Department of Kinesiology, Curry School of Education and Human Development, University of Virginia, Charlottesville, VA, United States.
Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, United States.
J Nutr. 2024 Jul;154(7):2205-2214. doi: 10.1016/j.tjnut.2024.05.008. Epub 2024 May 15.
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.
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.
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.
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.
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.
水果和蔬菜（F&V）是健康饮食的重要组成部分，但在慢性肾脏病（CKD）中可能受到限制，以避免高钾摄入。我们之前为国家健康和营养检查调查（NHANES）中的患者生成了 F&V 模式，并表明 CKD 患者整体低摄入量模式的患病率增加。
评估 F&V 模式（整体低摄入量、高未加工、中加工和高超加工）与肾衰竭风险及其与死亡的复合风险的相关性。
纳入 NHANES III 中具有有效饮食数据和肾衰竭及死亡纵向随访的成年人。使用 24 小时膳食回顾和潜在类别分析确定 F&V 模式，产生 4 种模式。Cox 模型用于评估每种模式与 ≤20 年内肾衰竭或肾衰竭或死亡复合的风险的前瞻性关联。模型调整了人口统计学和选择的合并症，并对复杂的调查设计进行了加权。二次分析评估了血清类胡萝卜素作为 F&V 摄入量的客观生物标志物。
在 NHANES III 中符合条件的 16726 名参与者中，F&V 消费与高超加工模式一致，与人口统计学和合并症调整后的肾衰竭风险最高，但与肾功能调整后减弱。高未加工模式与死亡或肾衰竭复合的最低调整风险相关[风险比（HR）：0.73；95%置信区间（CI）：0.65，0.81 与整体低摄入量相比]。更高的血清类胡萝卜素与死亡或肾衰竭复合的调整后风险降低相关（HR：0.57；95%CI：0.49，0.65 与四分位 4 相比，四分位 1）。在基线时有 CKD 的患者中，结果相似。
更高的未加工 F&V 摄入量与一般人群和 CKD 患者的更好结局相关。结果强调需要安全地提高 CKD 患者的 F&V 摄入量。
