Nutritional intervention strategies for urinary stones

Nutritional interventions cannot play a major therapeutic role for stones that have already appeared, and usually have to intervene only after the clinical treatment of urinary stones has been initiated, however, they are of great importance for the prevention of recurrence. 1.Energy intake to maintain normal body shape Overweight or obese people should pay attention to the maintenance of water-electrolyte and acid-base balance in the process of weight reduction, regular meals to avoid dehydration, so as not to induce stone recurrence. 2, water intake to maintain urine volume of not less than 2000ml / d as the standard daily should be greater than or equal to 2, 5L, which is based on a quiet lifestyle, non-significant water loss minus endogenous water of about 500ml / d. If there is a lot of activity, sweating, or accompanied by other cases of fluid loss, it should be added at your discretion. To keep the body adequately hydrated, urine abundant and not overly concentrated. At the same time, the dietitian should assess the type of fluid intake of the patient, such as becoming acidic or alkaline, fructose content, phosphate content, sodium content, etc., and provide the necessary guidance to the patient. Appropriate low salt and low energy intake helps to maintain the hydration status. It is generally recommended that sodium intake of patients with urinary stones should not exceed 100 mmol/d, i.e. 2300 mg sodium. 3. control of oxalic acid The ADA recommends controlling oxalic acid intake to no more than 60 mg/d. Avoiding foods with high oxalic acid intake, oxalic acid intake in the daily diet can generally be limited to 50-60 mg/d. Common foods rich in oxalic acid include nuts such as almonds, peanuts, sesame, soybeans, spinach, strawberries, chocolate, radishes, tea, bran or whole wheat products, etc. Intestinal colonization with Bacillus oxalicus can reduce enterogenic hyperoxaluria. 4. Control of uric acid Patients who are overweight or obese and have diabetes or insulin resistance, the occurrence of stones is associated with excessive urinary uric acid excretion and urinary acidification, so purine intake should be actively restricted, and allopurinol medication can be used if necessary. Excessive intake of animal foods with high purine content tends to cause urinary acidification as well. Therefore, improvement of uric acid metabolism is the effect of comprehensive nutritional adjustment, not only because of restriction of exogenous purines. 5, calcium control It is generally recommended to maintain a normal intake and advocate splitting the intake between three or more meals, which is conducive to giving full play to the role of calcium in the intestinal tract in combining dietary oxalic acid and reducing the absorption of the latter. It can be arranged to use calcium-rich milk or yogurt with meals, 100-150ml per meal is sufficient, which is equivalent to 100-150mg/meal of calcium supplement. 6, vitamins In clinical practice, there is a general lack of objective criteria for evaluating the nutritional status of vitamins. On this premise, it is generally recommended that vitamin supplementation be carried out according to the standards of healthy people, including vitamin D. Unless it is clear that stones are related to deficiency, it is not recommended to add extra to the dietary intake. The exception is vitamin B6, for which the dietary recommended standard is between 1,2 and 1,9 mg/d. For the prevention of urinary stones, supplementation at no less than 40 mg/d in the form of pyridoxal phosphate is appropriate.