TABLE 4.
Mortality risk in RTRs with the poorest diet (high UPFs and low diet quality) compared with RTRs with the best possible diet (low UPFs and high diet quality)1
| UPFs in total | UPFs based on score only including SSBs, desserts, and processed meat | |||||
|---|---|---|---|---|---|---|
| Best possible diet | Poorest possible diet | Best possible diet | Poorest possible diet | |||
| All-cause mortality | Reference | HR (95% CI) | P value | Reference | HR (95% CI) | P value |
| Diet quality based on MDS | ||||||
| Events, n | 12 | 26 | 11 | 29 | ||
| Model 1 | 1.00 | 3.01 (1.50, 6.03) | 0.002 | 1.00 | 2.98 (1.48, 6.01) | 0.002 |
| Model 2 | 1.00 | 3.39 (1.68, 6.84) | 0.001 | 1.00 | 3.01 (1.47, 6.14) | 0.002 |
| Model 3 | 1.00 | 3.11 (1.51, 6.43) | 0.002 | 1.00 | 2.71 (1.29, 5.68) | 0.008 |
| Model 4 | 1.00 | 3.21 (1.54, 6.70) | 0.002 | 1.00 | 2.66 (1.27, 5.60) | 0.01 |
| Model 5 | 1.00 | 2.66 (1.27, 5.55) | 0.009 | 1.00 | 2.39 (1.13, 5.08) | 0.02 |
| Diet quality based on DASH score | ||||||
| Events, n | 15 | 25 | 19 | 32 | ||
| Model 1 | 1.00 | 3.47 (1.80, 6.70) | <0.001 | 1.00 | 3.04 (1.70, 5.43) | <0.001 |
| Model 2 | 1.00 | 3.86 (1.97, 7.56) | <0.001 | 1.00 | 2.95 (1.61, 5.39) | <0.001 |
| Model 3 | 1.00 | 4.27 (2.13, 8.57) | <0.001 | 1.00 | 3.16 (1.70, 5.90) | <0.001 |
| Model 4 | 1.00 | 4.16 (2.07, 8.36) | <0.001 | 1.00 | 2.08 (1.65, 5.75) | <0.001 |
| Model 5 | 1.00 | 5.11 (2.48, 10.53) | <0.001 | 1.00 | 3.80 (1.96, 7.37) | <0.001 |
Cox proportional hazards regression analyses were performed to assess the risk of all-cause mortality in 632 RTRs, comparing those who have the poorest possible diet (high intake of UPFs in total and based on score only including SSBs, desserts, and processed meat combined with low adherence to the Mediterranean diet or the DASH diet) and those with the best possible diet (low intake of UPFs in total and based on score only including SSBs, desserts, and processed meat and high adherence to the Mediterranean diet or the DASH diet). HRs are for doubling in the weight proportion of UPF intake (percentage of total food weight in g/d). Model 1, adjustment for age and sex; model 2, model 1 + adjustment for time between transplantation and baseline, estimated glomerular filtration rate, urinary protein excretion, primary renal disease, and donor age; model 3, model 2 + adjustment for total energy intake, alcohol consumption, smoking status, and physical activity; model 4, model 3 + adjustment for use of calcineurin inhibitors, antihypertensive drugs, and statins; model 5, model 3 + adjustment for 24-h urinary creatinine excretion and BMI. DASH, Dietary Approaches to Stop Hypertension; MDS, Mediterranean Diet Score; RTR, renal transplant recipient; SSB, sugar-sweetened beverage; UPF, ultra-processed food.