Renal transplantation is the preferred treatment in patients with end-stage kidney disease (ESKD). Despite the success of renal transplantation, renal transplant recipients (RTRs) have a 6-fold greater risk of mortality than their counterparts in the general population. Dietary factors are crucial to the protection of kidney function after renal transplantation. However, it is not yet fully understood to what extent diet affects patient survival in RTRs.
Ultra-processed food is an emerging dietary risk factor, and has been found to be linked to higher risks of diabetes, cancer, and cardiovascular diseases. The increasing consumption of ultra-processed food calls for attention to study its health effects on RTRs.
Using the data from the TransplantLines Food and Nutrition Biobank and Cohort Study, we conducted a prospective cohort study in adult RTRs with a stable graft. Of 632 stable RTRs, during median follow-up of 5.4 years, 129 (20%) RTRs died. We found that ultra-processed foods were associated with all-cause mortality (hazard ratio [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.
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.
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