Food Costs Can Lead To Less Protein and Phosphorous in Indigent Kidney Transplant Patients

MedicalResearch.com Interview with:

Ms. Shifra Mincer Medical Student in the class of 2019 SUNY Downstate Medical School

Shifra Mincer

Ms. Shifra Mincer
Medical Student in the class of 2019
SUNY Downstate Medical School

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Hypophosphatemia is commonly encountered in the post-transplant setting. Early post-transplant hypophosphatemia has been ascribed to excess FGF23 and hyperphosphaturia.

Many patients remain hypohosphatemic months or even years after their transplant and the mechanism was assumed to be the same, however, our group recently reported that patients with late post-transplant hypophosphatemia had very little phosphorous in their urine (Wu S, Brar A, Markell, MS. Am J Kidney Dis. 2016,67(5): A18). We hypothesized that they were not eating enough phosphorous to compensate for the acute phosphorous losses they experienced immediately post-transplant.

In this study, using both 3-day diet journals and 24-hour diet recall questionnaires, we found that mean intake of phosphorous and protein was barely at the Recommended Daily Allowance, and that despite 70% of the patients using EBT, 30% of those patients still reported concerns regarding food security. Patients who reported that the cost of food influenced their dietary choices ate 43% less protein (average 48,5 gms vs. 85.8 gms) and 29% less phosphorous (average 887 mg vs 1257 mg). When ability to rise from a chair over a 30 second period was evaluated, only patients who expressed food cost concerns were unable to complete the test.

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Poor Kids More Likely To Have More Than One Chronic Health Condition

MedicalResearch.com Interview with:

Christian D. Pulcini, MD, MEd, MPH Pediatric Resident, Children's Hospital of Pittsburgh of UPMC Chair, Section on Pediatric Trainees (SOPT) American Academy of Pediatrics

Dr. Christian Pulcini

Christian D. Pulcini, MD, MEd, MPH
Pediatric Resident
Children’s Hospital of Pittsburgh of UPMC
Chair, Section on Pediatric Trainees (SOPT)
American Academy of Pediatrics

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Poverty influences the well-being of children and adolescents in a negative way. Poor children are often exposed to toxic health stressors, including violence, environmental toxins, and inadequate nutrition. Children in poverty with chronic health conditions also are more likely to have higher rates of secondary disorders and worse outcomes. We studied children with asthma, attention-deficit/hyperactivity disorder (ADHD), and autism spectrum disorder (ASD), to describe the how much disease and if the children had multiple (comorbid) conditons and how these vary by poverty status.

Parents reported through the National Survey of Children’s Health that asthma and ADHD rose 18% and 44% from 2003-2011/2012, respectively, whereas the lifetime prevalence of ASD rose 32% from 2007-2011/2012 in all income levels. For asthma, the rise was most among the poor at 25.8%. For ADHD, the percent change among the poor was similar, however the rise in autism spectrum disorder was associated with being non-poor. Publicly insured children with asthma, ADHD, and ASD also had a significant higher chance (1.9×, 1.6×, 3.0×, respectively) of having higher more than one chronic condition. In addition, kids who were poor with asthma and ADHD.
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HUD Housing Assistance, But Not Vouchers, Linked To Improvement in Health Measurements

MedicalResearch.com Interview with:

Andrew Fenelon PhD Assistant Professor, Department of Health Services Administration University of Maryland School of Public Health. College Park, MD 20742

Dr. Andrew Fenelon

Andrew Fenelon PhD
Assistant Professor, Department of Health Services Administration
University of Maryland School of Public Health.
College Park, MD 20742

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Despite the relatively large public investment in housing assistance at the federal level, there have been few nationwide analyses of the impacts of these programs on health and well-being. And as policymakers seek solutions to health disparities that incorporate some of the non-medical determinants of health (such as housing quality), our study can make an important contribution to both health and housing policy.

We use an innovative data linkage program which links individuals in a federal household health survey and administrative housing records from the U.S. Department of Housing and Urban Development (HUD). We examine the health impacts of three HUD housing programs: public housing, housing choice vouchers, and multifamily housing. We find that public housing and multifamily housing lead to an improvement in self-reported health status, and public housing leads to a reduction in serious psychological distress. We do not find health impacts associated with housing choice vouchers.

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Association Between Poverty and Chronic Kidney Disease May Be Getting Stronger Over Time

Holly Kramer, MD, MPH Department of Public Health Sciences Loyola University Chicago Health Sciences Campus Maywood, ILMedicalResearch.com Interview with:
Holly Kramer, MD, MPH

Department of Public Health Sciences
Loyola University Chicago
Health Sciences Campus
Maywood, IL

MedicalResearch: What is the background for this study? What are the main findings?

Dr. Kramer: The U.S. dialysis dependent population continues to grow with  636,905 prevalent cases of end-stage renal disease (ESRD) in the U.S. as of December 31, 2012, , an increase of 3.7% since 2011.  Poverty is a well described risk factor for ESRD because poverty impacts access to care and nutritious foods.  The definitions for poverty in the U.S. have not changed over the past several decades despite marked changes in social structure.  For example, social integration in the U.S. society currently requires a cell phone, computer and internet access and access to transportation.  Healthy foods also cost more now relative to unhealthy foods compared to past decades.  Thus, the link between poverty and any chronic disease or health outcome is likely dynamic due to the evolving financial burden for living in a rapidly changing industrialized society.  Our study defined poverty as living in a zip code defined area with > 20% of the residents living below the federal poverty line.  We show that the prevalence of adults receiving dialysis who are living in poverty has increased over time.  We also show that the association between poverty and ESRD may be getting stronger over time.  

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Specific Cancer Types Linked to Socioeconomic Status

Recinda L Sherman, MPH, PhD, CTR Program Manager, Data Use & Research North America Association of Central Cancer Registries (NAACCR)MedicalResearch.com Interview with:
Recinda L Sherman, MPH, PhD, CTR
Program Manager, Data Use & Research
North America Association of Central Cancer Registries (NAACCR)

 

MedicalResearch: What is the context of the study?
Dr. Sherman:

  • It has long been known that poverty is associated with adverse health conditions. In general, increasing poverty results in higher disease rates and higher mortality.
  • This study assessed the relationship between poverty and cancer incidence using national cancer data on nearly 3 million tumors from the North American Association of Central Cancer Registries (NAACCR).
  • Cancer registries do not collect economic information on cancer patients, so we used an area-based social measure: % of persons living below poverty within a census tract. This measure is a proxy for an individual’s economic status and also gives insight into the type of neighborhood in which an individual lives.

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