Uric acid levels mediate the association between four dietary indices and kidney stones in US adults: A cross-sectional study of NHANES 2007–2018

Abstract

Background Diet and uric acid are closely linked to the formation of kidney stones. However, the specific dietary indices associated with kidney stone risk and the mediating role of uric acid remain unclear. This study investigates the association between four dietary indices and kidney stone risk while exploring the mediating role of uric acid. Methods Data were obtained from the National Health and Nutrition Examination Survey (NHANES). Four dietary indices were calculated: the Mediterranean Diet (MED), Healthy Eating Index-2020 (HEI-2020), Alternate Healthy Eating Index (AHEI), and Dietary Approaches to Stop Hypertension (DASH). Univariate logistic regression analysis and restricted cubic splines (RCS) curve were used to analyze the single effect of dietary index and kidney stones. Weighted Quantile Sum (WQS) and Bayesian Kernel Machine Regression (BKMR) to visualize the mixed effects of multiple dietary indices and kidney stone risk. Finally, mediation analyses were employed to assess associations and mediation effects. Results Among 25,421 participants, 2,470 had a history of kidney stones. All four dietary indices showed a significant negative association with kidney stone risk, with MED and HEI-2020 showing the strongest effects. WQS regression results indicated that the mixed effects of the four dietary indices were negatively correlated with kidney stones, with the highest weight attributed to HEI2020 (49.2%), followed by DASH (26.4%), MED (21.8%), and AHEI (2.9%). BKMR analysis revealed a negative exposure-response trend for each dietary indices to the risk of kidney stones and HEI2020, DASH, MED, and AHEI are negative related with kidney stones at all three quantiles. Mediation analysis revealed that uric acid mediated the relationship between dietary indices and kidney stone risk, with mediation proportions of 25.56% (MED), 12.14% (AHEI), 5.88% (DASH), and 2.52% (HEI-2020). Conclusion Healthy dietary patterns are associated with a reduced risk of kidney stones, partially mediated by uric acid levels.