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Influence of a mineral water rich in calcium, magnesium and bicarbonate on urine composition and the risk of calcium oxalate crystallization


Objective: To evaluate the effect of a mineral water rich in magnesium (337 mg/l), calcium (232 mg/l) and bicarbonate (3388 mg/l) on urine composition and the risk of calcium oxalate crystallization.

Design: A total of 12 healthy male volunteers participated in the study. During the baseline phase, subjects collected two 24-h urine samples while on their usual diet. Throughout the control and test phases, lasting 5 days each, the subjects received a standardized diet calculated according to the recommendations. During the control phase, subjects consumed 1.4 l/day of a neutral fruit tea, which was replaced by an equal volume of a mineral water during the test phase. On the follow-up phase, subjects continued to drink 1.4 l/day of the mineral water on their usual diet and collected 24-h urine samples weekly.

Results: During the intake of mineral water, urinary pH, magnesium and citrate excretion increased significantly on both standardized and normal dietary conditions. The mineral water led to a significant increase in urinary calcium excretion only on the standardized diet, and to a significantly higher urinary volume and decreased supersaturation with calcium oxalate only on the usual diet.

Conclusions: The magnesium and bicarbonate content of the mineral water resulted in favorable changes in urinary pH, magnesium and citrate excretion, inhibitors of calcium oxalate stone formation, counterbalancing increased calcium excretion. Since urinary oxalate excretion did not diminish, further studies are necessary to evaluate whether the ingestion of calcium-rich mineral water with, rather than between, meals may complex oxalate in the gut thus limiting intestinal absorption and urinary excretion of calcium and oxalate.

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  • Ackermann D, Baumann JM, Futterlieb A & Zingg EJ (1988): Influence of calcium content in mineral water on chemistry and crystallization conditions in urine of calcium stone formers. Eur. Urol. 14, 305–308.

    CAS  Article  Google Scholar 

  • Bellizzi V, De Nicola L, Minutolo R, Russo D, Cianciaruso B, Andreucci M, Conte G & Andreucci VE (1999): Effects of water hardness on urinary risk factors for kidney stones in patients with idiopathic nephrolithiasis. Nephron 81 (Suppl 1), 66–70.

    CAS  Article  Google Scholar 

  • Borghi L, Meschi T, Amato F, Briganti A, Novarini A & Giannini A (1996): Urinary volume, water and recurrences in idiopathic calcium nephrolithiasis: a 5-year randomized prospective study. J. Urol. 155, 839–843.

    CAS  Article  Google Scholar 

  • Caudarella R, Rizzoli E, Buffa A, Bottura A & Stefoni S (1998): Comparative study of the influence of 3 types of mineral water in patients with idiopathic calcium lithiasis. J. Urol. 159, 658–663.

    CAS  Article  Google Scholar 

  • Coen G, Sardella D, Barbera G, Ferrannini M, Comegna C, Ferazzoli F, Dinnella A, D'Anello E & Simeoni P (2001): Urinary composition and lithogenic risk in normal subjects following oligomineral versus bicarbonate-alkaline high calcium mineral water intake. Urol. Int. 67, 49–53.

    CAS  Article  Google Scholar 

  • Couzy F, Kastenmayer P, Vigo M, Clough J, Munoz-Box R & Barclay DV (1995): Calcium bioavailability from a calcium- and sulfate-rich mineral water, compared with milk, in young adult women. Am. J. Clin. Nutr. 62, 1239–1244.

    CAS  Article  Google Scholar 

  • Curhan GC, Willett WC, Rimm EB & Stampfer MJ (1993): A prospective study of dietary calcium and other nutrients and the risk of symptomatic kidney stones. N. Engl. J. Med. 328, 833–838.

    CAS  Article  Google Scholar 

  • Curhan GC, Willett WC, Speizer FE, Spiegelman D & Stampfer MJ (1997): Comparison of dietary calcium with supplemental calcium and other nutrients as factors affecting the risk for kidney stones in women. Ann. Intern. Med. 126, 497–504.

    CAS  Article  Google Scholar 

  • Deutsche Gesellschaft für Ernährung, Österreichische Gesellschaft für Ernährung, Schweizerische Gesellschaft für Ernährungsforschung, Schweizerische Vereinigung für Ernährung (German, Austrian and Swiss Societies of Nutrition) (2000): Referenzwerte für die Nährstoffzufuhr (Reference values for nutritient intake ). Frankfurt: Umschau Braus.

  • Graham LA, Caesar JJ & Burgen ASV (1960): Gastrointestinal absorption and excretion of Mg28 in man. Metab. Clin. Exp. 9, 646–659.

    CAS  Google Scholar 

  • Hesse A, Tiselius HG & Jahnen A (2002): Urinary Stones. Diagnosis, Treatment, and Prevention of Recurrence, 2nd Edition. Basel: Karger.

    Book  Google Scholar 

  • Keßler T & Hesse A (2000): Cross-over study of the influence of bicarbonate-rich mineral water on urinary composition in comparison with sodium potassium citrate in healthy male subjects. Br. J. Nutr. 84, 865–871.

    PubMed  Google Scholar 

  • Keßler T & Hesse A (2002): Effect of blackcurrant-, cranberry- and plum juice consumption on risk factors associated with kidney stone formation. Eur. J. Clin. Nutr. 56, 1020–1023.

    Article  Google Scholar 

  • Kohri K, Garside J & Blacklock NJ (1988): The role of magnesium in calcium oxalate urolithiasis. Br. J. Urol. 61, 107–115.

    CAS  Article  Google Scholar 

  • Li MK, Blacklock NJ & Garside J (1985): Effects of magnesium on calcium oxalate crystallization. J. Urol. 133, 123–125.

    CAS  Article  Google Scholar 

  • Liebman M & Costa G (2000): Effects of calcium and magnesium on urinary oxalate excretion after oxalate loads. J. Urol. 163, 1565–1569.

    CAS  Article  Google Scholar 

  • Marangella M, Vitale C, Petrarulo M, Rovera L & Dutto F (1996): Effects of mineral composition of drinking water on risk for stone formation and bone metabolism in idiopathic calcium nephrolithiasis. Clin. Sci. 91, 313–318.

    CAS  Article  Google Scholar 

  • Massey LK & Kynast-Gales (1998): Substituting milk for apple juice does not increase kidney stone risk in most normocalciuric adults who form calcium oxalate stones. J. Am. Diet. Assoc. 98, 303–308.

    CAS  Article  Google Scholar 

  • Nicar MJ, Hill K & Pak CYC (1987): Inhibition by citrate of spontaneous precipitation of calcium oxalate in vitro. J. Bone Miner. Res. 2, 215–220.

    CAS  Article  Google Scholar 

  • Quamme GA (1993): Magnesium homeostasis and renal magnesium handling. Miner. Electrolyte Metab. 19, 218–225.

    CAS  PubMed  Google Scholar 

  • Reungjui S, Prasomgwatana V, Premgamone A, Tosukhowong P, Jirakulsomchok S & Sriboonlue P (2002): Magnesium status of patients with renal stones and its effect on urinary citrate excretion. BJU Int. 90, 635–639.

    CAS  Article  Google Scholar 

  • Rodgers AL (1997): Effect of mineral water containing calcium and magnesium on calcium oxalate urolithiasis risk factors. Urol. Int. 58, 93–99.

    CAS  Article  Google Scholar 

  • Sabatier M, Arnaud MJ, Kastenmayer P, Rytz A & Barclay DV (2002): Meal effect on magnesium bioavailability from mineral water in healthy women. Am. J. Clin. Nutr. 75, 65–71.

    CAS  Article  Google Scholar 

  • Simpson DP (1983): Citrate excretion: a window on renal metabolism. Am. J. Physiol. 244, 223–234.

    Google Scholar 

  • Werness PG, Brown CM, Smith LH & Finlayson B (1985): EQUIL2: a basic computer program for the calculation of urinary saturation. J. Urol. 134, 1242–1244.

    CAS  Article  Google Scholar 

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Guarantor: R Siener.

Contributors: All authors collaborated closely in producing the data and writing the paper.

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Correspondence to R Siener.

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Siener, R., Jahnen, A. & Hesse, A. Influence of a mineral water rich in calcium, magnesium and bicarbonate on urine composition and the risk of calcium oxalate crystallization. Eur J Clin Nutr 58, 270–276 (2004).

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  • mineral water
  • magnesium
  • bicarbonate
  • calcium
  • urine composition

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