Ultraprocessed Foods and Kidney Disease Progression, Mortality, and Cardiovascular Disease Risk in the CRIC Study

• DOI: 10.1053/j.ajkd.2023.01.452
• Publication Date: 2023-04-06T06:19:50Z
• Authors: Valerie K. Sullivan; Lawrence J. Appel; Cheryl A.M. Anderson; Hyunju Kim; Mark L. Unruh; James P. Lash; Marsha Trego; James Sondheimer; Mirela Dobre; Nishigandha Pradhan; Panduranga S. Rao; Jing Chen; Jiang He; Casey M. Rebholz; Debbie L. Cohen; Harold I. Feldman; Alan S. Go; Robert G. Nelson; Mahboob Rahman; Vallabh O. Shah
• Keywords: 2. Zero hunger; Adult; CRIC Study; NOVA; kidney disease; ultraprocessed foods; 610; Kidney; United States; 3. Good health; Cohort Studies; nutrition; Cardiovascular Diseases; Risk Factors; Disease Progression; Humans; epidemiology; Renal Insufficiency; Prospective Studies; Chronic; Renal Insufficiency, Chronic; dietary intake; Glomerular Filtration Rate

Ultraprocessed foods are widely consumed in the United States and are associated with cardiovascular disease (CVD), mortality, and kidney function decline in the general population. We investigated associations between ultraprocessed food intake and chronic kidney disease (CKD) progression, all-cause mortality, and incident CVD in adults with chronic kidney disease (CKD).Prospective cohort study.Chronic Renal Insufficiency Cohort Study participants who completed baseline dietary questionnaires.Ultraprocessed food intake (in servings per day) classified according to the NOVA system.CKD progression (≥50% decrease in estimated glomerular filtration rate [eGFR] or initiation of kidney replacement therapy), all-cause mortality, and incident CVD (myocardial infarction, congestive heart failure, or stroke).Cox proportional hazards models adjusted for demographic, lifestyle, and health covariates.There were 1,047 CKD progression events observed during a median follow-up of 7 years. Greater ultraprocessed food intake was associated with higher risk of CKD progression (tertile 3 vs tertile 1, HR, 1.22; 95% CI, 1.04-1.42; P=0.01 for trend). The association differed by baseline kidney function, such that greater intake was associated with higher risk among people with CKD stages 1/2 (eGFR≥60mL/min/1.73m2; tertile 3 vs tertile 1, HR, 2.61; 95% CI, 1.32-5.18) but not stages 3a-5 (eGFR<60mL/min/1.73m2; P=0.003 for interaction). There were 1,104 deaths observed during a median follow-up of 14 years. Greater ultraprocessed food intake was associated with higher risk of mortality (tertile 3 vs tertile 1, HR, 1.21; 95% CI, 1.04-1.40; P=0.004 for trend).Self-reported diet.Greater ultraprocessed food intake may be associated with CKD progression in earlier stages of CKD and is associated with higher risk of all-cause mortality in adults with CKD.Ultraprocessed foods are industrial formulations produced using ingredients and processes that are not commonly used in culinary preparations and contain few, if any, intact unprocessed foods. Ultraprocessed foods are widely consumed in the United States, and high intakes of such foods have been linked to cardiovascular disease, kidney disease, and mortality in the general population. In this study, we found that greater intake of ultraprocessed foods was associated with higher risk of kidney disease progression and mortality in adults with chronic kidney disease. Our findings suggest that patients with kidney disease may benefit from greater consumption of fresh, whole, and homemade or hand-prepared foods and fewer highly processed foods.