrition Service Capacity and education.J Ren Nutr. 2022; 32: 127-130Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar the role of social media in renal nutrition,17Biruete A. Kistler B.M. Kalantar-Zadeh K. Moore L.W. Kidney nutrition in the Era of social media: Bridging the Gap of nutrition education and kidney health literacy by Leveraging resources of social networking.J Ren Nutr. 2022; 32: 629-632Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar and the role of functional nutrition, naturopathic nutrition, and integrative and holistic renal nutrition in kidney health,18Kalantar-Zadeh K. Moore L.W. Functional nutrition, naturopathic nutrition, and integrative and holistic renal nutrition in kidney health and value-based kidney care Models.J Ren Nutr. 2022; 32: 493-497Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar Highlighted initiatives can encompass community educational workshops that aim to increase access to fresh, nutritious foods, and improve nutritional knowledge within local communities at risk of CKD. To that end the importance of collaboration between healthcare professionals, community organizations, and policymakers should underscore effective approaches to implement and sustain these initiatives. A kidney-friendly diet for promoting kidney health includes moderating animal protein consumption including plant-dominant low protein diets (also known as PLADO), explain how community nutrition programs can help individuals make healthier food choices, provide resources for food preparation and meal planning, grocery shopping, and cooking kidney-friendly meals. Community involvement, support networks, and education programs are important in promoting kidney health and fostering behavior change, and sustaining healthy habits, highlighting the value of support groups and peer-to-peer mentoring for individuals living with kidney disease. Finally, assessing social determinants of health and promoting equitable access devoid of vestiges of structural racism13Kalantar-Zadeh K. Norris K.C. Moore L.W. Overcoming vestiges of structural racism in kidney care and renal nutrition and revisiting Cockcroft-Gault creatinine clearance and its weight index.J Ren Nutr. 2022; 32: 1-4Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar is of essence to address disparities in kidney health outcomes within communities. In this issue of the Journal, Kalantar-Zadeh et al19Kalantar-Zadeh K. Bellizzi V. Piccoli G.B. et al.Caring for patients with Advanced chronic kidney disease: dietary Options and conservative care Instead of maintenance Dialysis.J Ren Nutr. 2023; 33: 508-519Abstract Full Text Full Text PDF Scopus (1) Google Scholar provide a consensus statement on assisting patients who want to transition slowly toward renal replacement therapy. The focus is on patient empowerment and utilizing dietary strategies together with pharmacotherapies to support a conservative approach, which can benefit from community nutrition initiatives. Kowal et al20Kowal A. Wojczuk M. Grabowska M. et al.Activity and profile of the Users of a Novel mobile application supporting proper diet among maintenance hemodialysis patients.J Ren Nutr. 2023; 33: 592-600Abstract Full Text Full Text PDF Scopus (1) Google Scholar performed a prospective study of patient acceptance of a mobile application providing diet information for patients on hemodialysis. Patients below 50 years of age were more likely to utilize the app than older patients and women were more accepting than men. Wakasugi et al21Wakasugi M. Yokoseki A. Wada M. et al.Vegetable and fruit intake frequency and mortality in patients with and without Chronic Kidney Disease: a hospital-based cohort study.J Ren Nutr. 2023; 33: 566-574Abstract Full Text Full Text PDF Scopus (1) Google Scholar performed an evaluation of dietary intake of fruits and vegetables in over 2000 patients in a hospital outpatient clinic and associated the outcomes with mortality. Lower fruit and vegetable intake was positively associated with lower kidney function and risk for all-cause mortality. These findings can be shared with larger groups of persons in the context of community nutrition programs. de Paula et al22de Paula B.L. Pinheiro B.V. Segura-Ortí E. et al.Association between Protocols of the sit-to-stand test and lower Limb muscle Force Output in patients on hemodialysis and Subjects without chronic kidney disease.J Ren Nutr. 2023; 33: 584-591Abstract Full Text Full Text PDF Scopus (1) Google Scholar report on the physical function of patients on hemodialysis compared to healthy controls using three types of sit-to-stand (STS) tests and handgrip strength tests. Patients on hemodialysis were slower in the STS performance than controls and the 10-repetition test was most closely associated with handgrip strength. Shah et al23Shah L.N. Leonard M.B. Ziolkowski S.L. Grimm P. Long J. Cystatin C and creatinine Concentrations are Uninformative Biomarkers of Sarcopenia: a Cross-Sectional NHANES study.J Ren Nutr. 2023; 33: 538-545Abstract Full Text Full Text PDF Scopus (1) Google Scholar examined whether an association exists between cystatin C or serum creatinine and appendicular lean muscle index (APMI) from whole body dual-energy absorptiometry as an assessment of sarcopenia. They utilized data from the National Health and Nutrition Examination Survey in adults and found that the kidney function markers did not improve the relationship with reduced APMI better than age, sex, and body mass index. Parker et al24Parker J.R. Andrade J.M. Tibbetts J. Jiao Y. Larkin J.W. Hymes J.L. High protein whole food snack and albumin outcomes in patients with Dialysis-Dependent chronic kidney disease.J Ren Nutr. 2023; 33: 601-609Abstract Full Text Full Text PDF Scopus (1) Google Scholar performed a prospective assessment of the use of a high-protein whole food snack after hemodialysis sessions taken over a 6-month period. In patients with serum albumin <4 g/dL, high consumers of the snack experienced qualitative increases in serum albumin. Iida et al25Iida T. Morimoto S. Okuda H. et al.Impact of abdominal fat distribution on mortality and its changes over time in patients undergoing hemodialysis: a prospective cohort study.J Ren Nutr. 2023; 33: 575-583Abstract Full Text Full Text PDF Scopus (1) Google Scholar examined the impact of changes in abdominal fat on mortality in patients on maintenance hemodialysis. They determined that visceral fat and ratios of visceral fat to subcutaneous fat were independently associated with mortality over a 60-month follow-up period. Fang and colleagues26Fang H.-Y. Wilund K.R. Muscle sodium accumulation in kidney Failure: Physiological impact and Mitigation strategies.J Ren Nutr. 2023; Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar provide a review of the literature regarding the relationship of accumulation of sodium in muscle to muscle function in patients with CKD. The review demonstrates the paucity of data on the mechanisms for increased muscle sodium in CKD, and proposes areas for further study that may lead to improved muscle function in this population. Importance of muscle health in CKD can be more effectively communicated in nutrition community programs. Pourghazi et al10Pourghazi F. Mohammadi S. Eslami M. et al.Association between childhood obesity and later Life kidney disorders: a systematic review.J Ren Nutr. 2023; 33: 520-528Abstract Full Text Full Text PDF Scopus (1) Google Scholar performed a systematic review on the literature of childhood obesity and its impact on kidney function in later years. They found a significantly positive association of childhood obesity for adult kidney disease in 75% of the examined studies. Lee et al27Lee J. Ryu H. Kim Y.-C. et al.Nutritional status is associated with preserved kidney function in patients with autosomal dominant polycystic kidney disease.J Ren Nutr. 2023; 33: 529-537Abstract Full Text Full Text PDF Scopus (1) Google Scholar applied nutrition assessment using Subjective Global Assessment (SGA) criteria to examine rate of decline in glomerular filtration rate (GFR) of 236 patients with autosomal dominant polycystic kidney disease. The study demonstrated that SGA 3-6 at baseline was associated with >3 mL/min/1.73 m2 decline in estimated GFR regardless of the presence of proteinuria. Kelly et al28Kelly J.T. Jegatheesan D.K. Dawson J. et al.Are digital health technologies and models of nutrition care the future of chronic kidney disease management?.J Ren Nutr. 2023; Abstract Full Text Full Text PDF Scopus (1) Google Scholar provide a review of the status of using digital and virtual technologies in providing nutrition care of patients with kidney disease. They review methods that can be applied during each phase of nutrition therapy and critique the potential barriers and benefits of each. Digital and virtual technologies can be important components of future programs in the context of community nutrition in kidney medicine. In conclusion, community nutrition and lifestyle medicine approaches can promote kidney health significantly. Individuals and communities should be encouraged to embrace healthier lifestyles, make informed dietary choices, and engage in regular physical activity to support kidney health. The role of community support, education, and policy changes should be emphasized in creating an environment that prioritizes Community Nutrition for kidney health for all.