Dietary determinants of renal stone among patients treated at the urology department of Adama Hospital Medical College, Adama, Oromia, Ethiopia

Dietary determinants of renal stone among patients treated at the urology department of Adama Hospital Medical College, Adama, Oromia, Ethiopia | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Dietary determinants of renal stone among patients treated at the urology department of Adama Hospital Medical College, Adama, Oromia, Ethiopia Gemechu Dereje Feyissa, Melkamu Negassa Bidu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5640691/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Kidney stones are solid crystals that form from dissolved minerals in the nephrons of the kidney. Next to urinary tract infections and prostate disorders, kidney stones are the third most common urinary tract problem. Despite the availability of a large number of studies investigating the correlation between kidney stone formation and several risk factors, data regarding the association between dietary practices and renal stone disease is not available in the study area. Objective: To identify the dietary determinants of renal stones among patients treated at Adama Hospital Medical College, Adama, Ethiopia, 2023. Methods: An institution-based unmatched case-control study was conducted among a total of 243 patients (81 cases and 162 controls). Cases were recruited consecutively while systematic sampling technique was used to select controls. Data were collected using pretested interviewer-administered structured questionnaires and patient chart reviews. Data were entered and analyzed using SPSS software 22. The association between independent and dependent variables was done by using a binary logistic regression model. Adjusted odds ratio (AOR) along with 95% confidence interval (CI) was calculated to evaluate the strength of association between independent variables and the outcome variable. Variables having p-value < 0.05 in the multivariable analysis were considered statistically significant. Result: From the total, 59 (72.8%) cases and 85 (52.5%) controls were male. In the adjusted model, water intake < 2 liters per day [AOR=16.79, 95% CI: (5.22, 53.97)], consumption of salted nut [AOR=4.96, 95% CI: (2.00, 12.28)], frequent meat consumption [AOR=2.31, 95% CI: (1.04, 5.12)] were independent dietary determinantsof renal stone. On the other hand, being male [AOR=7.79, 95% CI: (3.07, 19.76)], age category 20-39 years [AOR= 4.18, 95% CI: (1.50, 11.67)] and 40-59 years [AOR=11.69, 95% CI: (4.19, 32.59)], reside in low land areas [AOR= 3.66, 95% CI: 1.18, 11.36)], and family history of renal stones [AOR= 7.50, 95% CI: 2.60, 21.71)] were independent socio-demographic determinants of renal stone. Conclusion : Volume of water intake, meat, and salted nut consumption patterns were independent dietary determinants of renal stone. Therefore, a dietary intervention like drinking water above 2 liters per day, minimizing salt nut, and meat consumption, and providing health education targeting the risk groups may help to prevent renal stones. We recommend future researchers conduct studies that focus on identifying the types of stones and associated risk factors. Dietary determinants renal stone Adama Oromia Ethiopia Figures Figure 1 Introduction Kidney stones (nephrolithiasis) are solid crystals that form from dissolved minerals in the nephrons of the kidney and are usually excreted in the urethra ( 1 , 2 ). Next to urinary tract infections and prostate disorders, Kidney stones are the third most common urinary tract problem ( 3 ). Kidney stones have different causes and are comprised of different materials. There are four major kinds of kidney stones. These are calcium stones, struvite stones, uric acid stones, and cysteine stones ( 4 ). The most common type of renal stones is calcium stones which account for almost 70 to 80% of all kidney stones ( 5 ). Uric acid stones are formed due to the occurrence of supersaturated urea which can be caused by multiple factors. Globally, uric acid stones are the third most common type of kidney stones ( 6 ). Struvite stones are the fourth most common type of renal stones occurring due to bacterial imbalances which leads to an increased level of ammonia, reduced phosphate solubility, and carbonate imbalance in the body. This all causes the precipitation of these phosphate-rich struvite salts. The last types of kidney stones are cysteine stones which occur due to genetic mutation that leads to malabsorption in the renal tubal. Cysteine stones are also a rare form of kidney stones globally ( 4 , 7 ). Nephrolithiasis is rising in both developing and developed countries at an alarming rate ( 8 ). Worldwide, the number of people affected by the disease continues to rise each year with 200 million people ( 2 ). Kidney stone disease affects 1–5% of the societies in Asian countries, 5–10% of the societies in Europe, and 13% of the societies in North America ( 9 ). However, there is no adequate data regarding the incidence and prevalence of kidney stone disease in Africa and other developing countries ( 10 ). Kidney stone formation is influenced by diet, genetics, environment, and lifestyle ( 2 ). Pieces of evidence showed that socioeconomic status, sex, geographic region race, education, hot climate, occupation, positive family history, unhealthy diet, smoking, physical activity, alcohol consumption, obesity, low fluid intake, dehydration, water quality, genetic background, and comorbid metabolic disorders such as hypertension, diabetes mellitus, cardiovascular disease, and chronic kidney disease are associated with kidney stones formation ( 4 ). Renal stone disease is a significant public health problem because of its incidence, recurrence, and severe consequences ( 11 ). It seriously affects the health and quality of life of populations globally. It is also affecting the patient's life socially and psychologically ( 12 ). Renal stone diseases cause significant morbidity including urinary tract infection, flank pain, hydronephrosis, and decreased renal function ( 13 ). Kidney stone disease is associated with an elevated risk of chronic and end-stage kidney disease, probably as a result of kidney injury from obstructive nephropathy ( 14 , 15 ). Severe pain due to kidney stones affects about 10–20% of men, and 3–5% of women ( 1 ). Besides, it is the leading cause of the consumption of strong addictive pain medication ( 16 ). Findings also revealed that metabolic bone diseases, cardiovascular events, and vascular calcifications are more likely to occur in patients affected by urolithiasis ( 17 ). Previous studies have revealed that the prevalence and incidence of renal stone disease have continued to rise in the last two decades globally as a result of changes in lifestyle, dietary practices, and global warming as possible causes ( 14 , 18 – 20 ). Previously renal stone disease was restricted to developed countries; however, it is now a serious public health problem in many developing countries ( 21 ). The prevalence of urolithiasis has also continued to rise in tropical and sub-Saharan African countries. As Ethiopia is a fast-growing, sub-Saharan African country (SSA), located near the Afro-Asian stone belt, the burden is expected to be rising and becoming a public health issue ( 22 , 23 ). Dietary factors play a vital role in kidney stone formation. Increased intake of dietary calcium, potassium, alcohol, and total fluid is associated with a lower risk of Kidney stone formation, whereas supplemental calcium, sodium, sucrose, and animal protein may be associated with an elevated risk ( 10 ). Moreover, a high‑protein diet, a high-salt diet, and extreme fasting could contribute to the rising incidence of renal stones ( 24 ). Many studies have also demonstrated the protective role of fruits and vegetables against renal stone formation ( 25 ). Dietary practices are one of the factors that contribute to the growing incidence and prevalence of kidney stone disease ( 26 ). Previously conducted research indicated that dietary factors such as carbohydrates, protein, sodium, fiber, folate, vitamin C, lipids, beans, cereals, leaves, and vegetables could change the chemical composition of the urinary tract and cause super-saturation ( 27 ). However, data regarding the association between dietary factors and renal stone disease is not available in the study area. Therefore this study aimed to determine the association between dietary factors and renal stones among patients treated at the urology department of Adama Hospital Medical College (AHMC), Adama, Oromia, Ethiopia. Methods Study area and period The study was carried out in Adama Hospital Medical College (AHMC) which is located in Adama town, Oromia region. The city is located 98 kilometers far away to the east of Addis Ababa, the capital of Ethiopia. In this hospital, the urology department began operations in 2017: six years earlier with one urologist, one outpatient department (OPD) clinic, and one operating room table. Five years later, the department employed two urologists, two outpatient department clinics, and two operating rooms (OR) that operated twice a week. In addition, two times a week, shock wave therapy is used to treat kidney stones in four to six patients. (The urology department has grown from one surgeon to two, with two OPD clinics, two OR tables, and a shock wave procedure for renal stone). The hospitals have a total of 184 beds. The investigation was carried out from March 1, 2023, to April 12, 2023. A urology surgeon was assigned to AHMC in 2009. The department previously operated under general surgery but became independent in 2012. Study design, study population, and inclusion criteria An institution-based unmatched case-control study design was employed. The source population was all adult patients ( ≥ 18 years) on follow-up care at the urology department of Adama Hospital Medical College. The study population for the cases was adult patients with renal stones. Ca ses were radiological or/and Ultrasongraphically confirmed adult patients with renal stones attending the urology department during the study period. The study populations for the controls were randomly selected adult patients without renal stones and attending the urology department during the study period. For cases, patients who are diagnosed with renal stone disease were included in the study. For controls, patients without renal stone disease were included in the study. Patients with chronic renal failure and chronic urinary system disorder were excluded from the study. Sample size determination The sample size was calculated based on the double population proportion formula using Epi Info version 7.2.4.0 STATCALC software. Assuming the percentage of exposure among control is 50% (48), OR = 2.47 for renal stone as obtained from a previously conducted study ( 28 ), 95% confidence interval, 80% power, 2:1 ratio of controls to cases, and 10% non-response rate, The largest sample size becomes 243. Hence 81 cases and 162 controls were included in the study (Table 1 ). Table 1 Sample size determination among patients treated at the urology department of AHMC, Adama, Oromia, Ethiopia, 2023 Dietary variables 95% confidence level Power Percent of control exposed The ratio of control to case Odd ratio Percent of cases exposed Sample size By adding 10% non-response Highly intake of milk/milk product 95% 80 50 2 2.47 70.6 209 230 High salt intake 95% 80 50 2 2.70 73.0 177 195 Low water intake 95% 80 50 2 2.39 70.5 222 243 Sampling procedures and techniques The patient lists in the registration book showed about 400 patients visited the urology department per month. Among those about 80 were diagnosed with renal stones while about 320 did not. The daily average number of cases and controls were determined based on the data available for three months before the start of the data collection. Cases were recruited consecutively from the Department of Urology until the final sample was achieved. A systematic random sampling technique was used to select controls. Accordingly, by dividing eligible 320 non-renal stones by our sample size of 162, we obtained a sampling interval (k = 2). From 1–2, we randomly select one number for the initial start by lottery method. For every case selected two consecutive controls were included in the study (Fig. 1 ). Study variables Dependent variable : renal stone disease Independent variables: dietary factors like fluid intake per day, consumption of tea, coffee consumption, consumption of extra salt, consumption of packed chips, consumption of salted nut, consumption of condiments, consumption of meat and fish, vegetable and fruit consumption, soft and homemade local drinks and consumption of milk and milk product.Socio-demographic factors include age, sex, marital status, educational status, occupation, body mass index, and family history of renal stone disease . Comorbidity factors such as hypertension, duration of high blood pressure, diabetes, and duration of diabetes. Lifestyle factors include smoking, alcohol intake, and exercise. Operational definitions Cases : Patients who were diagnosed with renal stone disease in the urology department of AMHC during the study period using ultrasound and radiographic evaluation. Controls : Patients attending OPD in AHMC who do not have renal stone disease in the study period. Patients who had a history of renal stones were excluded from the study. Patients who have current symptoms of renal stones such as vomiting, abdominal pain, and burning micturition were not included as controls. Alcohol drinker : the use of any type of alcohol-based beverage, whether locally produced or manufactured in industries, by the participant/s in any volume regularly ranging from days to months. Less frequent dietary intake : Participants who reported consumption of particular foods intake one to two days per week. More frequent dietary intake : Participants who reported consumption of particular diets more than two times per week. Data collection procedure and tools Data were collected by an interviewer-administered structured questionnaire developed from reviewed pieces of literature (29, 30) and reviewing patient charts. The questionnaire contains four parts: socio-demographic, lifestyle, comorbidity, and dietary factors.The questionnaire was designed in English first and then translated into Afan Oromo and finally back into English to ensure its consistency. Three experienced professional nurses in data collection and a supervisor who had no role in patient care at that unit were selected to collect data and supervise the data collection process. Two professional nurses were collecting the data and the remaining one professional nurse was assigned as a supervisor. Data quality control Before collecting the actual data, a pre-test was carried out on 5% of the total sample size (12) to ensure that the tool was understandable and consistent. The questionnaire was modified based on the results of the pretest. The data collectors and supervisors were trained on study objectives, data collection tools (questionnaire), data collection methods and procedures, and ethical issues by the principal investigator for two days. Besides, the supervisors were trained on how to ensure data quality (completeness, consistency, and reliability of collected data). Data processing and analysis Data was entered using Epi-Info version 7.2 Software after each filled questionnaire was checked for completeness and coding was done. Data cleaning was carried out to address missed values, outliers, and inconsistencies. Finally, data was exported into Statistical Product and Service Solutions (SPSS) version 25 and data were checked for missed values, consistency, and outliers by using frequency and sort. Descriptive statistics such as frequencies and percentages were calculated to summarize and describe the data, and tables and graphs were used. The effect of multicollinearity was checked using variance inflation factors (VIF). A binary logistic regression model was used to assess the association between the independent variables and the outcome variable. Variables with a p-value less than 0.25 during the bi-variable analysis were considered candidates for multivariable analysis. To test how well the logistic regression model explained the data, the Hosmer-Lemeshow Goodness of the fit test was used. To assess the degree of association between independent variables and the outcome variable, adjusted odds ratio (AOR) with 95 % confidence interval (CI) was computed. A p-value less than 0.05 in the multi-variable analysis was used to declare statistical significance. Results Socio-demographic characteristics of the study participants A total of 243 participants (81 cases and 162 controls) were included in the study making a response rate of 100%. From the total, 59 (72.8%) of cases and 85 (52.5%) of controls were male. In terms of their age category about 42 (51.9%) of cases were within 40–59 years of age while 67 (41.4%) of controls were found within 60 years and above. Concerning their marital status, 55 (67.9%) of cases and 127 (78.4%) controls were married. Regarding their educational background, 43 (53.1%) of cases were primary level education while most of the controls 59 (36.4%were no formal education. Residentially, 29 (35.8%) cases and 92 (56.8%) controls were from self-reported cold climatic areas (Table 2 ). Table 2 Socio-demographic characteristics of patients treated at the urology department of AHMC, Adama, Oromia, Ethiopia, 2023 Variables Category Cases N (%) Controls N (%) Sex Male Female 59 (72.8) 22 (27.2) 85 (52.5) 77 (47.5) Age Category 20–39 years 40–59 years 60 years and above 22 (27.2) 42 (51.9) 17 (21.0) 51 (31.5) 44 (27.2) 67 (41.4) Marital status Married Single Divorce 55 (67.9) 21 (25.9) 5 (6.2) 127 (78.4) 27 (16.7) 8 (4.9) Area of residence Hot area Warm Area Cold area 21 (25.9) 31 (38.3) 29 (35.8) 17 (10.5) 53 (32.7) 92 (56.8) Educational status No formal education Primary school Secondary school Diploma and above 12 (14.8) 43 (53.1) 10 (12.3) 16 (19.8) 59 (36.4) 54 (33.3) 21 (13.0) 28 (17.3) Lifestyle and comorbidity-related characteristics of study participants Of the study participants, 19 (23.5%) cases and 14 (8.6%) controls had a history of drinking alcohol. In addition, 9 (11.1%) cases and 14 (8.6%) controls had a history of smoking tobacco. Regarding khat chewing habit, 9 (11.1%) of cases and 24 (14.4%) controls had practices of chewing khat. In terms of physical exercise, 35 (43.2%) cases and 38 (23.5%) controls were undergoing physical exercise 3–5 days a week. Concerning the history of chronic illness, 26 (32.1%) cases and 24 (14.8%) controls had a history of chronic illness. Additionally, 10 (12.3%) cases and 3 (1.9%) of controls had urinary tract infection. Among the total participants, 4 (4.9%) cases and 7 (4.3%) controls had a history of diabetes. This study also showed that 9 (11.1%) cases and 8 (4.9%) controls were hypertensive (Table 3 ). Table 3 Lifestyle and comorbidity-related characteristics of patients attending the urology department of AHMC, Adama, Oromia, Ethiopia, 2023 Variables Category Cases N (%) Controls N (%) Drinking alcohol Yes No 19 (23.5) 62 (76.5) 14 (8.6) 148 (91.4) Smoking tobacco Yes No 9 (11.1) 72 (88.8) 14 (8.6) 148 (91.4) khat chewing Yes No 9 (11.1) 72 (88.9) 24 (14.8) 138 (85.2) Physical exercise Yes No 35 (43.2) 46 (56.8) 38 (23.5) 124 (76.5) Chronic illness Yes No 26 (32.1) 55 (67.9) 24 (14.8) 138 (85.2) Urinary tract infection Yes No 10 (12.3) 71 (87.7) 3 (1.9) 159 (98.1) Diabetes Yes No 4 (4.9) 77 (95.1) 7 (4.3) 155 (95.7) Hypertension Yes No 9 (11.1) 72 (88.9) 8 (4.9) 154 (95.1) Behavior regarding voiding urine Hold for a long period Hold for some times voiding frequently 13(16.0) 21 (25.9) 47 (58.0) 35(21.6) 70 (43.2) 57 (35.2) Dietary-related characteristics of study subjects The dietary habits of the participants showed that 75 (92.6%) cases and 120(74.1%) of controls were reported drinking less than 2 Liter of water per day. Among study participants, 57(70.4%) cases and 75(46.3%) of controls consume milk and milk products. Regarding tea intake, 52(64.2%) cases and 67(41.4%) of controls drunk tea daily. In addition to this, 38(46.9%) cases and 84(51.9%) controls consumes coffee daily. In addition 65(80.2%) cases and 77(47.5%) controls were consuming meat usually. Concerning fish-eating habits, 17(21.0%) cases and 15(9.3%) controls had the habit of eating fish daily (Table 4 ). Table 4 Dietary-related characteristics of patients attending the urology department of AHMC, Adama, Oromia, Ethiopia, 2023 Variables Category Cases N (%) Controls N (%) Milk and milk product Yes No 57 (70.4) 24 (29.6) 75 (46.3) 87 (53.7) Drink tea Yes No 52 (64.2) 29 (35.8) 67 (41.4) 95 (58.6) Drink coffee Yes No 38 (46.9) 43 (53.1) 84 (51.9) 78 (48.1) salt consumption Yes No 21 (25.9) 60 (74.1) 36 (22.2) 126 (77.8) Chips consumption Yes No 1 (1.2) 80 (98.8) 16 (9.9) 146 (90.1) Nutt consumption Yes No 21 (25.9) 60 (74.1) 19 (11.7) 143 (88.3) Consume condiments Yes No 10 (12.3) 71 (87.7) 21 (13.0) 141 (87.0) Consume meat Yes No 65 (80.2) 16 (19.8) 77 (47.5) 85 (52.5) Eat fish Yes No 17 (21.0) 64 (79.0) 15 (9.3) 147 (90.7) Eat potato Yes No 63 (77.8) 18 (22.2) 112 (69.1) 50 (30.9) Eat Tomato’s Yes No 67 (82.7) 14 (17.3) 148 (91.4) 14 (8.6) The water you drink per day < 2 Liter ≥ 2 Liter 75 (92.6) 6 (7.4) 120 (74.1) 42 (25.9) Body mass index Overweight Normal Underweight 46 (56.8) 31 (38.3) 4 (4.9) 56 (34.6) 95 (58.6) 11 (6.8) Soft drink Yes No 46 (56.8) 35 (43.2) 68 (42.0) 94 (58.0) Dietary determinants of renal stones In bivariate analysis, the sex, age, area of residence, and family history from socio-demographic characteristics; physical exercise in a week; and a history of drinking alcohol, Volume of water intake per day, meat intake patterns, vegetable consumption, soft drinks, drinking tea, consumption of salted nuts, and coffee drinking had a p-value of 0.25. The final model that best predicted the determinants of renal stones was selected based on the theoretical and statistical significance of the predictors. As a result, the volume of water intake per day, meat intake patterns, and consumption of salted nuts were identified as independent dietary determinants of renal stones in the multivariable analysis. On the other hand, age, sex, family history, and area of residence remain socio-demographic determinants of renal stone. Accordingly, participants who reported drinking < 2 liters of water per day had higher odds [AOR = 16.79, 95% CI: (5.22, 53.97)] of developing renal stones as compared to those who reported drinking two or more liters of water per day. On the other hand, the odds of developing renal stones were higher [AOR = 4.96, 95% CI: (2.00, 12.28)] among patients who consumed salted nuts than those who did not consume. Moreover, more frequent meat consumers had more than 2 times higher odds [AOR = 2.31, 95% CI: (1.04, 5.12)] of developing renal stones as compared to those who consumed meat less frequently. Furthermore, the odds of developing renal stones were higher for male patients [AOR = 7.79, 95% CI: (3.07, 19.76)] compared to their counterparts. Moreover, participants in the age category 20–39 years [AOR = 4.18, 95% CI: (1.50, 11.67)] and 40–59 years [AOR = 11.69, 95% CI: (4.19, 32.59)] had higher odds of developing renal stone compared to those sixty and above years old, respectively. Additionally, patients who reside in a self-reported low land area had higher odds [AOR = 3.66, 95% CI: 1.18, 11.36)] of developing renal stones as compared to those who live in highland areas (Table 4 ). Participants who had a family history of renal stones had higher odds [AOR = 7.50, 95% CI: 2.60, 21.71)] of developing renal stones as compared to their counterparts (Table 5 ). Table 5 Bivariate and multivariate analysis showing the dietary determinants of renal stones among patients attending the urology department of AHMC, Adama, Oromia Ethiopia, 2023 Variables Category COR (95% CI) AOR (95% CI) P-value Case Control Sex Male Female 59 22 85 77 2.43 (1.36, 4.33) 1.00 7.79 (3.07, 19.76) 1.00 0.001 Age category 20–39 years 40–59 years ≥ 60 years 22 42 17 51 44 67 1.70 (0.82, 3.53) 3.76 (1.91, 7.42) 1.00 4.18 (1.50, 11.67) 11.69 (4.19, 32.59) 1.00 0.006 0.001 Family history Yes No 31 50 12 150 7.75 (3.70, 16.23) 1.00 7.50 (2.60, 21.71) 1.00 0.001 Water drink per day < 2 liters ≥ 2 liters 75 6 120 42 4.38 (1.77, 10.79) 1.00 16.79 (5.22, 53.97) 1.00 0.001 Salted nut consumption Yes No 21 60 19 143 2.63 (1.32, 5.25) 1.00 4.96 (2.00, 12.28) 1.00 0.001 Meat intake patterns Less frequent More frequent 59 22 97 65 1.00 1.71 (1.02, 3.23) 1.00 2.31 (1.04, 5.12) 0.039 Residential area High land Mid land Low land 29 31 21 92 53 17 1.00 1.86 (1.01, 3.41) 3.92 (1.83, 8.41) 1.00 1.64 (0.65, 4.14) 3.66 (1.18, 11.36) 1.00 0.279 0.025 Milk intake patterns Less frequent More frequent 43 38 85 77 1.00 1.01 (0.62, 1.73) 1.00 1.77 (0.83, 3.79) 0.139 Physical exercise Yes No 28 53 38 124 0.58 (0.32, 1.04) 1.00 0.48 (0.21, 1.07) 1.00 0.074 Alcohol intake Yes No 19 62 14 148 1.00 3.24 (1.53, 6.87) 1.00 2.75 (0.95, 7.95) 0.062 Vegetable intake patterns Less frequent More frequent 36 45 117 45 1.00 0.31 (0.22, 0.53) 1.00 1.86 (0.78, 4.41) 0.160 Drink tea Yes No 52 29 67 95 2.54 (1.47, 4.41) 1.00 2.05 (0.93, 4.53) 1.00 0.077 Soft drink Yes No 46 35 68 94 1.82 (1.06, 3.12) 1.00 1.56 (0.69, 3.49) 1.00 0.280 COR = Crude Odd Ratio, AOR = Adjusted Odd Ratio, 1:00 = reference category Discussion The current study was conducted to identify the dietary determinants of renal stones among patients treated at the urology department of AHMC in Adama town. The result of our current study showed that the male gender has a significant association with renal stones. Accordingly, male patients had nearly eight times higher odds of developing renal stones compared to their counterparts. This finding is similar to studies conducted in Saudi Arabia and China ( 13 , 24 ). The probable reason for this association might be males may more participate in working outside of the home which exposes them to dehydration. As a result, their urine becomes more concentrated, and more calcium accumulates when the ambient temperature. In addition, uric acid stones are more common in men as men do not drink enough water. However, our finding is not supported by a study done in a coastal Union Territory in India ( 11 ) that reported a significant association between female gender and renal stones. The possible justification for the difference might be the demographic, socio-cultural, and racial differences among the study population. The findings of the present study showed age was a significant predictor of renal stones. Participants in the age category 20–39 and 40–59 years had higher odds of developing renal stones compared to those sixty and above years old. This finding is comparable with the studies done in Jeddah Riyadh, and Southern Punjab, Pakistan ( 31 , 32 ). This age group is more likely to be exposed to risk factors like drinking alcohol and engaging in vigorous activity. Such practices may make them more susceptible to dehydration and consequently, high fluid loss, which in turn causes high electrolyte concentrations, which lead to the formation of renal stones. As per our study, respondents with a family history of renal stones were more than seven times more likely to develop renal stones as compared to those without a family history of renal stones. This finding is supported by the studies done in India ( 11 ). The possible reason for this association could be a hereditary genetic disorder called cystinuria that can lead to excessive amounts of the amino acid cysteine collecting in the urine. This can result in the formation of stones in the kidneys ( 33 ). In this study, there was a statistically significant association between volume of water intake and renal stone. Accordingly, patients who drank less than two liters of water have increased the odds of developing renal stones by more than sixteen times. This finding is comparable with studies done in a tertiary care hospital in Karaikal, Puducherry, and Western Rajasthan, in India ( 11 , 34 ). The plausible justification for this association might be that decreased water intake results in an increased concentration of acids and supersaturation of calcium oxalates that end up with crystal formation and renal stone. The present study showed a statistically significant association between nut salt consumption and renal stones. Patients who consumed nut salt were nearly five times more likely to develop renal stones as compared to their counterparts. This finding is parallel with several studies done in the Tertiary Care Hospital of Western Rajasthan, UK Biobank, and Botucatu University Hospital ( 34 , 35 ). This may be attributable to the fact that an aggravation of urinary calcium excretion from high salt intake and oxalates excretion from nut intake which aggravates the formation of renal stones when nuts are mixed with salt ( 36 ). The findings of the present study indicated that meat consumption was a statistically significant dietary determinant of renal stones. More frequent meat consumers were more than two times more likely to develop renal stones as compared to those who consumed meat less frequently. This finding is supported by studies done in the United Kingdom ( 35 ) and India ( 29 ). The plausible justification for this association might be that increasing meat intake may increase a uric acid crystal which is one form of kidney stones particularly if individuals consume red meat. Our study findings demonstrated that the area of residence was a significant determinant of renal stones. As a result, clients from the low-land residence had more than three times higher odds of developing renal stones as compared to those from highland and this finding is comparable with a study done by Stamatelou ( 37 ). This might be because of a higher volume of trans-dermal insensible losses of water. When limited water intake happens, especially where drinking water is not freely available, the result is concentrated urine, a possible supersaturation of calcium, oxalate, uric acid, and phosphate, and the promotion of urinary crystallization. Limitations of the study The current study findings may not be representative of the general population since it was a facility-based study. In addition, due to time and resource constraints matching controls were not done. Moreover, recall bias could increase the likelihood that renal stone cases recall and report exposures compared to their controls (patients without renal stones) due to the retrospective nature of case-control studies. Conclusion There is a statistically significant association between dietary practices and renal stones. Volume of water intake, meat, and salted nut consumption patterns were independent dietary determinants of renal stone. The finding demonstrated that among several determinants drinking < 2 liters of water per day, high salted nut consumption, and frequent meat consumption were dietary determinants that increased the odds of developing renal stones. All males should undergo regular screening and strict precautions for those risk factors of renal stone. Since populations of from hot areas are vulnerable to kidney stones, the Adama Health Office and Water Utility Office should collaboratively improve the water supply in those areas. All patients should be encouraged to drink water above 2 liters per day and minimize nut salt and meat consumption. Patients with a family history of renal stones should undergo regular follow-up for kidney stones. AHMC should provide health education for all outpatients by targeting those risk factors of renal stones. We recommend future researchers conduct studies that focus on identifying the types of stones and associated risk factors. Abbreviations AHMC: Adama Hospital Medical College; AOR: Adjusted odd ratio; COR: Crude odd ratio; MPH: Masters of Public Health; OPD: Outpatient department; OR: Operating rooms; SPSS: Statistical product and service solutions; SSA: Sub-Saharan Africa Declarations Acknowledgment We would like to express our sincere gratitude and deep appreciation to the Research and Publication Office of AHMC for the approval of ethical clearance. We would also like to extend our gratitude to the Oromia Health Bureau Research IRB for their letter of permission to conduct the study. Finally, our special thanks go to the data collectors, supervisors, and participants. Authors’ contributions MNB was involved in the study conception, design, analysis, and interpretation. GDF was involved in the review of the study design, analysis, interpretation, and writing the manuscript. Both authors read and approved the final manuscript. Funding Not applicable. Availability of data and materials The datasets generated and/or analyzed are available upon reasonable request from the corresponding author. Ethics approval and consent to participate First, ethical clearance was obtained from the Research and Publication Office of AMHC; project protocol number: AHMC/MPH/28/6/2015; referral number: 0217/k370/15; clinical trial number: not applicable. Then, letters of permission were sought from the Oromia Health Bureau. Following approval of ethical clearance and permission to conduct the research at AHMC, verbal informed consent was obtained from each respondent, after giving a clear explanation about the objectives and procedures of the study before the actual data collection. The participants were told that their participation was purely voluntary and that their rights to not respond at all were respected and their confidentiality and privacy were assured by arranging a suitable place for the interview and ensuring data were accessible to only the principal researcher. Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests. References Dhanalakshmi S, Gayathri R, Vishnupriya V. Correlation between inadequate intake of water and prevalence of renal calculi–A survey. Journal of Pharmaceutical Sciences and Research. 2017;9(4):429. Shin S, Srivastava A, Alli NA, Bandyopadhyay BC. Confounding risk factors and preventative measures driving nephrolithiasis global makeup. World Journal of Nephrology. 2018;7(7):129. Jayaraman UC, Gurusamy A. Review on urolithiasis pathophysiology and aesculapian discussion. IOSR J Pharm. 2018;8(2):30-42. Khalili P, Jamali Z, Sadeghi T, Esmaeili-Nadimi A, Mohamadi M, Moghadam-Ahmadi A, et al. Risk factors of kidney stone disease: a cross-sectional study in the southeast of Iran. BMC urology. 2021;21:1-8. Saigal CS, Joyce G, Timilsina AR, Project UDiA. Direct and indirect costs of nephrolithiasis in an employed population: opportunity for disease management? Kidney international. 2005;68(4):1808-14. Copelovitch L. Urolithiasis in children: medical approach. Pediatric Clinics of North America. 2012;59(4):881-96. Han H, Segal AM, Seifter JL, Dwyer JT. Nutritional management of kidney stones (nephrolithiasis). Clinical nutrition research. 2015;4(3):137-52. Icer MA, Gezmen-Karadag M. The potential effects of dietary food and beverage intakes on the risk of kidney stone formation. Revista de Nutrição. 2019;32:e190029. Al-Kazwini AT, Al-Arif MS, Abu-Mweis SS, Al-Hammouri TF. RETRACTED ARTICLE: The relationship between kidney stones and dietary habits. Research and reports in urology. 2019:201-14. Curhan GC, Willett WC, Knight EL, Stampfer MJ. Dietary factors and the risk of incident kidney stones in younger women: Nurses' Health Study II. Archives of internal medicine. 2004;164(8):885-91. Mathiyalagen P, Neelakantan A, Balusamy K, Vasudevan K, Cherian J, Sunderamurthy B. A case-control study on environmental and biological risk factors for renal calculi persisting in a coastal Union Territory, India. Journal of family medicine and primary care. 2017;6(1):126-30. Ali Z, Khan A, Mehmood T, Malik O, Khan J. Assessment of HRQoL and its Determinants for Kidney Stone Formers in urological settings of Pakistan. 2022. Wang W, Fan J, Huang G, Li J, Zhu X, Tian Y, et al. Prevalence of kidney stones in mainland China: a systematic review. Scientific reports. 2017;7(1):41630. Siener R. Nutrition and kidney stone disease. Nutrients. 2021;13(6):1917. Dhondup T, Kittanamongkolchai W, Vaughan LE, Mehta RA, Chhina JK, Enders FT, et al. Risk of ESRD and mortality in kidney and bladder stone formers. American Journal of Kidney Diseases. 2018;72(6):790-7. Alfuhigi ZDM, Alfuhigi AOF, Sulaiman AHA, Alruwaili AEM, Alshalan MHF, Alanazi AAS, et al. Renal Stones among Adult Population in Arar City, Northern Saudi Arabia. Egyptian Journal of Hospital Medicine. 2018;71(5). Ferraro PM, Bargagli M, Trinchieri A, Gambaro G. Risk of kidney stones: influence of dietary factors, dietary patterns, and vegetarian–vegan diets. Nutrients. 2020;12(3):779. Ziemba JB, Matlaga BR. Epidemiology and economics of nephrolithiasis. Investigative and clinical urology. 2017;58(5):299-306. Akpakli EA. Comparative Analysis of Kidney Stone Composition in Patients from Ghana and South Africa: Case Study of Kidney Stones from Accra and Cape Town. 2019. Legay C, Krasniqi T, Bourdet A, Bonny O, Bochud M. Methods for the dietary assessment of adult kidney stone formers: a scoping review. Journal of Nephrology. 2022;35(3):821-30. Raheem OA, Khandwala YS, Sur RL, Ghani KR, Denstedt JD. Burden of urolithiasis: trends in prevalence, treatments, and costs. European urology focus. 2017;3(1):18-26. Shoag J, Halpern J, Goldfarb DS, Eisner BH. Risk of chronic and end-stage kidney disease in patients with nephrolithiasis. The Journal of Urology. 2014;192(5):1440-5. Mohammed S, Yohannes B, Tegegne A, Abebe K. Urolithiasis: presentation and surgical outcome at a tertiary care hospital in Ethiopia. Research and Reports in Urology. 2020:623-31. Baatiah NY, Alhazmi RB, Albathi FA, Albogami EG, Mohammedkhalil AK, Alsaywid BS. Urolithiasis: Prevalence, risk factors, and public awareness regarding dietary and lifestyle habits in Jeddah, Saudi Arabia in 2017. Urology annals. 2020;12(1):57-62. Li S, Huang X, Liu J, Yue S, Hou X, Hu L, et al. Trends in the incidence and DALYs of urolithiasis from 1990 to 2019: results from the global burden of disease study 2019. Frontiers in Public Health. 2022;10:825541. Siener R. Impact of dietary habits on stone incidence. Urological research. 2006;34:131-3. Ryu HY, Lee YK, Park J, Son H, Cho SY. Dietary risk factors for urolithiasis in Korea: A case-control pilot study. Investigative and clinical urology. 2018;59(2):106-11. Vigneshvar C, Dongre AR, Deshmukh P. Epidemiology of renal stone disease among adults in a peri-urban locality of Pondicherry. Australasian Medical Journal (Online). 2013;6(4):266. DongRe AR, Rajalakshmi M, Deshmukh PR, Thirunavukarasu M, Kumar R. Risk factors for kidney stones in rural Puducherry: a case-control study. Journal of clinical and diagnostic research: JCDR. 2017;11(9):LC01. Nayak SG, D'Souza JP. Risk factors of urolithiasis: a case-control study. International Journal of Caring Sciences. 2019;12(2):1-10. Safdar OY, Alblowi SS, Aboulola NA, Alharazy DT. Renal stones and risk factors in Jeddah and Riyadh. Saudi journal of kidney diseases and transplantation. 2021;32(1):191-8. Ahmad S, Ansari TM, Shad MA. PREVALENCE OF RENAL CALCULI: TYPE, AGE AND GENDER SPECIFIC IN SOUTHERN PUNJAB, PAKISTAN. The Professional Medical Journal. 2016;23(04):389-95. FORMERS NS. FAMILY HISTORY AND BIOCHEMICAL DIAGNOSIS IN 1948 KID. Bhattacharya S, Joshi NK, Jain YK, Bajpai N, Bhardwaj P, Chaturvedi M, et al. Dietary determinants of renal calculi: a case-control study from a Tertiary Care Hospital of Western Rajasthan. Cureus. 2022;14(11). Littlejohns TJ, Neal NL, Bradbury KE, Heers H, Allen NE, Turney BW. Fluid intake and dietary factors and the risk of incident kidney stones in UK Biobank: a population-based prospective cohort study. European urology focus. 2020;6(4):752-61. Damasio PC, Amaro CR, Cunha NB, Pichutte AC, Goldberg J, Padovani CR, et al. The role of salt abuse on risk for hypercalciuria. Nutrition journal. 2011;10:1-4. Stamatelou K, Goldfarb DS, editors. Epidemiology of kidney stones. Healthcare; 2023: MDPI. Additional Declarations No competing interests reported. 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Next to urinary tract infections and prostate disorders, Kidney stones are the third most common urinary tract problem (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Kidney stones have different causes and are comprised of different materials. There are four major kinds of kidney stones. These are calcium stones, struvite stones, uric acid stones, and cysteine stones (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe most common type of renal stones is calcium stones which account for almost 70 to 80% of all kidney stones (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Uric acid stones are formed due to the occurrence of supersaturated urea which can be caused by multiple factors. Globally, uric acid stones are the third most common type of kidney stones (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Struvite stones are the fourth most common type of renal stones occurring due to bacterial imbalances which leads to an increased level of ammonia, reduced phosphate solubility, and carbonate imbalance in the body. This all causes the precipitation of these phosphate-rich struvite salts. The last types of kidney stones are cysteine stones which occur due to genetic mutation that leads to malabsorption in the renal tubal. Cysteine stones are also a rare form of kidney stones globally (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Nephrolithiasis is rising in both developing and developed countries at an alarming rate (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Worldwide, the number of people affected by the disease continues to rise each year with 200\u0026nbsp;million people (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Kidney stone disease affects 1\u0026ndash;5% of the societies in Asian countries, 5\u0026ndash;10% of the societies in Europe, and 13% of the societies in North America (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). However, there is no adequate data regarding the incidence and prevalence of kidney stone disease in Africa and other developing countries (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eKidney stone formation is influenced by diet, genetics, environment, and lifestyle (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Pieces of evidence showed that socioeconomic status, sex, geographic region race, education, hot climate, occupation, positive family history, unhealthy diet, smoking, physical activity, alcohol consumption, obesity, low fluid intake, dehydration, water quality, genetic background, and comorbid metabolic disorders such as hypertension, diabetes mellitus, cardiovascular disease, and chronic kidney disease are associated with kidney stones formation (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eRenal stone disease is a significant public health problem because of its incidence, recurrence, and severe consequences (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). It seriously affects the health and quality of life of populations globally. It is also affecting the patient's life socially and psychologically (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Renal stone diseases cause significant morbidity including urinary tract infection, flank pain, hydronephrosis, and decreased renal function (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Kidney stone disease is associated with an elevated risk of chronic and end-stage kidney disease, probably as a result of kidney injury from obstructive nephropathy (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Severe pain due to kidney stones affects about 10\u0026ndash;20% of men, and 3\u0026ndash;5% of women (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Besides, it is the leading cause of the consumption of strong addictive pain medication (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Findings also revealed that metabolic bone diseases, cardiovascular events, and vascular calcifications are more likely to occur in patients affected by urolithiasis (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e \u003cp\u003ePrevious studies have revealed that the prevalence and incidence of renal stone disease have continued to rise in the last two decades globally as a result of changes in lifestyle, dietary practices, and global warming as possible causes (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan additionalcitationids=\"CR19\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). Previously renal stone disease was restricted to developed countries; however, it is now a serious public health problem in many developing countries (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). The prevalence of urolithiasis has also continued to rise in tropical and sub-Saharan African countries. As Ethiopia is a fast-growing, sub-Saharan African country (SSA), located near the Afro-Asian stone belt, the burden is expected to be rising and becoming a public health issue (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eDietary factors play a vital role in kidney stone formation. Increased intake of dietary calcium, potassium, alcohol, and total fluid is associated with a lower risk of Kidney stone formation, whereas supplemental calcium, sodium, sucrose, and animal protein may be associated with an elevated risk (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Moreover, a high‑protein diet, a high-salt diet, and extreme fasting could contribute to the rising incidence of renal stones (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). Many studies have also demonstrated the protective role of fruits and vegetables against renal stone formation (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eDietary practices are one of the factors that contribute to the growing incidence and prevalence of kidney stone disease (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). Previously conducted research indicated that dietary factors such as carbohydrates, protein, sodium, fiber, folate, vitamin C, lipids, beans, cereals, leaves, and vegetables could change the chemical composition of the urinary tract and cause super-saturation (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). However, data regarding the association between dietary factors and renal stone disease is not available in the study area. Therefore this study aimed to determine the association between dietary factors and renal stones among patients treated at the urology department of Adama Hospital Medical College (AHMC), Adama, Oromia, Ethiopia.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy area and period\u003c/h2\u003e \u003cp\u003eThe study was carried out in Adama Hospital Medical College (AHMC) which is located in Adama town, Oromia region. The city is located 98 kilometers far away to the east of Addis Ababa, the capital of Ethiopia. In this hospital, the urology department began operations in 2017: six years earlier with one urologist, one outpatient department (OPD) clinic, and one operating room table. Five years later, the department employed two urologists, two outpatient department clinics, and two operating rooms (OR) that operated twice a week. In addition, two times a week, shock wave therapy is used to treat kidney stones in four to six patients. (The urology department has grown from one surgeon to two, with two OPD clinics, two OR tables, and a shock wave procedure for renal stone). The hospitals have a total of 184 beds. The investigation was carried out from March 1, 2023, to April 12, 2023. A urology surgeon was assigned to AHMC in 2009. The department previously operated under general surgery but became independent in 2012.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy design, study population, and inclusion criteria\u003c/h3\u003e\n\u003cp\u003eAn institution-based unmatched case-control study design was employed. The source population was all adult patients (\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026ge;\u003c/span\u003e\u0026thinsp;18 years) on follow-up care at the urology department of Adama Hospital Medical College. The study population for the cases was adult patients with renal stones. Ca\u003cb\u003eses\u003c/b\u003e were radiological or/and Ultrasongraphically confirmed adult patients with renal stones attending the urology department during the study period. The study populations for the controls were randomly selected adult patients without renal stones and attending the urology department during the study period. For cases, patients who are diagnosed with renal stone disease were included in the study. For controls, patients without renal stone disease were included in the study. Patients with chronic renal failure and chronic urinary system disorder were excluded from the study.\u003c/p\u003e\n\u003ch3\u003eSample size determination\u003c/h3\u003e\n\u003cp\u003eThe sample size was calculated based on the double population proportion formula using Epi Info version 7.2.4.0 STATCALC software. Assuming the percentage of exposure among control is 50% (48), OR\u0026thinsp;=\u0026thinsp;2.47 for renal stone as obtained from a previously conducted study (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e), 95% confidence interval, 80% power, 2:1 ratio of controls to cases, and 10% non-response rate, The largest sample size becomes 243. Hence 81 cases and 162 controls were included in the study (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSample size determination among patients treated at the urology department of AHMC, Adama, Oromia, Ethiopia, 2023\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDietary variables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e95% confidence level\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePower\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercent of control exposed\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eThe ratio of control to case\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eOdd ratio\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003ePercent of cases exposed\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eSample size\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eBy adding 10% non-response\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHighly intake of milk/milk product\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e95%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e70.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e209\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e230\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh salt intake\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e95%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e73.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e177\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e195\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow water intake\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e95%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e70.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e222\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003e243\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003eSampling procedures and techniques\u003c/h3\u003e\n\u003cp\u003eThe patient lists in the registration book showed about 400 patients visited the urology department per month. Among those about 80 were diagnosed with renal stones while about 320 did not. The daily average number of cases and controls were determined based on the data available for three months before the start of the data collection. Cases were recruited consecutively from the Department of Urology until the final sample was achieved. A systematic random sampling technique was used to select controls. Accordingly, by dividing eligible 320 non-renal stones by our sample size of 162, we obtained a sampling interval (k\u0026thinsp;=\u0026thinsp;2). From 1\u0026ndash;2, we randomly select one number for the initial start by lottery method. For every case selected two consecutive controls were included in the study (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e\u003cstrong\u003eStudy variables\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDependent variable\u003c/strong\u003e: renal stone disease\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIndependent variables:\u0026nbsp;\u003c/strong\u003edietary factors like fluid intake per day, consumption of tea, coffee consumption, consumption of extra salt, consumption of packed chips, consumption of salted nut, consumption of condiments, consumption of meat and fish, vegetable and fruit consumption, soft and homemade local drinks and consumption of milk and milk product.Socio-demographic factors include age, sex, marital status, educational status, occupation, body mass index, and family history of renal stone disease\u003cstrong\u003e.\u0026nbsp;\u003c/strong\u003eComorbidity factors such as hypertension, duration of high blood pressure, diabetes, and duration of diabetes. Lifestyle factors include smoking, alcohol intake, and exercise.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOperational definitions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCases\u003c/strong\u003e: Patients who were diagnosed with renal stone disease in the urology department of AMHC during the study period using ultrasound and radiographic evaluation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eControls\u003c/strong\u003e: Patients attending OPD in AHMC who do not have renal stone disease in the study period. Patients who had a history of renal stones were excluded from the study. Patients who have current symptoms of renal stones such as vomiting, abdominal pain, and burning micturition were not included as controls.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAlcohol drinker\u003c/strong\u003e: the use of any type of alcohol-based beverage, whether locally produced or manufactured in industries, by the participant/s in any volume regularly ranging from days to months.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLess frequent dietary intake\u003c/strong\u003e: Participants who reported consumption of particular foods intake one to two days per week.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMore frequent dietary intake\u003c/strong\u003e: Participants who reported consumption of particular diets more than two times per week.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData collection procedure and tools\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData were collected by an interviewer-administered structured questionnaire developed from reviewed pieces of literature\u0026nbsp; (29, 30) and reviewing patient charts. The questionnaire contains four parts: socio-demographic, lifestyle, comorbidity, and dietary factors.The questionnaire was designed in English first and then translated into Afan Oromo and finally back into English to ensure its consistency. Three experienced professional nurses in data collection and a supervisor who had no role in patient care at that unit were selected to collect data and supervise the data collection process. Two professional nurses were collecting the data and the remaining one professional nurse was assigned as a supervisor.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData quality control\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBefore collecting the actual data, a pre-test was carried out on 5% of the total sample size (12) to ensure that the tool was understandable and consistent. The questionnaire was modified based on the results of the pretest. The data collectors and supervisors were trained on study objectives, data collection tools (questionnaire), data collection methods and procedures, and ethical issues by the principal investigator for two days. Besides, the supervisors were trained on how to ensure data quality (completeness, consistency, and reliability of collected data).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData\u0026nbsp;processing and analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData was entered using Epi-Info version 7.2 Software after each filled questionnaire was checked for completeness and coding was done. Data cleaning was carried out to address missed values, outliers, and inconsistencies. Finally, data was exported into Statistical Product and Service Solutions (SPSS) version 25 and data were checked for missed values, consistency, and outliers by using frequency and sort. Descriptive statistics such as frequencies and percentages were calculated to summarize and describe the data, and tables and graphs were used. The effect of multicollinearity was checked using variance inflation factors (VIF). A binary logistic regression model was used to assess the association between the independent variables and the outcome variable. Variables with a p-value less than 0.25 during the bi-variable analysis were considered candidates for multivariable analysis. To test how well the logistic regression model explained the data, the Hosmer-Lemeshow Goodness of the fit test was used. To assess the degree of association between independent variables and the outcome variable, adjusted odds ratio (AOR) with 95 % confidence interval (CI) was computed. A p-value less than 0.05 in the multi-variable analysis was used to declare statistical significance.\u0026nbsp;\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eSocio-demographic characteristics of the study participants\u003c/h2\u003e \u003cp\u003eA total of 243 participants (81 cases and 162 controls) were included in the study making a response rate of 100%. From the total, 59 (72.8%) of cases and 85 (52.5%) of controls were male. In terms of their age category about 42 (51.9%) of cases were within 40\u0026ndash;59 years of age while 67 (41.4%) of controls were found within 60 years and above. Concerning their marital status, 55 (67.9%) of cases and 127 (78.4%) controls were married. Regarding their educational background, 43 (53.1%) of cases were primary level education while most of the controls 59 (36.4%were no formal education. Residentially, 29 (35.8%) cases and 92 (56.8%) controls were from self-reported cold climatic areas (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSocio-demographic characteristics of patients treated at the urology department of AHMC, Adama, Oromia, Ethiopia, 2023\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCases N (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eControls N (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59 (72.8)\u003c/p\u003e \u003cp\u003e22 (27.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e85 (52.5)\u003c/p\u003e \u003cp\u003e77 (47.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge Category\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20\u0026ndash;39 years\u003c/p\u003e \u003cp\u003e40\u0026ndash;59 years\u003c/p\u003e \u003cp\u003e60 years and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22 (27.2)\u003c/p\u003e \u003cp\u003e42 (51.9)\u003c/p\u003e \u003cp\u003e17 (21.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e51 (31.5)\u003c/p\u003e \u003cp\u003e44 (27.2)\u003c/p\u003e \u003cp\u003e67 (41.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarital status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003cp\u003eSingle\u003c/p\u003e \u003cp\u003eDivorce\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55 (67.9)\u003c/p\u003e \u003cp\u003e21 (25.9)\u003c/p\u003e \u003cp\u003e5 (6.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e127 (78.4)\u003c/p\u003e \u003cp\u003e27 (16.7)\u003c/p\u003e \u003cp\u003e8 (4.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eArea of residence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHot area\u003c/p\u003e \u003cp\u003eWarm Area\u003c/p\u003e \u003cp\u003eCold area\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21 (25.9)\u003c/p\u003e \u003cp\u003e31 (38.3)\u003c/p\u003e \u003cp\u003e29 (35.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17 (10.5)\u003c/p\u003e \u003cp\u003e53 (32.7)\u003c/p\u003e \u003cp\u003e92 (56.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducational status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo formal education\u003c/p\u003e \u003cp\u003ePrimary school\u003c/p\u003e \u003cp\u003eSecondary school\u003c/p\u003e \u003cp\u003eDiploma and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (14.8)\u003c/p\u003e \u003cp\u003e43 (53.1)\u003c/p\u003e \u003cp\u003e10 (12.3)\u003c/p\u003e \u003cp\u003e16 (19.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e59 (36.4)\u003c/p\u003e \u003cp\u003e54 (33.3)\u003c/p\u003e \u003cp\u003e21 (13.0)\u003c/p\u003e \u003cp\u003e28 (17.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eLifestyle and comorbidity-related characteristics of study participants\u003c/h2\u003e \u003cp\u003eOf the study participants, 19 (23.5%) cases and 14 (8.6%) controls had a history of drinking alcohol. In addition, 9 (11.1%) cases and 14 (8.6%) controls had a history of smoking tobacco. Regarding khat chewing habit, 9 (11.1%) of cases and 24 (14.4%) controls had practices of chewing khat. In terms of physical exercise, 35 (43.2%) cases and 38 (23.5%) controls were undergoing physical exercise 3\u0026ndash;5 days a week. Concerning the history of chronic illness, 26 (32.1%) cases and 24 (14.8%) controls had a history of chronic illness. Additionally, 10 (12.3%) cases and 3 (1.9%) of controls had urinary tract infection. Among the total participants, 4 (4.9%) cases and 7 (4.3%) controls had a history of diabetes. This study also showed that 9 (11.1%) cases and 8 (4.9%) controls were hypertensive (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eLifestyle and comorbidity-related characteristics of patients attending the urology department of AHMC, Adama, Oromia, Ethiopia, 2023\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCases N (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eControls N (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDrinking alcohol\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19 (23.5)\u003c/p\u003e \u003cp\u003e62 (76.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14 (8.6)\u003c/p\u003e \u003cp\u003e148 (91.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmoking tobacco\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (11.1)\u003c/p\u003e \u003cp\u003e72 (88.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14 (8.6)\u003c/p\u003e \u003cp\u003e148 (91.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ekhat chewing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (11.1)\u003c/p\u003e \u003cp\u003e72 (88.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24 (14.8)\u003c/p\u003e \u003cp\u003e138 (85.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhysical exercise\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35 (43.2)\u003c/p\u003e \u003cp\u003e46 (56.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e38 (23.5)\u003c/p\u003e \u003cp\u003e124 (76.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChronic illness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26 (32.1)\u003c/p\u003e \u003cp\u003e55 (67.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24 (14.8)\u003c/p\u003e \u003cp\u003e138 (85.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrinary tract infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (12.3)\u003c/p\u003e \u003cp\u003e71 (87.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (1.9)\u003c/p\u003e \u003cp\u003e159 (98.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (4.9)\u003c/p\u003e \u003cp\u003e77 (95.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 (4.3)\u003c/p\u003e \u003cp\u003e155 (95.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (11.1)\u003c/p\u003e \u003cp\u003e72 (88.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (4.9)\u003c/p\u003e \u003cp\u003e154 (95.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBehavior regarding voiding urine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHold for a long period\u003c/p\u003e \u003cp\u003eHold for some times\u003c/p\u003e \u003cp\u003evoiding frequently\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13(16.0)\u003c/p\u003e \u003cp\u003e21 (25.9)\u003c/p\u003e \u003cp\u003e47 (58.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35(21.6)\u003c/p\u003e \u003cp\u003e70 (43.2)\u003c/p\u003e \u003cp\u003e57 (35.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eDietary-related characteristics of study subjects\u003c/h2\u003e \u003cp\u003eThe dietary habits of the participants showed that 75 (92.6%) cases and 120(74.1%) of controls were reported drinking less than 2 Liter of water per day. Among study participants, 57(70.4%) cases and 75(46.3%) of controls consume milk and milk products. Regarding tea intake, 52(64.2%) cases and 67(41.4%) of controls drunk tea daily. In addition to this, 38(46.9%) cases and 84(51.9%) controls consumes coffee daily. In addition 65(80.2%) cases and 77(47.5%) controls were consuming meat usually. Concerning fish-eating habits, 17(21.0%) cases and 15(9.3%) controls had the habit of eating fish daily (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDietary-related characteristics of patients attending the urology department of AHMC, Adama, Oromia, Ethiopia, 2023\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCases N (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eControls N (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMilk and milk product\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e57 (70.4)\u003c/p\u003e \u003cp\u003e24 (29.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e75 (46.3)\u003c/p\u003e \u003cp\u003e87 (53.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDrink tea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e52 (64.2)\u003c/p\u003e \u003cp\u003e29 (35.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e67 (41.4)\u003c/p\u003e \u003cp\u003e95 (58.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDrink coffee\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38 (46.9)\u003c/p\u003e \u003cp\u003e43 (53.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e84 (51.9)\u003c/p\u003e \u003cp\u003e78 (48.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003esalt consumption\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21 (25.9)\u003c/p\u003e \u003cp\u003e60 (74.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36 (22.2)\u003c/p\u003e \u003cp\u003e126 (77.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChips consumption\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (1.2)\u003c/p\u003e \u003cp\u003e80 (98.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16 (9.9)\u003c/p\u003e \u003cp\u003e146 (90.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNutt consumption\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21 (25.9)\u003c/p\u003e \u003cp\u003e60 (74.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19 (11.7)\u003c/p\u003e \u003cp\u003e143 (88.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConsume condiments\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (12.3)\u003c/p\u003e \u003cp\u003e71 (87.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21 (13.0)\u003c/p\u003e \u003cp\u003e141 (87.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConsume meat\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e65 (80.2)\u003c/p\u003e \u003cp\u003e16 (19.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e77 (47.5)\u003c/p\u003e \u003cp\u003e85 (52.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEat fish\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17 (21.0)\u003c/p\u003e \u003cp\u003e64 (79.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15 (9.3)\u003c/p\u003e \u003cp\u003e147 (90.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEat potato\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e63 (77.8)\u003c/p\u003e \u003cp\u003e18 (22.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e112 (69.1)\u003c/p\u003e \u003cp\u003e50 (30.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEat Tomato\u0026rsquo;s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e67 (82.7)\u003c/p\u003e \u003cp\u003e14 (17.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e148 (91.4)\u003c/p\u003e \u003cp\u003e14 (8.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe water you drink per day\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;2 Liter\u003c/p\u003e \u003cp\u003e\u0026ge;\u0026thinsp;2 Liter\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e75 (92.6)\u003c/p\u003e \u003cp\u003e6 (7.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e120 (74.1)\u003c/p\u003e \u003cp\u003e42 (25.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBody mass index\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOverweight\u003c/p\u003e \u003cp\u003eNormal\u003c/p\u003e \u003cp\u003eUnderweight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46 (56.8)\u003c/p\u003e \u003cp\u003e31 (38.3)\u003c/p\u003e \u003cp\u003e4 (4.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e56 (34.6)\u003c/p\u003e \u003cp\u003e95 (58.6)\u003c/p\u003e \u003cp\u003e11 (6.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSoft drink\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46 (56.8)\u003c/p\u003e \u003cp\u003e35 (43.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e68 (42.0)\u003c/p\u003e \u003cp\u003e94 (58.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eDietary determinants of renal stones\u003c/h2\u003e \u003cp\u003eIn bivariate analysis, the sex, age, area of residence, and family history from socio-demographic characteristics; physical exercise in a week; and a history of drinking alcohol, Volume of water intake per day, meat intake patterns, vegetable consumption, soft drinks, drinking tea, consumption of salted nuts, and coffee drinking had a p-value of 0.25. The final model that best predicted the determinants of renal stones was selected based on the theoretical and statistical significance of the predictors. As a result, the volume of water intake per day, meat intake patterns, and consumption of salted nuts were identified as independent dietary determinants of renal stones in the multivariable analysis. On the other hand, age, sex, family history, and area of residence remain socio-demographic determinants of renal stone.\u003c/p\u003e \u003cp\u003eAccordingly, participants who reported drinking\u0026thinsp;\u0026lt;\u0026thinsp;2 liters of water per day had higher odds [AOR\u0026thinsp;=\u0026thinsp;16.79, 95% CI: (5.22, 53.97)] of developing renal stones as compared to those who reported drinking two or more liters of water per day. On the other hand, the odds of developing renal stones were higher [AOR\u0026thinsp;=\u0026thinsp;4.96, 95% CI: (2.00, 12.28)] among patients who consumed salted nuts than those who did not consume. Moreover, more frequent meat consumers had more than 2 times higher odds [AOR\u0026thinsp;=\u0026thinsp;2.31, 95% CI: (1.04, 5.12)] of developing renal stones as compared to those who consumed meat less frequently. Furthermore, the odds of developing renal stones were higher for male patients [AOR\u0026thinsp;=\u0026thinsp;7.79, 95% CI: (3.07, 19.76)] compared to their counterparts. Moreover, participants in the age category 20\u0026ndash;39 years [AOR\u0026thinsp;=\u0026thinsp;4.18, 95% CI: (1.50, 11.67)] and 40\u0026ndash;59 years [AOR\u0026thinsp;=\u0026thinsp;11.69, 95% CI: (4.19, 32.59)] had higher odds of developing renal stone compared to those sixty and above years old, respectively. Additionally, patients who reside in a self-reported low land area had higher odds [AOR\u0026thinsp;=\u0026thinsp;3.66, 95% CI: 1.18, 11.36)] of developing renal stones as compared to those who live in highland areas (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Participants who had a family history of renal stones had higher odds [AOR\u0026thinsp;=\u0026thinsp;7.50, 95% CI: 2.60, 21.71)] of developing renal stones as compared to their counterparts (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBivariate and multivariate analysis showing the dietary determinants of renal stones among patients attending the urology department of AHMC, Adama, Oromia Ethiopia, 2023\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCOR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAOR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCase\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e59\u003c/p\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e85\u003c/p\u003e \u003cp\u003e77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.43 (1.36, 4.33)\u003c/p\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e7.79 (3.07, 19.76)\u003c/b\u003e\u003c/p\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003eAge category\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e20\u0026ndash;39 years\u003c/p\u003e \u003cp\u003e40\u0026ndash;59 years\u003c/p\u003e \u003cp\u003e\u0026ge;\u0026thinsp;60 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22\u003c/p\u003e \u003cp\u003e42\u003c/p\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51\u003c/p\u003e \u003cp\u003e44\u003c/p\u003e \u003cp\u003e67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.70 (0.82, 3.53)\u003c/p\u003e \u003cp\u003e3.76 (1.91, 7.42)\u003c/p\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e4.18 (1.50, 11.67)\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e11.69 (4.19, 32.59)\u003c/b\u003e\u003c/p\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.006\u003c/p\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003eFamily history\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31\u003c/p\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003cp\u003e150\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.75 (3.70, 16.23)\u003c/p\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e7.50 (2.60, 21.71)\u003c/b\u003e\u003c/p\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003eWater drink per day\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;2 liters\u003c/p\u003e \u003cp\u003e\u0026ge;\u0026thinsp;2 liters\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e75\u003c/p\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e120\u003c/p\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.38 (1.77, 10.79)\u003c/p\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e16.79 (5.22, 53.97)\u003c/b\u003e\u003c/p\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003eSalted nut consumption\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21\u003c/p\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19\u003c/p\u003e \u003cp\u003e143\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.63 (1.32, 5.25)\u003c/p\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e4.96 (2.00, 12.28)\u003c/b\u003e\u003c/p\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003eMeat intake patterns\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLess frequent\u003c/p\u003e \u003cp\u003eMore frequent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e59\u003c/p\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e97\u003c/p\u003e \u003cp\u003e65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003cp\u003e1.71 (1.02, 3.23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003cp\u003e\u003cb\u003e2.31 (1.04, 5.12)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.039\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003eResidential area\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh land\u003c/p\u003e \u003cp\u003eMid land\u003c/p\u003e \u003cp\u003eLow land\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29\u003c/p\u003e \u003cp\u003e31\u003c/p\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e92\u003c/p\u003e \u003cp\u003e53\u003c/p\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003cp\u003e1.86 (1.01, 3.41)\u003c/p\u003e \u003cp\u003e3.92 (1.83, 8.41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003cp\u003e1.64 (0.65, 4.14)\u003c/p\u003e \u003cp\u003e\u003cb\u003e3.66 (1.18, 11.36)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003cp\u003e0.279\u003c/p\u003e \u003cp\u003e0.025\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003eMilk intake patterns\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLess frequent\u003c/p\u003e \u003cp\u003eMore frequent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e43\u003c/p\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e85\u003c/p\u003e \u003cp\u003e77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003cp\u003e1.01 (0.62, 1.73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003cp\u003e1.77 (0.83, 3.79)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.139\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003ePhysical exercise\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28\u003c/p\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38\u003c/p\u003e \u003cp\u003e124\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.58 (0.32, 1.04)\u003c/p\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.48 (0.21, 1.07)\u003c/p\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.074\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003eAlcohol intake\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19\u003c/p\u003e \u003cp\u003e62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14\u003c/p\u003e \u003cp\u003e148\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003cp\u003e3.24 (1.53, 6.87)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003cp\u003e2.75 (0.95, 7.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.062\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003eVegetable intake patterns\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLess frequent\u003c/p\u003e \u003cp\u003eMore frequent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36\u003c/p\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e117\u003c/p\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003cp\u003e0.31 (0.22, 0.53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003cp\u003e1.86 (0.78, 4.41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.160\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003eDrink tea\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e52\u003c/p\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e67\u003c/p\u003e \u003cp\u003e95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.54 (1.47, 4.41)\u003c/p\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.05 (0.93, 4.53)\u003c/p\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.077\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003eSoft drink\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e46\u003c/p\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e68\u003c/p\u003e \u003cp\u003e94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.82 (1.06, 3.12)\u003c/p\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.56 (0.69, 3.49)\u003c/p\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.280\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eCOR\u0026thinsp;=\u0026thinsp;Crude Odd Ratio, AOR\u0026thinsp;=\u0026thinsp;Adjusted Odd Ratio, 1:00\u0026thinsp;=\u0026thinsp;reference category\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe current study was conducted to identify the dietary determinants of renal stones among patients treated at the urology department of AHMC in Adama town. The result of our current study showed that the male gender has a significant association with renal stones. Accordingly, male patients had nearly eight times higher odds of developing renal stones compared to their counterparts. This finding is similar to studies conducted in Saudi Arabia and China (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). The probable reason for this association might be males may more participate in working outside of the home which exposes them to dehydration. As a result, their urine becomes more concentrated, and more calcium accumulates when the ambient temperature. In addition, uric acid stones are more common in men as men do not drink enough water. However, our finding is not supported by a study done in a coastal Union Territory in India (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e) that reported a significant association between female gender and renal stones. The possible justification for the difference might be the demographic, socio-cultural, and racial differences among the study population.\u003c/p\u003e \u003cp\u003eThe findings of the present study showed age was a significant predictor of renal stones. Participants in the age category 20\u0026ndash;39 and 40\u0026ndash;59 years had higher odds of developing renal stones compared to those sixty and above years old. This finding is comparable with the studies done in Jeddah Riyadh, and Southern Punjab, Pakistan (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). This age group is more likely to be exposed to risk factors like drinking alcohol and engaging in vigorous activity. Such practices may make them more susceptible to dehydration and consequently, high fluid loss, which in turn causes high electrolyte concentrations, which lead to the formation of renal stones.\u003c/p\u003e \u003cp\u003eAs per our study, respondents with a family history of renal stones were more than seven times more likely to develop renal stones as compared to those without a family history of renal stones. This finding is supported by the studies done in India (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). The possible reason for this association could be a hereditary genetic disorder called cystinuria that can lead to excessive amounts of the amino acid cysteine collecting in the urine. This can result in the formation of stones in the kidneys (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn this study, there was a statistically significant association between volume of water intake and renal stone. Accordingly, patients who drank less than two liters of water have increased the odds of developing renal stones by more than sixteen times. This finding is comparable with studies done in a tertiary care hospital in Karaikal, Puducherry, and Western Rajasthan, in India (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). The plausible justification for this association might be that decreased water intake results in an increased concentration of acids and supersaturation of calcium oxalates that end up with crystal formation and renal stone.\u003c/p\u003e \u003cp\u003eThe present study showed a statistically significant association between nut salt consumption and renal stones. Patients who consumed nut salt were nearly five times more likely to develop renal stones as compared to their counterparts. This finding is parallel with several studies done in the Tertiary Care Hospital of Western Rajasthan, UK Biobank, and Botucatu University Hospital (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). This may be attributable to the fact that an aggravation of urinary calcium excretion from high salt intake and oxalates excretion from nut intake which aggravates the formation of renal stones when nuts are mixed with salt (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe findings of the present study indicated that meat consumption was a statistically significant dietary determinant of renal stones. More frequent meat consumers were more than two times more likely to develop renal stones as compared to those who consumed meat less frequently. This finding is supported by studies done in the United Kingdom (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e) and India (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). The plausible justification for this association might be that increasing meat intake may increase a uric acid crystal which is one form of kidney stones particularly if individuals consume red meat.\u003c/p\u003e \u003cp\u003eOur study findings demonstrated that the area of residence was a significant determinant of renal stones. As a result, clients from the low-land residence had more than three times higher odds of developing renal stones as compared to those from highland and this finding is comparable with a study done by Stamatelou (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e). This might be because of a higher volume of trans-dermal insensible losses of water. When limited water intake happens, especially where drinking water is not freely available, the result is concentrated urine, a possible supersaturation of calcium, oxalate, uric acid, and phosphate, and the promotion of urinary crystallization.\u003c/p\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eLimitations of the study\u003c/h2\u003e \u003cp\u003eThe current study findings may not be representative of the general population since it was a facility-based study. In addition, due to time and resource constraints matching controls were not done. Moreover, recall bias could increase the likelihood that renal stone cases recall and report exposures compared to their controls (patients without renal stones) due to the retrospective nature of case-control studies.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThere is a statistically significant association between dietary practices and renal stones. Volume of water intake, meat, and salted nut consumption patterns were independent dietary determinants of renal stone. The finding demonstrated that among several determinants drinking\u0026thinsp;\u0026lt;\u0026thinsp;2 liters of water per day, high salted nut consumption, and frequent meat consumption were dietary determinants that increased the odds of developing renal stones. All males should undergo regular screening and strict precautions for those risk factors of renal stone. Since populations of from hot areas are vulnerable to kidney stones, the Adama Health Office and Water Utility Office should collaboratively improve the water supply in those areas. All patients should be encouraged to drink water above 2 liters per day and minimize nut salt and meat consumption. Patients with a family history of renal stones should undergo regular follow-up for kidney stones. AHMC should provide health education for all outpatients by targeting those risk factors of renal stones. We recommend future researchers conduct studies that focus on identifying the types of stones and associated risk factors.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eAHMC: Adama Hospital Medical College; AOR: Adjusted odd ratio; COR: Crude odd ratio; MPH: Masters of Public Health; OPD: Outpatient department; OR: Operating rooms; SPSS: Statistical product and service solutions; SSA: Sub-Saharan Africa\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to express our sincere gratitude and deep appreciation to the Research and Publication Office of AHMC for the approval of ethical clearance. We would also like to extend our gratitude to the Oromia Health Bureau Research IRB for their letter of permission to conduct the study. Finally, our special thanks go to the data collectors, supervisors, and participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMNB was involved in the study conception, design, analysis, and interpretation. GDF was involved in the review of the study design, analysis, interpretation, and writing the manuscript. Both authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analyzed are available upon reasonable request from the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFirst, ethical clearance was obtained from the Research and Publication Office of AMHC; project protocol number: AHMC/MPH/28/6/2015; referral number: 0217/k370/15; clinical trial number: not applicable. Then, letters of permission were sought from the Oromia Health Bureau. Following approval of ethical clearance and permission to conduct the research at AHMC, verbal informed consent was obtained from each respondent, after giving a clear explanation about the objectives and procedures of the study before the actual data collection. The participants were told that their participation was purely voluntary and that their rights to not respond at all were respected and their confidentiality and privacy were assured by arranging a suitable place for the interview and ensuring data were accessible to only the principal researcher.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eDhanalakshmi S, Gayathri R, Vishnupriya V. 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The Professional Medical Journal. 2016;23(04):389-95.\u003c/li\u003e\n\u003cli\u003eFORMERS NS. FAMILY HISTORY AND BIOCHEMICAL DIAGNOSIS IN 1948 KID.\u003c/li\u003e\n\u003cli\u003eBhattacharya S, Joshi NK, Jain YK, Bajpai N, Bhardwaj P, Chaturvedi M, et al. Dietary determinants of renal calculi: a case-control study from a Tertiary Care Hospital of Western Rajasthan. Cureus. 2022;14(11).\u003c/li\u003e\n\u003cli\u003eLittlejohns TJ, Neal NL, Bradbury KE, Heers H, Allen NE, Turney BW. Fluid intake and dietary factors and the risk of incident kidney stones in UK Biobank: a population-based prospective cohort study. European urology focus. 2020;6(4):752-61.\u003c/li\u003e\n\u003cli\u003eDamasio PC, Amaro CR, Cunha NB, Pichutte AC, Goldberg J, Padovani CR, et al. The role of salt abuse on risk for hypercalciuria. Nutrition journal. 2011;10:1-4.\u003c/li\u003e\n\u003cli\u003eStamatelou K, Goldfarb DS, editors. Epidemiology of kidney stones. Healthcare; 2023: MDPI.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Dietary determinants, renal stone, Adama, Oromia, Ethiopia","lastPublishedDoi":"10.21203/rs.3.rs-5640691/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5640691/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eKidney stones are solid crystals that form from dissolved minerals in the nephrons of the kidney. Next to urinary tract infections and prostate disorders, kidney stones are the third most common urinary tract problem. Despite the availability of a large number of studies investigating the correlation between kidney stone formation and several risk factors, data regarding the association between dietary practices and renal stone disease is not available in the study area.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective:\u003c/strong\u003eTo identify the dietary determinants of renal stones among patients treated at Adama Hospital Medical College, Adama, Ethiopia, 2023.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eAn\u003cstrong\u003e \u003c/strong\u003einstitution-based\u003cstrong\u003e \u003c/strong\u003eunmatched\u003cstrong\u003e \u003c/strong\u003ecase-control study was conducted among a total of 243 patients (81 cases and 162 controls). Cases were recruited consecutively while systematic sampling technique was used to select controls. Data were collected using pretested interviewer-administered structured questionnaires and patient chart reviews. Data were entered and analyzed using SPSS software 22. The association between independent and dependent variables was done by using a binary logistic regression model. Adjusted odds ratio (AOR) along with 95% confidence interval (CI) was calculated to evaluate the strength of association between independent variables and the outcome variable. Variables having p-value \u0026lt; 0.05 in the multivariable analysis were considered statistically significant.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResult:\u003c/strong\u003eFrom the total, 59 (72.8%) cases and 85 (52.5%) controls were male. In the adjusted model, water intake \u0026lt; 2 liters per day [AOR=16.79, 95% CI: (5.22, 53.97)], consumption of salted nut [AOR=4.96, 95% CI: (2.00, 12.28)], frequent meat consumption [AOR=2.31, 95% CI: (1.04, 5.12)] were independent dietary determinantsof renal stone. On the other hand, being male [AOR=7.79, 95% CI: (3.07, 19.76)], age category 20-39 years [AOR= 4.18, 95% CI: (1.50, 11.67)] and 40-59 years [AOR=11.69, 95% CI: (4.19, 32.59)], reside in low land areas [AOR= 3.66, 95% CI: 1.18, 11.36)], and family history of renal stones [AOR= 7.50, 95% CI: 2.60, 21.71)] were independent socio-demographic determinants of renal stone.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: Volume of water intake, meat, and salted nut consumption patterns were independent dietary determinants of renal stone. Therefore, a dietary intervention like drinking water above 2 liters per day, minimizing salt nut, and meat consumption, and providing health education targeting the risk groups may help to prevent renal stones. We recommend future researchers conduct studies that focus on identifying the types of stones and associated risk factors.\u003c/p\u003e","manuscriptTitle":"Dietary determinants of renal stone among patients treated at the urology department of Adama Hospital Medical College, Adama, Oromia, Ethiopia","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-12-24 16:42:43","doi":"10.21203/rs.3.rs-5640691/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c7460350-bc92-449c-b934-e99b9db946d8","owner":[],"postedDate":"December 24th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-02-21T07:39:02+00:00","versionOfRecord":[],"versionCreatedAt":"2024-12-24 16:42:43","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5640691","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5640691","identity":"rs-5640691","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}