Oxalate intake and the risk for nephrolithiasis
Oxalate intake and the risk for nephrolithiasis
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DOI：
10.1681/asn.2007020219
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发表时间：
2007-07-01
影响因子：
13.6
通讯作者：
Curhant, Gary C.
中科院分区：
文献类型：
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作者：
Taylor, Eric N.;Curhant, Gary C.
大多数肾结石由草酸钙组成，尿中草酸含量高会增加患草酸钙肾结石的风险。然而，饮食草酸盐与结石风险之间的关系尚不清楚。本研究在卫生专业人员随访研究（n = 45,985名男性）、护士健康研究I （n = 92,872名老年女性）和护士健康研究II （n = 101,824名年轻女性）中前瞻性地检查了草酸盐摄入量与肾结石事件之间的关系。每4年使用食物频率问卷评估草酸盐摄入量。Cox比例风险回归用于调整年龄、体重指数、噻嗪类药物使用和饮食因素。在44年的随访中，共记录了4605例肾结石事件。男性草酸盐的平均摄入量为214毫克/天，老年女性为185毫克/天，年轻女性为183毫克/天，结石患者和非结石患者的平均摄入量相似。菠菜占草酸摄入量的40%。对于饮食中草酸含量最高和最低的五分位数的参与者，男性患结石的相对风险为1.22(95%可信区间[Cl] 1.03至1.45;P = 0.01)，老年女性为1.21（95%可信区间[Cl] 1.01至1.44;P = 0.05）。饮食中钙含量较低的男性风险更高（相互作用P = 0.08）。与每月少于1份菠菜相比，每月吃8份或更多菠菜的参与者的相对风险为男性1.30 (95% Cl 1.08至1.58)，老年女性1.34 （95% Cl 1.10至1.64）。在年轻女性中，草酸盐摄入和菠菜与风险无关。这些数据并不意味着饮食草酸盐是肾结石的主要危险因素。
Most kidney stones consist of calcium oxalate, and higher urinary oxalate increases the risk for calcium oxalate nephrolithiasis. However, the relation between dietary oxalate and stone risk is unclear. This study prospectively examined the relation between oxalate intake and incident nephrolithiasis in the Health Professionals Follow-up Study (n = 45,985 men), the Nurses' Health Study I (n = 92,872 older women), and the Nurses' Health Study II (n = 101,824 younger women). Food frequency questionnaires were used to assess oxalate intake every 4 yr. Cox proportional hazards regression was used to adjust for age, body mass index, thiazide use, and dietary factors. A total of 4605 incident kidney stones were documented over a combined 44 yr of follow-up. Mean oxalate intakes were 214 mg/d in men, 185 mg/d in older women, and 183 mg/d in younger women and were similar in stone formers and non-stone formers. Spinach accounted for > 40% of oxalate intake. For participants in the highest compared with lowest quintile of dietary oxalate, the relative risks for stones were 1.22 (95% confidence interval [Cl] 1.03 to 1.45; P = 0.01 for trend) for men and 1.21 (95% Cl 1.01 to 1.44; P = 0.05 for trend) for older women. Risk was higher in men with lower dietary calcium (P = 0.08 for interaction). The relative risks for participants who ate eight or more servings of spinach per month compared with fewer than 1 serving per month were 1.30 (95% Cl 1.08 to 1.58) for men and 1.34 (95% Cl 1.10 to 1.64) for older women. Oxalate intake and spinach were not associated with risk in younger women. These data do not implicate dietary oxalate as a major risk factor for nephrolithiasis.