*Purpose: Poor long-term outcomes in kidney transplantation may relate to coincident diseases, including diabetes and cardiovascular illnesses. Poor nutrition habits may cause progression of complications related to these diseases, as well as impact kidney function long-term. We investigated dietary quality and nutrition literacy in a population of stable outpatient kidney transplant recipients, in an indigent, inner-City population.

*Methods: A face-to-face survey was conducted in a random convenience sample of patients from an inner-city transplant clinic. Dietary intake was assessed by 24-hour food recall, with nutrient intake analyzed using ASA24 software. Nutrient intakes were used to calculate standardized DASH (Dietary Approaches to Stop Hypertension) and Healthy Eating Index (HEI) scores. Nutritional literacy was assessed via the Newest Vital Signs toolkit consisting of 6 questions relating to a standardized food label.

*Results: 31 patients were interviewed. There were 19 (61%) men and 12 (39%) women. Racial breakdown was 26 black, 1 white, 2 Hispanic and 2 other. Mean age was 56+2.4 (range 18-56). 17 patients were born in other countries (mean time in the US 32.6+2.7 yrs), mean time since transplant 6.7+1.4 yrs. Creatinine 2.32+0.4 mg/dl, BMI was 27.5+1.04. The mean HEI score was 55.5+1.98%, with a range from 36.7 – 76.5%. Less than 80% is scored as poor or needs improvement, and < 51% is poor. The DASH score mean was 3.69 + 0.19 on a scale of 1-10. Under 5 is considered poorly adherent. Only 8 (26%) patients had a nutritional literacy score indicating adequate nutritional literacy (5 or 6 out of 6 points), and 19 (61%) patients met the criteria for nutritionally illiterate (4 or less out of 6 points). 28 (90%) patients had reported receiving nutritional information from either a doctor or a dietician, although only 25% had seen a dietician in the past year and 35% got information from a friend or the Internet. 20 (69%) agreed with the statement “I maintain a high, quality, nutritious diet” although 23 (80%) believed that their diet could be improved.

*Conclusions: Social determinants of health, including ability to read and interpret a food label, have been increasingly recognized as important factors in health but have not been systematically studied in KTRs. Although the majority of our patients reported having received dietary counseling and believed their diet to be healthy, many reported getting nutrition information from a friend or the Internet and we found that our population as whole had poor dietary habits as measured by either the HEI or DASH indices. This may have resulted from poor nutritional literacy and inability to understand food labels and how to actually change their diet, as the majority recognized that they could improve in some way. Further study is warranted to identify efficacious modalities for facilitating healthy eating among inner-city KTRs.

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