U.O.S. Terapia Conservativa della Malattia Renale Cronica, U.O.C. Nefrologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy.
Clin J Am Soc Nephrol. 2022 Jan;17(1):83-89. doi: 10.2215/CJN.09200721. Epub 2021 Nov 19.
Diet is an important contributor to kidney stone formation, but there are limited data regarding long-term changes in dietary factors after a kidney stone.
DESIGN, SETTING, PARTICIPANTS & MEASUREMENTS: We analyzed data from three longitudinal cohorts, the Health Professionals Follow-Up Study and Nurses' Health Study I and II, comparing changes in dietary factors in participants with and without kidney stones during follow-up. The daily intake of dietary calcium, supplemental calcium, animal protein, caffeine, fructose, potassium, sodium, oxalate, phytate, vitamin D, vitamin C, sugar-sweetened beverages, fluids, net endogenous acid production, and Dietary Approaches to Stop Hypertension score were assessed by repeat food frequency questionnaires and computed as absolute differences; a difference-in-differences approach was used to account for temporal changes using data from participants without kidney stones from the same calendar period.
Included were 184,398 participants with no history of kidney stones, 7095 of whom became confirmed stone formers. Several intakes changed significantly over time in stone formers, with some showing a relative increase up to 8 years later, including caffeine (difference in differences, 8.8 mg/d; 95% confidence interval [95% CI], 3.4 to 14.1), potassium (23.4 mg/d; 95% CI, 4.6 to 42.3), phytate (12.1 mg/d; 95% CI, 2.5 to 21.7), sodium (43.1 mg/d; 95% CI, 19.8 to 66.5), and fluids (47.1 ml/d; 95% CI, 22.7 to 71.5). Other dietary factors showed a significant decrease, such as oxalate (-7.3 mg/d; 95% CI, -11.4 to -3.2), vitamin C (-34.2 mg/d; 95% CI, -48.8 to -19.6), and vitamin D (-18.0 IU/d; 95% CI, -27.9 to -8.0). A significant reduction was observed in sugar-sweetened beverages intake of -0.5 (95% CI, -0.8 to -0.3) and -1.4 (95% CI, -1.8 to -1.0) servings per week and supplemental calcium of -105.1 (95% CI, -135.4 to -74.7) and -69.4 (95% CI, -95.4 to -43.4) mg/d for women from Nurses' Health Study I and II, respectively. Animal protein, dietary calcium, fructose intake, Dietary Approaches to Stop Hypertension score, and net endogenous acid production did not change significantly over time.
After the first episode of a kidney stone, mild and inconsistent changes were observed concerning dietary factors associated with kidney stone formation.
饮食是导致肾结石形成的一个重要因素，但有关肾结石发生后饮食因素的长期变化的数据有限。
设计、地点、参与者和测量：我们分析了三个纵向队列（健康专业人员随访研究和护士健康研究 I 和 II）的数据，比较了随访期间肾结石患者和无肾结石患者饮食因素的变化。通过重复食物频率问卷评估膳食钙、补充钙、动物蛋白、咖啡因、果糖、钾、钠、草酸盐、植酸盐、维生素 D、维生素 C、含糖饮料、液体、内源性酸生成和高血压饮食法评分的每日摄入量，并计算为绝对差异；使用同一时期来自无肾结石参与者的数据，采用差异中的差异方法来解释时间变化。
共纳入 184398 名无肾结石病史的参与者，其中 7095 人确诊为肾结石患者。在结石形成者中，一些摄入量随时间发生了显著变化，其中一些在 8 年后仍呈现相对增加，包括咖啡因（差异中的差异，8.8mg/d；95%置信区间[95%CI]，3.4 至 14.1）、钾（23.4mg/d；95%CI，4.6 至 42.3）、植酸盐（12.1mg/d；95%CI，2.5 至 21.7）、钠（43.1mg/d；95%CI，19.8 至 66.5）和液体（47.1ml/d；95%CI，22.7 至 71.5）。其他饮食因素也呈现显著下降，如草酸盐（-7.3mg/d；95%CI，-11.4 至-3.2）、维生素 C（-34.2mg/d；95%CI，-48.8 至-19.6）和维生素 D（-18.0IU/d；95%CI，-27.9 至-8.0）。含糖饮料摄入量每周减少 0.5（95%CI，-0.8 至-0.3）和 1.4（95%CI，-1.8 至-1.0）份，以及女性分别来自护士健康研究 I 和 II 的补充钙摄入量减少 105.1（95%CI，-135.4 至-74.7）和 69.4（95%CI，-95.4 至-43.4）mg/d，这两种情况都具有统计学意义。动物蛋白、膳食钙、果糖摄入量、高血压饮食法评分和内源性酸生成在随访期间没有发生显著变化。
肾结石首次发作后，与肾结石形成相关的饮食因素发生了轻微且不一致的变化。
