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

Ten-year trajectories of ultra-processed food intake and prospective associations with cardiovascular diseases and all-cause mortality: findings from the Whitehall II cohort study

BACKGROUND

Ultra-processed food (UPF) intake has been associated with adverse health outcomes; however, research on UPF intake and cardiovascular disease (CVD) prognosis has largely neglected its longitudinal pattern over time. This study investigated trajectories of UPF intake over a decade and their prospective associations with the risk of fatal and non-fatal CVD, as well as all-cause mortality, using data spanning from 16 to 19 years.

METHODS

This study utilized data from the British Whitehall II cohort study, including 7,138 participants (68.3% male; median baseline age 60.4 years), all free of CVD at baseline. Dietary intake was assessed using a validated 127-item food frequency questionnaire at three time points: phase 3 (1991-1994), phase 5 (1997-1999), and phase 7 (2002-2004). UPF intake was estimated using the Nova classification, and group-based trajectory modelling identified different longitudinal consumption patterns. Phase 7 (2002-2004) was the baseline for subsequent monitoring of cardiovascular events and mortality outcomes until 2019/2021. Multivariate Cox proportional hazards models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs), adjusting for socio-demographics, lifestyle, diet quality, energy intake, and clinical factors.

RESULTS

Three distinct UPF trajectory groups were identified: high (26.2% of participants), moderate (52.9%) and low UPF intake (20.9%). All groups showed a slight increase in UPF intake over time. Over the median follow-up of 16 years for incident cases and 19 years for mortality, we observed 1,128 incident CVD events, 859 CHD cases and 1,314 deaths. The highest vs. lowest UPF intake group had a 23% higher risk of CVD (HR 1.23, 95% CI 1.01 to 1.40), and a 32% higher risk of CHD (HR 1.32, 95% CI 1.06 to 1.65). No significant associations were observed between UPF trajectory groups and CVD mortality, CHD mortality, or all-cause mortality.

CONCLUSIONS

Sustained high UPF intake over 10 years was associated with increased risks of non-fatal CVD and CHD but not with CVD-specific, CHD-specific, or all-cause mortality. These findings suggest that sustained high intake of UPF may be a modifiable risk factor for preventing non-fatal cardiovascular risks.

Ultra-Processed Food and Chronic Kidney Disease Risk: A Systematic Review, Meta-Analysis, and Recommendations

Background: Ultra-processed foods (UPFs) are formulations of ingredients that are mostly of exclusive industrial use and may contain additives like artificial colors, flavors, or stabilizers. The sale and consumption of these foods have been increasing despite their associations with increased risk for several non-communicable diseases, including chronic kidney disease (CKD). Compared to less processed and perishable foods, UPFs have longer shelf stability, are widely accessible, and are convenient. They also tend to be more affordable and lower in nutritional quality. The aim of this systematic review and meta-analysis (PROSPERO ID: CRD42023488201) was to investigate whether consumption of UPF is associated with a higher risk of CKD in adults. Methods: We completed a systematic search using Medline, EMBASE, CINAHL, and Cochrane Central databases to identify observational studies published since the wide acceptance of UPF classification and conducted a random-effects model to pool the risk estimates. Results: A total of seven studies met the inclusion criteria for the systematic review, of which four were eligible for meta-analysis. Across these studies, there were 19,645 incident CKD cases from individuals free of baseline CKD. Using a random-effects model, higher UPF intake was significantly associated with increased CKD risk (pooled log-hazard ratio = 0.17; 95% CI: 0.07-0.28; p < 0.001). Conclusions: Given the substantial evidence from this systematic review and meta-analysis indicating an association between UPF and CKD, it is recommended for public health policies to address this risk. Promoting dietary guidelines that encourage the consumption of minimally processed foods could potentially mitigate the prevalence of CKD and improve overall public health outcomes.

Trimethylamine N-Oxide Plasma Levels Following Red Meat and Cod Fish Intake: A Pilot Crossover Trial in Hemodialysis Patients

SCOPE

The uremic toxin trimethylamine N-oxide (TMAO) accumulates in patients with chronic kidney disease (CKD) and is associated with its progression, cardiovascular disease, and other complications. The gut microbiota produces TMAO from substrates mainly found in red meat, eggs, and dairy. However, some saltwater fish also contain high levels of TMAO. Although fish consumption is generally linked to beneficial effects, its effects on CKD patients require further research.

METHODS AND RESULTS

This study compares the effect of red meat and cod fish intake on TMAO plasma levels in CKD patients undergoing hemodialysis (HD). Participants received a single animal protein source (red meat vs. cod fish) for lunch and dinner for four consecutive days (each intervention), with a 2-week washout period in between. TMAO plasma levels were analyzed using LC-MS/MS. All 14 patients concluded the red meat intervention, while one refused to participate in the fish intervention. No significant difference in TMAO plasma levels was found post-red meat (p = 0.21) or fish intervention (p = 0.91), as well as between groups (p = 0.43).

CONCLUSION

In this study, 4 days of red meat and cod fish intake did not significantly impact TMAO levels in HD patients, while other factors may be associated with their circulating levels.

Ultra-processed foods and cardio-kidney-metabolic syndrome: A review of recent evidence

The rapid increase in the consumption of ultra-processed foods (UPFs) has become a significant global public health concern. UPFs are typically high in unhealthy fats, refined sugars, sodium, and other additives while being low in proteins, fibers, and other essential nutrients. Their high glycemic index and glycemic load lead to blood sugar spikes, contributing to metabolic dysregulation. Emerging evidence links UPF intake to the development of the cardiovascular-kidney-metabolic (CKM) syndrome and a higher risk of adverse health outcomes, such as all-cause and cardiovascular mortality. The pathophysiological mechanisms likely involve chronic inflammation, oxidative stress, dysregulated lipid metabolism, insulin resistance, immune dysfunction, and gut microbiota disruption. The adverse effects are even more concerning in vulnerable populations, including individuals with chronic kidney disease, kidney failure, and the elderly. This review article explores how UPF intake contributes to chronic diseases across the CKM spectrum, including cardiovascular disease, kidney disease, obesity, and type 2 diabetes mellitus, while also exacerbating frailty and reducing quality of life. The focus goes beyond risks of individual metabolic complications to address the broader health implications of UPFs on the increased prevalence of multiple coexistent non-communicable diseases, frailty, reduced quality of life, meta-inflammation, metabolic memory, and syndemics, which are particularly critical for the aging geriatric population.

Ultra-processed foods and risk of declined renal function: a dose-response meta-analysis of 786,216 participants

OBJECTIVES

Earlier investigations have documented an association between elevated consumption of Ultra-Processed Foods (UPFs) and adverse renal outcomes. To explore this relationship further, we executed a comprehensive dose-response meta-analysis to examine the link between UPFs intake and the risk of declined renal function.

SETTING

A systematic search was completed utilizing the ISI Web of Science, Scopus, Embase as well as PubMed/MEDLINE databases (without any restrictions), up until September 5, 2024. Effect sizes of declined renal function were recalculated by applying a random effects model. The GRADE tool was adopted to assess the certainty of the evidence, while study quality and potential publication bias were examined via validated methods such as the Newcastle-Ottawa Scale, Egger's regression asymmetry and Begg's rank correlation test.

RESULTS

Thirty-three studies (comprising 786,216 participants) were incorporated in the quantitative analysis. The results demonstrated that a greater UPFs intake was significantly associated with an enhanced risk of declined renal function (RR = 1.16; 95% CI: 1.09, 1.23; I2 = 68.8%; p < 0.001; n = 37). Additionally, we observed that each 1-serving-per-day increase in UPFs consumption was associated to a 5% greater risk of reduced renal function (RR = 1.05; 95% CI: 1.02, 1.09; I2 = 80.9%; p = 0.013; n = 9). A positive, linear association between UPF intake and the risk of declined renal function (Pnonlinearity = 0.107, Pdose-response < 0.001) was further displayed in the non-linear dose-response analysis.

CONCLUSION

Greater exposure to UPFs is positively associated with the risk of declined renal function. The information emphasizes the importance of considering UPFs in the prevention and management of adverse renal outcomes.

2025 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association

BACKGROUND

The American Heart Association (AHA), in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, nutrition, sleep, and obesity) and health factors (cholesterol, blood pressure, glucose control, and metabolic syndrome) that contribute to cardiovascular health. The AHA Heart Disease and Stroke Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, brain health, complications of pregnancy, kidney disease, congenital heart disease, rhythm disorders, sudden cardiac arrest, subclinical atherosclerosis, coronary heart disease, cardiomyopathy, heart failure, valvular disease, venous thromboembolism, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs).

METHODS

The AHA, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States and globally to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2025 AHA Statistical Update is the product of a full year's worth of effort in 2024 by dedicated volunteer clinicians and scientists, committed government professionals, and AHA staff members. This year's edition includes a continued focus on health equity across several key domains and enhanced global data that reflect improved methods and incorporation of ≈3000 new data sources since last year's Statistical Update.

RESULTS

Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics.

CONCLUSIONS

The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.

Barriers and Facilitators to Adherence to a Healthy Diet Across the Spectrum of Chronic Kidney Disease

Purpose

A healthy diet plays an important role for chronic kidney disease (CKD) treatment, but adherence to nutritional recommendations is frequently low. The aim of the present study was to describe barriers and facilitators to adherence to a healthy diet in people with CKD.

Patients and Methods

Cross-sectional study; 80 predialysis (n=20), hemodialysis (n=20), peritoneal dialysis (n=20) and transplant (n=20) patients matched by age and sex, were included. Nutritional evaluation included subjective global assessment, anthropometry, quality of food consumption (Mini-ECCA v.2), self-perception about diet and willingness to change. Barriers and facilitators were evaluated with a qualitative approach (semi-structured interviews). Concepts were converted into "in vivo" and "theoretical" codes, then, grouped into categories. A second analysis was performed with the ATLAS.ti software.

Results

Frequency of malnutrition was 50% in people receiving dialysis. Quality of food consumption was healthier on people with CKD stages 3b-5 (40%) and people with kidney transplant (65%) compared to peritoneal dialysis (25%) and hemodialysis (0%). The main themes influencing adherence to a healthy diet were: need for nutritional guidance, economy, dietary restrictions, willingness to change, relationship with consequences in disease control and health status, aversion for healthy foods, bad and good self-perception, family support, feelings and emotions, environment, eating habits and CKD itself. Lack of time, work, economy, food preferences and cravings were the main barriers in people with CKD stage 3b-5 and transplant, while low willingness to eat healthy foods and dietary restrictions were the main barriers in people receiving dialysis.

Conclusion

Personal, environmental, health professional-related, CKD related as well as feelings and emotions aspects that people with CKD face in a daily basis, act as barriers or facilitators when trying to follow a healthy diet. Individualizing nutritional treatment taking into account people with CKD perspectives and situations is of utmost importance to improve adherence to nutritional treatment.

Decoding diets: insights on ultra-processed food consumption among Lebanese adults from the updated LEBANese natiONal food consumption survey (LEBANON-FCS)

Introduction

Ultra-processed foods are evident to play a role in the development of nutrition-related non-communicable diseases (NR-NCDs). There's a scarcity of data in the Eastern Mediterranean Region (EMR) regarding ultra-processed food consumption, which highlights the need for such data in this region that is witnessing a nutrition transition. This study was conducted to assess the dietary pattern of Lebanese adults according to different degrees of food processing.

Methods

A cross-sectional study involving a nationally representative sample (n = 444) of Lebanese adults (18-64 years) was conducted over the course of 5 months. A validated food frequency questionnaire and two non-consecutive 24-h recalls were used to collect the dietary intake. Sociodemographic and medical characteristics were collected using a validated questionnaire. Anthropometric measurements were taken by trained dietitians. Food items were classified according to the NOVA food classification system, and the percent contribution of every type of processing to the energy intake was calculated.

Results

Ultra-processed foods contributed to the highest percent of energy intake in the sample (46.7%), followed by unprocessed and minimally processed foods (39.6%). Being male, and younger increased the odds of higher ultra-processed food intake; being employed and food secure increased the odds of a higher NOVA-UPF score. Compared with participants in Beirut, participants residing in North Lebanon and Akkar had higher odds of having a high UPF intake and lower odds of having a high NOVA-UPF score. The three most contributing food items to energy intake were ultra-processed (breads and breakfast cereals, fast foods, sweets and desserts). Compared to the unprocessed and minimally processed food diet fraction, the ultra-processed food diet fraction was significantly higher in sodium and thiamin and lower in proteins, fiber, and essential vitamins and minerals such as vitamins A, D, B12, folate, iron, calcium, and magnesium.

Conclusion

UPF intake was the main contributor to TEI, and the intake was considerably higher among those who reported having renal disease, younger adults, and males. In comparison to the minimally processed diet fraction, the UPF diet fraction was found to have considerably greater levels of sodium and thiamin and lower levels of proteins, fiber, and essential vitamins and minerals. The study findings call for public health policies and interventions to encourage the consumption of minimally processed foods and decrease the consumption of ultra-processed foods, especially sweets and sweetened beverages, which are especially problematic.

Ultra-processed foods and cardiovascular disease: analysis of three large US prospective cohorts and a systematic review and meta-analysis of prospective cohort studies

Background

Prospective associations between total and groups of ultra-processed foods (UPF) and cardiovascular disease (CVD) remained to be characterised. Our aim was to assess the association of total and group-specific UPF intakes with CVD, coronary heart disease (CHD), and stroke in three large prospective cohorts of US adults. Additionally, we conducted a systematic review and meta-analyses on the existing evidence on the associations of total UPF intake with these outcomes.

Methods

UPF intake was assessed through food frequency questionnaires in the Nurses' Health Study (NHS; n = 75,735), Nurses' Health Study II (NHSII; n = 90,813), and Health Professionals Follow-Up Study (HPFS; n = 40,409). Cox regression estimated cohort-specific associations of total and group-specific UPF intake with risk of CVD (cases = 16,800), CHD (cases = 10,401), and stroke (cases = 6758), subsequently pooled through fixed-effect models. Random-effects meta-analyses pooled existing prospective findings on the UPF-CVD association identified on Medline and Embase up to April 5, 2024, without language restrictions. Risk of bias was assessed with the Newcastle-Ottawa Scale, funnel plots, and Egger's tests, and meta-evidence was evaluated using NutriGrade.

Findings

The baseline mean (SD) age was 50.8 years (7.2) for the NHS, 36.7 years (4.6) for the NHSII, and 53.4 years (9.6) for the HPFS. The proportion of participants of White race was 97.7% in the NHS, 96.4% in the NHSII, and 94.9% in the HPFS. Among the three cohorts, multivariable-adjusted hazard ratios [HRs (95% CIs)] for CVD, CHD, and stroke for the highest (vs. lowest) total UPF intake quintile were 1.11 (1.06-1.16), 1.16 (1.09-1.24), and 1.04 (0.96-1.12), respectively. UPF groups demonstrated divergent associations. Sugar-/artificially-sweetened drinks and processed meats were associated with higher CVD risk, whereas inverse associations were observed for bread/cold cereals, yoghurt/dairy desserts, and savoury snacks. Meta-analysing 22 prospective studies showed that total UPF intake at the highest category (vs. lowest) was associated with 17% (11%-24%), 23% (12%-34%), and 9% (3%-15%) higher CVD, CHD, and stroke risk. Meta-evidence quality was high for CHD, moderate for CVD, and low for stroke.

Interpretation

Total UPF intake was adversely associated with CVD and CHD risk in US adults, corroborated by prospective studies from multiple countries, also suggesting a small excess stroke risk. Nutritional advice for cardiovascular health should consider differential consequences of group-specific UPF. Replication is needed in racially/ethnically-diverse populations.

Funding

National Institutes of Health (NIH) grants supported the NHS, NHSII, and HPFS.

Fruit and Vegetable Intake Patterns, Kidney Failure, and Mortality in Adults with and without Chronic Kidney Disease in the United States

BACKGROUND

Fruits and vegetables (F&Vs) are vital components of healthy diets but may be restricted in chronic kidney disease (CKD) to avoid high-potassium intake. We previously generated F&V patterns for patients in the National Health and Nutrition Examination Survey (NHANES) and demonstrated an increased prevalence of the overall low-intake pattern in patients with CKD.

OBJECTIVE

To evaluate the association of F&V patterns (overall low intake, high unprocessed, moderate processed, and high ultraprocessed) with the risk of kidney failure and its composite with death.

METHODS

Adults in NHANES III with valid dietary data and longitudinal follow-up for kidney failure and death were included. F&V patterns were identified using 24-h dietary recalls and latent class analysis, yielding 4 patterns. Cox models were used to evaluate the prospective association between each pattern and hazard of kidney failure or a composite of kidney failure or death over ≤20 y. Models were adjusted for demographics and select comorbidities and weighted for the complex survey design. Secondary analyses evaluated serum carotenoids as objective biomarkers of F&V intake.

RESULTS

Among 16,726 eligible participants in NHANES III, F&V consumption consistent with the high-ultraprocessed pattern associated with the highest risk of kidney failure after demographic and comorbidity adjustment, but attenuated with adjustment for kidney function. The high unprocessed pattern associated with the lowest adjusted risk of death or kidney failure combined [hazard ratio (HR): 0.73; 95% confidence interval (CI): 0.65, 0.81 relative to overall low intake]. Higher-serum carotenoids were associated with a lower adjusted risk of death or kidney failure combined (HR: 0.57; 95% CI: 0.49, 0.65 for quartile 4 compared with quartile 1). Results were similar in patients with CKD at baseline.

CONCLUSIONS

Higher intake of unprocessed F&Vs was associated with better outcomes in the general population and patients with CKD. Results emphasize the need to safely improve F&V intake in CKD.

Ultra-Processed Foods: A Narrative Review of the Impact on the Human Gut Microbiome and Variations in Classification Methods

Ultra-processed foods (UPFs) are foods that are industrially processed and are often pre-packaged, convenient, energy-dense, and nutrient-poor. UPFs are widespread in the current Western diet and their proposed contribution to non-communicable diseases such as obesity and cardiovascular disease is supported by numerous studies. UPFs are hypothesized to affect the body in multiple ways, including by inducing changes in the gut microbiome. This review summarizes the available research on the effect of UPFs on the gut microbiome. We also review current usage of the NOVA food classification system in randomized controlled trials and observational studies and how its implementation effects UPF research. Despite some differences in methodology between studies, results often associate UPF consumption with a number of negative health consequences. There are attempts to standardize a UPF classification system; however, reaching and implementing a consensus is difficult. Future studies focusing on the mechanisms by which UPFs effect the body, including through the microbiome and metabolome, will be essential to refine our understanding of the effects of UPFs on human health.

Adherence to Plant-Based Diets and Risk of CKD Progression and All-Cause Mortality: Findings From the Chronic Renal Insufficiency Cohort (CRIC) Study

RATIONALE & OBJECTIVE

Studies have shown that generally healthy individuals who consume diets rich in plant foods have a lower risk of incident chronic kidney disease (CKD) and cardiovascular disease. This study investigated the prospective associations of plant-based diets with the risk of CKD progression and all-cause mortality in individuals with CKD.

STUDY DESIGN

Prospective cohort study.

SETTING & PARTICIPANTS

2,539 participants with CKD recruited between 2003-2008 into the Chronic Renal Insufficiency Cohort (CRIC) Study.

EXPOSURE

Responses on the Diet History Questionnaire were used to calculate scores for the overall plant-based diet index, healthy plant-based diet index, and unhealthy plant-based diet index.

OUTCOME

(1) CKD progression defined as≥50% estimated glomerular filtration rate decline from baseline or kidney replacement therapy (dialysis, transplant) and (2) all-cause mortality.

ANALYTICAL APPROACH

Cox proportional hazards models to compute hazard ratios and 95% confidence intervals adjusting for lifestyle, socioeconomic, and clinical covariates.

RESULTS

There were 977 CKD progression events and 836 deaths during a median follow-up period of 7 and 12 years, respectively. Participants with the highest versus lowest adherence to overall plant-based diets and healthy plant-based diets had 26% (HR, 0.74 [95% CI, 0.62-0.88], P trend<0.001) and 21% (HR, 0.79 [95% CI, 0.66-0.95], P trend=0.03) lower risks of all-cause mortality, respectively. Each 10-point higher score of unhealthy plant-based diets was modestly associated with a higher risk of CKD progression (HR, 1.14 [95% CI, 1.03-1.25) and all-cause mortality (HR, 1.11 [95% CI, 1.00-1.23).

LIMITATIONS

Self-reported diet may be subject to measurement error.

CONCLUSIONS

Adherence to an overall plant-based diet and a healthy plant-based diet is associated with a reduced risk of all-cause mortality among individuals with CKD. An unhealthy plant-based was associated with an elevated risk of CKD progression and all-cause mortality.

PLAIN-LANGUAGE SUMMARY

Plant-based diets are healthful dietary patterns that have been linked to a lower risk of chronic diseases. However, the impact of plant-based diets on clinical outcomes in patients with chronic kidney disease (CKD) is not well established. In 2,539 individuals with CKD, we examined the associations of adherence to 3 different types of plant-based diets with the risks of CKD progression and all-cause mortality. We found that following an overall plant-based diet and a healthy plant-based diet was associated with a lower risk of all-cause mortality. By contrast, following an unhealthy plant-based diet was associated with a higher risk of CKD progression and all-cause mortality. These results suggest that the quality of plant-based diets may be important for CKD management.

Association between dietary phosphate intake and skeletal muscle energetics in adults without cardiovascular disease

Highly bioavailable inorganic phosphate (Pi) is present in large quantities in the typical Western diet and represents a large fraction of total phosphate intake. Dietary Pi excess induces exercise intolerance and skeletal muscle mitochondrial dysfunction in normal mice. However, the relevance of this to humans remains unknown. The study was conducted on 13 individuals without a history of cardiopulmonary disease (46% female, 15% Black participants) enrolled in the pilot-phase of the Dallas Heart and Mind Study. Total dietary phosphate was estimated from 24-h dietary recall (ASA24). Muscle ATP synthesis was measured at rest, and phosphocreatinine (PCr) dynamics was measured during plantar flexion exercise using 7-T 31P magnetic resonance (MR) spectroscopy in the calf muscle. Correlation was assessed between dietary phosphate intake normalized to total caloric intake, resting ATP synthesis, and PCr depletion during exercise. Higher dietary phosphate intake was associated with lower resting ATP synthesis (r = -0.62, P = 0.03), and with higher levels of PCr depletion during plantar flexion exercise relative to the resting period (r = -0.72; P = 0.004). These associations remain significant after adjustment for age and estimated glomerular filtration rate (both P < 0.05). High dietary phosphate intake was also associated with lower serum Klotho levels, and Klotho levels are in turn associated with PCr depletion and higher ADP accumulation post exercise. Our study suggests that higher dietary phosphate is associated with reduced skeletal muscle mitochondrial function at rest and exercise in humans providing new insight into potential mechanisms linking the Western diet to impaired energy metabolism.NEW & NOTEWORTHY This is the first translational research study directly demonstrating the adverse effects of dietary phosphate on muscle energy metabolism in humans. Importantly, our data show that dietary phosphate is associated with impaired muscle ATP synthesis at rest and during exercise, independent of age and renal function. This is a new biologic paradigm with significant clinical dietary implications.

Ultra-processed food consumption and chronic kidney disease risk: a systematic review and dose-response meta-analysis

Background

High intake of ultra-processed food (UPF) has been associated with increased risk of chronic kidney disease(CKD), but the results remain inconsistent. We therefore performed this systematic review and dose–response meta-analysis of observational studies that shed light on the association between UPF consumption and the risk of CKD.

Methods

A systematic literature search of PubMed, Embase, Web of Science, Scopus and China National Knowledge Infrastructure (CNKI) databases was carried out to find the eligible articles published up to October 31, 2023. Random-effects or fixed-effects models were used to pool the relative risks(RRs) and their 95% confidence intervals (CIs).The potential sources of heterogeneity across studies were examined using the Cochran’s Q test and I-square(I2). Publication bias was examined using the visual inspection of asymmetry in funnel plots and quantified by Begg’s and Egger’s tests.

Results

Eight studies (six cohort and two cross-sectional studies) exploring the association between UPF consumption and risk of CKD, were included in the final analysis. The pooled analyses revealed that high consumption of UPF was associated with an increased risk of CKD (RR = 1.25; 95%CI: 1.09–1.42, p &lt; 0.0001). Moreover, a 10% increase of UPF consumption was associated with a 7% higher risk of CKD (RR = 1.07; 95%CI: 1.04–1.10, p &lt; 0.001). Dose–response analysis of all included studies showed a linear association between UPF consumption and the risk of CKD (RR = 1.02; 95%CI:0.99–1.05, Pdose–response = 0.178, Pnonlinearity = 0.843).

Conclusion

Our findings indicate that high consumption of UPF is significantly associated with an increased risk of CKD. Future research with prospective design is required to confirm this positive association.

Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023478483, PROSPERO identifier CRD42023478483.

Ultra-processed food consumption and risk of cardiovascular events: a systematic review and dose-response meta-analysis

Background

Ultra-processed food (UPF) consumption continues to increase worldwide. However, evidences from meta-analyses are limited regarding the effects on cardiovascular events (CVEs).

Methods

A meta-analysis was performed to assess the dose-response relationship of UPF consumption and CVEs risk (including the morbidity and mortality of cardiovascular causes, and myocardial infarction, stroke, transient ischemic attack, coronary intervention). Databases (PubMed, EMBASE, Cochrane Library, and Web of Science) were searched for observational studies published in English language up to October 24, 2023. Generalized least squares regression and restricted cubic splines were used to estimate the linear/nonlinear relationship. PROSPERO CRD 42023391122.

Findings

Twenty studies with 1,101,073 participants and 58,201 CVEs cases with a median follow-up of 12.2 years were included. A positive linear relationship between UPF intake and CVEs risk was identified. In addition, positive correlation between coronary heart disease and UPF consumption in terms of daily serving and daily energy proportion. No significant association of UPF consumption with the risk of cerebrovascular disease was observed. Briefly, 10% increase of UPF by daily weight proportion was associated with a 1.9% increase of CVEs risk (RR = 1.019; 95% CI, 1.007-1.031; P = 0.002), an additional daily serving corresponding to 2.2% CVEs risk increase (RR = 1.022; 95% CI, 1.013-1.031; P < 0.001), and 10% increase by daily energy proportion corresponding to 1.6% CVEs risk increase (RR = 1.016; 95% CI, 1.002-1.030; P = 0.022).

Interpretation

UPF consumption were associated with a higher risk of CVEs in the positive linear relationship. Our findings highlight the importance of minimizing UPF consumption for cardiovascular health and might be help to pursue public health policies in control of UPF consumption.

Funding

This work was supported by the Key Research and Development Program of Shaanxi Province (2023-ZDLSF-22), the Innovative Talent Support Program of Shaanxi Province (2022KJXX-106), and the Key Research and Development Program of Shaanxi Province (2023-YBSF-424).

From ultra-processed foods towards healthy eating for CKD patients: a proposal of educational infographics

Ultraprocessed food (UPF) is defined as industrialized, packaged and ready-to-eat food produced on a large scale, using sophisticated industrial machinery. Examples of UPFs include salty and sweet snacks, industrialized biscuits and packaged meals, processed meats and sugary drinks. Ultraprocessed food has a long-shelf life, is highly palatable, microbiologically safe, affordable and most of all, easy to consume. For these reasons, its consumption has been increasing worldwide, and is replacing healthy homemade meals. The main concern of this dietary shift is that UPFs come with the addition of salt, sugar, unhealthy fats, and several additives and taste enhancers that contain, among other substances, relevant quantities of potassium, phosphate and sodium. A large proportion of UPF in the diet may carry risks for patients with chronic kidney disease (CKD) since it can worsen blood pressure and glycemic control, and lead to constipation, hyperkalemia and hyperphosphatemia. Acknowledging the importance of UPF in kidney health implies integrating nutritional counseling with information on UPFs, and specific educational material can be helpful for patients, caregivers, and also for health care providers. We developed a set of 3 infographics dedicated to CKD patients, with information on how to identify UPFs, reasons for decreasing consumption, how to compose a healthy CKD plate and tips for reading food labels in supermarkets and grocery shops. We hope that this material can be useful in CKD outpatient clinics and dialysis centers as well as in general practitioners' offices, caring for early stage CKD.

Emerging Preventive Strategies in Chronic Kidney Disease: Recent Evidence and Gaps in Knowledge

PURPOSE OF REVIEW

Chronic kidney disease (CKD) is increasingly prevalent worldwide and is associated with increased cardiovascular risk. New therapeutic options to slow CKD progression and reduce cardiovascular morbidity and mortality have recently emerged. This review highlights recent evidence and gaps in knowledge in emerging CKD preventive strategies.

RECENT FINDINGS

EMPA-Kidney trial found that empagliflozin, a sodium-glucose co-transporter 2 inhibitor (SGLT2i) led to 28% lower risk of progression of kidney disease or death from cardiovascular causes, compared to placebo. This reinforced the previous findings from DAPA-CKD and CREDENCE trials and led to inclusion of SGLT2i as the cornerstone of CKD preventive therapy in both diabetic and non-diabetic CKD. Finerenone, a selective nonsteroidal mineralocorticoid receptor antagonist, slowed diabetic kidney disease progression by 23% compared to placebo in a pool analysis of FIDELIO-DKD and FIGARO-DKD trials. Non-pharmacological interventions, including low protein diet, and early CKD detection and risk stratification strategies based on novel biomarkers have also gained momentum. Ongoing efforts to explore the wealth of molecular mechanisms in CKD, added to integrative omics modeling are well posed to lead to novel therapeutic targets in kidney care. While breakthrough pharmacological interventions continue to improve outcomes in CKD, the heterogeneity of kidney diseases warrants additional investigation. Further research into specific kidney disease mechanisms will facilitate the identification of patient populations most likely to benefit from targeted interventions.