Ultra-processed foods and risk of all-cause mortality in renal transplant recipients

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ABSTRACT

Background

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.

Objectives

We aimed to study the association between high consumption of ultra-processed foods and all-cause mortality in stable RTRs.

Methods

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.

Results

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.

Conclusions

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.

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Most cited references 56

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Equations to estimate glomerular filtration rate (GFR) are routinely used to assess kidney function. Current equations have limited precision and systematically underestimate measured GFR at higher values. To develop a new estimating equation for GFR: the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Cross-sectional analysis with separate pooled data sets for equation development and validation and a representative sample of the U.S. population for prevalence estimates. Research studies and clinical populations ("studies") with measured GFR and NHANES (National Health and Nutrition Examination Survey), 1999 to 2006. 8254 participants in 10 studies (equation development data set) and 3896 participants in 16 studies (validation data set). Prevalence estimates were based on 16,032 participants in NHANES. GFR, measured as the clearance of exogenous filtration markers (iothalamate in the development data set; iothalamate and other markers in the validation data set), and linear regression to estimate the logarithm of measured GFR from standardized creatinine levels, sex, race, and age. In the validation data set, the CKD-EPI equation performed better than the Modification of Diet in Renal Disease Study equation, especially at higher GFR (P < 0.001 for all subsequent comparisons), with less bias (median difference between measured and estimated GFR, 2.5 vs. 5.5 mL/min per 1.73 m(2)), improved precision (interquartile range [IQR] of the differences, 16.6 vs. 18.3 mL/min per 1.73 m(2)), and greater accuracy (percentage of estimated GFR within 30% of measured GFR, 84.1% vs. 80.6%). In NHANES, the median estimated GFR was 94.5 mL/min per 1.73 m(2) (IQR, 79.7 to 108.1) vs. 85.0 (IQR, 72.9 to 98.5) mL/min per 1.73 m(2), and the prevalence of chronic kidney disease was 11.5% (95% CI, 10.6% to 12.4%) versus 13.1% (CI, 12.1% to 14.0%). The sample contained a limited number of elderly people and racial and ethnic minorities with measured GFR. The CKD-EPI creatinine equation is more accurate than the Modification of Diet in Renal Disease Study equation and could replace it for routine clinical use. National Institute of Diabetes and Digestive and Kidney Diseases.

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Flavonoids: an overview

A. N. Panche, A. D. Diwan, S. Chandra (2016)

Flavonoids, a group of natural substances with variable phenolic structures, are found in fruits, vegetables, grains, bark, roots, stems, flowers, tea and wine. These natural products are well known for their beneficial effects on health and efforts are being made to isolate the ingredients so called flavonoids. Flavonoids are now considered as an indispensable component in a variety of nutraceutical, pharmaceutical, medicinal and cosmetic applications. This is attributed to their anti-oxidative, anti-inflammatory, anti-mutagenic and anti-carcinogenic properties coupled with their capacity to modulate key cellular enzyme function. Research on flavonoids received an added impulse with the discovery of the low cardiovascular mortality rate and also prevention of CHD. Information on the working mechanisms of flavonoids is still not understood properly. However, it has widely been known for centuries that derivatives of plant origin possess a broad spectrum of biological activity. Current trends of research and development activities on flavonoids relate to isolation, identification, characterisation and functions of flavonoids and finally their applications on health benefits. Molecular docking and knowledge of bioinformatics are also being used to predict potential applications and manufacturing by industry. In the present review, attempts have been made to discuss the current trends of research and development on flavonoids, working mechanisms of flavonoids, flavonoid functions and applications, prediction of flavonoids as potential drugs in preventing chronic diseases and future research directions.

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Ultra-processed foods: what they are and how to identify them

Carlos A. Monteiro, Geoffrey Cannon, Renata B. Levy … (2019)

The present commentary contains a clear and simple guide designed to identify ultra-processed foods. It responds to the growing interest in ultra-processed foods among policy makers, academic researchers, health professionals, journalists and consumers concerned to devise policies, investigate dietary patterns, advise people, prepare media coverage, and when buying food and checking labels in shops or at home. Ultra-processed foods are defined within the NOVA classification system, which groups foods according to the extent and purpose of industrial processing. Processes enabling the manufacture of ultra-processed foods include the fractioning of whole foods into substances, chemical modifications of these substances, assembly of unmodified and modified food substances, frequent use of cosmetic additives and sophisticated packaging. Processes and ingredients used to manufacture ultra-processed foods are designed to create highly profitable (low-cost ingredients, long shelf-life, emphatic branding), convenient (ready-to-consume), hyper-palatable products liable to displace all other NOVA food groups, notably unprocessed or minimally processed foods. A practical way to identify an ultra-processed product is to check to see if its list of ingredients contains at least one item characteristic of the NOVA ultra-processed food group, which is to say, either food substances never or rarely used in kitchens (such as high-fructose corn syrup, hydrogenated or interesterified oils, and hydrolysed proteins), or classes of additives designed to make the final product palatable or more appealing (such as flavours, flavour enhancers, colours, emulsifiers, emulsifying salts, sweeteners, thickeners, and anti-foaming, bulking, carbonating, foaming, gelling and glazing agents).

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Author and article information

Contributors

Maryse C J Osté

Ming-Jie Duan

Antonio W Gomes-Neto

Petra C Vinke

Juan-Jesus Carrero

Carla Avesani

QingQing Cai

Louise H Dekker

Gerjan J Navis

Stephan J L Bakker

Eva Corpeleijn

Journal

Journal ID (nlm-ta): Am J Clin Nutr

Journal ID (iso-abbrev): Am J Clin Nutr

Journal ID (publisher-id): ajcn

Title: The American Journal of Clinical Nutrition

Publisher: Oxford University Press

ISSN (Print): 0002-9165

ISSN (Electronic): 1938-3207

Publication date Collection: June 2022

Publication date (Electronic): 26 April 2022

Publication date PMC-release: 26 April 2022

Volume: 115

Issue: 6

Pages: 1646-1657

Affiliations

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

Department of Medical Epidemiology and Biostatistics, Karolinska Institute , Stockholm, Sweden

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

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

Author notes

Address correspondence to MCJO (e-mail: m.c.j.oste@ 123456umcg.nl )

Article

Publisher ID: nqac053

DOI: 10.1093/ajcn/nqac053

PMC ID: 9170470

PubMed ID: 35470855

SO-VID: 15480cb1-4570-47f4-b672-563119da4304

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@ 123456oup.com

History

Date received : 01 November 2021

Date accepted : 24 February 2022

Page count

Pages: 12

Funding

Funded by: Dutch Top Institute Food and Nutrition;

Award ID: A-1003

Funded by: European Union, DOI 10.13039/501100000780;

Award ID: 754425

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Ultra-processed foods and risk of all-cause mortality in renal transplant recipients

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ABSTRACT

Background

Objectives

Methods

Results

Conclusions

Related collections

Karger: Nutrition and Dietetics

Most cited references 56

A new equation to estimate glomerular filtration rate.

Flavonoids: an overview

Ultra-processed foods: what they are and how to identify them

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Author notes

Article

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Funding

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Cited by 11

Most referenced authors 1,067