尿路結石症の発生原因に関する検討 (第4報):食事が尿中排泄物質に及ぼす影響と食事指導について DIETARY MANAGEMENT OF RENAL STONE DISEASE:With Special Reference to Oxalate

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食事が尿中排泄物質 (とくに蓚酸) に及ばす影響について検討した.<br>1) 健康成人男子9名に16時間の絶食の後普通食を与えると, Ca排泄量は食後2~4時間目にピークをしめし, 蓚酸は食後4~6時間目にはじめて有意に増加した. 食事負荷による食後6時間の増加分は, Ca 38.4%, 蓚酸11.8%, 尿酸7.1%, Mg 27.8%で, 普通食が尿中蓚酸排泄量に及ぼす影響はCaに比べてはるかに少なかった.<br>2) 健康成人男子11名に一定の朝食と, 昼食として標準食, 高蓚酸食 (標準食+ホウレンソウの油イタメ150g), 高蓚酸高蛋白食を負荷した. 高蓚酸食負荷により蓚酸排泄量は標準食の約2倍増加したが, 逆にCa, Mg排泄量は標準食の約半分に減少した. 高蓚酸高蛋白質食を負荷すると, 高蓚酸食負荷時に比べてCa排泄量は有意に増加し, 逆に蓚酸排泄量は有意に減少した.<br>3) 上記と同じ高蓚酸高蛋白食を absorptive hypercalciuria と診断した男子結石患者13名に負荷したところ, Ca排泄量は対照群より著明に増加していたが, 蓚酸排泄量には差がなかった.<br>以上の結果ならびに既報の結石患者の食生活調査成績 (日本栄養・食糧学会誌37:1~7, 1984) をもとに, 再発予防法としての食事指導の実際について具体的に述べた.

The influence of dietary load on urinary oxalate and electrolytes was investigated in normal healthy subjects.<br>Under the load of a normal lunch, urinary oxalate, calcium, uric acid and magnesium excretion were increased by 11.8%, 38.4%, 7.1% and 27.8% respectively during 6 hours after the meal.<br>Under the load of an oxalate-rich lunch (containing 150g spinach fried in oil), urinary oxalate excretion was surprisingly increased. Conversely, urinary calcium and magnesium excretion were remarkablly decreased.<br>Under the load of an oxalate and animal protein rich lunch, urinary oxalate excretion was decreased, and urinary calcium excretion was increased compared with the oxalate rich lunch loading.<br>Under the load of an oxalate and animal protein rich lunch, urinary calcium excretion was significantly higher in calcium stone formers than in normal healthy subjects but urinary oxalate excretion in calcium stone formers was equal to that in normal healthy subjects.<br>From thease results, and from other nutritional reseach on Japanese stone formers (Urologica Internationalis, 39:32, 1984), it can be said that calcium restriction alone is not sufficient for the prophylaxis of renal stone disease and individual dietary guidance should be the primary measure.<br>This general dietary guidance should be advised.<br>a) high fluid intake<br>b) prolongation of the time between dinner and sleep<br>c) avoidance of making the evening meal the main meal (there should be a balance of meals throughout the day)<br>d) correction of unbalanced diet; the diet should include all kinds of food.

Journal

  • The Japanese Journal of Urology

    The Japanese Journal of Urology 76(3), 293-302, 1985

    THE JAPANESE UROLOGICAL ASSOCIATION

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