Journal of Renal Nutrition · Nov 2, 2026
Metabolomic biomarkers of ultraprocessed food intake and their associations with all-cause mortality in the Chronic Renal Insufficiency Cohort (CRIC)
By Sullivan VK, Chen J, Kim H et al.
Objective Higher ultraprocessed food (UPF) intake is associated with higher mortality risk in people with chronic kidney disease (CKD). The mechanisms underlying this association are not fully understood. Plasma metabolites reflect endogenous metabolism and exogenous exposures and may provide insights into the biological effects of diet. We aimed to identify metabolites associated with UPF intake and examine their prospective associations with mortality. Methods Among adults with CKD in the Chronic Renal Insufficiency Cohort (CRIC) study (n=1226; 48% women, mean age 59 years), we assessed cross-sectional associations between UPF intake (servings/day) and 486 plasma metabolites using multivariable linear regression. UPF intake was classified according to the Nova system. Metabolites were measured using liquid chromatography-mass spectrometry (Broad Institute). We examined prospective associations between significant UPF-related metabolites and the risk of death using Cox proportional hazards regression models. Results At FDR-adjusted P<0.05, 26 metabolites were significantly associated with UPF intake. Three metabolites (C4-OH carnitine, myristoleate, and aconitate) were positively associated with UPF intake. The remaining 23 were inversely associated with UPF consumption, including several highly unsaturated (≥5 double bonds) ≥34-carbon glycerophospholipids. Over a median follow-up of 15 years (25th-75th percentile: 8-17), 539 deaths occurred. Nine UPF-related metabolites were associated with mortality (FDR-adjusted P<0.05). Highly unsaturated (≥6 double bonds) 38- and 40-carbon glycerophospholipids were among the metabolites most strongly associated with UPF intake (inversely) and with a lower risk of death. Conclusion Metabolite markers of a dietary pattern rich in ultraprocessed foods may participate in metabolic pathways contributing to mortality risk in CKD.