Fruit and Vegetable Intake Patterns, Kidney Failure, and Mortality in Adults with and without Chronic Kidney Disease in the United States

• Published in: The Journal of nutrition Vol. 154; no. 7; pp. 2205 - 2214
• Main Authors: Kranz, Sibylle, Sharma, Binu, Pourafshar, Shirin, Mallawaarachchi, Indika, Ma, Jennie Z, Scialla, Julia J
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.07.2024; American Institute of Nutrition
• Subjects: Adult; Adults; Aged; Biomarkers; Carotenoids; Chronic illnesses; chronic kidney disease; Comorbidity; Death; Demographics; Demography; Diet; Failure; Female; Food intake; Fruit; Fruits; Humans; Kidney diseases; Kidneys; Male; Middle Aged; Mortality; NHANES; Nutrient deficiency; Nutrition; Nutrition Surveys; Pattern analysis; patterns of intake; Quartiles; Renal failure; Renal Insufficiency - epidemiology; Renal Insufficiency - mortality; Renal Insufficiency, Chronic - epidemiology; Renal Insufficiency, Chronic - mortality; Risk; Surveys; United States - epidemiology; Vegetables; United States; eGFR; chronic kidney disease; NCHS; HR; UPF; vegetables; patterns of intake; fruits; USRDS; NHANES; UACR; CKD; F&Vs
• ISSN: 0022-3166; 1541-6100; 1541-6100
• DOI: 10.1016/j.tjnut.2024.05.008

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.