Dietary pattern analysis among stone formers: resemblance to a DASH-style diet

Rodrigues, Fernanda Guedes; Lima, Thalita Melo; Zambrano, Lysien; Heilberg, Ita Pfeferman

doi:10.1590/2175-8239-JBN-2019-0183

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Brazilian Journal of Nephrology

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Original Article • J. Bras. Nefrol. 42 (3) • Jul-Sep 2020 • https://doi.org/10.1590/2175-8239-JBN-2019-0183 copy

Dietary pattern analysis among stone formers: resemblance to a DASH-style diet

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Recent epidemiological studies have shown that dietary patterns may have a more persistent impact on the risk of stone formation than single nutrients of the diet. Dietary Approaches to Stop Hypertension (DASH), a low-sodium and fruits/vegetables-rich diet, has been associated with a lower risk of nephrolithiasis, due to altered urinary biochemistry. This observational study aimed to investigate whether the dietary pattern of stone formers (SF) resembled a DASH-diet and its influence on urinary lithogenic parameters. Anthropometric data, fasting serum sample, 24-h urine samples, and a 3-day food intake record under an unrestricted diet were obtained from 222 SF and compared with 136 non-SF subjects (controls). The DASH-diet food portions were determined from the food records whereas intakes of sodium chloride (NaCl) and protein (protein equivalent of nitrogen appearance, PNA) were estimated from 24-hr urinary sodium and urea. A dietary profile close to a DASH-diet was not observed in any of the groups. NaCl intake and PNA were significantly higher in SF versus non-SF (12.0 ± 5.2 v.s. 10.1 ± 3.4 g/day, p = 0.01 and 1.8 ± 0.1 v.s. 1.4 ± 0.1 g/kg/day, p = 0.03). SF exhibited a positive correlation of NaCl intake and PNA with urinary calcium, oxalate and uric acid, and of PNA with urinary sodium. SF consumed more vegetables and legumes, but less fruits and low-fat dairy items than non-SF. The present series presented a dietary profile characterized by low calcium and high salt and protein contents, not reflecting an ideal DASH-style diet pattern.

Keywords:
Nephrolithiasis; Diet; Nutritional Status; DASH Diet; Obesity

	Non-SF n = 136	SF n = 222	p
Male/Female [n (%)]	43 (31.6)/93 (68.4)	104 (46.8)/118 (53.2)	0.004
Age	36.0 ± 12.5	41.7 ± 12.5	< 0.001
BMI (kg/m²)	25.8 ± 4.9	28.3 ± 5.8	< 0.001
Eutrophic [n (%)]	67 (49.3%)	69 (31.1%)	0.54
Overweight [n (%)]	42 (30.9%)	80 (36.0%)	< 0.001
Obese [n (%)]	27 (19.9%)	67 (30.2%)	0.03
WC (cm)	89.7 ±14.0	96.5 ± 14.2	0.012
Diabetes [n (%)]	5 (3.7%)	26 (11.7%)	0.006
Hypertension [n (%)]	10 (7.4%)	57 (25.7%)	< 0.001
Serum
Fasting glucose (mg/dL)	81.7 ± 9.9	96.6 ± 24.7	< 0.001
Urea (mg/dL)	28.4 (23.0 - 34.5)	29.9 (24.0 - 34.7)	0.22
Creatinine (mg/dL)	0.8 (0.6 - 0.9)	0.9 (0.7 - 1.0)	0.07
Uric acid (mg/dL)	4.9 (4.0 - 5.8)	5.2 (4.0 - 6.3)	0.38
Potassium (mg/dL)	4.5 (4.2 - 4.7)	4.3 (4.1 - 4.5)	0.02
Phosphorus (mg/dL)	3.4 (2.9 - 3.7)	3.3 (2.9 - 3.7)	0.50
Total cholesterol (mg/dL)	183 (156 - 209)	198 (166 - 224)	0.16
LDL cholesterol (mg/dL)	105 (80 - 126)	114 (91 - 138)	0.07
HDL cholesterol (mg/dL)	53.2 ± 12.8	52.2 ± 23.0	0.69
Triglycerides (mg/dL)	116 ± 88.0	159 ± 93.1	0.01
Urine
Volume (mL)	1478 ± 691	1937 ± 763	< 0.001
Calcium (mg/24h)	158 ± 88	216 ± 118	0.01
Sodium (mEq/24h)	172 ± 62	206 ± 89	0.04
Potassium (mEq/24h)	49.0 (33.7 - 60.7)	50.0 (39.5 - 63.5)	0.57
Magnesium (mg/24h)	98.2 ± 78.7	87.5 ± 38.0	0.23
Citrate (mg/24h)	765 ± 578	449 ± 254	< 0.001
Oxalate (mg/24h)	20.2 ± 7.4	23.9 ± 10.4	0.02
Uric acid (mg/24h)	551 (430 - 665)	585 (438 - 726)	0.31
Phosphorus (mg/24h)	741 (498 - 923)	821 (598 - 1052)	0.58
Urea (g/24h)	18.4 (14.4 - 24.2)	20.7 (16.1 - 24.8)	0.15
Creatinine (mg/24h)	1379 (1108 - 1801)	1478 (1174 - 1892)	0.36
pH	6.2 (5.6 - 6.6)	6.1 (5.7 - 6.5)	0.15

Urinary parameters	Non-SF		SF
	BMI	WC	BMI	WC
	r	r	r	r
Urea (mg/24hs)	0.30	0.54^* * p < 0.05.	0.35^† † p < 0.001;	0.38^† † p < 0.001;
Creatinine (mg/24hs)	0.07	0.39^* * p < 0.05.	0.39^† † p < 0.001;	0.39^† † p < 0.001;
Uric acid (mg/24hs)	0.36	0.42^* * p < 0.05.	0.49^† † p < 0.001;	0.45^† † p < 0.001;
Calcium (mg/24hs)	0.21	0.37^* * p < 0.05.	0.14	0.18^* * p < 0.05.
Citrate (mg/24hs)	0.22	0.43^* * p < 0.05.	-0.01	-0.04
Sodium (mEq/24hs)	0.02	0.16	0.43^† † p < 0.001;	0.39^† † p < 0.001;
Oxalate (mg/24hs)	0.04	0.11	0.31^* * p < 0.05.	0.31^* * p < 0.05.
pH	0.10	-0.08	-0.07	-0.15^* * p < 0.05.

		Non-SF	SF	p
PNA (g/kg)		1.4 ± 0.1	1.8 ± 0.1	0.03
Lipids (% energy)		29.9 ± 9.2	25.4 ± 11.5	< 0.001
Carbohydrate (% energy)		49.6 ± 9.3	50.7 ± 8.8	0.52
Fiber (g)		17.1 ± 7.9	20.1 ± 11.2	0.02
Calcium (mg)		596 ± 292	492 ± 266	0.001
animal (mg)		437 ± 275	330 ± 227	< 0.001
vegetable (mg)		158 ± 72.0	161 ± 99.6	0.84
Phosphorus (mg)		1000 ± 33.5	961 ± 26.5	0.09
animal (mg)		632 ± 270	590 ± 350	0.18
vegetable (mg)		378 ± 171	364 ± 159	0.44
Oxalate (mg)		47.9 ± 5.5	56.2 ± 4.4	0.51
Potassium (mEq)		52.8 ± 18.7	51.3 ± 21.0	0.32
Magnesium (mg)		205 ± 71.0	195 ± 72.1	0.44
Vitamin C (mg)		61.5 ± 69.3	77.3 ± 79.6	0.48
NaCl (g)		10.1 ± 3.4	12.0 ± 5.2	0.01
DASH-style food groups	Recommended Servings
Refined grains^a	6 - 8	7.3 ± 2.4	7.8 ± 3.1	0.09
Whole grains^a	ND	0.3 ± 0.7	0.3 ± 0.8	0.50
Vegetables^a	4 - 5	1.4 ± 1.3	1.6 ± 1.4	0.03
Fruits^a	4 - 5	1.4 ± 1.3	1.3 ± 1.5	0.02
Low-fat dairy^a	2 - 3	0.6 ± 0.9	0.3 ± 0.7	< 0.001
Lean meats (red, poultry and fish) and eggs^a	< 2	1.5 ± 0.8	1.5 ± 0.9	0.52
Nuts, seeds and legumes^b	4 - 5	8.1 ± 7.3	12.3 ± 10.3	< 0.001
Fats and oils^a	2 - 3	2.2 ± 1.0	2.5 ± 1.2	0.008
Sweets and added sugar^b	< 5	24.7 ± 18.2	20.4 ± 14.6	< 0.001
Sodium (mg)^a	2300	2810 ± 136	4110 ± 290	0.02

Food groups servings	Calcium	Oxalate	Sodium	Citrate	Uric Acid	Potassium
Refined grains	0.08	0.29^* * p < 0.05.	0.17^* * p < 0.05.	0.05	0.16^* * p < 0.05.	-0.04
Whole grains	0.07	-0.05	-0.04	0.07	0.01	-0.00
Vegetables	0.03	0.16	0.08	-0.00	-0.04	0.19^* * p < 0.05.
Fruits	-0.03	0.09	-0.09	0.13^* * p < 0.05.	-0.02	0.06
Low-fat dairy	0.01	-0.20^* * p < 0.05.	-0.18^* * p < 0.05.	-0.21^* * p < 0.05.	-0.06	0.12
Lean meats and eggs	0.09	0.19^* * p < 0.05.	0.13^* * p < 0.05.	0.11	0.31^† † p < 0.001;	0.12
Nuts, seeds and legumes	0.10	0.36^* * p < 0.05.	0.26^† † p < 0.001;	0.17	0.18^* * p < 0.05.	0.20^* * p < 0.05.
Fats and oils	-0.01	0.09	0.08	005	-0.03	-0.04
Sweets and added sugar	-0.05	-0.12	-0.03	0.03	-0.03	-0.12

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[1] Correspondence to: Ita Pfeferman Heilberg. E-mail: ita.heilberg@gmail.com