Chronic Kidney Disease (CKD) Patients Who Receive SNAP Benefits Have a Higher Risk of Food Insecurity, Poorer Diet Quality, and Lower Vegetable Intake Than Those Who Don’t

Abstract

Abstract Objectives Many CKD/ESKD pts rely on SNAP benefits to help offset the cost of food. We studied the association of SNAP benefits with food insecurity and dietary habits in our inner-City population. Methods A face-to-face survey was conducted with a sample of patients from inner-city CKD (23), dialysis (24), and transplant (33) clinics. As SNAP usage was similar across all clinics data were pooled. Diet was assessed using 24-hour recall and analyzed using ASA24 software. The Healthy Eating Index was scored using the HEI-15, with a value below 50 considered poor. Food security was evaluated using the question “In the last 12 months did you ever eat less than you think you should because there wasn't enough money for food?”. All comparisons were by t-test except where noted. Results Mean age was 54.7 ± 1.7. There were 46 (58%) men and 34 (42%) women with 65 Black, 5 Asian, 5 Hispanic, and 4 others. 34 people (42.5%) had an income < $20 K, with 22 (27.4%) between $20 K and 40 K. 21 (26.3%) were employed. 42 people (44.2%) participated in SNAP in the last year and 53 (55.8%) did not. There was no significant difference in age, gender, years in the US, or education level between the SNAP recipients (SNAP-Y) and those who did not receive. SNAP-Y were less likely to be employed (10% vs 39%, P < 0.5 by Chi square) and reported more food insecurity (23% vs 2%, P = 0.007 by Chi-square). SNAP-Y ate a poorer diet by HEI (53.0 ± 7.2 vs 59.6 ± 1.6, P = 0.015), ate less fiber (11.5 ± 6.9 vs 15.5 ± 1.04, P = 0.009), less magnesium (234 ± 16.9 vs 298 ± 23.8, P = 0.05), less vitamin C (54.9 ± 9.4 vs 99.1 ± 16.6, P = 0.025), fewer total vegetables (1.15 ± 0.25 vs 1.77 ± 0.18, P < 0.05), and fewer dark green leafy vegetables (0.4 ± 0.5 vs 0.5 ± 0.12, P = 0.009). There was no difference in intake of total calories, sodium, protein, fat or total carbohydrate intake. Conclusions In our population: 1. Patients who received SNAP benefits reported more food insecurity. 2. All patients had poor adherence to Dietary Guidelines but SNAP recipients were worse, ate less fiber, magnesium and vitamin C and ate fewer vegetables, including dark green leafy vegetables. 3. As data suggest that plant-based eating may be advantageous for patients with kidney disease, and most Greenmarkets in our neighborhood take SNAP, these latter findings are particularly concerning and warrant further study to discern if this is an issue of cost or education. Funding Sources None.