Association of Dietary Vitamin E Intake with Current Stone Formation: A NHANES Analysis 2017-2020
Vikram S. Lyall, MD1, Tyler S. Bartholomew, PhD2, Vernon M. Pais, Jr., MD MS1.
1Dartmouth Hitchcock Medical Center, Lebanon, NH, USA, 2University of Miami Miller School of Medicine, Miami, FL, USA.
BACKGROUND: Free radical-mediated oxidative renal tubular injury secondary to hyperoxaluria is a proposed mechanism in the formation of calcium oxalate stones. Vitamin E, an important physiologic anti-oxidant, has been shown in animal models to decrease oxidative injury and calcium oxalate crystal deposition. Current recommendations are to maintain 15mg/day vitamin E intake. Our objective was to determine if insufficient dietary vitamin E intake was associated with increased annual incidence of stones.
METHODS: We analyzed data from the 2017-2020 NHANES (National Health and Nutrition Examination Survey), a nationally representative sample (N=7,707). A multivariable logistic regression model was used to assess the association between elevated dietary vitamin E intake (>15mg/day) and nephrolithiasis within the previous 12 months, controlling for gender, race/ethnicity, BMI, diabetes, water, sodium, calcium, and vitamin C intake.
RESULTS: The annual cumulative incidence of nephrolithiasis was 1.53% (CI 1.29%-1.80%). In patients consuming a <15mg/day vitamin E, the annual cumulative incidence was 1.8% compared to 0.8% in patients with vitamin E intake >15mg/day (p=0.024). In adjusted models, participants who consumed <15mg/day vitamin E had significantly higher odds of reporting stones in the previous 12 months (aOR=2.17, 95% CI [1.01-4.55]).
CONCLUSIONS: Vitamin E intake less than the recommended 15mg/day is associated with a 2x greater odds of nephrolithiasis, a finding maintained with multivariable adjustment. These data are consistent with basic science literature suggesting that vitamin E may play an important protective role in the pathogenesis of calcium oxalate stone formation. Future investigation of vitamin E supplementation in recurrent stone formers may help further determine if vitamin E is useful in the management of calcium oxalate stones.
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