Impact of body mass index on size and composition of urinary stones: a systematic review and meta-analysis

Wang, Daoqi; Tan, Jiahong; Geng, Erkang; Wan, Chuanping; Xu, Jinming; Yang, Bin; Zhou, Yuan; Zhou, Guiming; Ye, Zhenni; Li, Jiongming; Liu, Jianhe

doi:10.1590/S1677-5538.IBJU.2022.0587

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REVIEW ARTICLE • Int. braz j urol 49 (3) • May-Jun 2023 • https://doi.org/10.1590/S1677-5538.IBJU.2022.0587 copy

Impact of body mass index on size and composition of urinary stones: a systematic review and meta-analysis

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Background

Several studies have explored the impact of BMI on size and composition of urinary stones. Because there were controversies, a meta-analysis was necessary to be carried out to provide some evidence of the relationship of BMI and urolithiasis.

Materials and Methods

PubMed, Medline, Embase, Web of Science databases, and the Cochrane Library were searched up to August 12th 2022 for eligible studies. The urolithiasis patients were summarized into two groups: BMI < 25 and ≥ 25 kg/m2. Summary weighted mean difference (WMD), relative risk (RR) and 95% confidence intervals (CI) were calculated through random effects models in RevMan 5.4 software.

Results

A total of fifteen studies involving 13,233 patients were enrolled in this meta-analysis. There was no significant correlation of BMI and size of urinary stone (WMD -0.13mm, 95% CI [-0.98, 0.73], p = 0.77). Overweight and obesity increased the risk of uric acid stones in both genders and in different regions (RR=0.87, [95% CI] = 0.83, 0.91, p<0.00001). There was a higher risk of calcium oxalate stones formation in overweight and obesity group in total patients (RR=0.95, [95% CI] = 0.91, 0.98, p = 0.006). The relationship of BMI and calcium phosphate was not observed in this meta-analysis (RR=1.12, [95% CI] = 0.98, 1.26, p = 0.09). Sensitivity analysis was performed and indicated similar results.

Conclusions

The current evidence suggests a positive association between BMI and uric acid and calcium oxalate stones. It would be of great guiding significance to consider losing weight when treating and preventing urinary stones.

Urinary Calculi; Body Mass Index; Obesity

Studies	Nation	LOE	Study quality	Number of samples	BMI (kg/m2) Classification (Number of each group)	Age (years) (M± SD)	Sex (male: female)
Takeuchi H,. 2019 [14]	Japan	2b	7/9	63	BMI<25: (36) BMI≥25: (27)	55.6±16	49:14
Trinchieri A, et al. 2016 [19]	Italy	3b	7/9	1698	BMI<18.5: (91) 18.5≤BMI<24.9: (924) 25≤BMI<29.9: (542) 30≤BMI: (141)	45.9±14.6	984:714
Lee SC, et al. 2007 [20]	South Korea	3b	7/9	704	BMI<25: (475) BMI≥25: (229)	42.8±13.2	470:234
Ekeruo WO, et al. 2004 [21]	The USA	3b	7/9	1021	BMI<25: (881) BMI≥25: (140)	53.2±14.9	ND
Daudon M, et al. 2006(1) [22]	France	3b	7/9	1930	BMI<25: (1259) 25≤BMI<30: (480) 30≤BMI: (191)	ND	1370:561
Daudon M, et al. 2006(2) [23]	France	3b	7/9	2464	BMI<25: (1416) 25≤BMI<30: (703) 30≤BMI: (345)	53.6±11.4	1760:704
Chou YH, et al. 2010 [24]	Taiwan, China	3b	7/9	907	18.5≤BMI<25: (251) 25≤BMI<27: (304) 27≤BMI: (352)	53.9±14	661:246
del Valle EE, et al. 2010 [25]	Argentina	3b	7/9	817	BMI<24.9: (337) 25≤BMI<29.9: (322) 30≤BMI: (158)	ND	459:358
Mosli HA, et al. 2012 [26]	Saudi Arabia	2b	7/9	173	BMI<18: (5) 18.5≤BMI<24.9: (30) 25≤BMI<30: (64) 30≤BMI: (24)	46.03±12.7	131:42
Al-Hayek S, et al. 2013 [27]	The USA	3b	7/9	325	BMI<25: (88) 25≤BMI<30: (103) 30≤BMI: (134)	51.8±12.5	162:163
Najeeb Q, et al. 2013 [28]	India	3b	7/9	100	BMI<25: (28) 25≤BMI<30: (38) 30≤BMI: (34)	38.49±13.72	70:30
Çaltık Yılmaz A, et al. 2015 [29]	Turkey	2b	6/9	84	BMI<18: (52) 18≤BMI<25: (20) 25≤BMI: (12)	ND	42:42
Fram EB, et al. 2015 [30]	The USA	3b	7/9	382	BMI<25: (79) 25≤BMI<30: (140) 30≤BMI: (163)	46.4±15	224:382
Shavit L, et al. 2014 [31]	The UK	3b	6/9	2132	BMI<25: (833) 25≤BMI<30: (863) 30≤BMI: (436)	46±15	1503:629
Almannie RM, et al. 2019 [32]	Saudi Arabia	3b	7/9	433	BMI<18: (24) 18≤BMI<25: (81) 25≤BMI: (328)	ND	316:117

	Characteristics	Studies	Number of patients	Heterogeneity		Overall effect
	Characteristics	Studies	BMI<25 vs BMI≥25(kg/m²)	p value	I2 (%)	WMD (95% CI)	p value*
Serum	Calcium (mg/dL)	[20, 28]	503/301	0.95	0	-0.10 (-0.19, -0.01)	0.03
Serum	Urate (mg/dL)	[20, 28, 30]	582/604	0.02	75%	-0.86 (-1.04, -0.68)	<0.00001
24-urine	Volume (mL)	[19, 20, 30]	1362/1069	0.4	0	-88.49 (-148.02, -28.95)	0.004
	pH	[14, 19, 20, 28, 31]	2180/2164	<0.00001	98%	0.13(0.09, 0.16)	<0.00001
	Calcium excretion (mg/day)	[20, 30, 31]	1387/1831	0.26	26%	-11.47(-19.97, -2.96)	0.008
	Oxalate excretion (mg/day)	[20, 30, 31]	1387/1831	0.58	0	-1.62(-2.67, -0.57)	0.003
	Urate excretion (mg/day)	[14, 20, 30, 31]	1423/1858	0.006	76%	-88.23(-101.87, -74.59)	<0.00001
	Citrate excretion (mg/day)	[20, 30, 31]	1387/1831	0.1	57%	-33.28(-52.16, -14.40)	0.00006

Items	Studies	Number of patients	Heterogeneity		Overall effect
Items	Studies	BMI<25 vs BMI≥25 (kg/m2)	p value	I2 (%)	RR/WMD (95% CI)	p value*
size of urolithiasis	[14, 20, 26, 29]	618/406	0.64	0	-0.13(-0.98, 0.73)	0.77
calcium oxalate	[19, 21, 22, 24, 25, 27, 28, 30-32]	4103/3831	<0.00001	96%	0.95(0.91, 0.98)	0.006
calcium oxalate (male)	[22, 25, 27]	970/728	0.8	0%	1.34(1.05, 1.72)	0.02
calcium oxalate (female)	[22, 25, 27]	484/337	0.32	13%	1.16(0.85, 1.58)	0.36
calcium phosphate	[21, 22, 24, 25, 27, 28, 30-32]	3264/3292	<0.00001	91%	1.15(0.97, 1.35)	0.1
calcium phosphate(male)	[22, 25, 27]	970/728	0.82	0%	1.52(1.06, 2.17)	0.02
calcium phosphate(female)	[22, 25, 27]	484/337	0.76	0%	1.19(0.90, 1.58)	0.22
uric acid	[19, 21, 22, 23, 24, 25, 27, 28, 30-32]	5519/4879	0.00001	98%	0.87(0.83, 0.91)	<0.00001
uric acid (male)	[22, 25, 27]	970/728	0.66	0%	0.48(0.36, 0.64)	<0.00001
uric acid (female)	[22, 25, 27]	484/337	0.72	0%	0.47(0.29, 0.76)	0.002
carbapatite	[19, 27, 32]	1032/1104	0.52	0%	1.09(0.85, 1.40)	0.51
cystin	[27, 32]	193/565	0.02	81%	2.52(1.20, 5.31)	0.01
mixed stones	[19, 24, 25, 27, 31]	1751/2316	0.36	9%	1.15(1.06, 1.24)	0.00009
mixed stones (male)	[25, 27]	86/242	0.79	0%	1.04(0.68, 1.57)	0.87
mixed stones (female)	[25, 27]	109/151	0.07	69%	1.05(0.77, 1.43)	0.74

Items	Studies	Number of patients	Heterogeneity		Overall effect		Higher in
Items	Studies	BMI<25 vs BMI≥25 (kg/m²)	p value	I2 (%)	RR/WMD (95% CI)	p value*
size of urinary stones	14, 20, 26]	546/394	0.45	0	-0.15(-1.01, 0.72)	0.74	/
calcium oxalate	[19, 21, 22, 24, 25, 27, 28, 30, 32]	3867/3427	<0.00001	97%	0.95(0.91, 0.99)	0.01	BMI ≥25
calcium phosphate	[21, 22, 24, 25, 27, 28, 30, 32]	3028/2888	<0.00001	91%	0.98(0.85, 1.14)	0.83	/
uric acid	[19, 21, 22, 23, 24, 25, 27, 28, 30, 32]	5283/4475	0.00001	98%	0.89(0.86, 0.93)	<0.00001	BMI ≥25
carbapatite	[19, 27, 32]	1032/1104	0.52	0%	1.09(0.85, 1.40)	0.51	/
cystin	[27, 32]	193/565	0.02	81%	2.52(1.20, 5.31)	0.01	BMI <25
mixed stones	[19, 24, 25, 27]	1515/1912	0.63	0%	1.20(1.08, 1.34)	0.001	BMI <25

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[1] Correspondence address: Jiahong Tan, MD Department of Obstetrics and Gynecology, The First People’s Hospital of Yunnan Province, No. 157 of Jinbi Road, Xishan District, Kunming, 650032, China; E-mail: whtjtjh@163.com