A PRO-INFLAMMATORY DIETARY PATTERN IS ASSOCIATED WITH 10-YEAR RISK OF CHRONIC KIDNEY DISEASE: THE DUTCH LIFELINES COHORT STUDY

Chronic systemic inflammation plays a central role in a wide range of adverse health outcomes, including chronic kidney disease (CKD). Among lifestyle factors, dietary patterns (DPs) have been widely recognized as important modulators of systemic inflammation. However, evidence regarding inflammation-related DPs and their long-term associations with CKD risk remains limited.

The current study was based on the Lifelines Cohort Study, a prospective population-based study conducted from 2006 to 2024 in Northern Netherlands. Baseline dietary intake was assessed using a 212-item food frequency questionnaire and aggregated into 43 food groups. The analysis consisted of two stages: (1) derivation of a DP, and (2) assessment of its relationship with CKD risk. In stage 1: 46,010 participants free of severe inflammation-related diseases at baseline were included. Long-term average blood cell counts were estimated from repeated measurements using linear mixed-effects models adjusted for age, sex, and time since baseline. Reduced rank regression was applied to derive an inflammation-related DP that explained the maximum variation in a weighted linear combination of neutrophil, eosinophil, basophil, lymphocyte, and monocyte counts. Participants were further categorized into quintiles (Q1–Q5) of DP scores. Aggregate index of systemic inflammation (AISI) was used to evaluate the association between the DP and systemic inflammation status. In stage 2: A total of 26,973 participants who were free of severe inflammation-related diseases and CKD at baseline and had complete follow-up were included. CKD was defined as an eGFR <60 mL/min/1.73 m2 during follow-up. The association between DP and risk of CKD, as well as the mediating role of systemic inflammation was examined using generalized linear model and path analysis.

A DP with pro-inflammatory potential was identified, explaining 1.80% of the total variation in the response variables. It was characterized by a higher intake of beverages, organ meat, snacks, red and processed meat, and coffee. It was further characterized by a lower intake of tea, fruits, whole grains, vegetables, chocolate, plant-based (vegan) meat alternatives, nuts, and yogurt, indicating a Dutch-specific pro-inflammatory dietary profile. Participants in the highest quintile of DP adherence (Q5) showed a 12.5% higher level of systemic inflammation, compared with those in the lowest quintile (Q1) (AISI relative difference = 12.5%, 95% CI: 11.0%–14.0%, P-trend < 0.001). During a mean follow-up of 10.0 ± 1.6 years, 1,091 participants (4.04%) developed CKD. After adjusting for potential confounders, participants in Q5 had a 1.72-fold higher risk of CKD compared with those in Q1 (95% CI: 1.24–2.38, P-trend < 0.001). Mediation analysis showed systemic inflammation accounted for 10.2% (95% CI: 5.4%–19.8%, P < 0.001) of the total effect of the DP on CKD risk. Additionally, a 3-knot restricted cubic spline analysis was consistent with a linear association between the DP and CKD risk (P for non-linearity = 0.751).

The identified pro-inflammatory dietary pattern was linked to higher systemic inflammation and increased CKD risk among the Dutch population, with inflammation explaining part of this relationship. These findings emphasize the importance of adopting anti-inflammatory dietary behaviors as a potential strategy for CKD prevention.