Professional Documents
Culture Documents
1 s2.0 S0272638623000045 Main
1 s2.0 S0272638623000045 Main
1 s2.0 S0272638623000045 Main
Nutritional epidemiology seeks to understand nutritional determinants of disease in human populations Complete author and article
using experimental and observational study designs. Though randomized controlled trials provide the information provided before
references.
strongest evidence of causality, the expense and difficulty of sustaining adherence to dietary in-
terventions are substantial barriers to investigating dietary determinants of kidney disease. Therefore, Am J Kidney Dis.
nutritional epidemiology commonly employs observational study designs, particularly prospective 81(6):717-727. Published
online January 4, 2023.
cohort studies, to investigate long-term associations between dietary exposures and kidney disease.
Due to the covarying nature and synergistic effects of dietary components, holistic characterizations of doi: 10.1053/
dietary exposures that simultaneously consider patterns of foods and nutrients regularly consumed are j.ajkd.2022.11.014
generally more relevant to disease etiology than single nutrients or foods. Dietary intakes have tradi- © 2023 by the National
tionally been self-reported and are subject to bias. Statistical methods including energy adjustment Kidney Foundation, Inc.
and regression calibration can reduce random and systematic measurement errors associated with
self-reported diet. Novel approaches that assess diet more objectively are gaining popularity but have
not yet fully replaced self-report and require refinement and validation in populations with chronic
kidney disease. More accurate and frequent diet assessment in existing and future studies will yield
evidence to better personalize dietary recommendations for the prevention and treatment of kidney
disease.
the outcomes of nutrition RCTs are commonly interme- CKD progression, as well as other important clinical out-
diate markers of disease risk, with the notable exception of comes.13,14 Cohorts of individuals without CKD at base-
the Prevencion con Dieta Mediterranea (PREDIMED) study, line, such as the Atherosclerosis Risk in Communities
a multicenter randomized trial that demonstrated a pro- (ARIC) study, have been used to study the association
tective effect of a Mediterranean diet on incident cardio- between diet and incident CKD.15
vascular disease compared with a lower-fat diet.7 Trials in In prospective cohort studies, assessment of dietary
patients with kidney disease have used declines in exposures before outcomes occur supports causal infer-
glomerular filtration rate of varying magnitudes or the ence. By contrast, cross-sectional studies such as the Na-
onset of proteinuria as surrogate outcomes for the devel- tional Health and Nutrition Examination Survey
opment of kidney failure8,9 which may take years to occur. (NHANES) assess exposure and disease simultaneously
Although sample size and study duration for RCTs inves- and, therefore, yield weaker evidence regarding causal
tigating hard end points (kidney failure, death, cardio- effects of diet on disease but are useful to describe dietary
vascular events) could be minimized by enrolling intakes and quantify the burden of insufficient or excess
participants with advanced CKD, dietary interventions may intakes in a population. In observational studies, exposure
not be equally effective at later versus early stages.10 is selected by participants rather than assigned, so the in-
Evidence regarding the long-term effects of dietary fluence of confounding factors on observed associations
exposures on hard end points have mostly originated from must be accounted for in statistical analyses.
observational study designs, predominantly prospective
cohort studies, based on the participants’ self-reported
dietary intakes. Several large cohorts established Defining Dietary Exposures
throughout the past 50 years, including the Chronic Renal Diet is a complex exposure that varies in composition and
Insufficiency Cohort (CRIC) study of adults with existing quantity within and between days and seasons. The co-
CKD11 and the Chronic Kidney Disease in Children (CKiD) varying nature of dietary components further complicates
study of children with existing CKD,12 continue to yield the definition and statistical modeling of dietary exposures.
important discoveries of associations between diet and Conceptualizations of dietary exposures range from a
Table 2. Examples of a Priori Dietary Patterns and Other Holistic Dietary Exposures
Exposure Definition References
Alternate Mediterranean Diet Score (aMed) Scores relative adherence to a Mediterranean-style diet; 27
adapted for use in US populations
Dietary Approaches to Stop Hypertension Scores relative adherence to the blood pressure–lowering 28
(DASH) Diet Score dietary pattern tested in the DASH clinical trials
Healthy Eating Index (HEI) Scores alignment with the Dietary Guidelines for Americans, 29
with multiple versions corresponding to guideline updates every
5 years
Alternative Healthy Eating Index (AHEI) Scores relative adherence to dietary recommendations that are 30,31
predictive of chronic disease risk; updated in 2010 based on
evolving scientific evidence
Dietary diversity scores Assigns greater value to diets with more variety of foods or 32
nutrients
Plant-based diet indices Scores relative adherence to diets richer in plant-derived foods 33
and lower in animal-derived foods, with variations that
additionally consider the nutritional quality of plant-derived foods
Dietary Inflammatory Index (DII) Summarizes the inflammatory potential of a diet based on a 34
predefined list of foods, nutrients, and phytochemicals
Dietary acid load Summarizes the balance between acid- and base-producing 35-37
foods; estimated by calculating potential renal acid load (PRAL)
or net endogenous acid production (NEAP) based on dietary
protein and mineral intakes
Processing classification systems Categorizes foods according to the extent and purpose with 38,39
which they are processed
intake, and save time and costs associated with data entry consumption (to assess net intake) using a handheld
into nutrient analysis software.50,51 device and with a reference object in the frame to assist
with portion size estimation. Automated software or
24-Hour Dietary Recalls human raters subsequently identify foods and portions
A 24-hour dietary recall queries intake over the past day, consumed to estimate nutrient intakes. Comparable esti-
either from midnight to midnight or in the 24-hour mates of total energy intake were obtained by adults with
period immediately preceding the recall. Ideally these type 2 diabetes using image-based food records versus
recalls are unanticipated by the respondents so that di- weighted food records,59 and a mobile phone–based
etary intakes preceding the recall are not altered. Multiple automated image analysis application estimated meal
recalls estimate absolute dietary intakes more precisely carbohydrate content more accurately than patients with
than FFQs,52 and the accuracy of reporting can be opti- type 1 diabetes.60
mized with a multiple-pass interviewing technique.53 Passive approaches use wearable cameras to capture
Although they traditionally are administered by trained daily activities, including eating episodes, without users’
interviewers, an automated online version developed by conscious participation. Wearable cameras have been used
the National Cancer Institute may be a feasible, less- to identify the intake of forgotten foods on self-reported
resource-intensive option even for large epidemiological recalls61 and to observe cooking and eating behaviors62
studies.54,55 in free-living settings.
studying eating behaviors rather than assessing diet sales nor purchasing data directly measure food con-
composition. sumption because they do not account for culinary
preparation, distribution within and beyond the house-
Retail Sales and Purchasing Data hold, and waste. Still, these data may be useful to evaluate
Market research companies collect point-of-sale data from the nutritional quality of foods purchased, assess trends
food retailers as well as individual- and household-level over time, and model predicted effects of food refor-
purchasing data using barcode scanning.66 Neither retail mulation.67 For instance, retail sales were used to identify
phosphorus-based additives in frequently purchased exogenous (originating from diet) versus endogenous
grocery items.68 (originating from host or gut microbiota) compounds,
and evaluating dose-response and temporal response of
Dietary Intake Biomarkers compounds to food intake. Because most food-derived
Dietary intake biomarkers enable objective measurement compounds are only present in urine and plasma acutely
of intake based on concentrations of compounds measured after ingestion,77 habitual diet assessment may require
in a biospecimen, commonly urine or blood. They are multiple biospecimen collections over time76 or validation
broadly classified as recovery, concentration, and predic- of long-term biomarkers from alternative biospecimens
tive biomarkers. (eg, hair and nails).
Recovery biomarker concentrations are considered Finally, most nutritional biomarkers have not been
gold-standard approaches for dietary assessment and validated in patients with CKD.78 Alternative markers or
directly reflect dietary intake.69 Only 4 recovery bio- methods may be needed when urinary output is altered or to
markers have been identified: 24-hour urinary nitrogen, account for water-soluble solute removal in dialysate.78,79
reflecting protein intake; 24-hour urinary potassium and
sodium, reflecting intakes of these minerals; and doubly Summary of Dietary Assessments
labeled water, a measure of energy expenditure that is Errors associated with self-reported diet, their impacts on
interpreted as a marker of energy intake in weight-stable associations with outcomes, and strategies to reduce them
individuals.70 are well researched.80,81 Novel dietary assessment ap-
Concentration biomarkers, such as plasma carotenoids proaches reduce some of these errors, but they have not
and vitamin C, correlate with dietary intakes but are yet replaced traditional methods. Combining self-report
affected by individual-level characteristics (eg, adiposity), with novel assessments may more comprehensively and
such that measured concentrations do not directly reflect accurately ascertain dietary intakes.
amounts consumed.69 Predictive biomarkers exhibit a
time-dependent, dose-response relationship with dietary Sources of Error in Diet Assessment
intakes. They more closely reflect dietary intake than
concentration biomarkers but are not completely recov- Measurement Error: Random
ered in biospecimens, like recovery biomarkers. Only 24- True dietary intakes vary within people, day to day. The
hour urinary fructose and sucrose have been identified as degree of intraindividual variability differs by food and
predictive biomarkers and are useful measures in research nutrient, with higher variability for episodically consumed
settings.71 foods (eg, organ meats) and nutrients concentrated in few
Dietary biomarkers have traditionally been identified food sources (eg, vitamin A). A single day’s intake—even
using a hypothesis-driven approach. In recent years, if recorded correctly—does not accurately represent an
however, the discovery of novel dietary biomarkers has individual’s usual dietary intake of most foods or nutrients.
accelerated with the advancement of high-throughput Because usual intake is generally more relevant to CKD,
platforms capable of simultaneously identifying many such daily deviations from the true long-term average are
metabolites and proteins in biospecimens. Characterization regarded as random measurement error. Averaging intakes
of the food metabolome and proteome—the sum of across multiple dietary assessments can improve precision
compounds resulting from digestion, absorption, and of an individual’s estimated usual intake by reducing
metabolism of consumed foods72—is currently being random error.82 However, the representativeness of
explored to identify objective biomarker “signatures” of collected days should be considered. Dietary intakes may
foods and dietary patterns, and to study relationships be- vary across seasons and days of the week,83 and differ on
tween diet and CKD. dialysis versus nondialysis treatment days.84,85 In addition,
Although few foods are uniquely identified by bio- dietary intakes on consecutive days are more closely
markers, a profile of biomarkers may serve to characterize correlated than nonconsecutive days, resulting in under-
adherence to a particular dietary pattern. Plasma metabolic estimation of within-person variation in intakes. Gains in
signatures of healthy dietary patterns (eg, Alternative precision and representativeness must be weighed against
Healthy Eating Index [AHEI]-2010, DASH, Mediterranean) the expense and participant burden of multiple assess-
have been identified in adults with CKD,73 and serum ments. Distributing shorter automated dietary assessments
metabolomic signatures of plant-based diets have been (eg, automated self-administered 24-hour recalls54,86)
shown to predict incident CKD.74 Serum metabolomic over time, and including weekdays versus weekends and
markers of dietary acid load have also been identified75 and dialysis versus nondialysis days, may help maximize
predict incident CKD.75 representativeness while reducing participant burden and
Candidate biomarkers are primarily identified through expense.
cross-sectional correlations with self-reported diet, though For epidemiological research questions, group-level
controlled feeding studies are needed before biomarkers (rather than individual) usual intake estimates are typi-
can serve as objective and quantitative dietary intake cally of interest. On any given day, observed intakes in a
markers.76 Challenges include differentiating between population will include individuals with exceptionally
high and low true single-day intakes, but the distribution nutrient contents for branded foods or restaurant dishes,
will cluster around a central mean. Thus, a single 24- actual nutrient contents may differ substantially from re-
hour recall or record per person is considered sufficient ported values.95,96 In addition, nutrient losses during food
to estimate population mean intakes, but extreme high preparation or cooking may not be considered. Finally,
and low consumers will flatten the estimated distribution database values do not account for biological availability of
of intakes and overestimate the proportion of a popula- consumed nutrients. For instance, phosphorus intakes
tion in the distribution tails. As such, comparisons of from natural and added sources are weighed equally in
population intakes to some target—for instance, an database summations, though true absorption varies sub-
estimated minimum requirement—will overestimate the stantially.22 Cautious interpretation of nutrient intakes is
proportion of deficient individuals. Statistical methods warranted because summed database totals may not fully
are available to more precisely estimate the usual intake represent actual consumed or biologically available
distribution in a population with as few as 2 recalls nutrients.
obtained from a subset of respondents.87-89 Such
methods should be used when assessing the adequacy or Statistical Modeling in Nutritional Epidemiology
insufficiency of population intakes relative to a recom-
mended target or when comparing usual intakes between Energy Adjustment
2 or more groups. A methodological consideration unique to nutritional
In contrast to 24-hour recalls and food records, FFQs epidemiology is whether and how to adjust for energy
solicit average consumption over a defined time period intake.90,97-99 People consuming more energy generally
and are intended to capture usual intake. However, dietary consume greater absolute amounts of nutrients, and en-
intakes may change over extended periods of follow-up, ergy intake itself may be associated with CKD. Associations
especially in persons with CKD, who may experience between absolute dietary intakes and CKD may, therefore,
changes in appetite and receive dietary counseling. If only be confounded by energy intake. Thus, epidemiological
baseline diet is assessed, unmeasured subsequent shifts in analyses of associations between dietary intake and CKD
intakes could result in misclassification of exposure status typically aim to statistically isolate between-person varia-
and attenuation of estimated associations with CKD. tion in intakes due to energy intake from variation
Repeating assessments and averaging intakes across repeated explained by changes in dietary composition. Controlling
FFQs may reduce random measurement error arising from for total energy also helps to reduce error in self-reported
intraindividual changes in dietary intakes over time.90 dietary intakes because error in self-reported energy intake
measurement is correlated with error in self-reported in-
Measurement Error: Systematic takes of nutrients and foods.99 The interpretation of
While repeating dietary assessments can improve precision regression coefficients from energy adjusted models differs
by reducing random measurement error, it will not depending on whether nutritional exposures are modeled
address systematic misreporting of intakes. The degree of continuously or categorically100 and whether other dietary
misreporting varies for different population groups, foods, covariates are included (substitution).101
and dietary assessment tools.80,91 For instance, people may
overreport intakes of “healthy” foods and underreport Substitution
“unhealthy” foods to align with social norms (social When energy balance is maintained, increasing intake of a
desirability and social approval biases),92 and people with macronutrient or energy-containing food or beverage re-
low true intakes tend to overreport their intake, while quires decreasing intakes of others, and its biological effect
those with truly high intakes tend to underreport (the may differ depending on what it displaces in the diet. For
“flattened slope phenomenon”).81 Regression calibration instance, replacing saturated fat with unsaturated fat is asso-
can help correct risk estimates for biased measurements of ciated with lower coronary heart disease risk whereas no
self-reported dietary exposures when a less biased refer- association is observed when it is replaced with refined car-
ence assessment is available for at least a subset of the study bohydrates.102 Specific isocaloric food or macronutrient
population.81,93 substitutions can be modeled by including total energy and
all other energy sources excluding the food or macronutrient
Limitations of Food Composition Databases to be substituted as covariates.101 Modeled substitutions
Whether dietary intakes are self-reported or observed, should ideally represent realistic exchanges and consider how
conversion to nutrients and foods requires linkage to foods are actually consumed within a dietary pattern.103
nutrient databases. Misestimation of nutrient contents may Models that only adjust energy are difficult to interpret
arise due to geographical, seasonal, or other natural because associations may be attributable to increasing intake
sources of variation in the nutritional composition of of the dietary exposure or decreasing intakes of unspecified
foods. For instance, selenium can vary substantially due to other energy sources. Substitution analyses better inform
differences in soil content.94 Misestimation also arises dietary guidance by identifying appropriate dietary re-
from variation in the composition of prepared foods and placements to reduce CKD risk.101 A clear and specific
manufactured items. Although some databases include research question will ultimately guide model specification.
meta-analysis of cohort studies. Clin J Am Soc Nephrol. 32. Kant AK, Schatzkin A, Harris TB, Ziegler RG, Block G. Dietary
2019;14(10):1441-1449. doi:10.2215/CJN.00530119 diversity and subsequent mortality in the First National Health
15. The ARIC Investigators. The Atherosclerosis Risk in Commu- and Nutrition Examination Survey Epidemiologic Follow-up
nities (ARIC) Study: design and objectives. Am J Epidemiol. Study. Am J Clin Nutr. 1993;57(3):434-440. doi:10.1093/
1989;129(4):687-702. doi:10.1093/oxfordjournals.aje.a115184 AJCN/57.3.434
16. National Kidney Foundation. K/DOQI clinical practice guide- 33. Satija A, Bhupathiraju SN, Rimm EB, et al. Plant-based dietary
lines for bone metabolism and disease in chronic kidney dis- patterns and incidence of type 2 diabetes in US men and women:
ease. Am J Kidney Dis. 2003;42(4)(suppl 3):S1-201. doi:10. results from three prospective cohort studies. PLoS Med.
1016/S0272-6386(03)00905-3 2016;13(6):e1002039. doi:10.1371/journal.pmed.1002039
17. Kidney Disease Outcomes Quality Initiative (K/DOQI). K/DOQI 34. Shivappa N, Steck SE, Hurley TG, Hussey JR, H ebert JR.
clinical practice guidelines on hypertension and antihypertensive Designing and developing a literature-derived, population-
agents in chronic kidney disease. Am J Kidney Dis. based dietary inflammatory index. Public Health Nutr.
2004;43(5)(suppl 1):S1-S290. doi:10.1053/j.ajkd.2004.03.003 2014;17(8):1689-1696. doi:10.1017/S1368980013002115
18. KDIGO 2017 clinical practice guideline update for the diag- 35. Remer T, Manz F. Potential renal acid load of foods and its in-
nosis, evaluation, prevention, and treatment of chronic kidney fluence on urine pH. J Am Diet Assoc. 1995;95(7):791-797.
disease-mineral and bone disorder (CKD-MBD). Kidney Int doi:10.1016/S0002-8223(95)00219-7
Suppl. 2017;7(1):1-59. doi:10.1016/J.KISU.2017.04.001 36. Frassetto LA, Todd KM, Morris RC, Sebastian A. Estimation of
19. Ikizler T, Burrowes J, Byham-Gray L, et al. KDOQI clinical net endogenous noncarbonic acid production in humans from
practice guideline for nutrition in CKD: 2020 update. Am J diet potassium and protein contents. Am J Clin Nutr.
Kidney Dis. 2020;76(3)(suppl 1):S1-S107. doi:10.1053/J. 1998;68(3):576-583. doi:10.1093/AJCN/68.3.576
AJKD.2020.05.006 37. Scialla JJ, Anderson CAM. Dietary acid load: a novel nutritional
20. Kidney Disease: Improving Global Outcomes (KDIGO) Dia- target in chronic kidney disease? Adv Chronic Kidney Dis.
betes Work Group. KDIGO 2020 clinical practice guideline for 2013;20(2):141-149. doi:10.1053/J.ACKD.2012.11.001
diabetes management in chronic kidney disease. Kidney Int. 38. Monteiro CA, Cannon G, Moubarac JC, Levy RB,
2020;98(4)(suppl):S1-S115. doi:10.1016/j.kint.2020.06.019 Louzada MLC, Jaime PC. The UN Decade of Nutrition, the
21. Kidney Disease: Improving Global Outcomes (KDIGO) Blood NOVA food classification and the trouble with ultra-processing.
Pressure Work Group. KDIGO 2021 clinical practice guideline Public Health Nutr. 2018;21(1):5-17. doi:10.1017/
for the management of blood pressure in chronic kidney dis- S1368980017000234
ease. Kidney Int. 2021;99(3)(suppl):S1-S87. doi:10.1016/J. 39. Sadler CR, Grassby T, Hart K, Raats M, Sokolovi c M,
KINT.2020.11.003 Timotijevic L. Processed food classification: conceptualisation
22. Kalantar-Zadeh K, Gutekunst L, Mehrotra R, et al. Under- and challenges. Trends Food Sci Technol. 2021;112:149-162.
standing sources of dietary phosphorus in the treatment of doi:10.1016/j.tifs.2021.02.059
patients with chronic kidney disease. Clin J Am Soc Nephrol. 40. Hu EA, Steffen LM, Grams ME, et al. Dietary patterns and risk
2010;5(3):519-530. doi:10.2215/CJN.06080809 of incident chronic kidney disease: the Atherosclerosis Risk in
23. Jacobs DR, Steffen LM. Nutrients, foods, and dietary patterns as Communities study. Am J Clin Nutr. 2019;110(3):713-721.
exposures in research: a framework for food synergy. Am J Clin doi:10.1093/ajcn/nqz146
Nutr. 2003;78(3):508S-513S. doi:10.1093/AJCN/78.3.508S 41. Rebholz CM, Crews DC, Grams ME, et al. DASH (Dietary
24. Hu FB. Dietary pattern analysis: a new direction in nutritional Approaches to Stop Hypertension) diet and risk of subsequent
epidemiology. Curr Opin Lipidol. 2002;13(1):3-9. doi:10.1097/ kidney disease. Am J Kidney Dis. 2016;68(6):853-861. doi:10.
00041433-200202000-00002 1053/j.ajkd.2016.05.019
25. US Department of Agriculture, US Department of Health and 42. Newby PK, Tucker KL. Empirically derived eating patterns using
Human Services. Dietary Guidelines for Americans, 2020-2025. factor or cluster analysis: a review. Nutr Rev. 2004;62(5):177-
9th ed. US Government; 2020. https://www.dietaryguidelines.gov 203. doi:10.1301/NR.2004.MAY.177-203
26. Lichtenstein AH, Appel LJ, Vadiveloo M, et al. 2021 Dietary 43. Willett WC, Sampson L, Stampfer MJ, et al. Reproducibility and
guidance to improve cardiovascular health: a scientific statement validity of a semiquantitative food frequency questionnaire. Am
from the American Heart Association. Circulation. 2021;144(23): J Epidemiol. 1985;122(1):51-65. doi:10.1093/oxfordjournals.
e472-e487. doi:10.1161/CIR.0000000000001031 aje.a114086
27. Fung TT, McCullough ML, Newby P, et al. Diet-quality scores 44. Affret A, Wagner S, el Fatouhi D, et al. Validity and reproduc-
and plasma concentrations of markers of inflammation and ibility of a short food frequency questionnaire among patients
endothelial dysfunction. Am J Clin Nutr. 2005;82(1):163-173. with chronic kidney disease. BMC Nephrol. 2017;18(1):297.
doi:10.1093/ajcn.82.1.163 doi:10.1186/S12882-017-0695-2
28. Fung TT, Chiuve SE, McCullough ML, Rexrode KM, 45. Bin Zarah A, Feraudo MC, Andrade JM. Development and
Logroscino G, Hu FB. Adherence to a DASH-style diet and risk relative validity of the Chronic Kidney Disease Short Food Fre-
of coronary heart disease and stroke in women. Arch Intern quency Questionnaire (CKD SFFQ) to determine diet quality
Med. 2008;168(7):713-720. doi:10.1001/archinte.168.7.713 and dietary habits among adults with chronic kidney disease.
29. Krebs-Smith SM, Pannucci TRE, Subar AF, et al. Update of the Nutrients. 2021;13(10):3610. doi:10.3390/NU13103610
Healthy Eating Index: HEI-2015. J Acad Nutr Diet. 46. Kalantar-Zadeh K, Kovesdy CP, Bross R, et al. Design and
2018;118(9):1591-1602. doi:10.1016/j.jand.2018.05.021 development of a dialysis food frequency questionnaire. J Ren
30. McCullough ML, Feskanich D, Stampfer MJ, et al. Diet quality Nutr. 2011;21(3):257-262. doi:10.1053/J.JRN.2010.05.013
and major chronic disease risk in men and women: moving 47. Delgado C, Ward P, Chertow GM, et al. Calibration of the brief
toward improved dietary guidance. Am J Clin Nutr. 2002;76(6): food frequency questionnaire among patients on dialysis.
1261-1271. doi:10.1093/AJCN/76.6.1261 J Ren Nutr. 2014;24(3):151-156.e1. doi:10.1053/J.JRN.
31. Chiuve SE, Fung TT, Rimm EB, et al. Alternative dietary indices 2013.12.004
both strongly predict risk of chronic disease. J Nutr. 48. Ahmed S, Rahman T, Ripon MSH, et al. A food frequency
2012;142(6):1009-1018. doi:10.3945/jn.111.157222 questionnaire for hemodialysis patients in Bangladesh (BDHD-
FFQ): development and validation. Nutrients. 2021;13(12): to promote weight loss. Smart Health (Amst). 2017;3-4:20-26.
4521. doi:10.3390/NU13124521 doi:10.1016/J.SMHL.2017.03.004
49. Rao SN, Chandra A, Tiwari P, Mishra P. Development and 65. Tseng P, Napier B, Garbarini L, Kaplan DL, Omenetto FG.
validation of a novel food-frequency questionnaire for hemodi- Functional, RF-trilayer sensors for tooth-mounted, wireless
alysis patients in Lucknow, India. Indian J Nephrol. 2021;31(3): monitoring of the oral cavity and food consumption. Adv Mater.
276. doi:10.4103/IJN.IJN_134_19 2018;30(18):1703257. doi:10.1002/adma.201703257
50. Raatz SK, Scheett AJ, Johnson LK, Jahns L. Validity of elec- 66. Economic Research Service, U.S. Department of Agriculture.
tronic diet recording nutrient estimates compared to dietitian Food-related data sources. Accessed April 25, 2022. https://
analysis of diet records: randomized controlled trial. J Med www.ers.usda.gov/about-ers/partnerships/strengthening-statistics-
Internet Res. 2015;17(1):e21. doi:10.2196/JMIR.3744 through-the-icars/food-related-data-sources/#consumerpurchases
51. Pendergast FJ, Leech RM, McNaughton SA. Novel online or 67. Bandy L, Adhikari V, Jebb S, Rayner M. The use of commercial
mobile methods to assess eating patterns. Curr Nutr Rep. food purchase data for public health nutrition research: a sys-
2017;6(3):212. doi:10.1007/S13668-017-0211-0 tematic review. PLoS One. 2019;14(1):e0210192. doi:10.
52. Carroll RJ, Midthune D, Subar AF, et al. Taking advantage of the 1371/journal.pone.0210192
strengths of 2 different dietary assessment instruments to 68. McCutcheon J, Campbell K, Ferguson M, Day S, Rossi M.
improve intake estimates for nutritional epidemiology. Am J Prevalence of phosphorus-based additives in the Australian
Epidemiol. 2012;175(4):340-347. doi:10.1093/AJE/KWR317 food supply: a challenge for dietary education? J Ren Nutr.
53. Moshfegh AJ, Rhodes DG, Baer DJ, et al. The US Department 2015;25(5):440-444. doi:10.1053/J.JRN.2015.04.003
of Agriculture Automated Multiple-Pass Method reduces bias in 69. Kaaks R, Riboli E, Sinha R. Biochemical markers of dietary
the collection of energy intakes. Am J Clin Nutr. 2008;88(2): intake. IARC Sci Publ. 1997;142:103-126.
324-332. doi:10.1093/ajcn/88.2.324 70. Schoeller DA. Measurement of energy expenditure in free-living
54. Kirkpatrick SI, Subar AF, Douglass D, et al. Performance of the humans by using doubly labeled water. J Nutr. 1988;118(11):
Automated Self-Administered 24-Hour Recall relative to a 1278-1289. doi:10.1093/jn/118.11.1278
measure of true intakes and to an interviewer-administered 24- 71. Tasevska N, Midthune D, Potischman N, et al. Use of the pre-
h recall. Am J Clin Nutr. 2014;100(1):233-240. doi:10.3945/ dictive sugars biomarker to evaluate self-reported total sugars
AJCN.114.083238 intake in the Observing Protein and Energy Nutrition (OPEN)
55. Thompson FE, Dixit-Joshi S, Potischman N, et al. Comparison of Study. Cancer Epidemiol Biomarkers Prev. 2011;20(3):490-
interviewer-administered and automated self-administered 24- 500. doi:10.1158/1055-9965.EPI-10-0820
hour dietary recalls in 3 diverse integrated health systems. Am J 72. Scalbert A, Brennan L, Manach C, et al. The food metabolome:
Epidemiol. 2015;181(12):970-978. doi:10.1093/AJE/KWU467 a window over dietary exposure. Am J Clin Nutr. 2014;99(6):
56. Mason B, Ross L, Gill E, Healy H, Juffs P, Kark A. Development 1286-1308. doi:10.3945/ajcn.113.076133
and validation of a dietary screening tool for high sodium 73. Kim H, Anderson CAM, Hu EA, et al. Plasma metabolomic
consumption in Australian renal patients. J Ren Nutr. signatures of healthy dietary patterns in the Chronic Renal
2014;24(2):123-134.e1-3. doi:10.1053/J.JRN.2013.10.004 Insufficiency Cohort (CRIC) Study. J Nutr. 2021;151(10):
57. Cappuccio FP, Rink E, Perkins-Porras L, McKay C, Hilton S, 2894-2907. doi:10.1093/JN/NXAB203
Steptoe A. Estimation of fruit and vegetable intake using a two- 74. Kim H, Yu B, Li X, et al. Serum metabolomic signatures of plant-
item dietary questionnaire: a potential tool for primary health based diets and incident chronic kidney disease. Am J Clin
care workers. Nutr Metab Cardiovasc Dis. 2003;13(1):12-19. Nutr. 2022;116(1):151-164. doi:10.1093/AJCN/NQAC054
doi:10.1016/S0939-4753(03)80163-1 75. Tariq A, Chen J, Yu B, et al. Metabolomics of dietary acid load
58. Dalakleidi KV, Papadelli M, Kapolos I, Papadimitriou K. Applying and incident chronic kidney disease. J Ren Nutr. 2022;32(3):
image-based food-recognition systems on dietary assessment: 292-300. doi:10.1053/J.JRN.2021.05.005
a systematic review. Adv Nutr. 2022;13(6):2590-2619. doi:10. 76. Brennan L, Hu FB. Metabolomics-based dietary biomarkers in
1093/advances/nmac078 nutritional epidemiology-current status and future opportu-
59. Rollo ME, Ash S, Lyons-Wall P, Russell AW. Evaluation of a nities. Mol Nutr Food Res. 2019;63(1):e1701064. doi:10.
mobile phone image-based dietary assessment method in 1002/MNFR.201701064
adults with type 2 diabetes. Nutrients. 2015;7(6):4897-4910. 77. Rafiq T, Azab SM, Teo KK, et al. Nutritional metabolomics and
doi:10.3390/NU7064897 the classification of dietary biomarker candidates: a critical
60. Rhyner D, Loher H, Dehais J, et al. Carbohydrate estimation by a review. Adv Nutr. 2021;12(6):2333-2357. doi:10.1093/AD-
mobile phone-based system versus self-estimations of in- VANCES/NMAB054
dividuals with type 1 diabetes mellitus: a comparative study. 78. Carrero JJ, Chen J, Kovesdy CP, Kalantar-Zadeh K. Critical
J Med Internet Res. 2016;18(5):e101. doi:10.2196/JMIR.5567 appraisal of biomarkers of dietary intake and nutritional status in
61. Gemming L, Ni Mhurchu C. Dietary under-reporting: what patients undergoing dialysis. Semin Dial. 2014;27(6):586. doi:
foods and which meals are typically under-reported? Eur J Clin 10.1111/SDI.12283
Nutr. 2016;70(5):640-641. doi:10.1038/EJCN.2015.204 79. Post A, Ozyilmaz A, Westerhuis R, Ipema KJR, Bakker SJL,
62. Raber M, Baranowski T, Crawford K, et al. The Healthy Cooking Franssen CFM. Complementary biomarker assessment of
Index: nutrition optimizing home food preparation practices components absorbed from diet and creatinine excretion rate
across multiple data collection methods. J Acad Nutr Diet. reflecting muscle mass in dialysis patients. Nutrients.
2020;120(7):1119-1132. doi:10.1016/J.JAND.2020.01.008 2018;10(12):1827. doi:10.3390/NU10121827
63. Turner-McGrievy GM, Wilcox S, Boutt e A, et al. The Dietary 80. Subar AF, Freedman LS, Tooze JA, et al. Addressing current
Intervention to Enhance Tracking with Mobile Devices (DIET Mo- criticism regarding the value of self-report dietary data. J Nutr.
bile) Study: a 6-month randomized weight loss trial. Obesity (Sil- 2015;145(12):2639-2645. doi:10.3945/jn.115.219634
ver Spring). 2017;25(8):1336-1342. doi:10.1002/OBY.21889 81. Freedman LS, Schatzkin A, Midthune D, Kipnis V. Dealing with di-
64. Turner-McGrievy GM, Boutt e A, Crimarco A, et al. Byte by Bite: etary measurement error in nutritional cohort studies. J Natl Cancer
use of a mobile bite counter and weekly behavioral challenges Inst. 2011;103(14):1086-1092. doi:10.1093/JNCI/DJR189
82. Basiotis PP, Welsh SO, Cronin FJ, Kelsay JL, Mertz W. Number for renal patients. J Ren Nutr. 2007;17(5):350-354. doi:10.
of days of food intake records required to estimate individual 1053/j.jrn.2007.05.008
and group nutrient intakes with defined confidence. J Nutr. 97. Willett W, Stampfer M. Total energy intake: implications for
1987;117(9):1638-1641. doi:10.1093/JN/117.9.1638 epidemiologic analyses. Am J Epidemiol. 1986;124(1):17-27.
83. Haines PS, Hama MY, Guilkey DK, Popkin BM. Weekend doi:10.1093/oxfordjournals.aje.A114366
eating in the United States is linked with greater energy, fat, 98. Tomova GD, Arnold KF, Gilthorpe MS, Tennant PWG. Adjust-
and alcohol intake. Obes Res. 2003;11(8):945-949. doi:10. ment for energy intake in nutritional research: a causal infer-
1038/OBY.2003.130 ence perspective. Am J Clin Nutr. 2022;115(1):189-198. doi:
84. Martins AM, Dias Rodrigues JC, de Oliveira Santin FG, et al. Food 10.1093/ajcn/nqab266
intake assessment of elderly patients on hemodialysis. J Ren Nutr. 99. Willett WC, Howe GR, Kushi LH. Adjustment for total energy
2015;25(3):321-326. doi:10.1053/J.JRN.2014.10.007 intake in epidemiologic studies. Am J Clin Nutr.
85. Burrowes JD, Larive B, Cockram DB, et al. Effects of dietary 1997;65(suppl):1220S-1228S.
intake, appetite, and eating habits on dialysis and non-dialysis 100. Brown CC, Kipnis V, Freedman LS, Hartman AM, Schatzkin A,
treatment days in hemodialysis patients: cross-sectional re- Wacholder S. Energy adjustment methods for nutritional epide-
sults from the HEMO study. J Ren Nutr. 2003;13(3):191-198. miology: the effect of categorization. Am J Epidemiol.
doi:10.1016/S1051-2276(03)00069-4 1994;139(3):323-338. doi:10.1093/oxfordjournals.aje.a117000
86. Subar AF, Kirkpatrick SI, Mittl B, et al. The Automated Self- 101. Ibsen DB, Laursen ASD, Wuürtz AML, et al. Food substitution
Administered 24-Hour Dietary Recall (ASA24): a resource for models for nutritional epidemiology. Am J Clin Nutr.
researchers, clinicians, and educators from the National Can- 2021;113(2):294-303. doi:10.1093/ajcn/nqaa315
cer Institute. J Acad Nutr Diet. 2012;112(8):1134-1137. doi: 102. Li Y, Hruby A, Bernstein AM, et al. Saturated fats compared with
10.1016/J.JAND.2012.04.016 unsaturated fats and sources of carbohydrates in relation to risk of
87. Tooze JA, Midthune D, Dodd KW, et al. A new statistical method coronary heart disease: a prospective cohort study. J Am Coll
for estimating the usual intake of episodically consumed foods Cardiol. 2015;66(14):1538-1548. doi:10.1016/j.jacc.2015.07.055
with application to their distribution. J Am Diet Assoc. 103. Song M, Giovannucci E. Substitution analysis in nutritional
2006;106(10):1575-1587. doi:10.1016/j.jada.2006.07.003 epidemiology: proceed with caution. Eur J Epidemiol.
88. Kipnis V, Freedman LS, Carroll RJ, Midthune D. A bivariate 2018;33(2):137-140. doi:10.1007/S10654-018-0371-2
measurement error model for semicontinuous and continuous 104. Mafra D, Borges NA, Lindholm B, Shiels PG, Evenepoel P,
variables: application to nutritional epidemiology. Biometrics. Stenvinkel P. Food as medicine: targeting the uraemic pheno-
2016;72(1):106-115. doi:10.1111/BIOM.12377 type in chronic kidney disease. Nat Rev Nephrol. 2021;17(3):
89. Tooze JA, Kipnis V, Buckman DW, et al. A mixed-effects model 153-171. doi:10.1038/s41581-020-00345-8
approach for estimating the distribution of usual intake of nu- 105. Kim Y, Lu S, Ho JE, et al. Proteins as mediators of the associ-
trients: the NCI method. Stat Med. 2010;29(27):2857-2868. ation between diet quality and incident cardiovascular disease
doi:10.1002/sim.4063 and all-cause mortality: the Framingham Heart Study. J Am Heart
90. Hu FB, Stampfer MJ, Rimm E, et al. Dietary fat and coronary Assoc. 2021;10(18):e021245. doi:10.1161/JAHA.121.021245
heart disease: a comparison of approaches for adjusting for 106. Meijers B, Evenepoel P, Anders HJ. Intestinal microbiome and
total energy intake and modeling repeated dietary measure- fitness in kidney disease. Nat Rev Nephrol. 2019;15(9):531-
ments. Am J Epidemiol. 1999;149(6):531-540. doi:10.1093/ 545. doi:10.1038/S41581-019-0172-1
OXFORDJOURNALS.AJE.A009849 107. Rysz J, Franczyk B, Ławi nski J, Olszewski R, Ciałkowska-
91. Freedman LS, Commins JM, Moler JE, et al. Pooled results Rysz A, Gluba-Brz ozka A. The impact of CKD on uremic toxins
from 5 validation studies of dietary self-report instruments and gut microbiota. Toxins (Basel). 2021;13(4):252. doi:10.
using recovery biomarkers for energy and protein intake. 3390/TOXINS13040252
Am J Epidemiol. 2014;180(2):172-188. doi:10.1093/AJE/ 108. Ramezani A, Raj DS. The gut microbiome, kidney disease, and
KWU116 targeted interventions. J Am Soc Nephrol. 2014;25(4):657-
92. Hebert JR, Ma Y, Clemow L, et al. Gender differences in social 670. doi:10.1681/ASN.2013080905
desirability and social approval bias in dietary self-report. Am J 109. Jovanovich A, Isakova T, Stubbs J. Microbiome and cardiovas-
Epidemiol. 1997;146(12):1046-1055. doi:10.1093/oxford- cular disease in CKD. Clin J Am Soc Nephrol. 2018;13(10):
journals.aje.a009233 1598-1604. doi:10.2215/CJN.12691117
93. Spiegelman D, McDermott A, Rosner B. Regression calibration 110. K€ottgen A, Pattaro C. The CKDGen Consortium: ten years of
method for correcting measurement-error bias in nutritional insights into the genetic basis of kidney function. Kidney Int.
epidemiology. Am J Clin Nutr. 1997;65(4)(suppl):1179S- 2020;97(2):236-242. doi:10.1016/J.KINT.2019.10.027
1186S. doi:10.1093/AJCN/65.4.1179S 111. Hsu CY, Ballard S, Batlle D, et al. Cross-disciplinary biomarkers
94. Willett W. Nutritional Epidemiology. 3rd ed. Oxford University research: lessons learned by the CKD Biomarkers Consortium.
Press; 2013. Clin J Am Soc Nephrol. 2015;10(5):894-902. doi:10.2215/
95. Moser M, White K, Henry B, et al. Phosphorus content of CJN.11541114
popular beverages. Am J Kidney Dis. 2015;65(6):969-971. 112. Dubin RF, Rhee EP. Proteomics and metabolomics in kidney
doi:10.1053/j.ajkd.2015.02.330 disease, including insights into etiology, treatment, and pre-
96. Sullivan CM, Leon JB, Sehgal AR. Phosphorus-containing food vention. Clin J Am Soc Nephrol. 2020;15(3):404-411. doi:10.
additives and the accuracy of nutrient databases: implications 2215/CJN.07420619