{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T15:54:35Z","timestamp":1791561275774,"version":"4.3.4"},"reference-count":51,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"11","funder":[{"DOI":"10.13039\/100000738","name":"US Department of Veterans Affairs","doi-asserted-by":"crossref","award":["1K1CX002847"],"award-info":[{"award-number":["1K1CX002847"]}],"id":[{"id":"10.13039\/100000738","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000738","name":"US Department of Veterans Affairs","doi-asserted-by":"crossref","award":["CIN 13-402"],"award-info":[{"award-number":["CIN 13-402"]}],"id":[{"id":"10.13039\/100000738","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000738","name":"US Department of Veterans Affairs","doi-asserted-by":"crossref","award":["IIR 20-222"],"award-info":[{"award-number":["IIR 20-222"]}],"id":[{"id":"10.13039\/100000738","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000738","name":"US Department of Veterans Affairs","doi-asserted-by":"crossref","award":["QUERI 20-013"],"award-info":[{"award-number":["QUERI 20-013"]}],"id":[{"id":"10.13039\/100000738","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["CJASN"],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:sec>\n                    <jats:title>Key Points<\/jats:title>\n                    <jats:p>\n                      <jats:list list-type=\"bullet\">\n                        <jats:list-item>\n                          <jats:p>Veterans' dietary choices may be influenced by key health events, urgency, consequences, and timely, impactful nutrition support.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>Rigid, conflicting dietary rules and military habits create barriers to diet adherence, warranting flexible, healthy diet principles.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>Tailored, transparent, and trusted nutrition education, counseling, and care improve adherence and patient engagement and experience.<\/jats:p>\n                        <\/jats:list-item>\n                      <\/jats:list>\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>CKD affects susceptible populations at higher rates than the general public. Dietary adherence, quality, and behaviors play a crucial role in CKD and chronic disease management. However, individuals with CKD, including Veterans and those with mission-driven occupations and cultures, face unique challenges navigating dietary recommendations and kidney-health promoting diets. Understanding factors such as military or occupational experiences, comorbidities, and dietary barriers may lead to developing effective, patient-centered dietary interventions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a qualitative descriptive study and semistructured interviews with 32 veterans with CKD (stages 3b\u20135; including dialysis), with a mean age of 71 years, 54% were White, and 16% were women, receiving care at the Veterans Affairs Eastern Colorado Health Care System, from June 2023 to July of 2024. Interview constructs included healthy eating, CKD management, food preferences, and decision making. We conducted thematic analyses using an inductive approach to understand participants' perspectives and experiences.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Three overarching domains emerged: (\n                      <jats:italic toggle=\"yes\">1<\/jats:italic>\n                      ) moments that matter, shaping dietary behaviors by themes such as health crises, diagnoses, and the perceived mortal consequences of food choices; (\n                      <jats:italic toggle=\"yes\">2<\/jats:italic>\n                      ) chronic disease perceptions, management, and adaptation, capturing the burden of rigid dietary restrictions, conflicting recommendations, and dichotomies between strict rules versus flexible healthy diet principles; and (\n                      <jats:italic toggle=\"yes\">3<\/jats:italic>\n                      ) contextual factors that influence health, nutrition, and adaptation, highlighting the effect of social support, military culture, and environmental influences on food behaviors.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Veterans' experiences with CKD nutrition and management are shaped by pivotal health events, rigid dietary frameworks, military-influenced eating habits, and other social-emotional contextual factors. Nutrition and health care approaches should focus on personalized, flexible approaches and leveraging existing veterans affairs\u2013based principles that emphasize patient-centered care and experience. These include supporting individuals by acknowledging urgency in dietary decision making, capitalizing on key moments for intervention, and increasing awareness of nutrition's role in health without reinforcing restrictive, unsustainable dietary patterns.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2215\/cjn.0000000800","type":"journal-article","created":{"date-parts":[[2025,8,8]],"date-time":"2025-08-08T16:00:44Z","timestamp":1754668844000},"page":"1503-1515","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":2,"title":["A Qualitative Study to Investigate the Nutrition Perspectives and Experiences of Veterans with CKD"],"prefix":"10.2215","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6431-2095","authenticated-orcid":false,"given":"Luis M.","family":"Perez","sequence":"first","affiliation":[{"name":"Rocky Mountain Regional Veterans Affairs Medical Center, Eastern Colorado Health Care System, Aurora, Colorado"},{"name":"Denver-Seattle Center of Innovation for Veteran-Centered and Value Driven Care, Aurora, Colorado"},{"name":"Division of General Internal Medicine, Department of Medicine, School of Medicine, University of Colorado, Aurora, Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6774-6569","authenticated-orcid":false,"given":"Lexus","family":"Ujano-De Motta","sequence":"additional","affiliation":[{"name":"Rocky Mountain Regional Veterans Affairs Medical Center, Eastern Colorado Health Care System, Aurora, Colorado"},{"name":"Denver-Seattle Center of Innovation for Veteran-Centered and Value Driven Care, Aurora, Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9989-2085","authenticated-orcid":false,"given":"Rachel","family":"Johnson-Koenke","sequence":"additional","affiliation":[{"name":"Denver-Seattle Center of Innovation for Veteran-Centered and Value Driven Care, Aurora, Colorado"},{"name":"College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alkesh","family":"Jani","sequence":"additional","affiliation":[{"name":"Rocky Mountain Regional Veterans Affairs Medical Center, Eastern Colorado Health Care System, Aurora, Colorado"},{"name":"Division of Renal Diseases and Hypertension, Department of Medicine, School of Medicine, University of Colorado, Aurora, Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5717-4218","authenticated-orcid":false,"given":"T. Alp","family":"Ikizler","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension, Vanderbilt University, Nashville, Tennessee"},{"name":"Nashville Veterans Affairs Medical Center, Veterans Affairs Tennessee Valley Health Care System, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0643-4873","authenticated-orcid":false,"given":"Sridharan","family":"Raghavan","sequence":"additional","affiliation":[{"name":"Rocky Mountain Regional Veterans Affairs Medical Center, Eastern Colorado Health Care System, Aurora, Colorado"},{"name":"Denver-Seattle Center of Innovation for Veteran-Centered and Value Driven Care, Aurora, Colorado"},{"name":"Division of General Internal Medicine, Department of Medicine, School of Medicine, University of Colorado, Aurora, Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chelsea","family":"Leonard","sequence":"additional","affiliation":[{"name":"Rocky Mountain Regional Veterans Affairs Medical Center, Eastern Colorado Health Care System, Aurora, Colorado"},{"name":"Denver-Seattle Center of Innovation for Veteran-Centered and Value Driven Care, Aurora, Colorado"},{"name":"Division of Health Care Policy and Research, Department of Medicine, School of Medicine, University of Colorado, Aurora, Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4829-9801","authenticated-orcid":false,"given":"Christine D.","family":"Jones","sequence":"additional","affiliation":[{"name":"Rocky Mountain Regional Veterans Affairs Medical Center, Eastern Colorado Health Care System, Aurora, Colorado"},{"name":"Denver-Seattle Center of Innovation for Veteran-Centered and Value Driven Care, Aurora, Colorado"},{"name":"Division of Hospital Medicine, Department of Medicine, School of Medicine, University of Colorado, Aurora, Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,8,8]]},"reference":[{"issue":"9","key":"B2-20251110","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1177\/2165079919843308","article-title":"Chronic kidney disease among workers: a review of the literature","volume":"67","author":"Chicas","year":"2019","journal-title":"Workplace Health Saf."},{"issue":"3","key":"B3-20251110","doi-asserted-by":"crossref","first-page":"1","DOI":"10.16966\/2380-5498.111","article-title":"Agrochemicals and chronic kidney disease of multi-factorial origin: environmentally induced occupational exposure an occupational exposure disease","volume":"1","author":"Sunil J","year":"2015","journal-title":"Int J Nephrol Kidney Fail."},{"issue":"1","key":"B4-20251110","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1016\/S0377-1237(11)80004-3","article-title":"Prevalence of early stages of chronic kidney disease in healthy army personnel","volume":"67","author":"Varma","year":"2011","journal-title":"Med J Armed Forces India."},{"issue":"3","key":"B5-20251110","doi-asserted-by":"crossref","first-page":"846","DOI":"10.1681\/ASN.2005090986","article-title":"Mortality risk stratification in chronic kidney disease: one size for all ages?","volume":"17","author":"O\u2019Hare","year":"2006","journal-title":"J Am Soc Nephrol."},{"issue":"3","key":"B6-20251110","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1053\/j.ajkd.2020.07.013","article-title":"Burden and cost of caring for US veterans with CKD: initial findings from the VA renal information system (VA-REINS)","volume":"77","author":"Saran","year":"2021","journal-title":"Am J Kidney Dis."},{"issue":"1","key":"B8-20251110","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1056\/NEJM200101043440101","article-title":"Effects on blood pressure of reduced dietary sodium and the dietary approaches to stop hypertension (DASH) diet. 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