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Comparison of two diets for the prevention of recurrent stones in idiopathic hypercalciuria.

Abstract

BACKGROUND

A low-calcium diet is recommended to prevent recurrent stones in patients with idiopathic hypercalciuria, yet long-term data on the efficacy of a low-calcium diet are lacking. Recently, the efficacy of a low-calcium diet has been questioned, and greater emphasis has been placed on reducing the intake of animal protein and salt, but again, long-term data are unavailable.

METHODS

We conducted a five-year randomized trial comparing the effect of two diets in 120 men with recurrent calcium oxalate stones and hypercalciuria. Sixty men were assigned to a diet containing a normal amount of calcium (30 mmol per day) but reduced amounts of animal protein (52 g per day) and salt (50 mmol of sodium chloride per day); the other 60 men were assigned to the traditional low-calcium diet, which contained 10 mmol of calcium per day.

RESULTS

At five years, 12 of the 60 men on the normal-calcium, low-animal-protein, low-salt diet and 23 of the 60 men on the low-calcium diet had had relapses. The unadjusted relative risk of a recurrence for the group on the first diet, as compared with the group on the second diet, was 0.49 (95 percent confidence interval, 0.24 to 0.98; P=0.04). During follow-up, urinary calcium levels dropped significantly in both groups by approximately 170 mg per day (4.2 mmol per day). However, urinary oxalate excretion increased in the men on the low-calcium diet (by an average of 5.4 mg per day [60 micromol per day]) but decreased in those on the normal-calcium, low-animal-protein, low-salt diet (by an average of 7.2 mg per day [80 micromol per day]).

CONCLUSIONS

In men with recurrent calcium oxalate stones and hypercalciuria, restricted intake of animal protein and salt, combined with a normal calcium intake, provides greater protection than the traditional low-calcium diet.

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  • Authors+Show Affiliations

    ,

    Department of Clinical Sciences, University of Parma, Parma, Italy. loris.borghi@unipr.it

    , , , , ,

    Source

    The New England journal of medicine 346:2 2002 Jan 10 pg 77-84

    MeSH

    Adult
    Calcium
    Calcium Oxalate
    Calcium, Dietary
    Diet Therapy
    Diet, Sodium-Restricted
    Dietary Proteins
    Humans
    Incidence
    Kidney Calculi
    Male
    Middle Aged
    Oxalates
    Secondary Prevention

    Pub Type(s)

    Clinical Trial
    Comparative Study
    Journal Article
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    11784873

    Citation

    Borghi, Loris, et al. "Comparison of Two Diets for the Prevention of Recurrent Stones in Idiopathic Hypercalciuria." The New England Journal of Medicine, vol. 346, no. 2, 2002, pp. 77-84.
    Borghi L, Schianchi T, Meschi T, et al. Comparison of two diets for the prevention of recurrent stones in idiopathic hypercalciuria. N Engl J Med. 2002;346(2):77-84.
    Borghi, L., Schianchi, T., Meschi, T., Guerra, A., Allegri, F., Maggiore, U., & Novarini, A. (2002). Comparison of two diets for the prevention of recurrent stones in idiopathic hypercalciuria. The New England Journal of Medicine, 346(2), pp. 77-84.
    Borghi L, et al. Comparison of Two Diets for the Prevention of Recurrent Stones in Idiopathic Hypercalciuria. N Engl J Med. 2002 Jan 10;346(2):77-84. PubMed PMID: 11784873.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Comparison of two diets for the prevention of recurrent stones in idiopathic hypercalciuria. AU - Borghi,Loris, AU - Schianchi,Tania, AU - Meschi,Tiziana, AU - Guerra,Angela, AU - Allegri,Franca, AU - Maggiore,Umberto, AU - Novarini,Almerico, PY - 2002/1/11/pubmed PY - 2002/1/25/medline PY - 2002/1/11/entrez SP - 77 EP - 84 JF - The New England journal of medicine JO - N. Engl. J. Med. VL - 346 IS - 2 N2 - BACKGROUND: A low-calcium diet is recommended to prevent recurrent stones in patients with idiopathic hypercalciuria, yet long-term data on the efficacy of a low-calcium diet are lacking. Recently, the efficacy of a low-calcium diet has been questioned, and greater emphasis has been placed on reducing the intake of animal protein and salt, but again, long-term data are unavailable. METHODS: We conducted a five-year randomized trial comparing the effect of two diets in 120 men with recurrent calcium oxalate stones and hypercalciuria. Sixty men were assigned to a diet containing a normal amount of calcium (30 mmol per day) but reduced amounts of animal protein (52 g per day) and salt (50 mmol of sodium chloride per day); the other 60 men were assigned to the traditional low-calcium diet, which contained 10 mmol of calcium per day. RESULTS: At five years, 12 of the 60 men on the normal-calcium, low-animal-protein, low-salt diet and 23 of the 60 men on the low-calcium diet had had relapses. The unadjusted relative risk of a recurrence for the group on the first diet, as compared with the group on the second diet, was 0.49 (95 percent confidence interval, 0.24 to 0.98; P=0.04). During follow-up, urinary calcium levels dropped significantly in both groups by approximately 170 mg per day (4.2 mmol per day). However, urinary oxalate excretion increased in the men on the low-calcium diet (by an average of 5.4 mg per day [60 micromol per day]) but decreased in those on the normal-calcium, low-animal-protein, low-salt diet (by an average of 7.2 mg per day [80 micromol per day]). CONCLUSIONS: In men with recurrent calcium oxalate stones and hypercalciuria, restricted intake of animal protein and salt, combined with a normal calcium intake, provides greater protection than the traditional low-calcium diet. SN - 1533-4406 UR - https://www.unboundmedicine.com/medline/citation/11784873/full_citation L2 - https://www.nejm.org/doi/10.1056/NEJMoa010369?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=www.ncbi.nlm.nih.gov DB - PRIME DP - Unbound Medicine ER -