Ultraprocessed foods and chronic kidney disease-double trouble

Abstract

High energy intake combined with low physical activity generates positive energy balance, which, when maintained, favours obesity, a highly prevalent morbidity linked to development of non-communicable chronic diseases, including chronic kidney disease (CKD). Among many factors contributing to disproportionately high energy intakes, and thereby to the obesity epidemic, the type and degree of food processing play an important role. Ultraprocessed foods (UPFs) are industrialized and quite often high-energy-dense products with added sugar, salt, unhealthy fats and food additives formulated to be palatable or hyperpalatable. UPFs can trigger an addictive eating behaviour and is typically characterized by an increase in energy intake. Furthermore, high consumption of UPFs, a hallmark of a Western diet, results in diets with poor quality. A high UPF intake is associated with higher risk for CKD. In addition, UPF consumption by patients with CKD is likely to predispose and/or to exacerbate uraemic metabolic derangements, such as insulin resistance, metabolic acidosis, hypertension, dysbiosis, hyperkalaemia and hyperphosphatemia. Global sales of UPFs per capita increased in all continents in recent decades. This is an important factor responsible for the nutrition transition, with home-made meals being replaced by ready-to-eat products. In this review we discuss the potential risk of UPFs in activating hedonic eating and their main implications for health, especially for kidney health and metabolic complications of CKD. We also present various aspects of consequences of UPFs on planetary health and discuss future directions for research to bring awareness of the harms of UPFs within the CKD scenario.

Keywords: chronic kidney disease; high energy intake; non-communicable diseases; ultraprocessed food.

Figure 1:

Plausible links between higher consumption of UPFs and higher risk of developing NCDs. Higher UPF consumption is associated with lower dietary quality (first square). A high consumption of UPFs results in overeating a diet with high density food, with added sugar, salt, unhealthy fats, non-caloric artificial sweeteners, food additives and contaminants and molecular alterations of food components due food processing such as heating. UPFs lead to an increase in factors that are detrimental for health (second square). The conditions and factors listed in the first and second squares lead to an increased risk for obesity and NCDs, such as hypertension, cardiovascular disease (CVD), non-alcoholic fat liver disease (NAFLD) and CKD (third square). CKD: chronic kidney disease; NCD: non-communicable diseases; UPF: ultraprocessed food.

Figure 2:

Intersection of a diet based on UPFs in driving complications related to CKD. UPFs are characterized by poor dietary quality. This type of diet can further exacerbate comorbidities and contribute to the development of metabolic complications already present in CKD. UPF: ultraprocessed food.