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Urinary Tract Infection: Nutritional Considerations

The role of diet in the prevention and treatment of urinary tract infection remains unsettled. Some nutritional strategies with anecdotal support (vitamin C, high intake of fluids) have not demonstrated clinical effectiveness. Others, such as cranberry juice, have proven effective in clinical trials.4 Still others, such as probiotic treatment and high–fiber diets, await further evaluation. In epidemiologic or clinical studies, the following factors are associated with reduced risk:

Breast–feeding. Secretory immunoglobulin A (sIgA) in breast milk prevents the translocation of intestinal bacteria across the gut mucosa by blocking interactions between bacteria and the epithelial lining of the gut. Breast–feeding also alters the colonization of the gut, achieving a reduced presence of the P–fimbriated type of E coli that are associated with higher risk for UTI.5 Nonbreast–fed babies had on average twice the risk for urinary tract infection as breast–fed ones, and this risk was nearly 4–fold greater in girls.6

Flavonoid–containing juices. Certain classes of flavonoids (eg, epicatechin) block adhesion of E coli fimbria to uroepithelial cells. They may also prevent UTI by other mechanisms, such as the down–regulation of genes in E coli responsible for fimbrial expression. Epidemiological and clinical studies show that women who consume cranberry or cranberry–lingonberry juices have a 20% lower risk for UTI compared with those not drinking juice, a finding comparable to that of continuous low–dose antimicrobial prophylaxis.4,7

Lactobacilli. Limited evidence suggests that women who consume probiotic lactobacilli have a significantly (80% lower) decreased risk for UTI.8 However, this research requires confirmation. Lactobacilli can be purchased over the counter in many health food stores and pharmacies.

High–fiber diets. Constipation is a risk factor for UTI and recurrent UTI,9 although the reasons are unclear.10 Clinical trials have not yet established the usefulness of dietary fiber for UTI prevention, but increasing high–fiber foods in children with low–fiber diets is a potentially beneficial strategy.

Orders

Breast–feeding for at least 6 months of life, and hopefully longer, is recommended. For adults wishing to use flavonoid–containing juices as a preventive measure, cranberry juice consumed three times daily with meals would be appropriate.

What to Tell the Family

Urinary tract infection is often a combined result of a decreased ability to prevent opportunistic infection and the presence of a common (E coli) bacterial strain that travels from the gastrointestinal tract into the urethral opening. Useful preventive measures include careful personal hygiene and daily cranberry juice. Infections must be treated by antibiotics to prevent kidney damage.

 

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