Effect of Animal and Vegetable Protein Intake on Oxalate Excretion in Idiopathic Calcium Stone Disease

Marangella, Martino; Bianco, Ornella; Martini, C.; Petrarulo, Michele; Vitale, Corrado; Linari, F

doi:10.1111/j.1464-410x.1989.tb05214.x

Cited by 47 publications

(23 citation statements)

References 14 publications

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“…This result could be due either to an increased intake of fruits and vegetables with higher fiber content when reducing protein intake or by chance. In interventional studies in protein-restricted patients, urinary oxalate excretion either decreased [6] or remained stable [22] but never increased.…”

Section: Discussionmentioning

confidence: 99%

A Randomized Trial of Low-Animal-Protein or High-Fiber Diets for Secondary Prevention of Calcium Nephrolithiasis

et al. 2008

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Background: The purpose of this trial was to evaluate the efficacy of a low-animal-protein diet (LAPD) or a high-fiber diet (HFD) for the prevention of calcium nephrolithiasis recurrence. Methods: We conducted a 4-year randomized trial comparing the effect of 2 diets in 175 idiopathic calcium stone formers. Fifty-five were assigned to a LAPD (<13% of total energy derived from protein), 60 were assigned to a HFD (>25 g/day fiber) and 60 were placed on a normal diet (control group). The primary outcome measure was the time to the first recurrence of calcium nephrolithiasis. Daily urine compositions were analyzed at baseline, at month 4 (M4), M12, M24, M36 and M48. Results: Seventy-three patients completed the trial (23 in the LAPD group, 27 in the HFD group and 23 in the control group). Recurrence was 48% (11/23) in the LAPD group, 63% (17/27) in the HFD group and 48% (11/23) in the control group (p = not significant). During follow-up, urinary calcium levels and other urine parameters did not change significantly in the 3 groups, except for a significant decrease in 24-hour urinary sulfate in the LAPD group. Conclusions: In idiopathic calcium stone formers, neither a LAPD nor a HFD appeared to provide protection against recurrence.

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Section: Discussionmentioning

confidence: 99%

A Randomized Trial of Low-Animal-Protein or High-Fiber Diets for Secondary Prevention of Calcium Nephrolithiasis

et al. 2008

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“…Previous studies examining the relationship between dietary protein and urinary oxalate excretion did not control dietary oxalate, a major limitation of these investigations [6][7][8][9][11][12][13][14]. Such dietary control is essential when urinary oxalate excretion is an endpoint in any investigation due to the important contribution that dietary oxalate makes to urinary oxalate excretion [27].…”

Section: Discussionmentioning

confidence: 99%

“…However, the impact of dietary protein on urinary oxalate excretion has not been clearly delineated. Some studies reported that urinary oxalate excretion increased with increased protein intake and decreased with protein restriction [6][7][8][9][10], whereas others noted no change [11][12][13][14]. A limitation of these studies is a lack of dietary oxalate control.…”

Section: Introductionmentioning

confidence: 99%

Increased Protein Intake on Controlled Oxalate Diets Does Not Increase Urinary Oxalate Excretion

Knight¹,

Easter²,

Neiberg³

et al. 2009

Journal of Urology

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High animal protein intake is a risk factor for calcium oxalate stone disease. The effect of dietary protein on the urinary excretion of calcium, acid and citrate is well established. However, its effect on oxalate excretion is unclear, due in part to an inadequate control of dietary oxalate intake in previous studies. This relationship warrants clarification due to the proposed important role of the metabolism of amino acids in endogenous oxalate synthesis. In this study, 11 normal subjects consumed controlled oxalate diets containing 0.6, 1.2 and 1.8 g protein/kg body weight/day. The analysis of 24 h urine collections confirmed that as protein intake increased, urinary calcium and glycolate increased and urinary pH and citrate decreased. The increased glycolate excretion was due in part to an increased hydroxyproline, but not glycolate consumption. Total daily urinary oxalate excretion did not change. When indexed to creatinine there was a small but significant decrease in oxalate excretion. This is most likely due to hyperfiltration. These results indicate that as dietary protein intake increases, the catabolism of diet-derived amino acids is not associated with an increased endogenous oxalate synthesis in normal subjects.

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“…In spite of the high hydroxyproline content of animal protein, however, there is still considerable controversy as to whether or not a high animal protein diet increases the urinary excretion of oxalate. Some studies have concluded that there is a relationship between urinary oxalate and animal protein consumption [30, 31]; others have not found this to be the case [32]. The reasons for these discrepancies are still unclear, although one study has indicated that, for some reason, only about 30% of patients are sensitive to meat protein in terms of its effect on oxalate excretion [31].…”

Section: Dietary Oxalate and Its Precursorsmentioning

confidence: 99%

Role of Dietary Intake and Intestinal Absorption of Oxalate in Calcium Stone Formation

Jaeger¹,

Robertson²

2004

Nephron Physiol

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The factors affecting the urinary excretion of oxalate are critical to the risk of forming calcium oxalate stones. This article reviews the role of dietary and intestinal oxalate in determining the level of oxalate excreted in urine. The amount of oxalate available for absorption throughout the intestine is highly dependent on the state of oxalate (a) in the food ingested, and (b) in the intestinal contents at each section of the intestinal tract since only the soluble form of oxalate can be absorbed. In this respect, the solubility of calcium oxalate (CaOx) under the prevailing conditions is paramount in determining the amount of oxalate available for absorption at any particular site. In turn, the main factors that control how much oxalate is in the soluble form are pH and the concentrations of calcium, magnesium and (indirectly) phosphate. Based on these parameters, a model of the intestine has been constructed which brings together the available evidence on the prevailing concentrations of these various factors at different sites in the intestine after allowing for dietary intake and the concentration of the above ions in intestinal secretions. The model then calculates the likely concentration of oxalate that is in the soluble form at each site and therefore available for passive absorption at that site. The model shows that oxalate is likely to be absorbed in the stomach, although it can be also absorbed in the small intestine, particularly at the distal end (after the absorption of calcium), and in the colon, since, on a normal intake of calcium and phosphate, most of the calcium in the large bowel would be anticipated to be precipitated as calcium phosphate under the prevailing alkaline conditions and high concentration of phosphate. The amount of free oxalate in the colon is also controlled by the presence or absence of Oxalobacter formigenes, an anaerobe that has an obligate requirement for oxalate as a source of energy and cellular carbon.

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Effect of Animal and Vegetable Protein Intake on Oxalate Excretion in Idiopathic Calcium Stone Disease

Cited by 47 publications

References 14 publications

A Randomized Trial of Low-Animal-Protein or High-Fiber Diets for Secondary Prevention of Calcium Nephrolithiasis

A Randomized Trial of Low-Animal-Protein or High-Fiber Diets for Secondary Prevention of Calcium Nephrolithiasis

Increased Protein Intake on Controlled Oxalate Diets Does Not Increase Urinary Oxalate Excretion

Role of Dietary Intake and Intestinal Absorption of Oxalate in Calcium Stone Formation

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