PURE Healthy Diet Score, Genetic Susceptibility, and New-Onset CKD

Background: The Prospective Urban Rural Epidemiology (PURE) score, a novel dietary pattern that focuses exclusively on protective foods, is more practical than highly restrictive diets. However, its association with new-onset chronic kidney disease (CKD) and its performance in comparison to some conventional dietary patterns, including Dietary Approaches to Stop Hypertension (DASH), Alternate Mediterranean diet (aMed), Alternate Healthy Eating Index-2010 (AHEI-2010), and healthful Plant-Based Diet Index (hPDI) remain unclear. Methods: 179,569 participants without CKD and with complete dietary data at baseline from the UK Biobank were included. The PURE score was calculated based on six foods (fruits, vegetables, legumes, nuts, fish, and dairy), ranging from 6 to 30. The study outcome was new-onset CKD. Results: During a median follow-up of 12.1 years, 4,822 participants developed CKD. The PURE score was inversely associated with new-onset CKD (per 1 quintile increment: HR, 0.92; 95%CI,0.90-0.94). Compared to participants with PURE score <14 (unhealthy PURE score) and high genetic risk, those with PURE score ≥14 (healthy PURE score) and low genetic risk had the lowest risk of CKD (HR, 0.46; 95%CI, 0.42-0.51). The inverse association between PURE score and new-onset CKD remained, regardless of the levels of DASH, aMed, AHEI-2010, hPDI, and genetic risk of CKD (all P for interactions >0.05). None of the conventional dietary patterns (per 1 quintile increment: HRs ranging from 0.91 to 0.96) was significantly superior to PURE score in reducing the risk of CKD. Conclusion: Adherence to a high PURE score was associated with a lower risk of CKD, suggesting the importance of protective foods in CKD prevention.Figure 1. Associations of PURE score (A) and its components (B) with the risk of new-onset CKD.Figure 2. Joint association of PURE score and genetic susceptibility with the risk of new-onset CKD.