Abstract
The New Nordic Renal Diet (NNRD) is a meal pattern reduced in phosphorus, protein, and sodium for patients with moderate chronic kidney disease. The NNRD showed improvements in metabolic, and physiological outcomes after 26-weeks intervention. In the original study, participants were randomized to NNRD (n = 30), or control (habitual diet) (n = 30). The aim of this study was to explore adherence to the NNRD 3 months after cessation of intervention (follow-up). Fifty-seven participants completed the follow-up visit, which consisted of fasting blood samples and 24 h urine samples. At follow-up, there was no longer a significant reduction in 24 h urine phosphorus excretion in the NNRD group. From intervention to follow-up, 24 h urine phosphorus increased by 63 mg in the NNRD group, vs. −24.1 mg in the control group, between-group difference 87.1 mg (−10.1, 184.3, p = 0.08). Our findings show that more active intervention is needed to support adherence and maintain beneficial effects of the NNRD.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$259.00 per year
only $21.58 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
Data availability
Data described in the manuscript, code book, and analytic code will be made available upon request.
References
Hansen NM, Rix M, Kamper A, Feldt-Rasmussen B, Christoffersen C, Astrup A, et al. Study protocol: long-term effect of the New Nordic Renal Diet on phosphorus and lipid homeostasis in patients with chronic kidney disease, stages 3 and 4: a randomised controlled trial. BMJ Open. 2021;11:e045754.
Hansen NM, Kamper AL, Rix M, Feldt-Rasmussen B, Leipziger J, Sørensen MV, et al. Health effects of the New Nordic Renal Diet in patients with stage 3 and 4 chronic kidney disease, compared with habitual diet: a randomized trial. Am J Clin Nutr. 2023;118:1042–54.
Hu E, Coresh J, Anderson C, Appel L, Grams M, Crews DC, et al. Adherence to healthy dietary patterns and risk of CKD progression and all-cause mortality: findings from the CRIC (Chronic Renal Insufficiency Cohort) Study. Am J Kidney Dis. 2021;77:235–44.
Middleton KR, Anton SD, Perri MG. Long-term adherence to health behavior change. Am J Lifestyle Med. 2013;7:395–404.
Kaesler N, Baid-Agrawal S, Grams S, Nadal J, Schmid M, Schneider M, et al. Low adherence to CKD-specific dietary recommendations associates with impaired kidney function, dyslipidemia, and inflammation. Eur J Clin Nutr. 2021;75:1389–97.
Beto J, Schury K, Bansal V. Strategies to promote adherence to nutritional advice in patients with chronic kidney disease: a narrative review and commentary. Int J Nephrol Renovasc Dis. 2016;9:21–33.
Fjeldsoe B, Neuhaus M, Winkler E, Eakin E. Systematic review of maintenance of behavior change following physical activity and dietary interventions. Heal Psychol. 2011;30:99.
Kwasnicka D, Dombrowski S, White M. Theoretical explanations for maintenance of behaviour change: a systematic review of behaviour theories. Health Psychol Rev. 2016;10:277–96.
Hofmann W, Friese M, Wiers R. Impulsive versus reflective influences on health behavior: A theoretical framework and empirical review. Health Psychol Rev. 2008;2:111–37.
Funding
This project has received financial funding from Augustinus Foundation (N/A), Gangsted Foundation (N/A), Helen and Ejnar Bjørnow Foundation (N/A), the Capital Region of Denmark’s Research Foundation (N/A) and the Danish Kidney Association (N/A).
Author information
Authors and Affiliations
Contributions
NMH, LS, AA, MR, and ALK designed the study. NMH conducted the research and collected all data, and LS supervised the study including medical safety aspects. PB performed the statistical analyses. NMH, AA, LS, PB, ALK, MR, BFR, and MVS analyzed the data and interpreted the data. NMH and AA wrote the paper. NMH and AA had primary responsibility for the final content. All authors have read and approved the manuscript.
Corresponding author
Ethics declarations
Competing interests
The authors declare no competing interests.
Ethical
This study was conducted in accordance with the standards of the Declaration of Helsinki and was approved by the Scientific Ethical Committee of the Capital Region of Denmark (H-20026376), as well as the Danish Data Protection Agency. All participants handed in their written consent prior to inclusion in the study.
Additional information
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary information
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Hansen, N.M., Kamper, AL., Rix, M. et al. Post-intervention Adherence to the New Nordic Renal Diet among patients with chronic kidney disease, stages 3 and 4. Eur J Clin Nutr (2024). https://doi.org/10.1038/s41430-024-01413-z
Received:
Revised:
Accepted:
Published:
DOI: https://doi.org/10.1038/s41430-024-01413-z