Abstract
There is evidence that obese patients have an increased risk of renal stone formation, although this relationship could be less evident in some populations. The aim of this study was to evaluate the impact of overweight and obesity on the risk of renal stone formation in a population consuming a Mediterranean diet and to better elucidate the mechanisms underlying the increased risk of urolithiasis observed in obese subjects. We performed a retrospective review of 1698 stone forming patients (mean age 45.9 ± 14.6 years; 984/714 M/F), attending outpatient stone clinics in Milan and Florence, seen between January 1986 and June 2014. Records were reviewed and data collected pertaining to age, gender, weight, height, stone composition, association with diabetes type 2 or gout and metabolic profile of 24-h urine to perform a descriptive study. We estimated prevalence ratios for body mass index (BMI) categories (underweight: BMI <18.5, normal: BMI 18.5–24.9, overweight: BMI 25–29.9 and obese ≥30). Overweight and obesity were present in 40.7 and 8 % of the men and in 19.9 and 8.7 % of the women in the study population. The mean BMI of patients with urolithiasis was found to be 24.5 ± 7.5 kg/m2. BMI values were positively correlated with age (p = 0.000) and mean BMI was higher in males than in females (25.5 ± 8.9 vs 23.2 ± 4.4 kg/m2). In males, rates of overweight and obesity in renal stone formers were higher than the rates reported in the Italian general population in 2004 only for the age group 25–44 years, whereas males in all the other age groups and in females the rates of overweight and obesity in renal stone formers were similar to rates reported in the Italian general population. The rates of overweight and obesity were significantly different in patients with different chemical stone composition. In particular, patients with uric acid stones have rates of overweight and obesity higher than patients with calcium stones or other types of calculi. Also the rates of type 2 diabetes and gout were greater in patients with overweight and obesity. In overweight and obese patients, the urinary excretion of risk factors for stone formation, such as calcium, oxalate and urate, and also of inhibitory substances, such as citrate, were significantly higher than in patients with normal weight or underweight. The prevalence of overweight and obesity in patients with urinary calculi from a country consuming a Mediterranean diet is not higher than in the general population. It should be taken into account that not all the dietary patterns that are associated with obesity may involve a parallel increase in the risk of forming kidney stones and that epidemiological findings from one country could not be confirmed in other countries with different climatic, socioeconomic and cultural features.
Similar content being viewed by others
References
Curhan GC, Willett WC, Rimm EB, Speizer FE, Stampfer MJ (1998) Body size and risk of kidney stones. J Am Soc Nephrol 9:1645–1652
Asplin JR (2009) Obesity and urolithiasis. Adv Chronic Kidney Dis 16:11–20
Abu Ghazaleh LA, Budair Z (2013) The relation between stone disease and obesity in Jordan. Saudi J Kidney Dis Transpl 24:610–614
Sáenz J, Páez A, Alarcón RO, Casas JM, Sánchez A, Pereira E, Cáncer E, Alvarez M, Rendón D, Durán M (2012) Obesity as risk factor for lithiasic recurrence. Actas Urol Esp 36:228–233
Siener R, Glatz S, Nicolay C, Hesse A (2004) The role of overweight and obesity in calcium oxalate stone formation. Obes Res 12:106–113
Negri AL, Spivacow FR, Del Valle EE, Forrester M, Rosende G, Pinduli I (2008) Role of overweight and obesity on the urinary excretion of promoters and inhibitors of stone formation in stone formers. Urol Res 36:303–307
Nishio S, Yokoyama M, Iwata H, Takeuchi M, Kamei O, Sugamoto T, Seike Y, Ochi K, Kin M, Aoki K, Nabeshima S, Takeda H, Takei S (1998) Obesity as one of the risk factors for urolithiasis. Nihon Hinyokika Gakkai Zasshi 89:573–580
Daudon M, Lacour B, Jungers P (2006) Influence of body size on urinary stone composition in men and women. Urol Res 34:193–199
Taylor EN, Stampfer MJ, Curhan GC (2005) Obesity, weight gain, and the risk of kidney stones. JAMA 293:455–462
Gallus S, Colombo P, Scarpino V, Zuccaro P, Negri E, Apolone G (2006) La Vecchia C Overweight and obesity in Italian adults 2004, and an overview of trends since 1983. Eur J Clin Nutr 60:1174–1179
Austin GL, Ogden LG, Hill JO (2011) Trends in carbohydrate, fat, and protein intakes and association with energy intake in normal-weight, overweight, and obese individuals: 1971–2006. Am J Clin Nutr 93:836–843
Gallus S, Lugo A, Murisic B, Bosetti C, Boffetta P, La Vecchia C (2015) Overweight and obesity in 16 European countries. Eur J Nutr 54:679–689
Gallus S, Odone A, Lugo A, Bosetti C, Colombo P, Zuccaro P, La Vecchia C (2013) Overweight and obesity prevalence and determinants in Italy: an update to 2010. Eur J Nutr 52:677–685
Clark JM, Brancati FL (2000) The challenge of obesity-related chronic diseases. J Gen Intern Med 15:828–829
Taylor EN, Curhan GC (2006) Bidy size and 24-hour urine composition. Am J Kidney Dis 48:905–915
Pigna F, Sakhaee K, Adams-Huet B, Maalouf NM (2014) Body fat content and distribution and urinary risk factors for nephrolithiasis. Clin J Am Soc Nephrol. 9:159–165
Maalouf NM, Sakhae K, Parks JH, Coe FL, Adams-Huet B, Pak CYC (2004) Association of urinary pH with body weight in nephrolithiasis. Kidney Int 65:1422–1425
Kadlec AO, Greco K, Fridirici ZC, Hart ST, Vellos T, Turk TM (2012) Metabolic syndrome and urinary stone composition: what factors matter most? Urology 80:805–810
Hsiao PY, Jensen GL, Hartman TJ, Mitchell DC, Nickols-Richardson SM, Coffman DL (2011) Food intake patterns and body mass index in older adults: a review of the epidemiological evidence. J Nutr Gerontol Geriatr. 30:204–224
Togo P, Osler M, Sørensen TI, Heitmann BL (2001) Food intake patterns and body mass index in observational studies. Int J Obes Relat Metab Disord 25:1741–1751
Trinchieri A, Maletta A, Lizzano R, Marchesotti F (2013) Potential renal acid load and the risk of renal stone formation in a case-control study. Eur J Clin Nutr 67:1077–1080
Trinchieri A, Lizzano R, Marchesotti F, Zanetti G (2006) Effect of potential renal acid load of foods on urinary citrate excretion in calcium renal stone formers. Urol Res 34:1–7
Taylor EN, Fung TT, Curhan GC (2009) DASH-Style diet associates with reduced risk for kidney stones. J Am Soc Nephrol 20:2253–2259
Taylor EN, Stampfer MJ, Mount DB, Curhan GC (2010) DASH-style diet and 24-hour urine composition. Clin J Am Soc Nephrol. 5:2315–2322
Noori N, Honarkar E, Goldfarb DS, Kalantar-Zadeh K, Taheri M, Shakhssalim N, Parvin M, Basiri A (2014) Urinary lithogenic risk profile in recurrent stone formers with hyperoxaluria: a randomized controlled trial comparing DASH (Dietary Approaches to Stop Hypertension)-style and low-oxalate diets. Am J Kidney Dis 63:456–463
Fidanza F (1980) Changing patterns of food consumption in Italy. Am Diet Assoc 77:133–137
Alberti-Fidanza A, Fidanza F, Chiuchiu MP, Verducci G, Fruttini D (1999) Dietary studies on two rural italian population groups of the seven countries study. 3. Trend of food and nutrient intake from 1960 to 1991. Eur J Clin Nutr 1999(53):854–860
Ferro-Luzzi A, Branca F (1995) Mediterranean diet, Italian-style: prototype of a healthy diet. Am J Clin Nutr 61:1338S–1345S
Sofi F, Vecchio S, Giuliani G, Martinelli F, Marcucci R, Gori AM et al (2005) Dietary habits, lifestyle and cardiovascular risk factors in a clinically healthy Italian population: the ‘Florence’ diet is not Mediterranean. Eur J Clin Nutr 59:584
Silventoinen K, Sans S, Tolonen H, Monterde D, Kuulasmaa K, Kesteloot H, Tuomilehto J (2004) Trends in obesity and energy supply in the WHO MONICA Project. Int J Obes Relat Metab Disord 28:710–718
Pelucchi C, Galeone C, Negri E, La Vecchia C (2010) Trends in adherence to the Mediterranean diet in an Italian population between 1991 and 2006. Eur J Clin Nutr 64:1052–1056
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
The authors declare that they have no conflict of interest.
Rights and permissions
About this article
Cite this article
Trinchieri, A., Croppi, E. & Montanari, E. Obesity and urolithiasis: evidence of regional influences. Urolithiasis 45, 271–278 (2017). https://doi.org/10.1007/s00240-016-0908-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00240-016-0908-3