Food and nutrition insecurity in kidney disease. Practitioner considerations

The definition of food insecurity is lack of access to sufficient safe food for normal growth and for an active and healthy life. Food insecurity may be geographically classified: in low-income countries, it may be characterized by undernutrition and frank starvation, while in higher-income ones, food insecurity is associated with high consumption of energy-dense foods of poor nutritional quality. This Review highlights the relationship between food insecurity and chronic kidney disease (CKD) and its negative impact on kidney development, CKD progression, and health outcomes. In developed countries, compensatory eating behaviours as a coping strategy, subsequent health changes, and stress all work in a cyclic way, increasing disease onset and CKD progression. Food insecurity causes chronic stress, leading to visceral fat accumulation, insulin resistance, and diet-induced obesity, although the presence of multiple chronic conditions predicts food insecurity. Although data are scarce, in subjects at kidney disease risk, food insecurity is an additional factor for hospitalization, presence and development of kidney stones, progression to end-stage kidney disease (ESKD), and mortality. Moreover, food insecurity is a risk factor for the development of CKD in people with hypertension and diabetes. One of the most frequent methods for detecting food insecurity are questionnaires, although screening for and addressing food insecurity in primary care should be prioritzed. Food insecurity being a social determinant of health directly linked to inadequate financial resources represents a risk factor for development, progression, and negative outcomes in CKD. Also, political-economic items such as social policies, insufficient income, food advertising, inequitable education and low education attainment, food production, and marketing of unhealthy food should be considered. Interventions for addressing food insecurity need to be carefully planned due to the higher mortality of food-insecure individuals. Healthcare professionals should be educated to understand food insecurity, but resources for detecting and solving this global problem are needed.