A prospective study of dietary calcium and other nutrients and the risk of symptomatic kidney stones

N Engl J Med. 1993 Mar 25;328(12):833-8. doi: 10.1056/NEJM199303253281203.


Background: A high dietary calcium intake is strongly suspected of increasing the risk of kidney stones. However, a high intake of calcium can reduce the urinary excretion of oxalate, which is thought to lower the risk. The concept that a higher dietary calcium intake increases the risk of kidney stones therefore requires examination.

Methods: We conducted a prospective study of the relation between dietary calcium intake and the risk of symptomatic kidney stones in a cohort of 45,619 men, 40 to 75 years of age, who had no history of kidney stones. Dietary calcium was measured by means of a semiquantitative food-frequency questionnaire in 1986. During four years of follow-up, 505 cases of kidney stones were documented.

Results: After adjustment for age, dietary calcium intake was inversely associated with the risk of kidney stones; the relative risk of kidney stones for men in the highest as compared with the lowest quintile group for calcium intake was 0.56 (95 percent confidence interval, 0.43 to 0.73; P for trend, < 0.001). This reduction in risk decreased only slightly (relative risk, 0.66; 95 percent confidence interval, 0.49 to 0.90) after further adjustment for other potential risk factors, including alcohol consumption and dietary intake of animal protein, potassium, and fluid. Intake of animal protein was directly associated with the risk of stone formation (relative risk for men with the highest intake as compared with those with the lowest, 1.33; 95 percent confidence interval, 1.00 to 1.77); potassium intake (relative risk, 0.49; 95 percent confidence interval, 0.35 to 0.68) and fluid intake (relative risk, 0.71; 95 percent confidence interval, 0.52 to 0.97) were inversely related to the risk of kidney stones.

Conclusions: A high dietary calcium intake decreases the risk of symptomatic kidney stones.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Aged
  • Alcohol Drinking / adverse effects
  • Calcium, Dietary / administration & dosage*
  • Calcium, Dietary / adverse effects
  • Dietary Proteins / adverse effects
  • Humans
  • Kidney Calculi / etiology*
  • Male
  • Middle Aged
  • Nutrition Surveys
  • Potassium, Dietary / administration & dosage
  • Prospective Studies
  • Risk


  • Calcium, Dietary
  • Dietary Proteins
  • Potassium, Dietary