Factors Associated with Adherence to the Dietary Protein Intervention in the Modification of Diet in Renal Disease Study

doi:10.1016/S0002-8223(95)00340-1

Journal of the American Dietetic Association

Volume 95, Issue 11, November 1995, Pages 1295-1300

https://doi.org/10.1016/S0002-8223(95)00340-1 Get rights and content

Abstract

Objective To determine the characteristics and behaviors associated with adherence to dietary protein interventions among participants with chronic renal disease in the Modification of Diet in Renal Disease (MDRD) Study.

Design Participants were categorized as consistent adherers or nonadherers on the basis of urinary urea nitrogen excretion and dietary protein intake data from self-reports. Psychosocial and behavioral factors were compared between groups.

Subjects Subgroups of consistently adherent and non-adherent participants in the MDRD Study.

Setting 15 clinical centers in the United States.

Intervention In the nutrition intervention program, participants were assigned randomly to a usual-, low-, or very-low-protein diet group. Each eating pattern also specified a phosphorus goal.

Statistical analysis Analysis of variance.

Result Psychosocial factors significantly related to adherence included participant knowledge, attitude, support, satisfaction, and self-perception of success. Behavioral strategies including participant self-monitoring of protein intake and the provision of feedback by the dietitian were also significantly related to adherence.

Application Nutrition interventions for patients with renal disease should focus on psychosocial factors and behavioral approaches. Such approaches can be successfully incorporated into treatment programs and will assist the dietitian in promoting adherence to usual-, low-, and very-low-protein eating patterns. J Am Diet Assoc. 1995; 95:1295-1300.

Section snippets

Methods

The MDRD Study was a multicenter, randomized clinical trial designed to test the effect of three levels of protein and phosphorus intake and two levels of blood pressure control on the progression of chronic renal disease. Participants were 840 adults with renal diseases of diverse etiology who were not on dialysis and had not had a kidney transplant.

Participants were assigned to one of two studies on the basis of baseline glomerular filtration rate (GFR), a measure of renal function. In Study

Results

Table 2, Table 3, Table 4, Table 5 compare selected characteristics and factors of adherers and nonadherers in each diet group. These tables include only those variables that were significantly different between adherers and nonadherers in two or more diet groups, or variables that may have clinical implications, such as GFR and mean arterial pressure. Nonsignificant findings of interest will be discussed but not, reported in the tables.

Table 2 reports the EPI and dietary protein intake for the

Discussion

To our knowledge, the data presented in this article are unique. Unlike previous studies that have examined the effects of a low-protein diet in similar populations (16), we reported the factors related to dietary adherence. We also defined adherence in an unusually stringent fashion, that is, as being in range for both dietary protein intake and urinary urea nitrogen excretion for at least four of six adherence visits over a 2-year period. These stringent criteria allowed us to examine the

Applications

The MDRD Study nutrition intervention program was well received by participants, and the program has many components that could be adapted to clinical practice. Self-management strategies were used with great success, which provides an impetus to incorporate these strategies in practice.

Recording foods and their protein content enabled participants to monitor their own success and promoted self-efficacy. Self-monitoring can be easily incorporated into clinical settings. Nutrient counters are

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Factors Associated with Adherence to the Dietary Protein Intervention in the Modification of Diet in Renal Disease Study

Abstract

Section snippets

Methods

Results

Discussion

Applications

J Am Diet Assoc.

Psychosomalics.

J Am Diet Assoc.

J Am Diet Assoc.

J Am Diet Assoc.

Kidney Int.

J Renal Nutr.

Behav Ther.