Planetary Health Diet Index and Self-Reported Kidney Stones in US Adults: Mediating Role of High-Density Lipoprotein Cholesterol

Qinglong Yang¹Haolin Chen²Nan Luo^3,4Hanyuan Lin¹Haoxian Tang^3,5Jingtao Huang^3,6Xuan Zhang^3,7Wenqiang Liao¹Gaoming Hou¹Yu Xue Lin¹Zexuan Liu¹Xuxia Sui^3*Qingtao Yang^8*

• ¹Department of Urology, Second Affiliated Hospital of Shantou University Medical College,, Shantou, Guangdong Province, China
• ²Department of Thyroid, Breast and Hernia Surgery, Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong Province, China
• ³College of Medicine, Shantou University, Shantou, Guangdong Province, China
• ⁴Department of Psychiatry, Shantou University Mental Health Center, Shantou, Guangdong Province, China
• ⁵First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong Province, China
• ⁶Department of Sports Medicine and Rehabilitation, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China, Shenzhen, China
• ⁷Department of Bone & Joint Surgery, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China, Shenzhen, China
• ⁸Department of Urology, Second Affiliated Hospital of Shantou University Medical College, Shantou, China

Background: Kidney stone is a universal health concern, with its incidence influenced by dietary habits. The Planetary Health Diet (PHD) benefits human health and the environment. Objective: This study aims to examine the relationship between the Planetary Health Diet Index (PHDI) and self-reported kidney stones and to explore the mediating role of high-density lipoprotein cholesterol (HDL-C). Methods: This study included 19,249 participants (≥ 20 years old) from the National Health and Nutrition Examination Survey (NHANES) from 2007 to 2018. Kidney stone diagnoses were self-reported. Higher PHDI scores represented greater compliance with the PHD. The statistical analyses encompassed a weighted multivariable logistic regression model, restricted cubic spline curve analysis, mediation analyses, subgroup analysis, and sensitivity analysis. Results: In the fully adjusted model, each 10-point rise in PHDI was tied to an 8% decrease in self-reported kidney stone risk (OR, 0.92; 95% CI, 0.87-0.97). Participants in the top quintile of PHDI had a 25% lower risk of self-reported kidney stones than those in the bottom quintile (OR, 0.75; 95% CI, 0.58-0.96). HDL-C mediated 6.0% of the correlation between PHDI and self-reported kidney stones. Conclusion: PHDI reduced the risk of self-reported kidney stones, with HDL-C partially mediating this effect.