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

Sibylle Kranz; Binu Sharma; Shirin Pourafshar; Indika Mallawaarachchi; Jennie Z Ma; Julia J Scialla

doi:10.1016/j.tjnut.2024.05.008

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

J Nutr. 2024 May 15:S0022-3166(24)00285-2. doi: 10.1016/j.tjnut.2024.05.008. Online ahead of print.

Authors

Sibylle Kranz¹, Binu Sharma², Shirin Pourafshar², Indika Mallawaarachchi³, Jennie Z Ma³, Julia J Scialla⁴

Affiliations

¹ Department of Kinesiology, School of Education and Human Development, University of Virginia Curry, Charlottesville, VA, United States.
² Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, United States.
³ Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, United States.
⁴ Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, United States; Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, United States. Electronic address: jscialla@virginia.edu.

PMID: 38754840
DOI: 10.1016/j.tjnut.2024.05.008

Abstract

Background: 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.

Objective: 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.

Methods: 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.

Results: 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, 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]. High-serum carotenoids were associated with a lower 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.

Conclusions: 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.

Keywords: NHANES; chronic kidney disease; fruits; patterns of intake; vegetables.