{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T15:58:49Z","timestamp":1788537529874,"version":"build-2803163510"},"reference-count":52,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,2,11]],"date-time":"2025-02-11T00:00:00Z","timestamp":1739232000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Nutr."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>The dietary index for gut microbiota (DI-GM) reflects dietary patterns that support gut microbial health and may influence kidney stone (KS) risk. The role of DI-GM and its mediation by diabetes in KS pathogenesis remains unclear.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To investigate the association between DI-GM and KS prevalence, assess the mediation effect of diabetes, and explore subgroup-specific effects and underlying mechanisms.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A cross-sectional analysis of NHANES (2007\u20132018) data was conducted using a stratified, multistage probability sampling design. A total of 19,841 participants were included in the final analysis. Data entry and statistical analysis were performed using Empower version 4.2 (X&amp;amp;Y Solutions, Inc., Boston, MA, United States) and R version 3.4.3 (R Foundation). Multivariable logistic regression was employed to assess the association between DI-GM and KS prevalence, with statistical significance set at <jats:italic>p<\/jats:italic> &amp;lt;\u202f0.05. Mediation analysis evaluated diabetes\u2019s contribution to this relationship, and subgroup analyses were conducted based on sex, race\/ethnicity, and alcohol consumption.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Higher DI-GM scores were associated with lower KS prevalence (adjusted OR: 0.78, 95% CI: 0.65\u20130.92 per SD increase). Diabetes mediated 9.27% of this relationship. Subgroup analyses revealed stronger protective effects among females, non-Hispanic Black individuals, and heavy drinkers. Mechanistically, DI-GM may reduce KS risk through gut microbial modulation of oxalate metabolism, urinary citrate excretion, and systemic inflammation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion and recommendations<\/jats:title><jats:p>Higher DI-GM scores are associated with reduced KS prevalence, partially mediated by diabetes. These findings highlight the role of dietary interventions targeting gut microbiota in KS prevention and call for longitudinal studies to confirm these results and develop tailored dietary strategies.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fnut.2025.1532313","type":"journal-article","created":{"date-parts":[[2025,2,11]],"date-time":"2025-02-11T05:10:40Z","timestamp":1739250640000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":16,"title":["Dietary index for gut microbiota and its protective role against kidney stones: evidence of diabetes as a mediator from NHANES cross-sectional data"],"prefix":"10.3389","volume":"12","author":[{"given":"Lei","family":"Wang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junjun","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ziwen","family":"Jiang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chao","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fuxiang","family":"Lin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuxiang","family":"Zhong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pengpeng","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Wei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianhua","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhanping","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,2,11]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1111\/bju.13828","article-title":"Prevalence of kidney stones in China: an ultrasonography based cross-sectional study","volume":"120","author":"Zeng","year":"2017","journal-title":"BJU Int"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"41630","DOI":"10.1038\/srep41630","article-title":"Prevalence of kidney stones in mainland China: a systematic review","volume":"7","author":"Wang","year":"2017","journal-title":"Sci Rep"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"160","DOI":"10.1016\/j.eururo.2012.03.052","article-title":"Prevalence of kidney stones in the United States","volume":"62","author":"Scales","year":"2012","journal-title":"Eur Urol"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1007\/s00467-008-0960-5","article-title":"History, epidemiology and regional diversities of urolithiasis","volume":"25","author":"L\u00f3pez","year":"2010","journal-title":"Pediatr Nephrol"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"65","DOI":"10.2478\/anre-2020-0005","article-title":"Association of kidney stone disease with dietary factors: a review","volume":"83","author":"Konjengbam","year":"2020","journal-title":"Anthropol Rev"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"149","DOI":"10.1186\/s12882-015-0126-1","article-title":"Impact of nephrolithiasis on kidney function","volume":"16","author":"Sigurjonsdottir","year":"2015","journal-title":"BMC Nephrol"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"62","DOI":"10.1186\/s12894-022-01017-4","article-title":"Risk factors for kidney stone disease recurrence: a comprehensive meta-analysis","volume":"22","author":"Wang","year":"2022","journal-title":"BMC Urol"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"1409","DOI":"10.2215\/CJN.03210312","article-title":"Urolithiasis and the risk of ESRD","volume":"7","author":"El-Zoghby","year":"2012","journal-title":"Clin J Am Soc Nephrol"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"724","DOI":"10.1016\/j.eururo.2014.06.036","article-title":"Use of the National Health and Nutrition Examination Survey to calculate the impact of obesity and diabetes on cost and prevalence of urolithiasis in 2030","volume":"66","author":"Antonelli","year":"2014","journal-title":"Eur Urol"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"851","DOI":"10.1097\/JU.0000000000002331","article-title":"Incidence of kidney stones in the United States: the continuous National Health and Nutrition Examination Survey","volume":"207","author":"Hill","year":"2022","journal-title":"J Urol"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"224","DOI":"10.1038\/s41581-021-00513-4","article-title":"The genetics of kidney stone disease and nephrocalcinosis","volume":"18","author":"Singh","year":"2022","journal-title":"Nat Rev Nephrol"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"1204","DOI":"10.1016\/S0140-6736(20)30925-9","article-title":"Global burden of 369 diseases and injuries in 204 countries and territories, 1990\u20132019: a systematic analysis for the Global Burden of Disease Study 2019","volume":"396","author":"Vos","year":"2020","journal-title":"Lancet"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"184","DOI":"10.21037\/tau-20-929","article-title":"Relationship between urine specific gravity and the prevalence rate of kidney stone","volume":"10","author":"Mao","year":"2021","journal-title":"Transl Androl Urol"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1007\/s00240-022-01403-5","article-title":"The microbiome of kidney stones and urine of patients with nephrolithiasis","volume":"51","author":"Lemberger","year":"2023","journal-title":"Urolithiasis"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"858","DOI":"10.1016\/j.juro.2017.03.124","article-title":"Dietary and lifestyle risk factors associated with incident kidney stones in men and women","volume":"198","author":"Ferraro","year":"2017","journal-title":"J Urol"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"1045","DOI":"10.3390\/nu16071045","article-title":"The development and evaluation of a literature-based dietary index for gut microbiota","volume":"16","author":"Kase","year":"2024","journal-title":"Nutrients"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"1204","DOI":"10.1681\/ASN.2007101075","article-title":"Uric acid and incident kidney disease in the community","volume":"19","author":"Weiner","year":"2008","journal-title":"J Am Soc Nephrol"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"2407","DOI":"10.1681\/ASN.2008010080","article-title":"Elevated uric acid increases the risk for kidney disease","volume":"19","author":"Obermayr","year":"2008","journal-title":"J Am Soc Nephrol"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"804","DOI":"10.2215\/CJN.05811108","article-title":"Kidney stones and the risk for chronic kidney disease","volume":"4","author":"Rule","year":"2009","journal-title":"Clin J Am Soc Nephrol"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1053\/j.ajkd.2009.08.008","article-title":"Risk factors for CKD in persons with kidney stones: a case-control study in Olmsted County, Minnesota","volume":"55","author":"Saucier","year":"2010","journal-title":"Am J Kidney Dis"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"416","DOI":"10.1016\/j.ypmed.2010.08.011","article-title":"Correlates of kidney stone disease differ by race in a multi-ethnic middle-aged population: the ARIC study","volume":"51","author":"Akoudad","year":"2010","journal-title":"Prev Med"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"e9085","DOI":"10.1371\/journal.pone.0009085","article-title":"Gut microbiota in human adults with type 2 diabetes differs from non-diabetic adults","volume":"5","author":"Larsen","year":"2010","journal-title":"PLoS One"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"236","DOI":"10.1038\/pr.2014.170","article-title":"Understanding the role of gut microbiome in metabolic disease risk","volume":"77","author":"Sanz","year":"2015","journal-title":"Pediatr Res"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.diabres.2012.10.001","article-title":"Global guideline for type 2 diabetes","volume":"104","year":"2014","journal-title":"Diabetes Res Clin Pract"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"607","DOI":"10.1016\/j.ijsu.2016.11.024","article-title":"The role of the microbiome in kidney stone formation","volume":"36","author":"Mehta","year":"2016","journal-title":"Int J Surg"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"548","DOI":"10.3390\/nu12020548","article-title":"Calcium oxalate nephrolithiasis and gut microbiota: not just a gut-kidney axis. A nutritional perspective","volume":"12","author":"Ticinesi","year":"2020","journal-title":"Nutrients"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"1694","DOI":"10.1016\/j.juro.2014.05.086","article-title":"Dietary intake of fiber, fruit and vegetables decreases the risk of incident kidney stones in women: a women\u2019s health initiative report","volume":"192","author":"Sorensen","year":"2014","journal-title":"J Urol"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"429","DOI":"10.4103\/0974-8520.108860","article-title":"Evaluation of anti-urolithiatic activity of Pashanabhedadi Ghrita against experimentally induced renal calculi in rats","volume":"33","author":"Gupta","year":"2012","journal-title":"Ayu"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"e29317","DOI":"10.7759\/cureus.29317","article-title":"Gut microbiota interventions for the management of obesity: a literature review","volume":"14","author":"Gill","year":"2022","journal-title":"Cureus"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1007\/s11892-016-0791-x","article-title":"Diet and gut microbial function in metabolic and cardiovascular disease risk","volume":"16","author":"Meyer","year":"2016","journal-title":"Curr Diab Rep"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"774567","DOI":"10.3389\/fendo.2021.774567","article-title":"Higher triglyceride-glucose index is associated with increased likelihood of kidney stones","volume":"12","author":"Qin","year":"2021","journal-title":"Front Endocrinol"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"1389714","DOI":"10.3389\/fnut.2024.1389714","article-title":"Association between composite dietary antioxidant index and kidney stone prevalence in adults: data from National Health and Nutrition Examination Survey (NHANES, 2007\u20132018)","volume":"11","author":"Duan","year":"2024","journal-title":"Front Nutr"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"308","DOI":"10.3390\/ijms20020308","article-title":"Intestinal microbiota protects against MCD diet-induced steatohepatitis","volume":"20","author":"Schneider","year":"2019","journal-title":"Int J Mol Sci"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"133","DOI":"10.1111\/bju.14840","article-title":"Association of intestinal oxalate-degrading bacteria with recurrent calcium kidney stone formation and hyperoxaluria: a case-control study","volume":"125","author":"Tavasoli","year":"2020","journal-title":"BJU Int"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"16428","DOI":"10.1038\/s41598-021-95992-7","article-title":"Effect of antibiotic treatment on Oxalobacter formigenes colonization of the gut microbiome and urinary oxalate excretion","volume":"11","author":"Nazzal","year":"2021","journal-title":"Sci Rep"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"34712","DOI":"10.1038\/srep34712","article-title":"Hyperoxaluria leads to dysbiosis and drives selective enrichment of oxalate metabolizing bacterial species in recurrent kidney stone endures","volume":"6","author":"Suryavanshi","year":"2016","journal-title":"Sci Rep"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1186\/s12866-020-01734-6","article-title":"Profiling the urinary microbiome in men with calcium-based kidney stones","volume":"20","author":"Xie","year":"2020","journal-title":"BMC Microbiol"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"1358","DOI":"10.1681\/ASN.2019101131","article-title":"Perturbations of the gut microbiome and metabolome in children with calcium oxalate kidney stone disease","volume":"31","author":"Denburg","year":"2020","journal-title":"J Am Soc Nephrol"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"2097","DOI":"10.1136\/gutjnl-2017-315734","article-title":"Understanding the gut-kidney axis in nephrolithiasis: an analysis of the gut microbiota composition and functionality of stone formers","volume":"67","author":"Ticinesi","year":"2018","journal-title":"Gut"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"1453","DOI":"10.1007\/s11255-018-1873-2","article-title":"The crosstalk of gut microbiota and chronic kidney disease: role of inflammation, proteinuria, hypertension, and diabetes mellitus","volume":"50","author":"Kanbay","year":"2018","journal-title":"Int Urol Nephrol"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"1028","DOI":"10.1111\/bju.14805","article-title":"New-onset metabolic risk factors and the incidence of kidney stones: a prospective cohort study","volume":"124","author":"Ping","year":"2019","journal-title":"BJU Int"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1186\/s12894-021-00905-5","article-title":"Risk factors of kidney stone disease: a cross-sectional study in the southeast of Iran","volume":"21","author":"Khalili","year":"2021","journal-title":"BMC Urol"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"1277","DOI":"10.2215\/CJN.08331109","article-title":"Metabolic basis for low urine pH in type 2 diabetes","volume":"5","author":"Maalouf","year":"2010","journal-title":"Clin J Am Soc Nephrol"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"953392","DOI":"10.3389\/fcimb.2022.953392","article-title":"Urinary microbial and metabolomic profiles in kidney stone disease","volume":"12","author":"Gao","year":"2022","journal-title":"Front Cell Infect Microbiol"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"967","DOI":"10.21037\/tau-23-51","article-title":"Kidney stones are associated with metabolic syndrome in a health screening population: a cross-sectional study","volume":"12","author":"Chen","year":"2023","journal-title":"Transl Androl Urol"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"1792","DOI":"10.3390\/foods9121792","article-title":"Highly branched neo-fructans (agavins) attenuate metabolic endotoxemia and low-grade inflammation in association with gut microbiota modulation on high-fat diet-fed mice","volume":"9","author":"Huazano-Garc\u00eda","year":"2020","journal-title":"Foods"},{"key":"ref47","doi-asserted-by":"publisher","first-page":"700058","DOI":"10.3389\/fnut.2021.700058","article-title":"Role of the gut microbiota in regulating non-alcoholic fatty liver disease in children and adolescents","volume":"8","author":"Tokuhara","year":"2021","journal-title":"Front Nutr"},{"key":"ref48","doi-asserted-by":"crossref","DOI":"10.21203\/rs.3.rs-855238\/v1","article-title":"Metabolic risk factors in patients with kidney stones with and without type 2 diabetes","author":"Spivacow","year":"2021"},{"key":"ref49","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1007\/s12672-022-00465-6","article-title":"Antibiotics in early life and childhood pre-B-ALL. Reasons to analyze a possible new piece in the puzzle","volume":"13","author":"Cardesa-Salzmann","year":"2022","journal-title":"Discov Oncol"},{"key":"ref50","doi-asserted-by":"publisher","first-page":"1916","DOI":"10.3389\/fimmu.2019.01916","article-title":"The contribution of gut barrier changes to multiple sclerosis pathophysiology","volume":"10","author":"Buscarinu","year":"2019","journal-title":"Front Immunol"},{"key":"ref51","doi-asserted-by":"publisher","first-page":"5017","DOI":"10.1007\/s00203-021-02484-3","article-title":"Activity of probiotics from food origin for oxalate degradation","volume":"203","author":"Soliman","year":"2021","journal-title":"Arch Microbiol"},{"key":"ref52","doi-asserted-by":"publisher","first-page":"39","DOI":"10.3390\/diseases9020039","article-title":"Incidence and characteristics of kidney stones in patients on ketogenic diet: a systematic review and meta-analysis","volume":"9","author":"Acharya","year":"2021","journal-title":"Diseases"}],"container-title":["Frontiers in Nutrition"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnut.2025.1532313\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,2,11]],"date-time":"2025-02-11T15:59:23Z","timestamp":1739289563000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnut.2025.1532313\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,11]]},"references-count":52,"alternative-id":["10.3389\/fnut.2025.1532313"],"URL":"https:\/\/doi.org\/10.3389\/fnut.2025.1532313","relation":{},"ISSN":["2296-861X"],"issn-type":[{"value":"2296-861X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2,11]]},"article-number":"1532313"}}