Ultraprocessed food consumption and kidney function decline in a population-based cohort in the Netherlands

Background Ultraprocessing makes food products more convenient, appealing, and profitable. Recent studies show that high ultraprocessed food (UPF) intake is associated with cardiometabolic diseases. Objectives The aim of this study is to investigate the association between UPF consumption and risks of kidney function decline in the general population. Methods In a prospective, general population-based Lifelines cohort from Northern Netherlands, 78,346 participants free of chronic kidney disease (CKD) at baseline responded to a 110-item FFQ. We used a multivariable regression analysis to study the associations of the proportion (in grams/day) of UPFs in the total diet with a composite kidney outcome [incident CKD or a >= 30% estimated glomerular filtration rate (eGFR) decline relative to baseline] and annual change in eGFR. Results On average, 37.7% of total food intake came from UPFs. After 3.6 +/- 0.9 years of follow-up, 2470 participants (3.2%) reached the composite kidney outcome. Participants in the highest quartile of UPF consumption were associated with a higher risk of the composite kidney outcome (OR, 1.27; 95% CI, 1.09-1.47; P = 0.003) compared with those in the lowest quartile, regardless of their macro- or micronutrient intake or diet quality. Participants in the highest quartile had a more rapid eGFR decline (beta, -0.17; 95% CI, -0.23 to -0.11; P < 0.001) compared with those in the lowest quartile. Associations were generally consistent across different subgroups. Conclusions Higher UPF consumption was associated with a higher risk of a composite kidney outcome (incident CKD or >= 30% eGFR decline) and a more rapid eGFR decline in the general population, independent of confounders and other dietary indices.