Factors associated with adherence to the dietary protein intervention in the Modification of Diet in Renal Disease Study

J Am Diet Assoc. 1995 Nov;95(11):1295-300. doi: 10.1016/s0002-8223(95)00340-1.


Objective: To determine the characteristics and behaviors associated with adherence to dietary protein interventions among participants with chronic renal disease in the Modification of Diet in Renal Disease (MDRD) Study.

Design: Participants were categorized as consistent adherers or nonadherers on the basis of urinary urea nitrogen excretion and dietary protein intake data from self-reports. Psychosocial and behavioral factors were compared between groups.

Subjects: Subgroups of consistently adherent and non-adherent participants in the MDRD Study.

Setting: 15 clinical centers in the United States.

Intervention: In the nutrition intervention program, participants were assigned randomly to a usual-, low-, or very-low-protein diet group. Each eating pattern also specified a phosphorus goal.

Statistical analysis: Analysis of variance.

Result: Psychosocial factors significantly related to adherence included participant knowledge, attitude, support, satisfaction, and self-perception of success. Behavioral strategies including participant self-monitoring of protein intake and the provision of feedback by the dietitian were also significantly related to adherence.

Application: Nutrition interventions for patients with renal disease should focus on psychosocial factors and behavioral approaches. Such approaches can be successfully incorporated into treatment programs and will assist the dietitian in promoting adherence to usual-, low-, and very-low-protein eating patterns.

Publication types

  • Clinical Trial
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, U.S. Gov't, Non-P.H.S.
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Analysis of Variance
  • Data Collection
  • Diet, Protein-Restricted / standards*
  • Dietary Proteins / standards*
  • Feeding Behavior*
  • Health Knowledge, Attitudes, Practice
  • Humans
  • Kidney Diseases / diet therapy*
  • Kidney Diseases / psychology
  • Kidney Diseases / urine
  • Nitrogen / urine
  • Patient Compliance*
  • Patient Satisfaction
  • Phosphorus, Dietary / standards
  • Self Concept
  • Urea / urine


  • Dietary Proteins
  • Phosphorus, Dietary
  • Urea
  • Nitrogen