Division of Urology, Department of Veterans Affairs Medical Center, and Department of Urology, Urological Research Outcomes Collaboration, University of Washington School of Medicine, Seattle, Washington;
J Am Soc Nephrol. 2014 Feb;25(2):362-9. doi: 10.1681/ASN.2013050548. Epub 2013 Dec 12.
Obesity is a strong risk factor for nephrolithiasis, but the role of physical activity and caloric intake remains poorly understood. We evaluated this relationship in 84,225 women with no history of stones as part of the Women's Health Initiative Observational Study, a longitudinal, prospective cohort of postmenopausal women enrolled from 1993 to 1998 with 8 years' median follow-up. The independent association of physical activity (metabolic equivalents [METs]/wk), calibrated dietary energy intake, and body mass index (BMI) with incident kidney stone development was evaluated after adjustment for nephrolithiasis risk factors. Activity intensity was evaluated in stratified analyses. Compared with the risk in inactive women, the risk of incident stones decreased by 16% in women with the lowest physical activity level (adjusted hazard ratio [aHR], 0.84; 95% confidence interval [95% CI], 0.74 to 0.97). As activity increased, the risk of incident stones continued to decline until plateauing at a decrease of approximately 31% for activity levels ≥10 METs/wk (aHR, 0.69; 95% CI, 0.60 to 0.79). Intensity of activity was not associated with stone formation. As dietary energy intake increased, the risk of incident stones increased by up to 42% (aHR, 1.42; 95% CI, 1.02 to 1.98). However, intake <1800 kcal/d did not protect against stone formation. Higher BMI category was associated with increased risk of incident stones. In summary, physical activity may reduce the risk of incident kidney stones in postmenopausal women independent of caloric intake and BMI, primarily because of the amount of activity rather than exercise intensity. Higher caloric intake further increases the risk of incident stones.
肥胖是肾结石的一个强烈危险因素，但体力活动和热量摄入的作用仍知之甚少。我们在作为妇女健康倡议观察研究一部分的 84225 名无结石病史的女性中评估了这种关系，该研究是一项针对绝经后女性的纵向前瞻性队列研究，于 1993 年至 1998 年招募，中位随访 8 年。在调整肾结石危险因素后，评估了体力活动（代谢当量/周）、校准的膳食能量摄入和体重指数（BMI）与肾结石发生的独立相关性。在分层分析中评估了活动强度。与不活动女性相比，体力活动水平最低的女性发生肾结石的风险降低了 16%（校正后的危险比[aHR]，0.84；95%置信区间[95%CI]，0.74 至 0.97）。随着活动量的增加，肾结石发生的风险继续下降，直到活动量≥10MET/wk 时下降约 31%（aHR，0.69；95%CI，0.60 至 0.79），风险达到平台期。活动强度与结石形成无关。随着膳食能量摄入的增加，肾结石发生的风险增加了高达 42%（aHR，1.42；95%CI，1.02 至 1.98）。然而，摄入<1800kcal/d 并不能预防结石形成。更高的 BMI 类别与肾结石发生风险增加有关。总之，体力活动可能会降低绝经后女性肾结石发生的风险，这与热量摄入和 BMI 无关，主要是因为活动量而不是运动强度。较高的热量摄入会进一步增加肾结石发生的风险。
