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Indicator Details: Trends of Dash Dietary Pattern and Chronic Kidney Disease in the United States
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Adults with CKD showed more adherence to the DASH diet over the years, but with a moderately high proportion showing a poor diet adherence in those with advanced CKD

Chart Explanation: 

Overall, the prevalence of adherence to a DASH diet in adults with mild to moderate and advanced CKD was 13.5% and 17.1%, respectively.   

The age-standardized prevalence rate of adherence to an adequate diet among mild to moderate CKD increased from 9.8% in 2003-2006 to 16.8% in 2015-2018 (p-trend= 0.001).

The increase in adequate diet adherence among advanced CKD (from 14.5% to 17.7%) was not statistically significant (Figure).

The estimated proportion with a poor diet in adults with advanced CKD decreased from 39.4% to 37.6%, with the trend being significant (P = .001 for trend) but it remained high. 

The National Health and Nutrition Examination Survey (NHANES) is a nationally representative, cross-sectional survey that is currently conducted every 2 years by the Centers for Disease Control and Prevention's National Center for Health Statistics to examine disease prevalence and trends over time in noninstitutionalized U.S. civilian residents.

The survey consists of a standardized in-home interview and a physical examination and blood and urine collection at a mobile examination center (MEC). Here we characterized trends in diet composition and quality among individuals with CKD. We analyzed 4,255 CKD individuals enrolled from 8 National Health and Nutrition Examination Survey (NHANES) cycles (2003-2018) using 24-hour dietary recalls. Changes in diet composition was assessed with the use of the Dietary Approaches to Stop Hypertension (DASH) diet adherence score generated based on Mellan et al. work

Description of Measure

DASH dietary pattern

Data Source


Type of Data Source


Data Set


Health Care System Data


Regional or National?


Demographic Group

Noninstitutionalized U.S. residents aged 20+ years


DASH dietary intake


Individuals with CKD (Stages 1-2 and Stages 3-4)

Glomerular filtration rate

Estimated using CKD-EPI equation for calibrated creatinine: eGFR=141 x [min(calibrated serum creatinine in mg/dL) /κ, 1)]α x [max(calibrated serum creatinine in mg/dL/κ, 1)]κ  x 0.993age x (1.018 if female) x (1.159 if NH Black)

κ = 0.7 if female, and 0.9 if male

α = -0.329 if female, and -0.411 if male

Primary Data Source Indicator

DR1TXXX: Energy/Fiber/Saturated Fat/Trans Fat/Calcium/Potassium/Magnesium/Protein/Sodium Intake

Primary Indicator Method of Measurement

Dietary 24-hour Recall

Secondary (1) Variable

lbxscr: Serum creatinine

Secondary (1) Indicator Method of Measurement


Secondary (2) Variable

ridageyr: Age in years

Secondary (2) Indicator Method of Measurement

Questionnaire (interviewer-administered)

Secondary (3) Variable

ridgendr: Gender

Secondary (3) Indicator Method of Measurement

Questionnaire (interviewer-administered)

Secondary (3) from Medical Record?


Secondary (4) Data Source Indicator

ridreth1: Race/ethnicity

Secondary (4) Indicator Method of Measurement

Questionnaire (interviewer-administered)

Secondary (5) Data Source Indicator

urxuma: Urine albumin

Secondary (5) Indicator Method of Measurement


Secondary (5) Data Source Indicator

urxucr: Urine creatinine

Secondary (5) Indicator Method of Measurement


Secondary (5) Indicator Method of Measurement


Frequency of Measurement (Primary)

Once (cross-sectional)

U.S. Region Covered by Primary Variable


Period Currently Available


Pending Data
Limitations of Indicator

Dietary data collected at baseline and analyzed using one 24-hour recall

Analytical Considerations

Appropriate NHANES survey weights must be used for all analyses; creatinine measurements must be calibrated for NHANES years 1999-2000 and 2005-2006; if 2007-2008 data are combined with 1999-2006 data, the earlier data on urinary creatinine must be corrected; many variable names differ across surveys; if SE 30% or more of estimate, must suppress estimates and report as “low precision”

References and Sources:
  • Mellen PB, Gao SK, Vitolins MZ, et al. Deteriorating Dietary Habits among Adults with Hypertension: DASH Dietary Accordance, NHANES 1988-1994 and 1999-2004. Arch Intern Med. 2008;168 (3): 308-314.

Suggested Citation:
Centers for Disease Control and Prevention. Chronic Kidney Disease Surveillance System—United States.
website. http://www.cdc.gov/ckd