Association between drinking water type and kidney stone risk in U.S. adults: a cross-sectional analysis of NHANES 2009-2016 data

Purpose: While fluid intake and trace elements are known to influence kidney stone risk, the impact of drinking water type remains unclear. This study aimed to systematically evaluate the association between water source and kidney stone prevalence. Methods: This analysis included 10,246 adults (≥20 years) from the National Health and Nutrition Examination Survey database (2009–2016). Kidney stone history was self-reported, and drinking water sources were assessed through 24-hour dietary recalls. We employed multivariable-adjusted logistic regression models, adjusting for potential confounders including age, sex, race, body mass index (BMI), physical activity, calcium intake, smoking status, alcohol consumption, diabetes, and hypertension, to evaluate the association between drinking water type and kidney stone occurrence. To assess potential nonlinear relationships, restricted cubic spline (RCS) models were utilized. Additionally, cluster analysis was performed to categorize participants into distinct subgroups based on water consumption patterns. Finally, propensity score matching (PSM) and subgroup analyses were conducted to further validate the robustness of the findings. Results: Logistic regression suggested that higher tap water intake was significantly inversely related with kidney stone prevalence (adjusted OR = 0.678, 95% CI: 0.491–0.938, P for trend = 0.0177), suggesting a 32% lower odds of kidney stones with increased tap water consumption. However, bottled water intake was not significantly associated with kidney stone risk. The RCS model revealed a linear decreasing trend between tap water intake and kidney stone risk (P for all<0.0001, P for nonlinear = 0.8505). Cluster analysis showed that high tap water intake and low bottled water intake were associated with a lower prevalence of kidney stones. This association persisted in the propensity score-matched models and subgroup analyses after adjustment for bottled water intake. Conclusion: Our study revealed an inverse association between tap water intake and kidney stone prevalence among U.S. adults. Bottled water intake had no statistically significant effect on stone formation. These results suggest that higher tap water intake may confer a protective effect against kidney stone formation. These findings could guide public health recommendations on hydration habits.