American Journal of Epidemiology Vol. 144, No. 1: 25-33
Copyright © 1996 by The Johns Hopkins University School of Hygiene and Public Health
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Randomized Controlled Trial of a Low Animal Protein, High Fiber Diet in the Prevention of Recurrent Calcium Oxalate Kidney Stones
1Division of Research, Kaiser Permanente Medical Care Program Oakland, CA
2Department of Medicine, Kaiser Permanente Medical Center WaJnut Creek, CA
Reprint requests to Dr. Robert A. Hiatt, Division of Research, Kaiser Permanente Medical Care Program, 3505 Broadway, Oakland, CA 94611-5714
Low protein diets are commonly prescribed for patients with idiopathic calcium nephrolithiasis, who account for >80% of new diagnoses of kidney stones. This dietary advice is supported by metabolic studies and epidemiologic observational studies but has not been evaluated in a controlled trial. Using 1983–1985 data from three Northern California Kaiser Permanente Medical Centers, the authors randomly assigned 99 persons who had calcium oxalate stones for the first time to a low animal protein, high fiber diet that contained approximately 56–64 g daily of protein, 75 mg daily of purine (primarily from animal protein and legumes), one-fourth cup of wheat bran supplement, and fruits and vegetables. Intervention subjects were also instructed to drink six to eight glasses of liquid daily and to maintain adequate calcium intake from dairy products or calcium supplements. Control subjects were instructed only on fluid intake and adequate calcium intake. Both groups were followed regularly for up to 4.5 years with food frequency questionnaires, serum and urine chemistry analysis, and abdominal radiography; and they were urged to comply with dietary instructions. In the intervention group of 50 subjects, stones recurred in 12 (7.1 per 100 person-years) compared with two (1.2 per 100 person-years) in the control group; both groups received a mean of 3.4 person-years of follow-up (p = 0.006). After adjustment for possible confounding effects of age, sex, education, and baseline protein and fluid intake, the relative risk of a recurrent stone in the intervention group was 5.6 (95% confidence interval 1.2–26.1) compared with the control group. The authors conclude that advice to follow a low animal protein, high fiber, high fluid diet has no advantage over advice to increase fluid intake alone. Am J Epidemiol 1996; 144: 25–33.
calcium oxalate; diet; dietary proteins; kidney calculi; randomized controlled trials
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