Diet quality and diversity according to ultra-processed food consumption in non-dialytic chronic kidney disease: a cross-sectional study

Abstract

Objective To assess dietary quality and diversity according to ultra-processed food (UPF) consumption, focusing on mineral content in non-dialysis chronic kidney disease (CKD) patients (stages 3–5). Methods A cross-sectional study of 171 individuals from [blinded for review] Brazil, with 52.5% male participants, aged 65 (57–71) years, in stages 3–5, with an estimated glomerular filtration rate of 28.4 (19.0–39.2) mL/min/1.73m2. Dietary intake was assessed using 24-hour recalls, and foods were classified by the NOVA system. Diet quality was evaluated using the Dietary Approaches to Stop Hypertension (DASH) score, and dietary diversity by the consumption of 13 unprocessed food subgroups. Participants were grouped into UPF consumption tertiles. Results The mean proportion of UPF intake was 6.7% (g/day), reaching 17.2% in the highest tertile. Participants in the highest UPF consumption tertile had higher energy intake (P < 0.001), saturated fat (P < 0.001), sodium (P = 0.004), and phosphorus (P < 0.001), lower fiber intake (P < 0.001), and worse diet quality according to the DASH score. In adjusted analyses, higher UPF consumption was associated with a lower DASH score [β = -2.63; 95%, confidence interval (CI): - 4.13 to -1.13; P < 0.001]. No differences were observed between UPF tertiles for dietary diversity and carbohydrate, protein, total fat, magnesium, and potassium intake. Conclusions: Even at relatively low levels, UPF intake negatively affected dietary composition and quality among non-dialysis CKD patients, underscoring the need to limit UPF in CKD dietary guidelines and patient education.