Association between alcohol consumption and kidney stones in American adults：2007-2016 NHANES

doi:10.21203/rs.3.rs-2438471/v1

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Association between alcohol consumption and kidney stones in American adults：2007-2016 NHANES

https://doi.org/10.21203/rs.3.rs-2438471/v1

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Purpose

To investigate the association between alcohol consumption and kidney stones in American adults.

Materials and Methods

National Health and Nutrition Examination Survey (NHANES) datasets from 2007 to 2016 were utilized. Participants with a history of kidney stones and alcohol consumption aged 20 or older were included. Weighted proportions and regression analysis were used to assess the association between alcohol consumption and kidney stones by adjusting age, gender, race, marital status, education, recreational activities, smoking, and several comorbidities.

Results

Ten samples related to alcohol consumption were included based on questions from the Alcohol Use Questionnaire (ALQ). In the fully adjusted regression model, none of these ten samples demonstrated a significant association with urolithiasis, that is, alcohol consumption was not significantly associated with the incidence of kidney stones.

Conclusions

Alcohol consumption is not significantly associated with the prevalence of kidney stones. This finding requires a more adequate sample size and a more detailed review of the history of kidney stones to be further verified.

kidney stones

alcohol consumption

NHANES

association

cross-sectional analysis

Kidney stones have a high incidence rate worldwide that has been increasing every year^[1–4]. Alcohol is a common addictive substance, with about a third of the world's population currently consuming it for different reasons^[5]. Previous studies have shown that fluid intake may be associated with kidney stone formation^{[6, 7]}, and alcohol is one of the important liquids. Some researchers believe that alcohol intake is negatively associated with the formation of kidney stones^[8–12], while others believe that alcohol consumption is a risk factor for kidney stone formation^{[13, 14]}.

The purpose of this study was to investigate the relationship between different drinking profiles and history of kidney stones by analyzing National Health and Nutrition Examination Survey (NHANES) cross-sectional data.

Data resource and participants

NHANES, a major program of the National Center for Health Statistics (NCHS), is a program of studies designed to estimate the health and nutritional status of participants in the United States. The survey combines interviews and physical examinations. We utilized 5 continuous cycles of NHANES data from year 2007 to 2016. This cross-sectional study included 29201 adult American participants aged 20 years or older. 317 subsequently pregnant participants were excluded. Furthermore, 2483 participants with incomplete kidney stones history information or other factors unrelated to drinking were excluded. Finally, we selected a sample of 10 people based on questions in the Alcohol Use Questionnaire (ALQ), named Q1-Q10. For a more in-depth analysis, we processed certain questions from different cycles of the ALQ to get samples (Q1, Q4-Q6, Q8-Q10) that are more helpful for the analysis, shown in Supplementary Figure S1. Detailed inclusion and exclusion standards are shown in Fig. 1.

Results and exposure factors

Results of the questionnaire determines whether the participant has a history of nephrolithiasis. If the answer to the question “Have you ever had kidney stones?” is “yes”, we assume that the participant has a history of kidney stones. The veracity of self-reported was confirmed in a previous study^[15].

The main exposure factor was the lifetime and current (during the past 12 months) alcohol consumption of the participants, as determined by the ALQ in NHANES 2007–2016. The type of alcohol consumed was not specified.

Covariates

In order to increase accuracy and credibility, we included the following covariates: age, gender, race, marital status, education, recreational activities, smoking, asthma, overweight, gout, congestive heart failure, coronary heart disease, angina, stroke, cancer, diabetes, hypertension, and BMI. According to the recommendations of NHANES, we devided the age into three groups: 20–39, 40–59, and ≥ 60 years. Races included Mexican American, other Hispanic, non-Hispanic white, non-Hispanic black, and other races. Marital status was categorized as married, widowed, divorced, separated, never married, and living with partner. Education level included less than 9th grade, 9-11th grade (includes 12th grade with no diploma), high school graduate/GED or equivalent, some college or AA degree, and college graduate or above. BMI was divided into < 25, 25–30, and > 30 kg/m2. The comorbidities included asthma, overweight, gout, congestive heart failure, coronary heart disease, angina, stroke, cancer, diabetes, and hypertension.

Statistical methods

We used the NHANES recommended weighting data and the merging method. In the baseline characteristics table, categorical variables are expressed as proportions, and all continuous variables are treated as categorical variables, also expressed as proportions. The difference between those with and without kidney stones history was tested by survey-weighted Chi-square test.

To investigate the relationship between alcohol consumption and kidney stones prevalence, we applied three logistic regression models, including unadjusted, slightly adjusted, and fully adjusted covariates. Crude model was unadjusted. Model I was adjusted for age, gender and race. Model II was adjusted for age, gender, race, marital status, education, recreational activities, smoking, asthma, overweight, gout, congestive heart failure, coronary heart disease, angina, stroke, cancer, diabetes, hypertension, and BMI. The same method was used to examine ten different population samples separately to explore the association between alcohol consumption and kidney stones prevalence. To better assess the relationship, we treated the continuous variables in the ten samples as categorical variables for analysis and estimated trends. In addition, we performed a univariate analysis of the association of all confounders listed in the baseline tables with kidney stones.

We merged the sample weights of 5 continuous cycles according to the recommended method on the NHANES website (https://www.cdc.gov/nchs/nhanes/index.htm). According to the suggestions, we used a weight that was appropriate for the variable of interest that was collected on the smallest number of respondents. All analyses were performed using R packages (http://www.R-project.org; The R Foundation) and EmpowerStats (www.empowerstats.com, X&Y solutions Inc., Boston, MA.). A 2-tailed P < 0.05 was considered statistically significant.

Participants characteristics

Figure 1 shows the study design,inclusion and exclusion criteria. Ten groups of American adults were included in the corresponding sample (Q1-Q10), and the number of people in each group is also shown. Supplementary Figure S1 shows the integration of some questions in different cycles of ALQ for better access to the study sample (Q1, Q4-Q6, Q8-Q10). Table 1 shows the baseline demographic characteristics of the participants based on kidney stones history, using the population prior to classification by the ALQ. Patients with a history of kidney stones may be more likely to have other comorbidities than those without a history of kidney stones. Different histories of kidney stones may not be related to the level of education.

Regression analysis

We put ten samples (Q1-Q10) related to alcohol consumption into three logical regression models for analysis. Although Q1 was negatively correlated with the risk of kidney stones in crude model (OR = 0.70; 95%CI 0.60 to 0.82) and model I (OR = 0.76; 95%CI 0.64 to 0.90), it was not associated with kidney stones in model II (OR = 0.86; 95%CI 0.72 to 1.03). Q4 was positively correlated with the risk of kidney stones in crude model (OR = 1.34; 95%CI 1.02 to 1.76), but not in model I (OR = 1.01; 95%CI 0.76 to 1.33) and model II (OR = 1.06; 95%CI 0.79 to 1.40). The remaining samples were not associated with kidney stones in all three logical regression models (Table 2). In addition, we individually analyzed the effect of each covariate on the risk of kidney stones. When confounders were not considered, women appeared to be less likely to have kidney stones than men (OR = 0.76; 95% CI 0.68 to 0.85), and the risk of kidney stones seemed to be higher in those who smoked, were obese, and had other medical conditions. Interestingly, if covariates were not considered, those who were never married appeared to have a lower risk of kidney stones than those who were married (OR = 0.42; 95% CI 0.34 to 0.51). Furthermore, there was no association between education level and the risk of kidney stones. (Table 3).

This cross-sectional study investigated the association between alcohol consumption and history of kidney stones by analyzing 5 cycles of the NHANES dataset. The results displayed that there was no significant correlation between both lifetime and current (past 12 months) alcohol consumption and a history of kidney stones, that is, there was no significant association between the amount and frequency of alcohol consumption and the prevalence of kidney stones.

Consuming alcohol is a mean of socializing in many cultures. Unfortunately, of the population that do consume alcohol, many is addicted and drink it without restraint. Alcohol consumption is associated with a series of health problems, such as diabetes, obesity^{[16, 17]}etc. Diabetes and obesity have previously been reported to be risk factors for kidney stone formation ^{[18, 19]}. Furthermore, alcohol consumption can cause kidney injury, inflammation and fibrosis, all of which are associated with the formation of kidney stones ^[20–22]. Nevertheless, few studies have elucidated the direct correlation between alcohol consumption and kidney stones. In this study, although the direct association between alcohol consumption and kidney stones does not appear to be significant, other diseases associated with kidney stone formation due to alcohol consumption should be considered.

This study poses some limitations. First, we noticed that some questions in the ALQ explored alcohol consumption of participants in the last 12 months, however, the specific times of kidney stone occurrence for the corresponding participants were not specified in NHANES. As a result, it is unclear how data of participants with kidney stones that occurred before the last 12 months affect the results of this study. In addition, the ALQ questionnaire did not specify the type of alcohol consumed, which limits our ability to assess whether there is an association between different types of alcohol or alcoholic beverages and the formation of kidney stones. Furthermore, detailed data on the composition, size, and treatment history of kidney stones were not available in NHANES, therefore limiting our ability to investigate the correlation between alcohol consumption and different types of kidney stones.

By conducting a cross-sectional study of the available data in the NHANES dataset, we found that alcohol consumption is not significantly associated with the prevalence of kidney stones. This finding requires a more adequate sample size and a more detailed review of the history of kidney stones to be further verified.

ACKNOWLEDGEMENTS

This work was granted and financed by the National Natural Science Foundation of China (No. 8227031238), the Young Talent Support Project of Guangzhou Association for Science and Technology, and the Guangzhou Science Technology and Innovation Commission (No. 202102010214). We thank the participants and staff of NHANES.

DECLARATIONS OF INTERESTS

The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.

ETHICS STATEMENT

The studies involving human participants were reviewed and approved by National Center for Health Statistics (NCHS) research ethics review board. The patients/participants provided their written informed consent to participate in this study.

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Tables 1-3 is available in the Supplementary Files section.

No competing interests reported.

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Version 1

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You are reading this latest preprint version

Association between alcohol consumption and kidney stones in American adults：2007-2016 NHANES

Status:

Version 1

Abstract

Purpose

Materials and Methods

Results

Conclusions

Figures

Introduction

Materials And Methods

Data resource and participants

Results and exposure factors

Covariates

Statistical methods

Results

Participants characteristics

Regression analysis

Discussion

Conclusion

Declarations

References

Tables

Additional Declarations

Supplementary Files

Status:

Version 1