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 (β, −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.