Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.
Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.
Am J Clin Nutr. 2022 Jun 7;115(6):1646-1657. doi: 10.1093/ajcn/nqac053.
Renal transplant recipients (RTRs) have a 6-fold higher risk of mortality than age- and sex-matched controls. Whether high consumption of ultra-processed foods is associated with survival in RTRs is unknown.
We aimed to study the association between high consumption of ultra-processed foods and all-cause mortality in stable RTRs.
We conducted a prospective cohort study in adult RTRs with a stable graft. Dietary intake was assessed using a validated 177-item FFQ. Food items were categorized according to the NOVA classification system and the proportion ultra-processed foods comprised of total food weight per day was calculated.
We included 632 stable RTRs (mean ± SD age: 53.0 ± 12.7 y, 57% men). Mean ± SD consumption of ultra-processed foods was 721 ± 341 g/d (28% of total weight of food intake), whereas the intake of unprocessed and minimally processed foods, processed culinary ingredients, and processed foods accounted for 57%, 1%, and 14%, respectively. During median follow-up of 5.4 y [IQR: 4.9-6.0 y], 129 (20%) RTRs died. In Cox regression analyses, ultra-processed foods were associated with all-cause mortality (HR per doubling of percentage of total weight: 2.13; 95% CI: 1.46, 3.10; P < 0.001), independently of potential confounders. This association was independent from the quality of the overall dietary pattern, expressed by the Mediterranean Diet Score (MDS) or Dietary Approaches to Stop Hypertension (DASH) score. When analyzing ultra-processed foods by groups, only sugar-sweetened beverages (HR: 1.21; 95% CI: 1.05, 1.39; P = 0.007), desserts (HR: 1.24; 95% CI: 1.02, 1.49; P = 0.03), and processed meats (HR: 1.87; 95% CI: 1.22, 2.86; P = 0.004) were associated with all-cause mortality.
Consumption of ultra-processed foods, in particular sugar-sweetened beverages, desserts, and processed meats, is associated with a higher risk of all-cause mortality after renal transplantation, independently of low adherence to high-quality dietary patterns, such as the Mediterranean diet and the DASH diet.This trial was registered at clinicaltrials.gov as NCT02811835.
肾移植受者（RTR）的死亡率比年龄和性别匹配的对照者高 6 倍。超高加工食品的高摄入量是否与 RTR 的生存有关尚不清楚。
我们旨在研究稳定的 RTR 中超加工食品的高摄入量与全因死亡率之间的关系。
我们对稳定移植物的成年 RTR 进行了前瞻性队列研究。使用经过验证的 177 项 FFQ 评估饮食摄入量。根据 NOVA 分类系统对食物进行分类，并计算每天超加工食品占食物总重量的比例。
我们纳入了 632 名稳定的 RTR（平均年龄 ± 标准差：53.0 ± 12.7 岁，57%为男性）。超加工食品的平均 ± 标准差摄入量为 721 ± 341 g/d（占总食物摄入量的 28%），而未加工和最低限度加工的食物、加工烹饪原料和加工食品分别占 57%、1%和 14%。在中位数为 5.4 年（IQR：4.9-6.0 年）的随访期间，129 名（20%）RTR 死亡。在 Cox 回归分析中，超加工食品与全因死亡率相关（每增加总重量百分比的 HR：2.13；95%CI：1.46，3.10；P<0.001），独立于潜在的混杂因素。这种关联独立于整体饮食模式的质量，由地中海饮食评分（MDS）或停止高血压的饮食方法（DASH）评分表示。当按组分析超加工食品时，只有含糖饮料（HR：1.21；95%CI：1.05，1.39；P=0.007）、甜点（HR：1.24；95%CI：1.02，1.49；P=0.03）和加工肉类（HR：1.87；95%CI：1.22，2.86；P=0.004）与全因死亡率相关。
肾移植后，超高加工食品的消费，特别是含糖饮料、甜点和加工肉类，与全因死亡率升高有关，而与低质量饮食模式（如地中海饮食和 DASH 饮食）的低依从性无关。本试验在 clinicaltrials.gov 上注册为 NCT02811835。
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