Field Notes

Study Finds 10% of Nondialysis Kidney Patients Meet With a Dietitian

In patients with chronic kidney disease, MNT can slow the progression and significantly reduce health care costs.

But 90% of nondialysis kidney disease patients never meet with a dietitian, according to a report in the Journal of the Academy of Nutrition and Dietetics. The lead author is Holly Kramer, MD, MPH, of Loyola Medicine and Loyola University Chicago Stritch School of Medicine.

“Most adults with chronic kidney disease remain poorly informed of how diet influences disease management and progression,” Kramer and colleagues wrote.

About 30 million Americans—or 15% of adults—have chronic kidney disease, and the incidence is expected to increase in the next 20 years due to the obesity epidemic and aging population. Nearly one-half of adults aged 65 and older are expected to develop kidney disease during their lifetime. Medicare spends $33 billion per year on dialysis patients, and costs for nondialysis kidney patients are higher than the costs of treating stroke or cancer.

MNT is one of the most important ways to slow the progression of kidney disease and prevent kidney failure. It’s been shown to improve blood sugar control and blood pressure, thus slowing kidney disease progression and delaying or preventing the need for dialysis or a kidney transplant.

Although patients may receive dietary counseling from physicians or nurses, such counseling often is brief and typically involves only broad suggestions such as reducing salt or protein intake. By contrast, MNT includes an in-depth individualized nutrition assessment, personalized treatment plan, and periodic monitoring and reassessment. The National Kidney Foundation and Academy of Nutrition and Dietetics recommend MNT for all persons with kidney disease, regardless of stage.

There are several reasons why so few kidney patients receive MNT. Some physicians don’t refer patients to MNT under the mistaken belief the therapy isn’t covered. Other doctors may not recognize the strong role dietary factors play in kidney disease, or lack confidence that MNT will be effective. Some patients may be reluctant to invest the time and money in MNT. Moreover, only a limited number of RDs are trained in kidney disease management and many aren’t enrolled as Medicare providers.

More research is needed to study the barriers to MNT and effective solutions, according to the authors: “The high burden, cost, and growth of chronic kidney disease requires urgent action, and MNT services must be part of any broad plan to reduce [kidney failure] incidence and improve public health.”

— Source: Beth Israel Deaconess Medical Center


Poor Sleep Linked to No Breakfast, More Junk Food in Kids

Every parent knows that children, from toddlers to teens, can sometimes be fickle eaters. Yet, few would know that a child’s bedtime and how well they sleep at night also can affect how well they eat.

Research from the University of South Australia (UniSA) suggests that sleep timing and sleep quality can influence the dietary behaviors of school-aged children and are associated with skipping breakfast and eating more junk food.

The study examined the sleep and eating behaviors of 28,010 school children aged 9 to 17 from data collected via the South Australian Wellbeing and Engagement Collection from 368 government and independent schools in South Australia.

Results show that children who regularly went to bed after 11 PM were four to five times more likely to eat fewer than three breakfasts per week, and two to three times more likely to eat junk food at least five times per week.

Lead researcher, UniSA’s Alex Agostini, PhD, says the findings clearly demonstrate the links between sleep and diet among school-aged children.

“Sleep is important for everyone’s health and well-being, but when children and teenagers are regularly missing breakfast or eating junk food, their bodies and minds can suffer,” Agostini says.

“When children have poor sleep and go to bed late at night, it increases their chance of missing breakfast the next morning.

“Late bedtimes also increase the odds of children and teenagers eating junk food more often, which is never a good thing—not only does it lack nutritional benefit, but it also contributes to the growing concerns around childhood obesity.”

Kurt Lushington, PhD, coresearcher and head of UniSA’s discipline of psychology, says the study also found a substantial proportion of children in the study to be sleep deprived.

“The National Sleep Foundation recommends nine to 11 hours’ sleep for children aged 6 to 13, and eight to 10 hours’ sleep for children aged 14 to 17. Yet according to these standards, 16% of children in this study weren’t getting enough sleep,” Lushington says. “Good quality sleep—and enough of it—is important for children and adolescents. Without it, children not only develop fatigue and behavioral and emotional problems but also make poor food choices.”

The study also strengthens evidence for educational policy relating to the provision of breakfast or prelunch nutrition breaks in schools.

“Encouraging schools to offer breakfast programs and ‘brain food’ breaks earlier in the day can help counteract the effects of poor dietary choices as a result of lack of sleep,” Lushington says.

— Source: University of South Australia