Impact of Nutritional Factors on Incident Kidney Stone Formation: A Report From the WHI OS
Abstract
Purpose:
Increased fluid intake, and decreased dietary sodium and animal protein intake are thought to reduce the risk of kidney stones but the role of calcium intake is controversial. We evaluated the relationship between dietary factors and incident kidney stone formation.
Materials and Methods:
Secondary analysis was done of 78,293 women from the prospective WHI OS (Women's Health Initiative Observational Study) with no history of nephrolithiasis who completed the validated food frequency questionnaire. Multivariate logistic regression was used to determine demographic and dietary factors, and supplement use independently associated with incident kidney stones.
Results:
Overall 1,952 women (2.5%) reported an incident kidney stone in 573,575 person-years of followup. The risk of incident kidney stones was decreased by 5% to 28% (p = 0.01) with higher dietary calcium intake and by 13% to 31% (p = 0.002) with higher water intake after adjusting for nephrolithiasis risk factors. Conversely higher dietary sodium intake increased the risk of nephrolithiasis by 11% to 61% (p <0.001) after adjustment with the most pronounced effect in women with the highest intake. Higher body mass index independently increased the risk of incident nephrolithiasis (adjusted OR 1.19–2.01, p <0.001). Animal protein intake was not associated with nephrolithiasis on multivariate analysis.
Conclusions:
This study adds to the growing evidence underscoring the importance of maintaining adequate fluid and dietary calcium intake. Greater dietary calcium intake significantly decreased the risk of incident kidney stones. In contrast, excess sodium intake increased the risk of incident nephrolithiasis, especially in women with the highest intake. Animal protein intake was not independently associated with nephrolithiasis.
References
- 1 : Dietary factors and the risk of incident kidney stones in younger women: Nurses' Health Study II. Arch Intern Med2004; 164: 885. Google Scholar
- 2 : Diet, vitamin D and vertebral mineral density in hypercalciuric calcium stone formers. Kidney Int1991; 39: 1193. Google Scholar
- 3 : Relationship of animal protein-rich diet to kidney stone formation and calcium metabolism. J Clin Endocrinol Metab1988; 66: 140. Crossref, Medline, Google Scholar
- 4 : Relationship of frequency, age, sex, stone weight and composition in 15,624 stones: comparison of results for 1980 to 1983 and 1995 to 1998. J Urol2000; 164: 302. Link, Google Scholar
- 5 : A prospective study of dietary calcium and other nutrients and the risk of symptomatic kidney stones. N Engl J Med1993; 328: 833. Google Scholar
- 6 : Comparison of dietary calcium with supplemental calcium and other nutrients as factors affecting the risk for kidney stones in women. Ann Intern Med1997; 126: 497. Google Scholar
- 7 : Urinary oxalate excretion increases with body size and decreases with increasing dietary calcium intake among healthy adults. Kidney Int1996; 49: 200. Google Scholar
- 8 : Some factors influencing the urinary excretion of oxalic acid in man. Clin Chim Acta1969; 25: 1. Google Scholar
- 9 : Sodium-dependent idiopathic hypercalciuria in renal-stone formers. Lancet1983; 2: 484. Google Scholar
- 10 : The potential role of salt abuse on the risk for kidney stone formation. J Urol1993; 150: 310. Link, Google Scholar
- 11 : Relation between urinary calcium and sodium in patients with idiopathic hypercalciuria. Lancet1967; 1: 1354. Google Scholar
- 12 : Codependence of renal calcium and sodium transport. Annu Rev Physiol1998; 60: 179. Google Scholar
- 13 : The nature and significance of the relationship between urinary sodium and urinary calcium in women. J Nutr1993; 123: 1615. Google Scholar
- 14 : Changes in urinary stone risk factors in hypocitraturic calcium oxalate stone formers treated with dietary sodium supplementation. J Urol2009; 181: 1140. Link, Google Scholar
- 15 : Studies of the mechanism by which chronic metabolic acidosis augments urinary calcium excretion in man. J Clin Invest1967; 46: 1318. Google Scholar
- 16 : The relation of clinical catastrophes, endogenous oxalate production, and urolithiasis. Clin Chem1990; 36: 1717. Google Scholar
- 17 Design of the Women's Health Initiative clinical trial and observational study: Women's Health Initiative Study Group. Control Clin Trials1998; 19: 61. Google Scholar
- 18 : Measurement characteristics of the Women's Health Initiative food frequency questionnaire. Ann Epidemiol1999; 9: 178. Google Scholar
- 19 : Dietary therapy for patients with hypocitraturic nephrolithiasis. Nat Rev Urol2011; 8: 146. Google Scholar
- 20 : Dietary factors and the risk of incident kidney stones in men: new insights after 14 years of follow-up. J Am Soc Nephrol2004; 15: 3225. Google Scholar
- 21 : Dietary Reference Intakes Research Synthesis Workshop Summary. Washington, D.C.: National Academies Press2006. Google Scholar
- 22 : Impact of obesity in patients with urolithiasis and its prognostic usefulness in stone recurrence. J Urol2008; 179: 570. Link, Google Scholar
- 23 : Association of urinary pH with body weight in nephrolithiasis. Kidney Int2004; 65: 1422. Google Scholar
- 24 : Impact of body weight on urinary electrolytes in urinary stone formers. Urology2000; 55: 825. Crossref, Medline, Google Scholar
- 25 : Obesity, weight gain, and the risk of kidney stones. JAMA2005; 293: 455. Google Scholar
- 26 : Association between metabolic syndrome and nephrolithiasis in an inpatient population in southern Italy: role of gender, hypertension and abdominal obesity. Nephrol Dial Transplant2009; 24: 900. Google Scholar
- 27 : Metabolic syndrome and self-reported history of kidney stones: the National Health and Nutrition Examination Survey (NHANES III) 1988–1994. Am J Kidney Dis2008; 51: 741. Google Scholar
- 28 : Kidney stones and subclinical atherosclerosis in young adults: the CARDIA study. J Urol2011; 185: 920. Link, Google Scholar
- 29 : Calcium plus vitamin D supplementation and the risk of fractures. N Engl J Med2006; 354: 669. Google Scholar
- 30 : Urinary tract stone occurrence in the Women's Health Initiative (WHI) randomized clinical trial of calcium and vitamin D supplements. Am J Clin Nutr2011; 94: 270. Google Scholar
