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American Journal of Kidney Diseases

Association Between Ultraprocessed Food Consumption and Risk of Incident CKD: A Prospective Cohort Study

  • Shutong Du
    Affiliations
    Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Baltimore, Maryland

    Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University Baltimore, Maryland
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  • Hyunju Kim
    Affiliations
    Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Baltimore, Maryland

    Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University Baltimore, Maryland
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  • Deidra C. Crews
    Affiliations
    Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Baltimore, Maryland

    Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University Baltimore, Maryland
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  • Karen White
    Affiliations
    Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Baltimore, Maryland

    Division of General Internal Medicine (KW), School of Medicine, Johns Hopkins University Baltimore, Maryland
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  • Casey M. Rebholz
    Correspondence
    Address for Correspondence: Casey M. Rebholz, PhD, MS, MNSP, MPH, Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, 2024 E Monument St, Suite 2-500, Baltimore, MD 21287.
    Affiliations
    Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Baltimore, Maryland

    Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University Baltimore, Maryland

    Division of Nephrology and Division of General Internal Medicine, School of Medicine, Johns Hopkins University Baltimore, Maryland
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      Rationale & Objective

      Ultraprocessed foods have become readily available in the global food supply in the past few decades. Several adverse health outcomes have been linked with higher consumption of ultraprocessed foods. However, the impact of ultraprocessed foods on chronic kidney disease (CKD) risk remains unknown.

      Study Design

      Prospective cohort study.

      Setting & Participants

      14,679 middle-aged adults without CKD at baseline in the Atherosclerosis Risk in Communities (ARIC) study.

      Exposure

      Ultraprocessed foods consumption (servings per day) calculated using dietary data collected via a food frequency questionnaire at visit 1 and visit 3.

      Outcome

      Incident CKD defined as estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2 accompanied by ≥25% eGFR decline, CKD-related hospitalization or death, or kidney failure with kidney replacement therapy.

      Analytical Approach

      Multivariable-adjusted Cox proportional hazards models were used to assess the association between ultraprocessed foods consumption and CKD. Restricted cubic splines were used to examine the shape of the association.

      Results

      During a median follow-up period of 24 years, there were 4,859 cases of incident CKD. The incidence rate for the highest quartile of ultraprocessed foods consumption was 16.5 (95% CI, 15.6-17.4) per 1,000 person-years and 14.7 (95% CI, 13.9-15.5) per 1,000 person-years for the lowest quartile of consumption. After adjusting for a range of confounders including lifestyle factors, demographic characteristics, and health behaviors, participants in the highest quartile of ultraprocessed foods consumption had a 24% higher risk (HR, 1.24 [95% CI, 1.15-1.35]) of developing CKD compared with those in the lowest quartile. There was an approximately linear relationship observed between ultraprocessed food intake and risk of CKD. By substituting 1 serving of ultraprocessed foods with minimally processed foods, there was a 6% lower risk of CKD observed (HR, 0.94 [95% CI, 0.93-0.96]; P < 0.001).

      Limitations

      Self-reported data and residual confounding.

      Conclusions

      Higher ultraprocessed foods consumption was independently associated with a higher risk of incident CKD in a general population.

      Graphical abstract

      Index Words

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      Linked Article

      • Nutrition and Kidney Health: Processing Emerging Evidence About Foods
        American Journal of Kidney DiseasesVol. 80Issue 5
        • Preview
          When caring for patients with chronic kidney disease (CKD), nutrition is a key consideration for the overall management of high blood pressure, blood glucose, fluid retention, and cardiovascular disease risk.1 Adherence to nutrition recommendations is challenging for individuals with CKD because the guidance is complex and there is a marked difference between what is recommended and what is typically consumed. Notably, the typical diet in the United States is characterized by ultraprocessed, calorically dense foods, and it is higher than recommended in saturated fat, sodium, and added sugar, and lower than recommended in vegetables, fruits, and whole grains.
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