Editorial Comment: Effect of a low-calorie diet on 24-hour urinary parameters of obese adults with idiopathic calcium oxalate kidney stones

Silva, Sandra Barbosa da

doi:10.1590/S1677-5538.IBJU.2021.0140.1

COMMENT

The present work has an interesting approach to evaluate the effect of the hypocaloric diet on the 24-hour urinary metabolic parameters of obese adults with idiopathic calcium oxalate kidney stones. Adult idiopathic calcium oxalate stone formers, with body mass index (BMI) ≥ 30 kg/m2 and a known lithogenic metabolic abnormality, were submitted to low-calorie diet for twelve weeks (¹1. Danilovic A, Marchini GS, Pucci ND, Coimbra B, Torricelli FCM, Batagello C, et al. Effect of a low-calorie diet on 24-hour urinary parameters of obese adults with idiopathic calcium oxalate kidney stones. Int Braz J Urol. 2021;47; 1136-47.).

Obesity is a complex, multifactorial chronic disease influenced by genetic, behavioral, dietary, socioeconomic, and environmental factors (²2. Hruby A, Hu FB. The Epidemiology of Obesity: A Big Picture. Pharmacoeconomics. 2015;33:673-89.). In addition, obesity is associated with both development of kidney disease and progression towards end stage renal failure. Some authors considered kidney stone disease (nephrolithiasis) is one of the possible factors that contribute to an increase in the burden of kidney damage carried by obesity (³3. Carbone A, Al Salhi Y, Tasca A, Palleschi G, Fuschi A, De Nunzio C, et al. Obesity and kidney stone disease: a systematic review. Minerva Urol Nefrol. 2018;70:393-400.). Nephrolithiasis is a common problem that can be associated with in urinary solute composition, has a multifactorial aetiology involving genetic and environmental factors. Nonetheless, the genetic influence on stone formation in the idiopathic stone remains considerable (⁴4. Howles SA, Thakker RV. Genetics of kidney stone disease. Nat Rev Urol. 2020;17:407-21.).

In this context, there are some modifiable risk factors for kidney stones, being obesity one these factors. Obesity is associated with insulin resistance and compensatory hyperinsulinemia, which may lead to the formation of calcium containing kidney stones, by increasing the its urinary excretion (⁵5. Kerstetter J, Caballero B, O’Brien K, Wurtman R, Allen L. Mineral homeostasis in obesity: effects of euglycemic hyperinsulinemia. Metabolism. 1991;40:707-13., ⁶6. Taylor EN, Stampfer MJ, Curhan GC. Obesity, weight gain, and the risk of kidney stones. JAMA. 2005;293:455-62.).

Thus, weight loss can be a strategy for obese people to prevent or reduce the risk of developing kidney stones, including for those with idiopathic stones, however, some approaches are used to promote weight loss may increase kidney stone risk (⁷7. Poore W, Boyd CJ, Singh NP, Wood K, Gower B, Assimos DG. Obesity and Its Impact on Kidney Stone Formation. Rev Urol. 2020;22:17-23.).

This way, the weight loss may improve harm management of kidney stones, depending on how it is achieved. Weight loss could be harmful to prevention of kidney stones if associated with a high animal protein diet (for example, increase the risk of uric acid stones), excessive use of laxatives or rapid loss of muscle (⁸8. Frassetto L, Kohlstadt I. Treatment and prevention of kidney stones: an update. Am Fam Physician. 2011;84:1234-42., ⁹9. Breslau NA, Brinkley L, Hill KD, Pak CY. Relationship of animal protein-rich diet to kidney stone formation and calcium metabolism. J Clin Endocrinol Metab. 1988;66:140-6.). It is important to note that the dietetic advice for weight loss, in this case, should be based on the type of kidney stone.

In summary, although weight loss demonstrates a good strategy in cases ofkidney stones formes, medical and nutritional follow-up is necessary in choosing the strategy to lose weight. The present work showed that the short-term modest weight loss induced by twelve weeks low-calorie diet is not associated with a decrease of 24-hour urinary lithogenic parameters in idiopathic calcium oxalate stone formers. Calcium oxalate urinary stone formation is probably multifactorial and driven by other factors than weight.

REFERENCES

¹
Danilovic A, Marchini GS, Pucci ND, Coimbra B, Torricelli FCM, Batagello C, et al. Effect of a low-calorie diet on 24-hour urinary parameters of obese adults with idiopathic calcium oxalate kidney stones. Int Braz J Urol. 2021;47; 1136-47.
²
Hruby A, Hu FB. The Epidemiology of Obesity: A Big Picture. Pharmacoeconomics. 2015;33:673-89.
³
Carbone A, Al Salhi Y, Tasca A, Palleschi G, Fuschi A, De Nunzio C, et al. Obesity and kidney stone disease: a systematic review. Minerva Urol Nefrol. 2018;70:393-400.
⁴
Howles SA, Thakker RV. Genetics of kidney stone disease. Nat Rev Urol. 2020;17:407-21.
⁵
Kerstetter J, Caballero B, O’Brien K, Wurtman R, Allen L. Mineral homeostasis in obesity: effects of euglycemic hyperinsulinemia. Metabolism. 1991;40:707-13.
⁶
Taylor EN, Stampfer MJ, Curhan GC. Obesity, weight gain, and the risk of kidney stones. JAMA. 2005;293:455-62.
⁷
Poore W, Boyd CJ, Singh NP, Wood K, Gower B, Assimos DG. Obesity and Its Impact on Kidney Stone Formation. Rev Urol. 2020;22:17-23.
⁸
Frassetto L, Kohlstadt I. Treatment and prevention of kidney stones: an update. Am Fam Physician. 2011;84:1234-42.
⁹
Breslau NA, Brinkley L, Hill KD, Pak CY. Relationship of animal protein-rich diet to kidney stone formation and calcium metabolism. J Clin Endocrinol Metab. 1988;66:140-6.

Publication Dates

Publication in this collection
01 Oct 2021
Date of issue
Nov-Dec 2021

History

Received
01 Aug 2021
Accepted
10 Aug 2021

This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

[1] ¹
Danilovic A, Marchini GS, Pucci ND, Coimbra B, Torricelli FCM, Batagello C, et al. Effect of a low-calorie diet on 24-hour urinary parameters of obese adults with idiopathic calcium oxalate kidney stones. Int Braz J Urol. 2021;47; 1136-47.

[2] ²
Hruby A, Hu FB. The Epidemiology of Obesity: A Big Picture. Pharmacoeconomics. 2015;33:673-89.

[3] ³
Carbone A, Al Salhi Y, Tasca A, Palleschi G, Fuschi A, De Nunzio C, et al. Obesity and kidney stone disease: a systematic review. Minerva Urol Nefrol. 2018;70:393-400.

[4] ⁴
Howles SA, Thakker RV. Genetics of kidney stone disease. Nat Rev Urol. 2020;17:407-21.

[5] ⁵
Kerstetter J, Caballero B, O’Brien K, Wurtman R, Allen L. Mineral homeostasis in obesity: effects of euglycemic hyperinsulinemia. Metabolism. 1991;40:707-13.

[6] ⁶
Taylor EN, Stampfer MJ, Curhan GC. Obesity, weight gain, and the risk of kidney stones. JAMA. 2005;293:455-62.

[7] ⁷
Poore W, Boyd CJ, Singh NP, Wood K, Gower B, Assimos DG. Obesity and Its Impact on Kidney Stone Formation. Rev Urol. 2020;22:17-23.

[8] ⁸
Frassetto L, Kohlstadt I. Treatment and prevention of kidney stones: an update. Am Fam Physician. 2011;84:1234-42.

[9] ⁹
Breslau NA, Brinkley L, Hill KD, Pak CY. Relationship of animal protein-rich diet to kidney stone formation and calcium metabolism. J Clin Endocrinol Metab. 1988;66:140-6.

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