Abstract
Recent epidemiological studies have shown that dietary patterns may have a more persistent impact on the risk of stone formation than single nutrients of the diet. Dietary Approaches to Stop Hypertension (DASH), a low-sodium and fruits/vegetables-rich diet, has been associated with a lower risk of nephrolithiasis, due to altered urinary biochemistry. This observational study aimed to investigate whether the dietary pattern of stone formers (SF) resembled a DASH-diet and its influence on urinary lithogenic parameters. Anthropometric data, fasting serum sample, 24-h urine samples, and a 3-day food intake record under an unrestricted diet were obtained from 222 SF and compared with 136 non-SF subjects (controls). The DASH-diet food portions were determined from the food records whereas intakes of sodium chloride (NaCl) and protein (protein equivalent of nitrogen appearance, PNA) were estimated from 24-hr urinary sodium and urea. A dietary profile close to a DASH-diet was not observed in any of the groups. NaCl intake and PNA were significantly higher in SF versus non-SF (12.0 ± 5.2 v.s. 10.1 ± 3.4 g/day, p = 0.01 and 1.8 ± 0.1 v.s. 1.4 ± 0.1 g/kg/day, p = 0.03). SF exhibited a positive correlation of NaCl intake and PNA with urinary calcium, oxalate and uric acid, and of PNA with urinary sodium. SF consumed more vegetables and legumes, but less fruits and low-fat dairy items than non-SF. The present series presented a dietary profile characterized by low calcium and high salt and protein contents, not reflecting an ideal DASH-style diet pattern.
Highlights
Nephrolithiasis represents a common disorder with a lifetime cumulative incidence of 5-10% and with a progressively increasing prevalence worldwide[1]
Dietary intervention is an integral component of prevention of kidney stones, since diets rich in animal protein, sodium chloride, and low calcium and fluid intake confer a higher risk for stone formation[6,7]
A Dietary Approaches to Stop Hypertension (DASH)-style diet has been previously shown to be associated with a reduced risk of renal stone formation by increasing urinary citrate and volume[8]
Summary
Nephrolithiasis represents a common disorder with a lifetime cumulative incidence of 5-10% and with a progressively increasing prevalence worldwide[1]. This systemic condition results from the interaction of metabolic factors, genetic inheritance, and environmental exposure, and is associated with hypertension, coronary artery disease, metabolic syndrome, and diabetes mellitus[2]. Overweight, and weight gain have been associated with an increased risk of stone formation[3,4]. Metabolic syndrome and insulin resistance, the consequences of a larger body size, may contribute to the development of kidney stones by increasing the urinary excretion of calcium, uric acid, and oxalate and decreasing urinary pH3,5. Some dietary patterns have already been associated to the reduction of risk for nephrolithiasis, such as Dietary Approaches to Stop Hypertension (DASH)[8]
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