*Purpose: Appropriate nutrition and physical activity are critical for optimal post-transplant recovery and long term outcomes, especially in pediatric populations. Both malnutrition and obesity are detrimental for transplant recipients and are influenced by several factors including socioeconomic status and access to healthy food. The purpose of our study was to assess the nutritional status of pediatric kidney transplant recipients, in the context of household income and food access, since there is scant data in the literature about this.

*Methods: Data was collected from 79 patients (25 females; 38 White, 26 Black), who were ≥1 year post-transplant with stable, functioning allograft. Nutrition and physical activity were assessed using the validated Family Nutrition and Physical Activity Screening (FNPA) tool. Patients’ Body Mass Index (BMI), and Percentage Body Fat (PBF) were measured using Bioelectrical Impedance Analysis (BIA). Family economic status and zip codes were self-reported. Food access was assessed using United States Department of Agriculture (USDA) Food Access Research Atlas. Limited access was defined as the lack of a supermarket within 0.5 mile (urban) and 10 miles (rural), per USDA Economic Research Service food atlas 2020. Wilcoxon rank-sum tests and Chi-square tests were used for comparisons of continuous and categorical data, respectively.

*Results: Patients were 8-20 years old (median age: 15), with BMI showing 5%, underweight, 55% normal, 12% overweight and 27% obese. Reported household income (71 patients) showed 49% (n=35) below an annual income of <$50,000, designated as low income. BMI (p=0.004) and PBF (p=0.02) were higher in patients with low income, compared with high income. Patients in low income group had higher obesity (45% vs. 14%, p=0.028). Overall, 52% (n=41) lived in low food access areas which included 54% with a reported low household income. Of patients who lived in low food access areas 51% (n=19) had elevated BMI.

*Conclusions: Higher BMI, has traditionally been associated with comorbidities and sub-optimal post-transplant outcomes. Patients of lower economic status have less access, especially to healthy or fresh foods and are more at risk for higher BMI. The nuances of household income and food access should be taken into consideration when providing nutritional recommendations and education should be tailored for resources available to our pediatric kidney transplant patients and their families. It is critical to partner with community organizations and work for systemic change to mitigate these challenges.

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