Food As Medicine to Reduce CKD Burden in Health Disparity Populations (FAME to Reduce CKD) - Project Summary/Abstract Chronic kidney disease (CKD) is a major public health challenge that plagues approximately 1 in 7 Americans, most of whom experience asymptomatic progressive CKD until the disease is at advanced stages, resulting in devastating complications, including kidney failure and death. Due to the symptomless characteristics of early stages of CKD, many individuals remain underdiagnosed and untreated. This especially impacts African Americans (AA) and Hispanic persons and those with lower socio-economic status (SES) as they often engage with health systems at later stages of CKD leading to worse outcomes. Thus, community level interventions are needed to identify and intervene sooner for those unaware of their risk (~90%). Additionally, dietary intake, a significant social driver of health, plays a considerable role in the prevention and management of CKD and cardiovascular complications, yet lower SES communities have less access to health-promoting foods and lower self-efficacy for eating healthy, worsening CKD outcomes. To fill these gaps, our team has established that base-producing fruits and vegetables (F&V) preserved kidney function and reduced cardiovascular disease (CVD) risk in health system-based cohorts. These findings were translated to a community-dwelling population in our recently completed R21 (R21DK113440) that evaluated the benefits of base-producing F&V among 142 AA adults identified with CKD through community-based health screens. We found that participants who received a culinary medicine cooking intervention plus base-producing F&V as compared to those receiving F&V alone had 31% lower urine albumin to creatinine ratio (UACR) after 6 months of the intervention. In this R01, we propose to extend our group’s foundational work by evaluating whether cooking instructions delivered through community-based culinary medicine in addition to provision of base-producing F&V (FV+Cook) promotes greater kidney, and additionally CVD, benefits than providing base- producing F&V alone (FV Only) in a larger, multi-ethnic sample. This will be evaluated through the following Specific Aims: (1) Determine whether UACR is reduced to a greater extent with the FV+Cook intervention as compared to FV Only at 6- and 12-months (primary), (2) Determine whether F&V+Cook compared to F&V Only improves secondary measures (i.e., blood pressure, body mass index, lipid levels, hemoglobin A1c) at 6- and 12-months, (3) Evaluate F&V consumption, dietary behaviors and quality (ASA-24, Veggie Meter®), and behavioral mediators (nutrition knowledge, self-efficacy, social support, cooking skills) at 6- and 12-months, and (4) Use RE-AIM domains (Reach, Effectiveness, Adoption, Implementation, and Maintenance) to evaluate implementation outcomes. In summary, this study can provide critical data to guide sustainable, scalable, and feasible clinical and public health practice on improving CKD outcomes in populations at risk for adverse long-term consequences, ushering a new era of food as medicine health interventions in community settings.
