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Micronutrient inadequacy and urinary stone disease: an analysis of the National Health and Nutrition Examination Survey 2007–2018

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Abstract

Urinary stone disease is common and affects approximately 10% of the American adults. The role of diet in stone formation is well-recognized; however, the literature focus has been on dietary excess rather than micronutrient inadequacy. As patients with stones may be at risk for nutrient inadequacies, we investigated the role of micronutrient inadequacy in stone formation by performing a cross-sectional analysis of the National Health and Nutrition Examination Survey on adults who were not taking dietary supplements. Micronutrient intake was obtained from 24-h dietary recalls, and usual intake was calculated. Survey-weighted, adjusted logistic regression was used for an incident analysis on having any history of stones. An additional analysis on recurrent stone-formers was performed with the outcome being 2 or more stones passed. Finally, a sensitivity analysis using quasi-Poisson regression was performed with the outcome being number of stones passed. There were 9777 respondents representing 81,087,345 adults, of which 9.36% had a stone history. Our incident analysis revealed inadequate vitamin A intake to be associated with stone formation (OR 1.33, 95% CI: 1.03–1.71). Recurrent analysis did not find any significant associations, while our sensitivity analysis revealed inadequate vitamin A (IRR 1.96, 95% CI: 1.28–3.00) and pyridoxine (IRR 1.99, 95% CI: 1.11–3.55) to be associated with a higher number of recurrent stones. Hence, inadequate dietary intake of vitamin A and pyridoxine was associated with nephrolithiasis. Further research is needed to identify the roles of these micronutrients in stone-formers and the potential for evaluation and treatment.

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Availability of data and materials

NHANES is a publicly accessible database. The statistical code used in this study is available upon request.

References

  1. Chewcharat A, Curhan G (2021) Trends in the prevalence of kidney stones in the United States from 2007 to 2016. Urolithiasis 49(1):27–39. https://doi.org/10.1007/s00240-020-01210-w

    Article  CAS  PubMed  Google Scholar 

  2. Shin S, Srivastava A, Alli NA, Bandyopadhyay BC (2018) Confounding risk factors and preventative measures driving nephrolithiasis global makeup. World J Nephrol 7(7):129–142. https://doi.org/10.5527/wjn.v7.i7.129

    Article  PubMed  PubMed Central  Google Scholar 

  3. Pearle MS, Goldfarb DS, Assimos DG et al (2014) Medical management of kidney stones: AUA guideline. J Urol 192(2):316–324. https://doi.org/10.1016/j.juro.2014.05.006

    Article  PubMed  Google Scholar 

  4. Centers for Disease Control and Prevention (CDC). National Center for Health Statistics (NCHS). National Health and Nutrition Examination Survey Data. Hyattsville, MD: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, [2017] https://www.cdc.gov/nchs/nhanes/about_nhanes.htm

  5. Centers for Disease Control and Prevention (CDC). National Center for Health Statistics (NCHS). National Health and Nutrition Examination Survey Questionnaire. Hyattsville, MD: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, [2020] https://wwwn.cdc.gov/Nchs/Nhanes/2017-2018/DR1TOT_J.htm

  6. Dwyer J, Picciano MF, Raiten DJ, Members of the Steering Committee; National Health and Nutrition Examination Survey (2003) Estimation of usual intakes: what we eat in America-NHANES. J Nutr 133(2):609S-S623. https://doi.org/10.1093/jn/133.2.609S

    Article  PubMed  Google Scholar 

  7. U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2020–2025. 9th Edition. December 2020. Available at DietaryGuidelines.gov

  8. Centers for Disease Control and Prevention (CDC). National Center for Health Statistics (NCHS). National Health and Nutrition Examination Survey Questionnaire. Hyattsville, MD: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, [2020]. https://wwwn.cdc.gov/Nchs/Nhanes/2017-2018/BMX_J.htm

  9. Inker LA, Eneanya ND, Coresh J et al (2021) New creatinine- and cystatin C-based equations to estimate GFR without race. N Engl J Med 385(19):1737–1749. https://doi.org/10.1056/NEJMoa2102953

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Laureano GH, Torman VB, Crispim SP, Dekkers AL, Camey SA (2016) Comparison of the ISU, NCI, MSM, and SPADE methods for estimating usual intake: a simulation study of nutrients consumed daily. Nutrients 8(3):166. https://doi.org/10.3390/nu8030166

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Harttig U, Haubrock J, Knüppel S, Boeing H, EFCOVAL Consortium (2011) The MSM program: web-based statistics package for estimating usual dietary intake using the multiple source method. Eur J Clin Nutr 65(Suppl 1):S87–S91. https://doi.org/10.1038/ejcn.2011.92

    Article  PubMed  Google Scholar 

  12. Institute of Medicine (US) Subcommittee on Interpretation and Uses of Dietary Reference Intakes; Institute of Medicine (US) Standing Committee on the Scientific Evaluation of Dietary Reference Intakes. DRI Dietary Reference Intakes: Applications in Dietary Assessment. Washington (DC): National Academies Press (US); 2000. 4, Using the Estimated Average Requirement for Nutrient Assessment of Groups. Available from: https://www.ncbi.nlm.nih.gov/books/NBK222898/

  13. R Development Core Team. R: A language and environment for statistical computing. R Foundation for Statistical Computing, 2010

  14. Reider CA, Chung RY, Devarshi PP, Grant RW, Hazels Mitmesser S (2020) Inadequacy of immune health nutrients: intakes in US adults, the 2005–2016 NHANES. Nutrients 12(6):1735. https://doi.org/10.3390/nu12061735

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Abufaraj M, Xu T, Cao C et al (2021) Prevalence and trends in kidney stone among adults in the USA: analyses of National Health and Nutrition Examination Survey 2007–2018 data. Eur Urol Focus 7(6):1468–1475. https://doi.org/10.1016/j.euf.2020.08.011

    Article  PubMed  Google Scholar 

  16. Kancha RK, Anasuya A (1992) Contribution of vitamin A deficiency to calculogenic risk factors of urine: studies in children. Biochem Med Metab Biol 47(1):1–9. https://doi.org/10.1016/0885-4505(92)90002-g

    Article  CAS  PubMed  Google Scholar 

  17. Bardaoui M, Sakly R, Neffati F, Najjar MF, El Hani A (2010) Effect of vitamin A supplemented diet on calcium oxalate renal stone formation in rats. Exp Toxicol Pathol 62(5):573–576. https://doi.org/10.1016/j.etp.2009.08.005

    Article  CAS  PubMed  Google Scholar 

  18. Grases F, Garcia-Gonzalez R, Genestar C, Torres JJ, March JG (1998) Vitamin A and urolithiasis. Clin Chim Acta 269(2):147–157. https://doi.org/10.1016/s0009-8981(97)00198-8

    Article  CAS  PubMed  Google Scholar 

  19. Sakly R, Fekih M, Ben Amor A, Najjar MF, Mbazaa M (2003) Rôle possible de la carence en vitamines A et E dans les lithiases idiopathiques chez l’homme [Possible role of vitamin A and E deficiency in human idiopathic lithiasis]. Ann Urol (Paris) 37(4):217–219. https://doi.org/10.1016/s0003-4401(03)00074-3

    Article  CAS  PubMed  Google Scholar 

  20. Ferraro PM, Taylor EN, Gambaro G, Curhan GC (2018) Vitamin B6 intake and the risk of incident kidney stones. Urolithiasis 46(3):265–270. https://doi.org/10.1007/s00240-017-0999-5

    Article  CAS  PubMed  Google Scholar 

  21. Mitwalli A, Ayiomamitis A, Grass L, Oreopoulos DG (1988) Control of hyperoxaluria with large doses of pyridoxine in patients with kidney stones. Int Urol Nephrol 20(4):353–359. https://doi.org/10.1007/BF02549567

    Article  CAS  PubMed  Google Scholar 

  22. Jaeger P, Portmann L, Jacquet AF, Burckhardt P (1986) La pyridoxine peut normaliser l’oxalurie dans la lithiase rénale idiopathique [Pyridoxine can normalize oxaluria in idiopathic renal lithiasis]. Schweiz Med Wochenschr 116(50):1783–1786

    CAS  PubMed  Google Scholar 

  23. Tarplin S, Ganesan V, Monga M (2015) Stone formation and management after bariatric surgery. Nat Rev Urol 12(5):263–270. https://doi.org/10.1038/nrurol.2015.67

    Article  CAS  PubMed  Google Scholar 

  24. Curhan GC, Willett WC, Speizer FE, Stampfer MJ (1999) Intake of vitamins B6 and C and the risk of kidney stones in women. J Am Soc Nephrol 10(4):840–845. https://doi.org/10.1681/ASN.V104840

    Article  CAS  PubMed  Google Scholar 

  25. Curhan GC, Willett WC, Rimm EB, Stampfer MJ (1996) A prospective study of the intake of vitamins C and B6, and the risk of kidney stones in men. J Urol 155(6):1847–1851

    Article  CAS  PubMed  Google Scholar 

  26. Gupta M, Gallante B, Bamberger JN et al (2021) Prospective randomized evaluation of idiopathic hyperoxaluria treatments. J Endourol 35(12):1844–1851. https://doi.org/10.1089/end.2021.0122

    Article  PubMed  Google Scholar 

  27. Bird JK, Murphy RA, Ciappio ED, McBurney MI (2017) Risk of deficiency in multiple concurrent micronutrients in children and adults in the United States. Nutrients 9(7):655. https://doi.org/10.3390/nu9070655

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

We would like to thank Jimmy Duong for providing statistical advice for this study.

Funding

The authors have no relevant financial or non-financial interests to disclose.

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Authors and Affiliations

  1. Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA

    Amro A. Harb

  2. Department of Urology, Columbia University Irving Medical Center, 161 Fort Washington Avenue, 11th Floor, New York, NY, 10032, USA

    David S. Han, Justin A. Lee, Michael L. Schulster & Ojas Shah

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Contributions

AAH: conceptualization, methodology, software, formal analysis, data curation, writing—original draft, writing—review and editing, visualization. DSH: conceptualization, methodology, writing—original draft, writing—review and editing. JAL: conceptualization, methodology, writing—original draft, writing—review and editing. MLS: conceptualization, methodology, writing—review and editing, supervision, and project administration. OS: conceptualization, methodology, writing—review and editing, supervision, and project administration.

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Correspondence to Ojas Shah.

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Since this study used a public, deidentified dataset, Institutional Review Board approval was not required.

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Harb, A.A., Han, D.S., Lee, J.A. et al. Micronutrient inadequacy and urinary stone disease: an analysis of the National Health and Nutrition Examination Survey 2007–2018. Urolithiasis 51, 59 (2023). https://doi.org/10.1007/s00240-023-01432-8

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