Abstract
BackgroundDietary and lifestyle factors may play an important role in the increasing prevalence of nephrolithiasis. We aimed to review and quantify the associations between lifestyle factors and incident nephrolithiasis and suggest lifestyle changes for the primary prevention of nephrolithiasis.MethodsPubMed, EMBASE, and Cochrane Library were searched up to May 2019, for observational studies and randomized controlled trials (RCTs) that assessed modifiable lifestyle factors and risk of nephrolithiasis in adults. Pooled relative risks (RRs) and 95% confidence intervals (CIs) were computed using a random effects model. The I2 statistic was employed to evaluate heterogeneity. Subgroup analysis, sensitivity analysis and meta-regression were also conducted whenever possible.ResultsFifty relevant articles with 1,322,133 participants and 21,030 cases in total were identified. Prominent risk factors for incident stones were body mass index (1.39,1.27–1.52), dietary sodium (1.38, 1.21–1.56), fructose, meat, animal protein, and soda. In contrast, protective factors included fluid intake (0.55, 0.51–0.60), a Dietary Approaches to Stop Hypertension (DASH) style diet (0.69, 0.64–0.75), alcohol (0.69, 0.56–0.85), water, coffee, tea, vegetables, fruits, dietary fiber, dietary calcium (0.83, 0.76–0.90), and potassium. Vitamin D (1.22, 1.01–1.49) and calcium (1.16, 1.00–1.35) supplementation alone increased the risk of stones in meta-analyses of observational studies, but not in RCTs, where the cosupplementation conferred significant risk.ConclusionsSeveral modifiable factors, notably fluid intake, dietary patterns, and obesity, were significantly associated with nephrolithiasis. Long-term RCTs are required to investigate the cost-effectiveness of dietary patterns for stone prevention. The independent and combined effects of vitamin D and calcium supplementation on nephrolithiasis need further elucidation.
Highlights
Dietary and lifestyle factors may play an important role in the increasing prevalence of nephrolithiasis
The included studies either used self-report, abdominal ultrasound, medical record review or International Classification Disease code to ascertain a diagnosis of nephrolithiasis
Dietary calcium (RR: 0.83; 95% confidence intervals (CIs), 0.76–0.90), potassium (RR: 0.59; 95% CI, 0.46–0.75) and magnesium (RR: 0.66; 95% CI, 0.55–0.79) intake were inversely associated with the risk of incident nephrolithiasis, whereas high intake of dietary sodium increased the risk by 38% (Fig. 3)
Summary
Dietary and lifestyle factors may play an important role in the increasing prevalence of nephrolithiasis. Nephrolithiasis, though usually manifested as a benign painful condition, poses a tremendous threat to the health care system and individual well-being It incurs an enormous cost estimated at US $2.1 billion in 2000 and with a projected annual increase of US $1.24 billion by 2030 as a result of population growth and the pandemics of diabetes and obesity [1, 2]. Increased accidental detection by imaging studies is contributed to the growing prevalence, lifestyle and dietary factors have been suggested to play an important role [15]. This was evidenced by one cohort study [16] showing that more than half of incident stones were attributable to lifestyle factors. A recent meta-analysis reported a negative association with fluid consumption, its methodology was less robust in that it included cross-sectional studies and duplicated cohorts and combined data from both recurrent and incident stone formers [21]
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