Original ResearchComparison of the Availability and Cost of Foods Compatible With a Renal Diet Versus an Unrestricted Diet Using the Nutrition Environment Measures Survey
Introduction
The food environment is relevant for both health promotion and treatment of diet-related chronic diseases. The food environment includes several attributes such as the physical presence of food that affect a person's diet, a person's proximity to food store locations, and the distribution of different outlets where food may be obtained.1 The food environment can be studied at the macro level, looking at spatial characteristics such as number and location of food outlets, or at the micro level, examining the consumer environment within food outlets. Barriers in the consumer food environment such as a greater distance to full service supermarkets, lack of fresh fruits, vegetables, or disease-specific foods, and lower income are associated with worse outcomes for chronic diseases such as diabetes, obesity, hypertension, and chronic kidney disease.2, 3, 4, 5 For hemodialysis patients, diet is an important factor contributing to both morbidity and mortality.6, 7, 8 The food environment may affect hemodialysis patients' ability to access food that is affordable and compatible with the renal diet. Comparisons of the availability and cost of food items suitable for the renal diet versus a typical unrestricted diet were completed using the standard Nutrition Environment Measures Survey (NEMS) survey and a renal diet–modified NEMS survey (see Appendix).
Section snippets
Methods
Geographic sampling was used to identify the 6 largest hemodialysis facilities located in 3 diverse geographic settings in Cleveland, Ohio: the urban core (n = 2), inner ring suburbs (n = 2), and outer ring suburbs (n = 2). Next, renal dietitians at these facilities identified nearby grocery stores that they were aware their patients frequented. One full service grocery store and 1 discount grocery store within a 3-mile radius of each hemodialysis facility were selected as our study sample
Results
As indicated in Table 1, the mean total number of food items available differed significantly (P ≤ .001) between the unrestricted diet (mean = 38.9 ± 4.5) and renal diet (mean = 32.2 ± 4.7). The largest differences were milk (3.2, P ≤ .001) and frozen dinners (1.9, P = .005). As indicated in Table 2, the mean total cost per serving was similar (P = .48) for the renal diet ($5.76 ± 2.50) compared with the unrestricted diet ($5.67 ± 2.74). There were significant differences for some individual
Discussion
The renal diet–modified NEMS captured the limited availability of foods compatible with the renal diet. It did not show an increased cost associated with the renal diet that Soinski et al and León et al found.17, 18 These studies calculated total meal costs for multiple days while we priced individual items in a food category. The small number of food items priced in each category may have limited our ability to detect cost differences between them. To calculate a true cost of diet, other food
Practical Application
The decreased availability of renal diet compatible foods in grocery stores may create a barrier for patients trying to comply with the renal diet. Clinicians should ask patients where they shop and inventory these stores for items that are compatible with the renal diet. Clinicians could then educate and advise patients on appropriate choices that are available where they shop. Patients could also be directed to alternative shopping venues that might have a better selection of renal
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This work was supported in part by grants MD002265 and UL1TR000439 from the National Institutes of Health, Bethesda, Maryland.
The authors have no financial conflicts of interest.