Food Security Status Mediates the Relationship between Dietary Inflammation Index and Estimated Glomerular Filtration Rate: An Analysis of 2011-2018 NHANES

Abstract

While evidence links proinflammatory dietary patterns to impaired kidney function, the influence that food security is a mediator and/or moderator to this relationship remains unexplored. We hypothesized food security status (FSS) would be a mediator/moderator to the relationship between a proinflammatory diet and reduced kidney function. Participants (n = 13,557) from the 2011-2018 National Health and Nutrition Examination Survey (NHANES) were included. FSS was measured using the 10-item validated US Food Security Survey Module. Dietary Inflammatory Index (DII) scores were calculated from two 24-hour dietary recalls with higher scores indicating a proinflammatory diet. Kidney function was determined through estimated glomerular filtration rate (eGFR). Mediator and moderator analyses and general linear models were performed using SPSS v29, with statistical significance set at P < .05. FSS was a partial mediator of the relationship between DII scores and eGFR (P < .05), but was not a moderator. A one-unit increase in DII scores was associated with a 0.45-unit decrease in eGFR. DII component intakes were significantly higher in individuals with eGFR >= 60 and food secure compared to individuals with eGFR <60 and food insecure (P < .05). FSS mediates the relationship between diet and kidney function, highlighting the complex interplay between nutrition and socioeconomic factors. These findings emphasize the need for targeted interventions that address food insecurity and dietary habits to support kidney health. (c) 2026 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.