Institute of Radiation Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China.
Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, China.
Am J Clin Nutr. 2023 Feb;117(2):373-382. doi: 10.1016/j.ajcnut.2022.11.005. Epub 2022 Dec 16.
Many ultraprocessed food (UPF)-derived by-products may play a role in the development of chronic kidney disease (CKD). Although several studies have assessed the association of UPFs with kidney function decline or CKD in various countries, no evidence has been shown in China and the United Kingdom.
This study aims to evaluate the association between UPF consumption and risk of CKD in 2 large cohort studies from China and the United Kingdom.
In total, 23,775 and 102,332 participants without baseline CKD were enrolled in the Tianjin Chronic Low-Grade Systemic Inflammation and Health (TCLSIH) and UK Biobank cohort studies, respectively. Information on UPF consumption was obtained from a validated food frequency questionnaire in the TCLSIH and 24-h dietary recalls in the UK Biobank cohort. CKD was defined as an estimated glomerular filtration rate of <60 mL/min/1.73 m, albumin-to-creatinine ratio ≥30 mg/g, or as having a clinical diagnosis of CKD in both cohorts. Multivariable Cox proportional hazard models were used to examine the association between UPF consumption and the risk of CKD.
After a median follow-up of 4.0 and 10.1 y, the incidence rates of CKD were around 1.1% and 1.7% in the TCLSIH and UK Biobank cohorts, respectively. The multivariable hazard ratio [95% confidence interval] of CKD across increasing quartiles (quartiles 1-4) of UPF consumption were 1 (reference), 1.24 (0.89, 1.72), 1.30 (0.91, 1.87), and 1.58 (1.07, 2.34) (P for trend = 0.02) in the TCLSIH cohort and 1 (reference), 1.14 (1.00, 1.31), 1.16 (1.01, 1.33), and 1.25 (1.09, 1.43) (P for trend < 0.01) in the UK Biobank cohort, respectively.
Our finding indicated that higher UPF consumption is associated with a higher risk of CKD. Moreover, restricting UPF consumption may potentially benefit the prevention of CKD. Further clinical trials are required to clarify the causality. This trial was registered at UMIN Clinical Trials Registry as UMIN000027174 (https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000031137).
许多超加工食品（UPF）的副产物可能在慢性肾脏病（CKD）的发展中起作用。尽管已有几项研究评估了 UPF 与不同国家的肾功能下降或 CKD 之间的关联，但尚未在中国和英国得到证实。
本研究旨在评估来自中国和英国的 2 项大型队列研究中 UPF 摄入与 CKD 风险之间的关联。
共有 23775 名和 102332 名无基线 CKD 的参与者分别纳入天津慢性低度系统性炎症与健康（TCLSIH）和英国生物库队列研究。在 TCLSIH 中，通过经过验证的食物频率问卷获取 UPF 摄入信息，在英国生物库队列中通过 24 小时膳食回忆获取 UPF 摄入信息。CKD 的定义为估计肾小球滤过率<60 mL/min/1.73 m、白蛋白/肌酐比值≥30 mg/g 或在两个队列中均有 CKD 的临床诊断。多变量 Cox 比例风险模型用于检验 UPF 摄入与 CKD 风险之间的关联。
在中位随访 4.0 年和 10.1 年后，TCLSIH 和英国生物库队列的 CKD 发生率分别约为 1.1%和 1.7%。随着 UPF 摄入量逐渐增加（四分位 1-4 组），CKD 的多变量危险比（95%置信区间）分别为 1（参考）、1.24（0.89，1.72）、1.30（0.91，1.87）和 1.58（1.07，2.34）（TCLSIH 队列趋势 P 值=0.02）和 1（参考）、1.14（1.00，1.31）、1.16（1.01，1.33）和 1.25（1.09，1.43）（英国生物库队列趋势 P 值<0.01）。
我们的发现表明，较高的 UPF 摄入量与 CKD 风险增加相关。此外，限制 UPF 摄入可能有助于预防 CKD。需要进一步的临床试验来阐明因果关系。本试验在 UMIN 临床试验注册处注册，注册号为 UMIN000027174（https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000031137）。
