Association of unsweetened and sweetened tea consumption with the risk of new-onset chronic kidney disease: Findings from UK Biobank and Coronary Artery Risk Development in Young Adults (CARDIA) study

Abstract

Background: The association between tea consumption and chronic kidney disease (CKD) remained inconsistent. We aimed to evaluate the association of tea consumption with new-onset CKD and examine the effects of common additives (milk and sweeteners) and genetic variations in caffeine metabolism on the association.

Methods: 176 038 and 3104 participants free of CKD at baseline in the United Kingdom Biobank (UK Biobank) and Coronary Artery Risk Development in Young Adults (CARDIA) study were included, respectively. Dietary information was collected using 24-hour dietary recall questionnaires. The study outcome was new-onset CKD.

Results: In the UK Biobank, during a median follow-up of 12.13 years, 3535 (2.01%) participants developed CKD. Compared with tea non-consumers, the risk of new-onset CKD was significantly lower in unsweetened tea consumers (hazard ratio (HR) = 0.84, 95% confidence interval (CI) = 0.76-0.93), but not in sweetened tea consumers (HR = 0.96, 95% CI = 0.85-1.08), regardless of whether milk was added to tea. Accordingly, relative to tea non-consumers, the adjusted HRs (95% CIs) of new-onset CKD for participants who reported drinking unsweetened tea 1.5 or fewer, >1.5 to 2.5, >2.5 to 3.5, >3.5 to 4.5, and >4.5 drinks/d were HR = 0.86, 95% CI = 0.75-0.99; HR = 0.88, 95% CI = 0.78-1.00; HR = 0.83, 95% CI = 0.73-0.94; HR = 0.83, 95% CI = 0.72-0.95; and HR = 0.86, 95% CI = 0.75-0.99. Moreover, the association of unsweetened tea consumption with new-onset CKD was stronger among those with faster genetically predicted caffeine metabolism levels, although the interaction was insignificant (P-value interaction = 0.768). Consistently, in the CARDIA study, compared with tea non-consumers, a significantly lower risk of new-onset CKD was found in unsweetened tea consumers (HR = 0.80, 95% CI = 0.65-0.98) but not in sweetened tea consumers (HR = 0.97, 95% CI = 0.70-1.34).

Conclusions: Compared with tea non-consumers, consumption of unsweetened tea, but not sweetened tea, was significantly associated with a lower risk of new-onset CKD, regardless of whether milk was added.

Figure 1

Dose-response association of total, unsweetened, and sweetened tea consumption and new-onset CKD. Panel A. Dose-response association of total tea consumption and new-onset CKD. Panel B. Dose-response association of unsweetened tea consumption and new-onset CKD. Panel C. Dose-response association of sweetened tea consumption and new-onset CKD. Results were adjusted for age, sex, ethnicities, educational attainment, smoking status, alcohol consumption, physical activity, total energy intake, coffee consumption, body mass index, systolic blood pressure, diastolic blood pressure, glucose, triglycerides, total cholesterol, high-density lipoprotein cholesterol, estimated glomerular filtration rate and urine albumin-to-creatinine ratio. CKD – chronic kidney disease, HR – hazard ratio

Figure 2

Association of tea consumption and new-onset CKD stratified by tertiles of the wCMSG4 levels. Panel A. Association of unsweetened tea consumption and new-onset CKD stratified by tertiles of the wCMSG4 levels. Panel B. Association of sweetened tea consumption and new-onset CKD stratified by tertiles of the wCMSG4 levels. Results were adjusted for age, sex, ethnicities, educational attainment, smoking status, alcohol consumption, physical activity, total energy intake, coffee consumption, body mass index, systolic blood pressure, diastolic blood pressure, glucose, triglycerides, total cholesterol, high-density lipoprotein cholesterol, estimated glomerular filtration rate and urine albumin-to-creatinine ratio. CKD – chronic kidney disease, HR – hazard ratio, wCMSG4 – weighted genetic caffeine metabolism scores