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The association between dietary intakes and stone formation in patients with urinary stones in Shiraz

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Co 1. 2. 3.

4. 5. 6.

7.

Med

Med

_______________ orresponding autho

Student Research Shiraz University o Student Research Jundishapur Unive Research Center f School of Nutritio Sciences, Shiraz, Ir Department of N Jundishapur Unive Department of Su Medical Sciences,

Nutrition Research

Iran

Department of Bio University of Medi

The asso

in patien

Hadi Bazyar1,2 Mohammad H

Received: 20 D

Abstract

Background evaluate the ass Methods: In information wa (using food fre sample t test respectively. C Pearson test. Results: Out were male, wi beverages (p=0 of high-purine intake of vitam than in those w stones (p=0.01) 0.26) and Conclusion: purine, fructose effective in the

Keywords: Ur

Conflicts of Interes Funding:Student R

*This work has bee

Copyright© Iran

Cite this articl intakes and stone

Introducti

Kidney ston

dical Journa

J Islam Repub Ir

________________ or: Dr Afsane Ahmad

Committee, Schoo of Medical Sciences, Committee, Schoo

ersity of Medical Sci for Health Sciences on and Food Scien ran

Nutrition, School o ersity of Medical Sci urgery, Shaheed Fa

Shiraz, Iran

h Center, Shiraz Uni ostatistics, School o ical Sciences, Ahvaz

ociation b

nts with

2

, Afsane Ahm Hossein Hagh

Dec 2017

d: Kidney stone sociation betwe n this cross sect as collected, an equency questio and one-way A Chi square test w

t of 110 particip ith the mean B 0.03) was signif foods was sign min A (p=0.02), with uric acid st ). There was a -fructose (p=0.0

There was a e, and oxalate a e treatment of k

rinary stones, N

st: None declared Research Committe

en published under

University of Medi

le as:Bazyar H e formation in pat

on

ne is a commo

al of the Islam

ran. 2019(20 Feb

_

di, ahmadi.afsane@

ol of Nutrition and , Shiraz, Iran

ol of Allied Medical

iences, Ahvaz, Iran s, Department of C nces, Shiraz Unive of Allied Medical iences, Ahvaz, Iran ghihi Hospital, Shir iversity of Medical of Public Health, Ah z, Iran

between

urinary s

madi*3, Ahmad ighizadeh7

Published: 2

e is a common een dietary inta tional study, 11 nd anthropomet onnaire, analyze ANOVA were was also used t

pants in this stu BMI of 24.21±

ficantly greater nificantly highe , beta-carotene tones, while caf significant corr 048, correlation significant rela and formation o idney stones.

Nutritional facto

ee of Shiraz Universi

rCC BY-NC-SA 1.0 li

ical Sciences

, Ahmadi A, Zar tients with urinary

on and costly

mic Republic

);33.8. https://doi

@gmail.com

d Food Sciences,

Sciences, Ahvaz Clinical Nutrition, rsity of Medical Sciences, Ahvaz raz University of Sciences, Shiraz, hvaz Jundishapur

n dietary

stones in

d Zare Javid4,

20 Feb 2019

and costly dise ake and stone fo 10 patients with tric indices, dis ed by Nut 4 sof used to comp to compare qua

udy, 37 (33.6% ±2.96 kg/m2. T r in patients wit er in patients wi

(p=0.03), and ffeine intake wa relation between n coefficient = 0 ationship betwe of kidney stones

ors, Nutrients, O

ity of Medical Scien

icense.

re Javid A, Irani y stones in Shiraz

disease (1), w

c of Iran (MJ

i.org/10.34171/m

What is “alr

Prevalence of to unhealthy regimen. This costs on cou investigate th Iran.

What this

The results of was significan with uric ac consumed in However, the dietary referen reference valu

y intakes

n Shiraz

Dariush Irani5

ase, but it may ormation in pati h kidney stone sease-related v ftware, to estim pare the quant alitative variabl

%) were female, The mean intak th calcium ston ith uric acid sto

fructose (p=0.0 as significantly n consumption 0.18) with spon een consuming s. Therefore, ad

Obesity, Physica

nces.

i D, Mohammadi z. Med J Islam Re

which is fo

IRI)

mjiri.33.8

ready known” in

f kidney stones, e lifestyle (reduced s problem endan untries. To date, e relationship bet

article adds:

f this study showe ntly higher in the id stones. Howe the group with mean intake of nce intakes (DRI ues used to plan a

and ston

5

, Mohsen Mo

be improved b ients with urina e were selected ariables, physic mate micro and m

itative variable les. The correla

, with the mean ke of calcium-c es compared to ones than in tho 03) was signifi y higher in patie

of high-oxalic ntaneous stone e g vitamin A, b dopting a health

al activity

i Sartang M, Hag epub Iran. 2019 (

ormed by min

this topic:

especially in deve d physical activit ngers public heal no cross section tween dietary int

ed that the mean i e group with calc ever, high-purine uric acid stone c vitamin D and ca I) in both groups. and assess nutrien

ne forma

ohammadi Sar

by a healthy die ary stones in Sh from Faghihi h cal activity (us macro nutrients es between the ation between v

n BMI of 27.0 ± containing food o those with uric ose with calcium

cantly higher in ents with uric a

beverages (p=0 expulsion.

eta-carotene, a hy diet and incre

ghighizadeh MH (20 Feb);33:8. htt

neral density

eloping countries ty and increased lth and imposes nal study has b take and stone fo

intake of calcium cium stones comp e foods were s compared to calc alcium were sign . DRI is a genera nt intakes of healt

ation

rtang6,

et. The aim of th hiraz.

hospital, Shiraz sing IPAQ), an

s) were evaluat e 2 groups and variables was d

± 4.68 kg/m2, ds (p=0.02) an c acid stones. T um stones (p=0.

in patients with acid than in tho 0.005, correlati

and foods cont easing physical

H. The association tps://doi.org/10.3

due to chang

, is increasing du obesity) and foo great therapeuti een conducted t rmation in Shiraz

m-containing food pared to the grou ignificantly mor cium stone group nificantly less tha al term for a set o thy participants.

his study was to

z. Demographi d dietary intak ed. Independen d multi groups etermined using

and 73 (66.4% nd high-fructos The mean intak 007). The mean h calcium stone ose with calcium

on coefficient =

taining calcium activity may b

n between dietar 34171/mjiri.33.8

ges in urinary

ue d ic to z,

ds up re p. an of

o

c ke nt s, g

%) e ke n es m =

m, e

ry

y

(2)

Nutrition and

environmenta most importa stone is mor long-term im types of cryst ing calcium o stones (struvi of 2 or more calcium oxal stones (5). Th 5% in female prevalence of per 1000 (7). mon in men t ple working the summer. people (8). O stone formati kidney stone High-fiber an stones (11). containing fo ed with redu consumption crease oxalat without distur of animal pro increases urin the formation cated that in recurrence is in those with cium diet (14 these individu Consumption grams, is asso of stone form taining high p erate amount protein, reduc tually increas (17). Salt is a calcium ston forming kidn formation and pickled cucum foods (18). I oxalate, prote crease the risk in water, pot stone formati reduces the ri stones. In add reducing the found a stro sumption and (21).

Prevalence ent regions is study has bee

d kidney stone

al conditions ant factor in re prevalent i mmobility, and talline compo

oxalate, calci te), uric acid, forms of ston late, are invo he prevalence es and 10%-1 f kidney stone

Kidney ston than in wome in hot and lo This ratio is Obesity and o

ion (9). The r es was identi nd fruit diets Increased ods (almonds uced risk of s of high-oxala te secretion, rbing oxalate otein (like egg nary uric acid n of calcium a men with ca higher in tho a low protein 4). Also, there

uals with an n of 100 gra ociated with a mation (15). U potassium frui of low-fat da ces the risk o ses the amoun another factor nes, especially neys. There is d consumptio mber, canned In general, it ein, sodium, k of formation tassium, and ion (19). Dri isk of stone fo dition,

sugar-risk of stone ong correlatio d increased ris

of kidney sto s difference, en conducted i

es

(2). Low uri stone format in those with d osteoporosis unds for urina ium phosphat

and cysteine nes (4). Calciu olved in abou e of kidney sto 15% in males e disease was

e disease is 4 en and is more ow-mobile env also higher in overweight ar role of nutritio fied in adult may protect a consumption s and bananas stone formatio

ate foods may even in he metabolism ( g white) reduc d, which are h and uric acid s alcium stones, se with a low n, low sodium e is a risk of

increase in m ams of meat,

a 30%-50% in Using a DASH its and vegeta airy and a low f kidney ston nt of urinary s

contributing t y in people s a relationsh on of salty su d food, sausag

is suggested ascorbic acid n of kidney sto magnesium r inking fluids, ormation in pa free lemon ju e formation (2 on between h sk of formatio

ones and food and to date, n in Shiraz to in

ine volume is tion; also, ki h hypothyroid s (3). There a ary stones, inc te, bacteria-re

and a combin um stones, m ut 80% of ki one disease is s (6). In Iran reported to b 4 times more e common in vironments an n obese and w re risk factor on in formatio t population

against the ris of magnes ) may be asso on (12). Incre y significantl ealthy individ (13). Consump ces urinary pH

harmful agent stones. It was , the rate of s w calcium diet m, and normal hospitalization meat consump

compared to ncrease in the H diet (a diet ables), with a m

amount of an es (16), which secretion of ci to the formatio who have st hip between s ubstances, suc ges, and prep that diets ric d, and purine ones and diets reduce the ris especially w atients with ki uice is effectiv

20). Some stu high-fructose

n of kidney st

patterns in di no cross sect nvestigate the

s the idney dism, are 5 clud-elated nation mainly idney s 3%-n, the be 4.2

com- peo-nd in white rs for on of (10). sk of sium- ociat-eased ly in-duals, mption H and ts for indi-stone t than l

cal-n for ption. o 50 e risk con- mod-nimal

h ac-itrate on of tone-stone ch as pared ch in e in-s rich sk of water, idney ve in udies con-tones

iffer-tional

rela-tions Ther betw with

M

In ston selec 2016 pant Com 9769 parti com infec stud supp tests colle the ston tion used teris resid mas num sy, ques tionn tions (coe were 3000 ered son cons ques 42% sum mea tal s with parti mete metr SPS test quan grou varia used as m as si intak trien ston intak (n=1

ship between refore, this st ween dietary h urinary stone

Methods

n this cross se nes who refer cted using co 6. An informe ts. The prese mmittee of Shi 9). The partic icular diet, an mplications, su ction. Of the dy due to tak plements, and s, ultrasounds

ected. The typ morphologica ne was conside compared to d to collect da stics (age, sex dence), anthro

s index), info mber of stones

surgery, fami stionnaire (IPA

naire (FFQ). s as heavy act efficient of 4), e added up. Th 0, and greater d as light, mod

must work c sider the sco stionnaire we % and 70% by mable foods wa

asured using J scale, with a h the least po icipant was as er was used w ric indices we S version 19 w

and one-way ntitative varia ups, respective ables was don d for correlatio mean ± standa

ignificant. The kes of energy, nts. For certa ne, the intakes

kes (DRI) by 100) in this s

n dietary inta udy aimed to intake and s es in Shiraz.

ectional study rred to Faghih

onvenience s ed consent wa ent study wa iraz Universit ipants aged 18 nd did not hav uch as inflam participants, king calcium, d antacids. S , and the phy pe of stone w al analysis by ered for each

other stones. ata, which inc x, occupation, opometric ind ormation abou

, spontaneous ily history of AQ), and vali The IPAQ co tivity (coeffici , and walking he activities ra r than 3000 m derate, and he continuously

re. The valid re confirmed, y retest method

as reported as apanese body precision of ossible clothin

sked to stand with a precisio ere compared was used for d y ANOVA w ables between ely. Comparis ne using chi s on measureme rd deviation, e Nut 4 softwa , carbohydrate in nutrients c s were compa y one-sample study was est

akes and sto o determine th stone formatio

y, 115 patient ihi hospital in sampling met as obtained fro as approved b ty of Medical

8-60 years, di ve any underly mmation, kidn

5 were exclu vitamin D a Some specific ysician’s appro was determined y a microsco

stone with >5 A 5-part que cluded demog educational l dices (height, ut the diseas s expulsion, u f stones), phy idated food fr ontained 3 sec ient of 8), mo g (coefficient anged from 0 min/w, which eavy respectiv

for at least dity and relia

, with Cronb d (22). The a s servings. Bo y composition 0.1 kg, with ng. To measu

against the w on of 0.5 cm. d with CDC 2 data analysis. were used to n the 2 grou son between square test. Pe

ent. All data w and p<0.05 w are was used t e, protein, fat, considerably ared with die e t test. The timated using

ne formation he association on in patient

ts with kidney n Shiraz were thod in 2015 om the partici by the Ethic Sciences (No id not follow a ying or related ney or bladde

uded from the and vitamin C c biochemica oval were also d according to ope. The main 50% composi stionnaire wa raphic charac level, place o weight, body e (stone type se of lithotrip ysical activity equency ques ctions of ques oderate activity

of 3.3), which to 600, 600 to h were consid

vely. The per 10 minutes to ability of thi ach's alpha o mount of con dy weight wa n monitor digi out shoes and ure height, the wall, and a tape The anthropo -20 standards Independent compare the ups and mult n qualitative earson test wa were expressed was considered to estimate the , and micronu

related to the etary reference e sample size g the Cochran n.

n ts

y e - i-s o. a d er e C al o o n i-as c-of

y e,

p-y s-y h o

d- r-o

s of n-as

i-d e e

o-s. t e ti e as d d e

u-e e e n

(3)

formula, with

Results

Out of 110 female, with (66.4%) were kg/m2. Also,

tients had cal cystine stones excluded for b calcium-conta group with c uric acid ston cantly more c compared to (p=0.007). Th the group with in the group w ever, no sign groups in the mean intakes were significa

Table 1.Demo

Variable †Job

†Education

†Habitation

†Physical activ

†Type of urina

*Height (cm) *Weight (kg) * BMI (Kg / m *Age (year) †. The data are pr *. The data are pr

Table 2.Comp

Foodstuff

Potassium-rich Calcium-rich f High oxalate fo Drinks with hig High-sodium f High-purine fo High Fructose High-magnesiu *Significant with

h α=0.0, p=q=0

0 participants the mean BM e male, with

75.7% of fem lcium oxalate s). Also, 2 pa better analysi aining foods calcium stone nes (p=0.02). H

consumed in o the group he mean intak h uric acid sto with calcium nificant differe

e mean intake s of vitamin

antly higher i

ographic indices o

vity

ary stones

m2)

resented as "number

resented as "mean ±

parison of mean fo

h fruits foods

oods gh oxalate foods oods

Drinks um foods h p<0.05 using t - te

0.5, and d=0.1

in this study, MI of 27.0±4. the mean BM male and 74%

stones (18.9% atients with cy

s (Table 1). T was significa es compared t High-purine f the group wi p with calci ke of high-fruc one was signif

oxalate stones ence was obse e of other foo

A, beta-carot in patients wit

of participants ba

Unemploye The worke housewife Employee Total Illiterate-eleme

Tips Secondary sch

Academic Total Village

City Total Low Moderate

High Total Calcium oxa

Uric acid Sistine Total

r (percent)."

± SD".

food intake per we Stone type

est

1 (23).

, 37 (33.6%) .68 kg/m2, an

MI of 24.21± % of the male % uric acid, ystine stones The mean intak antly higher in to the group foods were sig

ith uric acid s um stone g ctose beverag ficantly lower s (p=0.038). H erved between ods (Table 2).

tene, and fruc th calcium ox

sed on sex Sex

ed er e e

entary

hool c

e

late d

eek based on type Calcium oxalat

24.75 ± 9.53 18.68 ± 7.82 9.64 ± 7.42 25.59 ± 15.93

13.13 ± 7.02 11 ± 4.59 5.83 ± 4.22 6.47 ± 4.39

were nd 73 ±2.96 e pa-1.9%

were ke of n the with gnifi-stone group ges in r than

How-n the . The uctose xalate

ston How uric ston intak Ther and in th ed t phor c, w intak than intak cant take rus, resu tion ston sign beve R=0

15 64

47

e of urinary stone te

Food intake (s mea

nes than in p wever, caffein acid stone t nes (p=0.01). T

ke of other nu re was no sign sex (p=0.61) he 2 groups. T

o kidney ston rus, vitamin D were compared

ke of vitamin n DRI in both

ke of sodium, tly greater tha e of other micr

and magnesiu ults of Pearson

between hig ne expulsion in nificant correl

erages and st 0.18); nonethe

Female

0 (0) 0 (0) 34 (91.8)

3 (8.1) 37 (100) 20 (54.1) 8 (21.6) 5 (13.5) 4 (10.8) 37 (100) 18 (48.6) 19 (51.4) 37 (100) 23 (62.2) 7 (18.9) 7 (18.9) 37 (100) 28 (75.5) 7 (18.9)

2 (5.4) 37 (100) 54.97 ± 6.82 4.67 ± 10.81 27 ± 4.68 7.35 ± 11.13

e

Uric ac ervings per week an ± SD

21.81 ± 14.88 ± 9.42 ± 6 25.09 ± 1 13 ± 4 13.86 ± 4.38 ± 2 6.38 ± 4

atients with ne intake was

han in the g There was no utrients betwe nificant differ and calcium o The intake of m

nes, including D, calcium, B d with DRI in n D and calci h groups (p< vitamin B6, a an DRI in bot

ronutrients, su um, were sim n correlation sh

gh-oxalate be n 1 year (p=0

ation was fou tone expulsion less, this relat

cid k)

9.53 5.11 6.12 12.42

.58 4.83 2.61 4.48

uric acid sto s higher in th group with ca significant di een the 2 grou rence between oxalate and u micronutrient g sodium, pot B6, magnesium

n all participan ium were sig <0.05). Howev

and vitamin C th groups (p< uch as potassi milar to DRI ( howed a signi everages and 0.005, R=0.26) und between n during 1 y tionship was n

Mal

29 (39 23 (31 0 (0 21 (28 73 (1 18 (24 18 (24 18 (24 19 (2 73 (1 30 (41 43 (58 73 (1 20 (27 21 (28 32 (43 73 (1

54 (7 19 (2 0 (0 73 (1 173.61 ± 73.13 ±

24.21 ± 42.46±

ones (p<0.05) he group with alcium oxalate fference in the ups (Table 3) n age (p=0.83 ric acid stone ts mostly relat tassium, phos m, and vitamin

nts. The mean nificantly les ver, the mean C were signifi <0.05). The in ium, phospho (Table 4). The ificant correla d spontaneou ). Moreover, a

high-fructose year (p=0.048

not significan

le

9.7) 1.5) 0)

8.8) 00) 4.7) 4.7) 4.7) 26)

00) 1.1) 8.9) 00) 7.4) 8.8) 3.8) 00) 74) 26) 0)

00) ± 7.11

10.77 ± 2.96 12.02

p

0.14 0.02* 0.88 0.88 0.91 0.007* 0.038* 0.92

). h e e ). ) s t- s-n n s n i- n- o-e a-us

a e 8, nt

(4)

Nutrition and

in other food expulsion wa tap water tha consumed stro but none were

Table 3.Comp

Stone t Nutrient Energy (kcal/d Carbohydrate ( Protein (g/d) Total fat (g/d) Saturated fat (g Mono fat (g/d) Cholesterol (g/ Poly fat (g / d) Vitamin A (RE Beta-carotene Vitamin D (ug Vitamin C (mg Vitamin B6 Calcium (mg/d Potassium (mg phosphor (mg/ Sodium (mg/d) Magnesium (m Fructose (g/d) Caffeine (mg/d *Significant with Mono fat, unsatu Poly fat, unsatura g = gram, mg = m

Table 4.Comp

Nutrient Potassium (mg Vitamin D (ug Phosphor (mg Calcium (mg/d Sodium (mg/d) Magnesium (m Vitamin c (mg B6 (mg/d) *Significant with ** mean ± SD

Table 5.The re

Type of food High- potassium High-oxalate fo High-oxalate dr High-calcium f High- sodium f High- purine fo High- fructose High-magnesiu Caffeine *Significant with

Table 6.The re

Type of drink

Consumed wate

Consumed tea

P< 0.05 was co a. One way Ano

d kidney stone

d groups (Tab as observed m an in others (p ong tea than l e significant (

parison of the mea type

d) (g/d)

g/d) )

/d) E)

(ug / d) g/d)

g/d)

d) g/d)

/d) ) mg/d)

d)

h p<0.05 using t- tes urated fat with a dou ated fat with multip milligram, RE = ret

parison of the mea

g/d) 508

g/d)

g/d) 7

d) 8

) 3

mg/d) 4

g/d) 22

h p<0.05 using t –te

elationship betwee

m fruits oods

rinks foods foods oods

drinks um foods

p<0.05 based on Pe

elationship betwee

er Mine

Purif ordin Ligh Heav onsidered signific ova, b. Independe

es

ble 5). Also, s more in partic

p=0.81) and light tea (p=0. (Table 6).

an intake of nutri

st uble bond ple double bonds

inol equivalent, ug

an intake of nutri

Male (n=73 84.38 ± 3010.45**

0.75 ± 0.68 65.89 ± 393.32 33.48 ± 468.38 3071.36 ± 2584 38.35 ± 237.65 27.34 ± 139.10 4.30 ± 3.39 est

en food groups an

earson-coefficient (

en water and tea c

eral water (n=1) fied water (n=1) nary (Pipe) water

t tea (n=43) vy tea (n=67)

ant. ent t – test

spontaneous s cipants consum

also in those .63) during 1

ients based on typ Calcium ox

Mean ± S 1432.94 ± 59 225.42 ± 15

43.71 ± 15 28.5 ± 1 12.54 ± 5. 8.68 ± 6.3 97.03 ± 50

3.05 ± 1.4 2704.24 ± 20 1374.83 ± 12 0.71 ± 0.6 260.43 ± 13

3.85 ± 3.0 777.68 ± 44 4657.54 ± 28 732.40 ± 38 2757.99 ± 10 407.61 ± 23 33.68 ± 17 148.61 ±

= microgram

ients with DRI Intake 3) Female

* 3931

0

597 269

339 221 3

nd stone expulsio

(p < 0.05).

consumption with Fr

(n=8)

stone uming who year,

Di

In men er, r

pe of urinary ston xalate

SD 99.99 56.96 5.64

2 .55 38 0.49

43 031.53 205.93

68 33.24

08 46.45 865.09 82.53 084.59 32.46 7.64

96

(n=37) 1.51 ± 2808.99 0.53 ± 0.49

635 ± 300 7.76 ± 332.75 96.43 ± 855.26

9.87 ± 229.92 1.40 ± 119.93 3.24 ± 2.97

on

Spon Correlation coe 0.03 -0.1 0.26 -0.13 0.15 0.063

0.18 0.03 -0.033

h frequency of sp requency of spont

Mean

iscussion

n the past, pa nded to limit t recent studies

ne

M 162

26 4 3

10

188 94

25

68 481 68 266

39 2 23

Male 4700

15 700 1000 2300 400-420

90 1.3-1.7

ntaneous stone ex efficient

pontaneous stone taneous stone exp

year n ± standard devia

2.5±1.5 2.63 ± 1.36 2.95 ± 2.67 2.72 ± 2.1 2.95 ± 2.61

tients with ca he intake of h s do not conf

Uric acid Mean ± SD 23.88 ± 804.27 63.98 ± 193.67 46.50 ± 20.68 30.48 ± 18.02 12.91 ± 7.49

8.92 ± 5.65 01.04 ± 54.41

3.58 ± 2.79 80.45 ± 1432.85 45.88 ± 783.25

0.58 ± 0.44 52.67 ± 142.87

4.21 ± 3.87 81.98 ± 421.30 16.68 ± 3371.74 89.45 ± 326.70

66.02 ± 905.92 97.78 ± 261.27 25.59 ± 14.64 34.03 ± 159.89

DRI e Female

4700 15 700 1000 2300 0 310-320

75 1.3-1.5

xpulsion duration

expulsion duratio pulsion duration 1

ation

alcium stones high-calcium firm it (24). I

Male 0.27 <0.001*

0.15 0.003* 0.013* 0.31 <0.001* <0.001*

1 year p 0.73 0.26 0.005*

0.15 0.10 0.51 0.048*

0.7 0.73

on 1 year

1 p

0.8

0.6

s were recom foods, howev In the presen

p

0.19 0.29 0.46 0.51 0.78 0.86 0.72 0.35 0.02* 0.03* 0.27 0.79 0.62 0.32 0.81 0.6 0.69 0.85 0.03* 0.01*

p Female

0.10 <0.001*

0.19 <0.001*

0.008* 0.51 <0.001*

0.001*

1a

3b

m- v-nt

(5)

study, it was DRI even in found that the with an incre was not signif size of the sub ducted by Le was lower in participants ( for oxalate a increase urina the mean con nificantly hig than in patien cated that red 1000 to 120 sources may b urinary oxala from food is e is not known through diet h whether the o The misinform bias of the 24 nal absorption ious availabil may be the r sorption from cretion of ox oxalate forma well understo completely at study conduc levels, high p urinary oxalat

Consuming for kidney sto found that the increases the than calcium of Tracy et al tein increases healthy indivi on uric acid le to beef or chi pH and uric amino acids acid results in the risk of sto In this stud expulsion dur ordinary cons stone expulsi heavy tea tha tea and low study by Brz black tea, an stones format (with low lev ate choice for

s found that c n patients wit

e amount of u ease in the hi

ficant, which bjects. Simila onetti et al, it

patients with (25). Consider

absorption, d ary oxalate (2 nsumption of h gher in patien nts with uric a ducing the int 00 milligrams be a useful ap ate (27). Abou expected to b n whether th has a major co oxalate in the mation about 4-hour food re

n of oxalate in lity of oxalat easons behind m oxalate beve xalate (28). T ation from in ood, In fact,

ttributed to th cted on the ef

production o te levels (29). g animal prote ones formatio e intake of hi risk of form oxalate stones l, who found t s the serum an

iduals. In add evels due to h icken (30). It acid decrease and that the n an increase i one formation dy, it was fou ring 1 year w sumption of w ion was more an light tea, w percentage in ezicha et al, i nd green tea h tion, respectiv vels of oxalate r patients with

calcium intak th calcium st urinary excret gh-calcium fo

may be due to arly, in a

case-t was found case-th h calcium ston

ring the impo decreasing cal 26). Moreover high-oxalate b nts with calciu acid stones. M

take of high-s per day ca pproach to red ut 40% to 50%

e secreted in he amount of ontribution in e body plays the amount o ecall and FFQ n different ind te from diffe d this, as incr erages increas Therefore, as nternal and fo

the stone for he food intak ffects of diet o

f internal ox .

ein is consider on. In the pre igh-purine foo

ation of uric s. This was sim that consumpt nd urinary lev dition, fish ha higher levels o has been ind e due to acidi conversion o in urinary leve

(31). und that the f

was higher in water than ot e frequent in with a high pe n green tea c it was indicat had the highe vely (32). Th e) is considere

h kidney ston

ke was lower tones. It was tion reduced a oods intake, b o the small sa -control study hat calcium in nes than in he ortance of cal lcium intake r, it was found beverages was um oxalate st Moreover, it is oxalate foods alcium from duce the amou % of oxalate in

urine. Howev f oxalate rece stone formatio a significant f food oxalate Q, different in

dividuals, and rent food sou reased oxalate ses the urinar

the proportio ood sources is rmation canno ke. According on urinary ox alate caused

red as a risk f esent study, it ods, such as m

acid stones, m milar to the re tion of animal vels of uric ac d a greater im f purine comp icated that uri ic load by sul of purine into el, which incre

frequency of s n patients wit

ther groups. A those consum ercentage in b consumption. ted that heavy est rate of ox herefore, green

ed as an appr nes. Jeong et a

than also along but it ample y

con-ntake ealthy lcium may d that s sig-tones

indi-s and

food unt of ntake ver, it eived on or role. e, the ntesti-d var-urces e ab-ry se-on of

s not ot be g to a xalate high

factor t was meat, more esults l pro-cid in mpact pared rinary lfuric o uric eases

stone th an Also, uming black In a y tea, xalate n tea

ropri-al

in-dica prev gala thes in b the n it wa erag sign In sign Pietr betw cium ed th daily and stud intak (36) leve due In was and cons form sults mec lism mula its le tose both rece ated So tient the m stud puls sign DRI sodi lead creti um mov calc cium It w cant may hand incre supe play ston So meta

ated that green vent stone for ate-catechin (3

e 2 studies, it lack tea may number and e as found that ges, such as b nificantly. n the present s nificantly grea ro Manuel et ween dietary in m oxalate ston

hat healthy pe y had up to 56 up to 61% i dies showed th ke in men, th ). One mechan els may conver to increased o n the present

found betwe stone expuls sumption is i mation of calc s are consisten

hanisms inclu m, which may

ated AMP is c evels (38). Ot

in insulin re h of which are ent studies ind d with a higher odium restrict ts with kidney most importan dy, there was

sion and high-nificant. Sodiu I in this study ium chloride ding to bone c

ion of calcium intake reduc ves bone calc

ium from the m levels and u was also showe

tly reduces uri y increase the r

d, high sodium easing NADP eroxide dismu ys an importan nes (45).

ome studies r abolites of vit

n tea, despite i rmation becau

33). Thus, ac t is suggested

be a possible expulsion of s higher consum black tea, inc

study, the leve ter in both gr t al showed ntake of vitam nes (34). How

eople who con 6% increased increased ston hat with a sma heir risk of st nism of action rt to oxalate w oxidative stres study, a sign en the intake sion. Taylor e

ndependently ium and uric nt with the re ude using AT result in AM converted into ther mechanism esistance and e associated w dicate that me

r risk of kidne tion is a usua y stones, as hi nt factors in s a positive cor -sodium food, um intake in bo

y. Frassetto et intake may in calcium releas m (42). It was ces calcium

ium, and stim intestine, thr rinary secretio ed that increa inary citrate le risk of stone f m intake induc PH oxidase en utase (SOD) e nt role in patho

reported that tamin D, such

its free oxalate use of the pre ccording to d that high lev

e mechanism stones. In the mption of hig creased the st

els of vitamin roups than DR

no significan min C and for wever, Baxman

nsumed 1g of urinary secret ne formation all increase in tones increase n is that high which secreted ss in kidney st nificant positi of high-fruct et al showed y associated w

acid stones ( esults of our s TP during fru MP accumulati o uric acid, w sms include th metabolic sy with chronic a etabolic syndr

ey stones (40) al recommend igh sodium in stone formatio rrelation betw , but this diffe oth groups wa et al showed t

ncrease metab se and increas s found that in

reuptake by mulates the re rough which t on of calcium asing sodium evels in adults formation (47) ces oxidative nzyme activity enzyme activit hogenesis of ca

increased lev h as 1,25 di-hy

e content, may esence of epi

the results o vels of oxalate

for increasing present study h-oxalate bev one expulsion

n C intake wa RI. A study by nt relationship rmation of cal nn et al report f ascorbic acid

tion of oxalate (35). Severa n ascorbic acid

ed up to 31% h ascorbic acid d into the urine

tones (37). ive correlation tose beverage d that fructose

with increased 21). These re study. Possible uctose metabo

ion. The accu which increase he role of fruc yndrome (39) acidosis. Some

ome is associ .

dation for pa ntake is one o on (41). In thi ween stone ex erence was no as greater than that additiona bolic acidosis sed urinary se ncreased sodi the kidneys eabsorption o the serum cal m increase (43) intake signifi s (15), and thi ). On the othe stress through y and reducing ty (44), which alcium oxalate

vels of active ydroxyvitamin y i-of

e g y,

v-n

as y p l- t-d e al d % d e

n s e d

e-e o- u-s

c-), e

i- a-of

s x-ot

n al s,

e- i-s, of l-).

i-s er h g h e

e n

(6)

Nutrition and

D, increase c mation of urin that vitamin D ly lower than ta-analysis stu min D levels kidney stones D increased t (47). In this were not incl cal studies re droxyvitamin urinary secret supplements i is controversi the main sour the food sourc should be pa plement in the dose of vitam droxyvitamin stones.

Vitamin A the formation intake of this with calcium stones. Grase creased the g (50). In anoth vitamin A in stones than i were not con exists in anim tion of foods cium oxalate son.

Caffeine is stone formati that stone ex caffeine intak which may be et al showed creases with i the results of that caffeine mation by in (52). Thus, ca ing ADH horm

Conclusion

Recommen sumption of h spite several kidney stones their dietary h

Acknowled

This work w search Comm ences. The a

d kidney stone

calcium secre nary stone. In D intakes from

DRI in patien udy, Hai Wan s were signifi s than in healt the risk of sto

study, patien luded. Howev eported no ass n D levels and tion of calciu in the formati ial (48). In th rce of vitamin ces of this vita aid to the pote e formation o min D intake n D are also

deficiency is n of kidney st s vitamin was m oxalate ston

es et al showe growth and f her study by ntake was hig

in other patie nsistent with mal and dairy

containing th stones may b

another subst ion. The resul xpulsion reduc

ke, but the r e due to the sm

that the risk o increasing caf f our study. O prevents calc ncreasing the

affeine may p mone in termi

n

ndations shoul high oxalate

problems as s, patients sho habits and red

dgments

was financiall mittee of Shir authors appre es

tion (46) and n the present s m food source nts with kidne ng et al showe ficantly highe

thy individual one formation nts who rece ver, several ot sociation betw formation of um. Thus, the ion of kidney his study, the r

n D was not c amin are limit ential role of f kidney stone e and serum o key determ

s considered a ones (49). In

significantly nes than thos ed that vitamin formation of

Nemati et al, gher in patien ents. The resu ours. Since v foods (51), t his vitamin in be considered

tance whose e lts of the pres ced in patient reduction wa mall sample s of developing ffeine intake, w One possible m

cium and uric volume of u lay a preventi inal tubules (2

ld focus on r food sources. sociated with ould be encou duce their body

ly supported b raz University eciate the hel

d increase the study, it was f s were signifi ey stones. In a ed that serum r in patients ls and that vit n in these pat eived supplem

ther epidemio ween serum 25

kidney stones role of vitam y stones in hum

role of sunlig considered an ted, more atten f this vitamin

es. In addition levels of 25 minants of ki

as a risk fact the present st higher in pat se with uric n A deficienc stones in ani it was found nts with uric ults of their s vitamin A m the high consu

patients with as a possible

effect is studie sent study sho ts with increa as not signifi

ize. Pietro Ma kidney stone which is simil mechanism ma c acid stones urine and dilu ive role by im 29).

reducing the . Furthermore h the treatmen

uraged to imp y weight.

by the Studen y of Medical

p of Student e for-found icant-a me- vita-with tamin tients ments

ologi-5 hy-s and min D mans ght as nd, as ntion sup-n, the 5

hy-idney

tor in tudy, tients acid cy

in-imals d that acid study mostly ump-h cal-e rcal-ea-

rea-ed on owed asing icant, anuel es

de-lar to ay be s

for-ution

mpair- con-e, de-nt of prove

nt Re- Sci-t

Re-sear ence Shir nel a

Inf

In clud

St

Th ining cost tient (Ma

Co

The

Re 1. Jo

Re 197 2. C

Va hyp 3. W ren 4. M 199 5. M Sta com 6. St

Tim Sta 7. Ta Co Sci 8. Bl Ka Teh 9. Ta risk 10.

Wa sto 50 11. H

for int Tra 12. S eff for 200 13. S red 20 14. B

et a idi 15. K

die the of 16. T

red 9. 17. T

ch Committe es and cooper raz. The autho and the partici

formed conse

nformed conse ded in the stud

tudy limitation

he limitations g healthy pe s of laborator ts because the any patients di

onflict of Inter

authors decla

eferences ohnson CM, Wil enal stone epidem

79;16(5):624-31. orbetta S, Bacca ainicher C, et al. R

perparathyroidism Watanabe T. Prox

nal tubular acidos Mandel N, editor

96.

Mandel NS, Mand ates veteran popu mposition. J Urol tamatelou KK, F me trends in rep ates: 1976–1994. adayyon F, Sabb omposition in Pat i. 2011;28(122). louc, Nigel et al. alhori and Ghol hran, Iran, p. 206 aylor EN, Stamp k of kidney stone Sorensen MD, K allace RB, et al. one formation: a r

.

Hess B, Michel R r low urinary citr ake and low uri ansplant. 1994;9( Siener R, Schade ficacy of dietary rmation in recu 05;173(5):1601-5 Siener R, Bade D duced by treatm

13;11(1):306. Borghi L, Schianc

al. Comparison o opathic hypercalc Kok DJ, Iestra J etary excesses in e crystallization k

healthy men. J C Taylor EN, Fung duced risk for kid

Taylor EN, Stamp

e of Shiraz U ration of mana ors also extend

ipants.

ent

ent was obtain dy.

ns

of the study ople due to ry tests; and e questionnair d not fully co

rests

are that they h

son DM, O'Fallo miology: a 25-yea

arelli A, Aroldi A Risk factors asso m. J Endocrinol In ximal renal tubu sis. Pediatr. Nephr

Mechanism of

del GS. Urinary ulation. II. Geog l. 1989;142(6):15 Francis ME, Jone ported prevalence Kidney Int. 2003 agh M. The Prev ients Referred to

Stem Cell Urolo lam Hossein Ha 6. [in Persian]

fer MJ, Curhan G es. Jama. 2005;29

Kahn AJ, Reine Impact of nutri report from the W

R, Takkinen R, Ac rate in calcium ne ne volume to be (6):642-9. e N, Nicolay C, y intervention on urrent calcium o 5.

DJ, Hesse A, Hopp ment with lactic

chi T, Meschi T, f two diets for th ciuria. N Engl J M A, Doorenbos C animal protein an kinetics of calciu

lin Endocrinol M TT, Curhan GC dney stones. J Am

pfer MJ, Mount D

University of agers of Fagh d their thanks

ned from all p

were as follo financial lim lack of coop re was too lon omplete the qu

have no compe

on WM, Malek ar study in Roch

A, Vicentini L, ociated to kidney

nvest. 2005;28(4 ular dysfunction hrol. 2005;20(1):8

stone formation

tract stone disea graphical analysi 516-21.

es CA, Nyberg e of kidney ston 3;63(5):1817-23. valence of Kidne the Lithotripsy W

ogy, Translations Hasani, Islamic A

GC. Obesity, we 93(4):455-62.

er AP, Tseng T itional factors on WHI OS. J Urol. 2

ckermann D, Jaeg nephrolithiasis: lo e added to the l

von UNRUH G on urinary risk

oxalate stone p

ppe B. Dietary hy c acid bacteria.

Guerra A, Alleg he prevention of r Med. 2002;346(2) CJ, Papapoulos S

nd sodium on the um oxalate mono Metab. 1990;71(4) C. DASH-style di m Soc Nephrol. 2

DB, Curhan GC.

f Medical Sci hihi hospital in

to the person

participants in

ow: Not exam mitations; high peration of pa

ng to complete uestionnaires.)

eting interests

RS, Kurland LT hester, Kidney Int

Fogazzi G, Eller stones in primar ):122-8.

in primary dista 86-8.

. Semin Nephro

ase in the Unite s of variations i

LM, Curhan GC nes in the Unite

ey Stone Differen Wards. J Res Me

by Amir Farrok Azad University

ight gain, and th

TY, Shikany JM n incident kidne 2012;187(5):1645

ger P. Risk factor ow vegetable fibr list. Nephrol Dia

GE, Hesse A. Th factors for ston patients. J Uro

yperoxaluria is no J Transl Med

gri F, Maggiore U recurrent stones i

):77-84. SE. The effects o

e composition an ohydrate in urine ):861-7. iet associates wit 2009;20(10):2253

. DASH-style die

i-n

n- m-h

a-e ).

.

T. t.

r-ry

al

l.

d n

C. d

nt d

kh y,

he

M, y

5-rs re al

he ne l.

ot d.

U, n

of d es

th

3-et

(7)

and 24-hour 2010;5(12):23 18. Hu JF, Zha

urinary excret women in Chin 19. Siener R, H urolithiasis. W 20. Rodgers A reduction of r Med J. 1998;8 21. Taylor E, C stones. Kidney 22. Gh FM. Eval physical activ 2011;14(56):3 23. Hossain Kha M. Relationsh Urinary Stone 15;12(5):65-76 24. Agarwal MM and dietary controversies urology: IJU: I 25. Leonetti F, D

and urinary ris compared w 1998;13(3):61 26. Al Zahrani H

habits of idi subjects. BJU 27. Holmes RP

excretion to 2016;44(1):27 28. von UNRUH

for gastrointes [13 C 2] oxala 29. Curhan G. Rounds. 2004; 30. Tracy CR, Sakhaee K, et comparative m 2014;192(1):1 31. Reddy ST, W

low-carbohydr forming prop 2002;40(2):26 32. Brzezicha-C and calcium co Eur Food Res 33. Jeong BC, K stone formati 2006;20(5):35 34. Ferraro PM, supplemental v J Kidney Dis. 2 35. Baxmann AC supplements o patients. Kidne 36. Taylor EN, S incident kidne up. J Am Soc N 37. Khan SR. I

obesity, hyper syndrome? Uro 38.Kochman P, S disease: New t 201. 39. Kretowicz

Sypniewska G consumption o patients with c Tętnicze. 2011 40. Elliott SS, K

gain, and th 2002;76(5):91

urine compos 15-22.

ao XH, Parpia B tion of calcium na. Am J Clin Nu Hesse A. Recen World J Urol. 2005

. The influence risk of calcium o

8(4).

Curhan G. Fructo y Int. 2008;73(2): luation of the reli vity questionnai 6-44.

ani A, Nemati A, hip between Urol es in Ardabil Cit

6.

M, Singh SK, Mav therapy for uro and lacunae of Indian J Urol. 20 Dussol B, Berthe sk factors for ston with healthy su

7-22.

H, Norman R, Th iopathic calcium Int. 2000;85(6):6 P, Knight J, As decrease calcium -32.

H GE, Voss S, Sa stinal oxalate abs ate absorption test

Diet and preve ;2(4).

Best S, Bagrod t al. Animal pro metabolic study

37-41. Wang C-Y, Sakh rate high-protein pensity, and cal

5-74.

Cirocka J, Grembe ontent in selected Technol. 2016;24 Kim BS, Kim JI, K ion: an in vivo

6-61.

Curhan GC, Gam vitamin C intake 2016;67(3):400-7 C, De OG Mendo on urinary oxala ey Int. 2003;63(3 Stampfer MJ, Cur ey stones in men: Nephrol. 2004;15 Is oxidative stres rtension, diabete ol Res. 2012;40(2 Stompór T. Gout treatment possibil

M, Goszka G, G, Manitius J. [ of fructose and b chronic kidney d 1;15(6):341–346 Keim NL, Stern J he insulin resist

1-22.

sition. Clin J

B, Campbell TC and acids: a cr utr. 1993;58(3):39 nt advances in n

5;23(5):304-8. of South Afric oxalate kidney s

se consumption 207-12. iability and valid ire (AFPAQ).

Naser Saead M, lithiasis and Nut ty. J Ardabil Un

vuduru R, Manda olithiasis: An a f current literatu

11;27(3):310. ezene P, Thirion

nes in idiopathic ubjects. Nephr

hompson C, Weer m stone‐formers

616-20. simos DG. Low m oxalate stone

auerbruch T, Hes sorption measure t. J Urol. 2003;16 ention of kidne

dia A, Poindexte otein and the ris of animal pro

haee K, Brinkley n diets on acid lcium metabolism

ecka M, Szefer P d kinds of tea: im 42(3):383-9. Kim HH. Effects

o and in vitro

mbaro G, Taylor and risk of incid 7.

onca C, Heilberg ate and pH in c

):1066-71. rhan GC. Dietary : new insights aft 5(12):3225-32.

ss, a link betwe es, chronic kidn

2):95-112. t, hyperuricemia a

lities. Pol Ann M

Brymora A, F [Is there a relati blood pressure a disease without di

[in Polish]. JS, Teff K, Have tance syndrome

Am Soc Ne

C. Dietary intake ross-sectional stu

98-406. nutritional resear

can mineral wat stone formation.

and the risk of k

ity of Azad-Fesha Arak Med Un

Hosseinzadeh S, trition in Patients ni Med Sci. 2012

al AK. Preventive appraisal of str ure. Indian journ

X, Berland Y. D calcium stone fo ol Dial Trans

rasinghe S. The d and normal c

wering urinary o disease. Urolit

sse A. Reference ed with a standa 69(2):687-90.

y stones. Nephr

er JR, Adams-Hu sk of kidney ston tein sources. J

y L, Pak CY. Eff d-base balance,

m. Am Kidney

P. Oxalate, magn mpact on human h

of green tea on u o study. J End

EN. Total, dietar dent kidney stone

IP. Effect of vita calcium stone-fo

y factors and the r fter 14 years of fo

en nephrolithiasi ney disease, met

and chronic kidne Med. 2016;23(2):1

lisiński M, Odr ionship between and uric acid lev iabetes?]. Nadciś

el PJ. Fructose, w e. Am J Clin

ephrol.

es and udy of

rch on

ter on S Afr

kidney

haraki's niv J.

Barak s with 2 Nov

e fluid rength, nal of

Dietary ormers splant.

dietary control

oxalate thiasis.

e range ardized

rology

uet B, ones: a Urol.

fect of stone-y Dis.

nesium health.

urinary dourol.

ry, and es. Am

amin C orming

risk of

follow-is and tabolic

ey

95-rowąż- n daily vels in śnienie

weight Nutr.

41. T nep 42. S pot Ur 43. F

int aci Ph 44.

La tren 45. K al. oxi 200 46. K cal exp 47. B for abs 48. W

vit ana 49. N CF inc 50.

Vit 51. H

M. Ur 76 52. F

and

Ticinesi A, Nouve phrolithiasis. Nep Sakhaee K, Harv tential role of sa ol. 1993;150(2):3 Frassetto LA, M ake independentl idosis in healthy h

ysiol Renal Phys Kovacevic L, kshmanan Y. F nd in pediatric ur Kitiyakara C, Cha Salt intake, ox idase and su 03;14(11):2775-8 Khan SR. Reactiv lcium oxalate kid perimental invest Broadus AE, Inso r disordered con sorptive hypercal Wang H, Man L, amin D levels an alysis. Nutr J. 20 Nguyen S, Bagge F. 25-Hydroxyvit cidence of kidney Grases F, Garci tamin A and urol Hossain Khani A, Relationship be inary Stones in A .

Ferraro PM, Tay d the risk of kidn

enne A, Maalouf phrol Dial Transp vey JA, Padalin alt abuse on the r

310-2.

Morris RC, Sebas ly predicts the de humans consumin iol. 2007;293(2): Wolfe-Christense rom hypercalciu rolithiasis? J Urol abrashvili T, Chen xidative stress, a

peroxide dismu 82.

ve oxygen specie dney stone form tigations. J Urol. 2 ogna KL, Lang R, ntrol of 1, 25-di ciuria. N Engl J M Li G, Huang G, L nd the risk of kid

15;15(1):32. rly L, French C, tamin D in the y stones. Am J Pu ia-Gonzalez R,

ithiasis. Clin Chim Nemati A, Naser etween Urolithias Ardabil City. J Ard

lor EN, Gambaro ey stones. Am J C

f NM, Borghi L, M plant. 2014;31(1) no PK, Whitson risk for kidney s

stian A. Dietary egree of hyperchl

ng a net acid-pro :F521-F5.

en C, Edwards uria to hypocitra l. 2012;188(4):16 n Y, Blau J, Karb and renal expres utase. J Am

es as the molecu mation: evidence

2013;189(3):803 R, Ellison AF, Dre ihydroxyvitamin Med. 1984;311(2 Liu N. Associatio dney stone: evide

Heaney RP, Gor range of 20 to ublic Health. 2014

Genestar C, To im Acta. 1998;26 er Saead M, Hoss sis and Nutrition rdabil Uni Med Sc

ro G, Curhan GC Clin Nutr. 2014:a

Meschi T. Salt an :39-45.

P, Pak CY. Th stone formation.

y sodium chlorid loremic metaboli oducing diet. Am

s L, Sadaps M aturia—a shiftin 623-7.

ber A, Aslam S, e ssion of NADPH

Soc Nephro

ular modulators o from clinical an -11.

eyer BE. Evidenc D production i 2):73-80.

on between serum ence from a meta

rham ED, Garlan 100 ng/mL an 4;104(9):1783-7. orres J, March J

9(2):147-57. einzadeh S, Bara n in Patients wit ci. 2012;12(5):65

C. Caffeine intak ajcn. 089987.

d

he J

de ic J

M, g

et H l.

of d

ce n

m

a-d d

J.

k th

5-ke

Figure

Table 2. Compparison of mean fofood intake per weeek based on typee of urinary stonee
Table 6. The reelationship betwee

References

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