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Articles by G. C. Curhan
Total Records ( 3 ) for G. C. Curhan
  E. N Taylor and G. C. Curhan

Background and objectives: Higher urinary calcium is a risk factor for nephrolithiasis. This study delineated associations between demographic, dietary, and urinary factors and 24-h urinary calcium.

Design, setting, participants, & measurements: Cross-sectional studies were conducted of 2201 stone formers (SF) and 1167 nonstone formers (NSF) in the Health Professionals Follow-up Study (men) and Nurses' Health Studies I and II (older and younger women).

Results: Median urinary calcium was 182 mg/d in men, 182 mg/d in older women, and 192 mg/d in younger women. Compared with NSF, urinary calcium as a fraction of calcium intake was 33 to 38% higher in SF (P values ≤0.01). In regression analyses, participants were combined because associations with urinary calcium were similar in each cohort and in SF and NSF. After multivariate adjustment, participants in the highest quartile of calcium intake excreted 18 mg/d more urinary calcium than those in the lowest (P trend =0.01). Caffeine and family history of nephrolithiasis were positively associated, whereas urinary potassium, thiazides, gout, and age were inversely associated, with urinary calcium. After multivariate adjustment, participants in the highest quartiles of urinary magnesium, sodium, sulfate, citrate, phosphorus, and volume excreted 71 mg/d, 37 mg/d, 44 mg/d, 61 mg/d, 37 mg/d, and 24 mg/d more urinary calcium, respectively, than participants in the lowest (P values trend ≤0.01).

Conclusions: Intestinal calcium absorption and/or negative calcium balance is greater in SF than NSF. Higher calcium intakes at levels typically observed in free-living individuals are associated with only small increases in urinary calcium.

  J Lin , F. B Hu and G. C. Curhan

Background and objectives: Sparse longitudinal data exist on how diet influences microalbuminuria and estimated GFR (eGFR) decline in people with well-preserved kidney function.

Design, settings, participants, & measurements: Of the 3348 women participating in the Nurses' Health Study who had data on urinary albumin to creatinine ratio in 2000, 3296 also had data on eGFR change between 1989 and 2000. Cumulative average intake of nutrients over 14 years was derived from semiquantitative food frequency questionnaires answered in 1984, 1986, 1990, 1994, and 1998. Microalbuminuria presence and eGFR decline ≥30% were the outcomes of interest.

Results: Compared with the lowest quartile, the highest quartile of animal fat (odds ratio (OR): 1.72; 95% confidence interval (CI): 1.12 to 2.64) and two or more servings of red meat per week (OR: 1.51; 95% CI: 1.01 to 2.26) were directly associated with microalbuminuria. After adjustment for other nutrients individually associated with eGFR decline ≥30%, only the highest quartile of sodium intake remained directly associated (OR: 1.52; 95% CI: 1.10 to 2.09), whereas β-carotene appeared protective (OR: 0.62, 95% CI: 0.43 to 0.89). Results did not vary by diabetes status for microalbuminuria and eGFR outcomes or in those without hypertension at baseline for eGFR decline. No significant associations were seen for other types of protein, fat, vitamins, folate, fructose, or potassium.

Conclusions: Higher dietary intake of animal fat and two or more servings per week of red meat may increase risk for microalbuminuria. Lower sodium and higher β-carotene intake may reduce risk for eGFR decline.

  E. N Taylor , M. J Stampfer , D. B Mount and G. C. Curhan

Background and objectives: We previously observed associations between a Dietary Approaches to Stop Hypertension (DASH)-style diet and large reductions in kidney stone risk. This study examined associations between a DASH-style diet and 24-hour excretions of urinary lithogenic factors.

Design, setting, participants, & measurements: We studied 3426 participants with and without nephrolithiasis in the Health Professionals Follow-up Study (HPFS) and the Nurses' Health Studies (NHS) I and II. A dietary DASH score was based on seven components: high intake of fruits, vegetables, nuts and legumes, dairy products, and whole grains and low intake of sweetened beverages and red and processed meats. We used analysis of covariance to adjust for age, stone history, body size, and other factors.

Results: Comparing participants in the highest to lowest quintiles of DASH score, multivariate-adjusted urinary calcium excretion was 3% greater in HPFS (P trend 0.12), 10% greater in NHS I (P trend <0.01), and 12% greater in NHS II (P trend 0.05). Urinary oxalate was 4% to 18% greater (P trend all ≤0.03), urinary citrate was 11% to 16% greater (P trend all <0.01), and urinary volume was 16% to 32% greater (P trend all <0.001). Higher DASH score was associated with higher urine potassium, magnesium, phosphate, and pH, and lower relative supersaturations (RSS) of calcium oxalate (women only) and uric acid.

Conclusions: A DASH-style diet may reduce stone risk by increasing urinary citrate and volume. The small associations between higher DASH score and lower RSS suggest unidentified stone inhibitors in dairy products and/or plants.

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