DIETARY PREDICTORS OF KIDNEY STONE RELAPSE AND COMPOSITION: ASSOCIATIONS WITH PASTA, MILK, AND ANIMAL PROTEIN INTAKE
DOI:
https://doi.org/10.22551/MSJ.2025.04.13Abstract
Dietary factors are known to influence the risk of nephrolithiasis recurrence, yet the specific contributions of refined carbohydrates (such as pasta), milk consumption (as a proxy for dietary calcium), and animal protein intake remain underexplored. Materials and methods: We analyzed data from 144 adult patients monitored between 2023 and 2025 at a clinical nutrition unit. Dietary exposures included weekly intake of pasta and milk (servings/week) and total animal protein (grams/week). The primary outcomes were lithiasis relapse (yes/no) and stone composition (calcium oxalate, uric acid, or mixed/other). Group comparisons were performed using the Mann-Whitney U or Kruskal-Wallis tests, followed by Benjamini-Hochberg False Discovery Rate (FDR) correction. Multivariate logistic regression was applied to identify independent dietary predictors of relapse and stone type, adjusting for age, sex, and residential environment. Random Forest models were used for exploratory prediction analyses. Results: Median pasta intake was higher among patients with relapse compared with non-relapsed individuals (1.0 vs 0.0 servings/week; p = 0.012). This association remained significant after FDR adjustment. Milk consumption differed significantly across stone types (p = 0.013; FDR-adjusted significant), with the highest values observed in calcium-oxalate stones. Animal protein intake showed a non-significant trend toward higher values in uric-acid stone formers. In multivariate analysis, pasta intake was an independent predictor of relapse, while milk and animal protein did not reach significance. The Random Forest models achieved modest predictive performance (accuracy = 0.53 for relapse; 0.68 for stone type classification). Conclusions: Higher pasta intake was independently associated with an increased risk of lithiasis relapse, and milk consumption differed by stone composition. These findings support the hypothesis that specific dietary patterns may influence nephrolithiasis outcomes, although the predictive value remains limited. Larger prospective studies are warranted to validate these associations and to refine personalized nutritional counselling strategies for stone prevention.
References
1. Sima CS, Rascu ASC, Radavoi DG, et al. Profile of Common Nephrolithiasis Risk Variants in the Romanian Population. Romanian J Urol 2019; 18(4): 9-15.
2. Pricop C, Ivănuță M, Nikolic M, Puia D. Occurrence of human health risks of oxalate lithiasis generated by environmental and dietary factors. Environ Eng Manag J 2023; 22(5): 891-898.
3. Almuhanna NR, Alhussain AM, Aldamanhori RB, Alabdullah QA. Association of Chronic Hy-perglycemia with the Risk of Urolithiasis. Cureus 2023; 15(10): e47385.
4. Curhan GC. Epidemiology of stone disease. Urol Clin North Am 2007; 34(3): 287-293.
5. Hughes P. Kidney stones epidemiology. Nephrology [Internet]. 2007 Feb [cited 2025 Oct 19]; 12(s1). Available from: https: //onlinelibrary.wiley.com/doi/10.1111/j.1440-1797. 2006. 00724.x
6. Ivanuta M, Puia D, Petrila O, Ivanuta AM, Pricop C. The Impact of Stone Composition on Treatment Strategies for Patients with Urolithiasis: A Narrative Review. Cureus [Internet]. 2024 Dec 8 [cited 2025 Oct 19]; Available from: https: //www.cureus.com/articles/323748-the-impact-of-stone-composition-on-treatment-strategies-for-patients-with-urolithiasis-a-narrative-review
7. Pricop C, Ivănuță M, Nikolic M, Puia D. Kidney Stones of Type I vs. Type II Diabetic Patients: Are There Any Differences? J Clin Med 2024; 13(20): 6110.
8. Barghouthy Y, Corrales M, Somani B. The Relationship between Modern Fad Diets and Kidney Stone Disease: A Systematic Review of Literature. Nutrients 2021; 13(12): 4270.
9. Taylor EN, Curhan GC. Dietary Calcium from Dairy and Nondairy Sources, and Risk of Symptomatic Kidney Stones. J Urol 2013; 190(4): 1255-1259.
10. Sorokin I, Mamoulakis C, Miyazawa K, Rodgers A, Talati J, Lotan Y. Epidemiology of stone disease across the world. World J Urol 2017; 35(9): 1301-1320.
11. Coe FL, Evan A, Worcester E. Kidney stone disease. J Clin Invest 2005; 115(10): 2598-2608.
12. Pricop C, Ivănuță M, Puia D. Active metabolic lithiasis: A condition that requires proper evaluation and monitoring. Exp Ther Med 2022; 24(6): 715.
13. Bray GA, Heisel WE, Afshin A, et al. The Science of Obesity Management: An Endocrine Society Scientific Statement. Endocr Rev 2018; 39(2): 79-132.
14. ElSayed NA, Aleppo G, Aroda VR, et al. Addendum. 2. Classification and Diagnosis of Diabetes: Standards of Care in Diabetes-2023. Diabetes Care 2023; 46(Suppl. 1): S19-S40. Diabetes Care 2023; 46(9): 1715-1715.
15. Marsden A, Shahtout A. International Organization for Standardization. In: Garcia LS, Allen TC, Baselski VS, Church DL, Karcher DS, Lewis MR, et al., editors. Clinical Laboratory Management [Internet]. 1st edition Wiley; 2024 [cited 2025 Oct 19]. p. 271-7. Available from: https: //onlinelibrary.wiley.com/doi/10.1002/9781683673941.ch19
16. Lin BB, Lin ME, Huang RH, Hong YK, Lin BL, He XJ. Dietary and lifestyle factors for primary prevention of nephrolithiasis: a systematic review and meta-analysis. BMC Nephrol 2020; 21(1): 267.
17. Ivănuță M, Puia D, Cimpoeșu DC, Ivănuță AM, Bîcă OD, Pricop C. Longitudinal Evaluation of Renal Function in Patients with Acquired Solitary Kidney-Urological Perspectives Post-Nephrectomy. J Clin Med 2024; 13(23): 7470.
18. World Medical Association Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Subjects. JAMA. 2013; 310(20): 2191.
19. Dai JC, Pearle MS. Diet and Stone Disease in 2022. J Clin Med. 2022 Aug 13; 11(16): 4740.
20. D’Alessandro C, Ferraro PM, Cianchi C, Barsotti M, Gambaro G, Cupisti A. Which Diet for Calcium Stone Patients: A Real-World Approach to Preventive Care. Nutrients 2019; 11(5): 1182.
21. Curhan GC, Willett WC, Rimm EB, Stampfer MJ. A Prospective Study of Dietary Calcium and Other Nutrients and the Risk of Symptomatic Kidney Stones. N Engl J Med. 1993 Mar 25; 328(12): 833-8.
22. Fan D, Liu H, Han Y, Gao Z, Gu Y. Machine learning algorithms for predicting stone residue and recurrence after lateral decubitus percutaneous nephrolithotomy. Medicine (Baltimore). 2025 Sept 19; 104(38): e44750.
23. Borghi L, Meschi T, Amato F, Briganti A, Novarini A, Giannini A. Urinary volume, water and recurrences in idiopathic calcium nephrolithiasis: a 5-year randomized prospective study. J Urol 1996; 155(3): 839-843.
24. Shah S, Calle JC. Dietary and medical management of recurrent nephrolithiasis. Cleve Clin J Med 2016; 83(6): 463-471.
25. Ferraro PM, Curhan GC, Gambaro G, Taylor EN. Total, Dietary, and Supplemental Vitamin C Intake and Risk of Incident Kidney Stones. Am J Kidney Dis 2016; 67(3): 400-407.
26. Ferraro PM, Taylor EN, Gambaro G, Curhan GC. Soda and Other Beverages and the Risk of Kidney Stones. Clin J Am Soc Nephrol 2013: 1389-1395.
27. Mahmoodi F, Andishgar A, Mahmoudi E, Monsef A, Bazmi S, Tabrizi R. Predicting symptomatic kidney stones using machine learning algorithms: insights from the Fasa adult’s cohort study (FACS). BMC Res Notes 2024; 17(1): 318.
28. Cheraghian B, Meysam A, Hashemi SJ, et al. Kidney stones and dietary intake in adults: a population-based study in southwest Iran. BMC Public Health 2024; 24(1): 955.
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