Diet and risk of kidney stones in the Oxford cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC)

Abstract

The lifetime prevalence of kidney stones is around 10 % and incidence rates are increasing. Diet may be an important determinant of kidney stone development. Our objective was to investigate the association between diet and kidney stone risk in a population with a wide range of diets. This association was examined among 51,336 participants in the Oxford arm of the European Prospective Investigation into Cancer and Nutrition using data from Hospital Episode Statistics in England and Scottish Morbidity Records. In the cohort, 303 participants attended hospital with a new kidney stone episode. Cox proportional hazards regression was performed to calculate hazard ratios (HR) and their 95 % confidence intervals (95 % CI). Compared to those with high intake of meat (>100 g/day), the HR estimates for moderate meat-eaters (50–99 g/day), low meat-eaters (<50 g/day), fish-eaters and vegetarians were 0.80 (95 % CI 0.57–1.11), 0.52 (95 % CI 0.35–0.8), 0.73 (95 % CI 0.48–1.11) and 0.69 (95 % CI 0.48–0.98), respectively. High intakes of fresh fruit, fibre from wholegrain cereals and magnesium were also associated with a lower risk of kidney stone formation. A high intake of zinc was associated with a higher risk. In conclusion, vegetarians have a lower risk of developing kidney stones compared with those who eat a high meat diet. This information may be important to advise the public about prevention of kidney stone formation.

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References

  1. 1.

    Boyce C, Pickhardt P, Lawrence E, Kim D, Bruce R. Prevalence of urolithiasis in asymptomatic adults: objective determination using low dose noncontrast computerized tomography. J Urol. 2010;183(3):1017–21.

    PubMed  Article  Google Scholar 

  2. 2.

    Stamatelou K, Francis M, Jones C, Nyberg L, Curhan G. Time trends in reported prevalence of kidney stones in the United States: 1976–1994. Kidney Int. 2003;63(5):1817–23.

    PubMed  Article  Google Scholar 

  3. 3.

    Akoudad S, Szklo M, McAdams M, Fulop T, Anderson C, Coresh J, et al. Correlates of kidney stone disease differ by race in a multi-ethnic middle-aged population: The ARIC study. Prev Med. 2010;51(5):416–20.

    Google Scholar 

  4. 4.

    http://www.hesonline.nhs.uk.

  5. 5.

    Romero V, Akpinar H, Assimos D. Kidney stones: a global picture of prevalence, incidence, and associated risk factors. Rev Urol. 2010;12(2–3):e86–96.

    PubMed Central  PubMed  Google Scholar 

  6. 6.

    Turney BW, Reynard JM, Noble JG, Keoghane SR. Trends in urological stone disease. BJU Int. 2012;109(7):1082–7.

    Google Scholar 

  7. 7.

    Borghi L, Meschi T, Amato F, Briganti A, Novarini A, Giannini A. Urinary volume, water and recurrences in idiopathic calcium nephrolithiasis: a 5-year randomized prospective study. J Urol. 1996;155(3):839–43.

    CAS  PubMed  Article  Google Scholar 

  8. 8.

    Taylor E, Stampfer M, Curhan G. Obesity, weight gain, and the risk of kidney stones. JAMA. 2005;293(4):455–62.

    CAS  PubMed  Article  Google Scholar 

  9. 9.

    Taylor E, Fung T, Curhan G. DASH-style diet associates with reduced risk for kidney stones. J Am Soc Nephrol. 2009;20(10):2253–9.

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  10. 10.

    Asplin J. Obesity and urolithiasis. Adv Chronic Kidney Dis. 2009;16(1):11–20.

    PubMed  Article  Google Scholar 

  11. 11.

    Saigal C, Joyce G, Timilsina A, Project UDiA. Direct and indirect costs of nephrolithiasis in an employed population: opportunity for disease management? Kidney Int. 2005;68(4):1808–14.

    PubMed  Article  Google Scholar 

  12. 12.

    Worcester E, Coe F. Clinical practice. Calcium kidney stones. N Engl J Med. 2010;363(10):954–63.

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  13. 13.

    Davey GK, Spencer EA, Appleby PN, Allen NE, Knox KH, Key TJ. EPIC-Oxford: lifestyle characteristics and nutrient intakes in a cohort of 33 883 meat-eaters and 31 546 non meat-eaters in the UK. Public Health Nutr. 2003;6(3):259–69.

    PubMed  Article  Google Scholar 

  14. 14.

    Bingham SA, Gill C, Welch A, Day K, Cassidy A, Khaw KT, et al. Comparison of dietary assessment methods in nutritional epidemiology: weighed records v. 24 h recalls, food-frequency questionnaires and estimated-diet records. Br J Nutr. 1994;72(4):619–43.

    CAS  PubMed  Article  Google Scholar 

  15. 15.

    Spencer EA, Appleby PN, Davey GK, Key TJ. Validity of self-reported height and weight in 4808 EPIC-Oxford participants. Public Health Nutr. 2002;5(4):561–5.

    PubMed  Article  Google Scholar 

  16. 16.

    Nguyen Q, Kälin A, Drouve U, Casez J, Jaeger P. Sensitivity to meat protein intake and hyperoxaluria in idiopathic calcium stone formers. Kidney Int. 2001;59(6):2273–81.

    CAS  PubMed  Article  Google Scholar 

  17. 17.

    Kok D, Iestra J, Doorenbos C, Papapoulos S. The effects of dietary excesses in animal protein and in sodium on the composition and the crystallization kinetics of calcium oxalate monohydrate in urines of healthy men. J Clin Endocrinol Metab. 1990;71(4):861–7.

    CAS  PubMed  Article  Google Scholar 

  18. 18.

    Breslau N, Brinkley L, Hill K, Pak C. Relationship of animal protein-rich diet to kidney stone formation and calcium metabolism. J Clin Endocrinol Metab. 1988;66(1):140–6.

    CAS  PubMed  Article  Google Scholar 

  19. 19.

    Curhan G, Willett W, Rimm E, Stampfer M. A prospective study of dietary calcium and other nutrients and the risk of symptomatic kidney stones. N Engl J Med. 1993;328(12):833–8.

    CAS  PubMed  Article  Google Scholar 

  20. 20.

    Curhan GC, Willett WC, Speizer FE, Spiegelman D, Stampfer MJ. Comparison of dietary calcium with supplemental calcium and other nutrients as factors affecting the risk for kidney stones in women. Ann Intern Med. 1997;126(7):497–504.

    CAS  PubMed  Article  Google Scholar 

  21. 21.

    Curhan G, Willett W, Knight E, Stampfer M. Dietary factors and the risk of incident kidney stones in younger women: Nurses’ Health Study II. Arch Intern Med. 2004;164(8):885–91.

    PubMed  Article  Google Scholar 

  22. 22.

    Hess B, Michel R, Takkinen R, Ackermann D, Jaeger P. Risk factors for low urinary citrate in calcium nephrolithiasis: low vegetable fibre intake and low urine volume to be added to the list. Nephrol Dial Transpl. 1994;9(6):642–9.

    CAS  Google Scholar 

  23. 23.

    Jahnen A, Heynck H, Gertz B, Classen A, Hesse A. Dietary fibre: the effectiveness of a high bran intake in reducing renal calcium excretion. Urol Res. 1992;20(1):3–6.

    CAS  PubMed  Article  Google Scholar 

  24. 24.

    Meschi T, Maggiore U, Fiaccadori E, Schianchi T, Bosi S, Adorni G, et al. The effect of fruits and vegetables on urinary stone risk factors. Kidney Int. 2004;66(6):2402–10.

    CAS  PubMed  Article  Google Scholar 

  25. 25.

    Siener R, Schade N, Nicolay C, von Unruh G, Hesse A. The efficacy of dietary intervention on urinary risk factors for stone formation in recurrent calcium oxalate stone patients. J Urol. 2005;173(5):1601–5.

    CAS  PubMed  Article  Google Scholar 

  26. 26.

    Li MK, Blacklock NJ, Garside J. Effects of magnesium on calcium oxalate crystallization. J Urol. 1985;133(1):123–5.

    CAS  PubMed  Google Scholar 

  27. 27.

    Liebman M, Costa G. Effects of calcium and magnesium on urinary oxalate excretion after oxalate loads. J Urol. 2000;163(5):1565–9.

    CAS  PubMed  Article  Google Scholar 

  28. 28.

    Tang J, McFann K, Chonchol M. Dietary zinc intake and kidney stone formation: evaluation of NHANES III. Am J Nephrol. 2012;36(6):549–53.

    PubMed  Article  Google Scholar 

  29. 29.

    Trinchieri A, Mandressi A, Luongo P, Rovera F, Longo G. Urinary excretion of citrate, glycosaminoglycans, magnesium and zinc in relation to age and sex in normal subjects and in patients who form calcium stones. Scand J Urol Nephrol. 1992;26(4):379–86.

    CAS  PubMed  Article  Google Scholar 

  30. 30.

    Carpentier X, Bazin D, Combes C, Mazouyes A, Rouzière S, Albouy PA, et al. High Zn content of Randall’s plaque: a μ-X-ray fluorescence investigation. J Trace Elem Med Biol. 2011;25(3):160–5.

    CAS  PubMed  Article  Google Scholar 

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Acknowledgments

EPIC-Oxford is supported by Cancer Research UK (formerly the Imperial Cancer Research Fund), the Medical Research Council and the European Commission. BT was supported by the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre based at Oxford University Hospitals NHS Trust and University of Oxford. None of these funding sources contributed directly to this study.

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None.

Ethical standard

EPIC-Oxford is registered under the Data Protection Act, has ethical approval from Scotland A Research Ethics Committee (MREC/02/0/90), and has approval for the collection of clinical and pathological NHS data from National Information Governance Board under Sect. 251 (PIAG3-09(e)/2003 and PIAG 1-05(d)/2008).

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Correspondence to Benjamin W. Turney.

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Turney, B.W., Appleby, P.N., Reynard, J.M. et al. Diet and risk of kidney stones in the Oxford cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC). Eur J Epidemiol 29, 363–369 (2014). https://doi.org/10.1007/s10654-014-9904-5

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Keywords

  • Diet
  • Kidney stones
  • Urolithiasis
  • Risk
  • Vegetarian
  • Obesity
  • Meat