Chronic Kidney Disease Nutrition & Education Specialist, Section of Nephrology, University of Chicago Medicine, Chicago, IL.
Senior Scientist, University of Wisconsin School of Medicine and Public Health, Department of Urology; and Clinical Nutritionist, UW Health University Hospital and Clinics, Madison, WI.
J Ren Nutr. 2023 Jan;33(1):53-58. doi: 10.1053/j.jrn.2022.05.005. Epub 2022 Jun 22.
In susceptible individuals, high dietary acid load may contribute to the formation of certain types of kidney stones via lowering urine pH and citrate excretion. The objective of this study is to determine the contribution of dietary acid from food groups in people with urolithiasis.
Patients with calcium urolithiasis (n = 83) who completed food records were used for this retrospective analysis. Descriptive statistics were calculated for nutrients, potential renal acid load (PRAL), and estimated net endogenous acid production (NEAP). Pearson's correlations were calculated between PRAL and NEAP with each nutrient.
Data from a total of 83 patients were used. Average PRAL was positively correlated with energy (r = 0.260, P = .02), total protein (r = 0.463, P < .001), animal protein (r = 0.555, P < .001), total fat (P = .399, P < .001), sodium (r = 0.385, P < .001), and phosphorus (r = 0.345, P < .001) intake. PRAL was negatively correlated with fiber (r = -0.246, P = .03) intake. NEAP was positively correlated with total protein (r = 0.269, P = .01), animal protein (r = 0.377, P < .001), fat (r = 0.222, P = .04), and sodium (r = 0.250, P = .02) intake. NEAP was negatively correlated with fiber (r = -0.399, P < .001), potassium (r = -0.360, P < .001), and magnesium (r = -0.233, P = .03) intake. For PRAL, meat contributed the highest acid load (52.7%), followed by grains (19.6%) and combination foods (19.6%). Beverages contributed the greatest alkali load (35.1%), followed by vegetables (30.6%) and fruits (28.6%). For NEAP, cheese contributed the highest acid load (21.8%), followed by grains (19.3%) and meat (18.1%).
For individuals with urolithiasis promoted by acidic urine and/or low urine citrate, dietary patterns with a high dietary acid load may contribute to recurrence risk. Meat and grains were the major contributors to dietary acid load in this cohort of patients with a history of kidney stones, whereas beverages, fruits, and vegetables contributed net alkali.
在易患个体中，高膳食酸负荷可能通过降低尿液 pH 值和柠檬酸盐排泄而促成某些类型的肾结石形成。本研究的目的是确定肾结石患者饮食中各食物组的酸负荷来源。
本回顾性分析纳入了完成饮食记录的 83 例钙性尿石症患者。对营养素、潜在肾酸负荷（PRAL）和估计的净内源性酸产生（NEAP）进行描述性统计分析。用 Pearson 相关分析 PRAL 与各营养素之间的关系。
共纳入 83 例患者的数据。平均 PRAL 与能量（r=0.260，P=0.02）、总蛋白（r=0.463，P<0.001）、动物蛋白（r=0.555，P<0.001）、总脂肪（P=0.399，P<0.001）、钠（r=0.385，P<0.001）和磷（r=0.345，P<0.001）摄入呈正相关。PRAL 与纤维（r=-0.246，P=0.03）摄入呈负相关。NEAP 与总蛋白（r=0.269，P=0.01）、动物蛋白（r=0.377，P<0.001）、脂肪（r=0.222，P=0.04）和钠（r=0.250，P=0.02）摄入呈正相关。NEAP 与纤维（r=-0.399，P<0.001）、钾（r=-0.360，P<0.001）和镁（r=-0.233，P=0.03）摄入呈负相关。对于 PRAL，肉贡献了最高的酸负荷（52.7%），其次是谷物（19.6%）和混合食物（19.6%）。饮料贡献了最大的碱负荷（35.1%），其次是蔬菜（30.6%）和水果（28.6%）。对于 NEAP，奶酪贡献了最高的酸负荷（21.8%），其次是谷物（19.3%）和肉（18.1%）。
对于酸性尿和/或低尿柠檬酸盐促进的尿石症患者，高膳食酸负荷的饮食模式可能会增加复发风险。在本队列中，肉类和谷物是肾结石患者饮食酸负荷的主要来源，而饮料、水果和蔬菜则提供净碱。
