ABSTRACT
INTRODUCTION AND OBJECTIVE: Nutrition therapy for stone prevention is indicated if risks are diet-related. Dietary recommendations (DRs) include higher fluid intake, lower salt intake, lower dietary acid load, and normal calcium (neither excessive nor insufficient). Adherence is challenging to assess and optimally includes multiple measures including patient-reported outcomes. We assessed adherence to individualized targeted DRs issued in our multidisciplinary stone prevention clinic. METHOD(S): From 1/2020-1/2021 we invited patients to complete a questionnaire 1 month after their appointment. They were to estimate the number of days within the last week they followed specific DRs prescribed them and number of days they followed all DRs. Questionnaires were sent by mail with postage-paid return envelopes. This was a quality improvement project;patients were offered to respond anonymously. RESULT(S): Respondents (n=132) represented 29% of patients who were sent questionnaires and were 50% female (61+/-13 y). Of those providing clinical details, 77% were recurrent stone formers;46% were on stone medication(s). There were no adherence differences for men vs. women, recurrent vs. one-time stone formers, nor for those on stone-related medications vs. not. Overall, adherence to eating more F/ V was lower (4.7 vs. 5.5 d/week for all other DRs, p<0.004). We separated responses by receipt: summer/fall (April to mid-November) and winter/spring (mid-November to April), and by pre- vs. post- COVID (before/after March 2020). F/V intake was significantly lower during winter/spring than summer/fall (4.4 vs. 5.5 d/week, p=0.009). Related to the COVID pandemic, patients reported lower adherence to all DRs after the pandemic start (5.0 vs. 5.9 d/week, P=0.009 for difference from before). CONCLUSION(S): Overall, adherence to eating more F/V was significantly lower than for other DRs and was lower yet during winter/ spring. The COVID pandemic did not affect F/V intake specifically but did reduce adherence to all DRs. F/V are important in stone prevention because they provide HCO3 precursors that increase urine citrate and pH. F/V also provide other stone inhibitors, including phytate (which in urine inhibits calcium stone formation) and prebiotics, some of which enhance oxalate-degrading gut bacteria. Moreover, F/V intake can account for up to 30% of urine output and thus may help meet fluid recommendations. Barriers to F/V intake, which may include seasonal variations in cost and availability, should be addressed .
ABSTRACT
Introduction & Objective: Nutrition therapy for stone prevention is indicated if risks are nutrition-related. Common dietary recommendations (DRs) include higher fluid intake, lower salt intake, lower dietary acid load (e.g., more fruits/vegetables, F/V), and normal calcium intake (neither excessive nor insufficient). Adherence is challenging to assess and optimally includes multiple measures including patient-reported outcomes. We assessed adherence to individualized, targeted DRs issued in our multidisciplinary stone prevention clinic. Methods: From 1/2020-1/2021 we invited patients to complete a questionnaire approximately 1 month after their appointment. We asked patients to estimate the number of days within the last week they followed the most common DRs and, in a separate question, days they followed all DRs. Questionnaires were sent by mail with postage-paid envelopes for return. This was a quality improvement project;patients were thus offered to respond anonymously. Results: Respondents (n = 132) represented 29% of patients who were sent questionnaires and were 50% female (61 ± 13 y). Of those providing clinical details, 77% were recurrent stone formers and 46% were on stone medication(s). There were no differences in adherence for men vs. women, recurrent vs. one-time stone formers, nor for those on stone-related medications vs. not. Overall, adherence to eating more F/V was lower (4.7 vs. nearly 5.5 d/week for all other DRs, P < 0.004). We separated responses by their receipt: summer/fall (April to mid-November) and winter/ spring (mid-November to April), and by pre- vs. post-COVID (before/after March 2020). F/V intake was significantly lower during winter/spring than summer/fall (4.4 vs. 5.5 d/week, P = 0.009). For the pre-post COVID pandemic comparison, patients reported lower adherence to all DRs after the start of the pandemic (5.0 vs. 5.9 d/week, P = 0.009 for difference from before). Conclusions: Overall, adherence to eating more F/V was significantly lower than for other DRs and was lower yet during winter/spring. The COVID pandemic did not affect F/V intake specifically but did reduce adherence to all DRs. F/V are important in stone prevention because they provide bicarbonate precursors that increase urine citrate and pH. F/V also provide other stone inhibitors, including phytate, which in urine inhibits calcium stone formation, and prebiotics, some of which selectively enhance oxalate-degrading gut bacteria. Moreover, F/V intake can account for up to 30% of urine output and thus may help to meet fluid recommendations. Barriers to F/V intake, which may include seasonal variations in cost and availability, should be addressed.