Advances in Clinical and Experimental Medicine
2018, vol. 27, nr 10, October, p. 1347–1354
Publication type: original article
Dietary acid load and cardiometabolic risk in the Polish adult population
1 Department of Human Nutrition, Faculty of Health Science, Medical University of Warsaw, Poland
2 Department of Clinical Dietetics, Medical University of Warsaw, Poland
3 Department of Epidemiology, Cardiovascular Disease Prevention and Health Promotion, National Institute of Cardiology, Warszawa, Poland
4 Department of Epidemiology and Population Studies, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, Kraków, Poland
5 3rd Department of Cardiology, Upper Silesian Centre of Cardiology, Medical University of Silesia, Katowice, Poland
6 Department of Hypertension, Angiology and Internal Medicine, Poznan University of Medical Sciences, Poland
7 Department of Arterial Hypertension and Diabetology, Medical University of Gdansk, Poland
8 Department of Social and Preventive Medicine, Medical University of Lodz, Poland
Background. The potential influence of disorders of acid/base homeostasis on cardiovascular risk factors has been suggested.
Objectives. The aim of the study was to estimate the relationship between dietary acid load and the prevalence of cardiovascular disease and the prevalence and intensity of cardiovascular risk factors (i.e., hypertension, diabetes, overweight and obesity, dyslipidemia) in the Polish adult population.
Material and Methods. Data was derived from a cross-sectional survey of a random sample of 6,170 Polish residents aged 20+ (Multi-Center National Population Health Examination Survey, WOBASZ II study), including anthropometric and laboratory measurements, and estimates of nutrient intakes by 24-h recall. Dietary acid/ base load was assessed as potential renal acid load (PRAL) and net endogenous acid production (NEAP).
Results. The median PRAL and NEAP values for the whole study population were: PRAL −3.85 mEq/day and NEAP 39.79 mEq/day. The prevalence of overweight and obesity, both in males and females, tended to decrease across tertiles of PRAL and to increase across tertiles of NEAP. In females, the values of several metabolic characteristics differed across tertiles of NEAP. After adjustment for age and waist circumference, these relationships did not persist, but the prevalence of diabetes was found to increase across tertiles of PRAL (p for trend <0.05) in females.
Conclusion. The dietary acid load in the Polish adult population was relatively low. There was no independent relationship between dietary acid load and cardiovascular disease and its risk factors in the population under study, except for the positive association between the PRAL value and diabetes prevalence in females.
cardiovascular risk factors, polish population, dietary acid load
- Remer T, Dimitriou T, Manz F. Dietary potential renal acid load and renal net acid excretion in healthy, free-living children and adolescents. Am J Clin Nutr. 2003;77:1255–1260.
- Manz F. History of nutrition and acid-base physiology. Eur J Nutr. 2001;40:189–199.
- Akter S, Eguchi M, Kurotani K, et al. High dietary acid load is associated with increased prevalence of hypertension: The Furukawa Nutrition and Health Study. Nutrition. 2015;31:298–303.
- Adeva MM, Souto G. Diet-induced metabolic acidosis. Clin Nutr. 2011; 30:416–421.
- Fagherazzi G, Vilier A, Bonnet F, et al. Dietary acid load and risk of type 2 diabetes: The E3N-EPIC cohort study. Diabetologia. 2014;57: 313–320.
- Tylavsky FA, Spence LA, Harkness L. The importance of calcium, potassium, and acid-base homeostasis in bone health and osteoporosis prevention. J Nutr. 2008;138:164–165.
- Robey IF. Examining the relationship between diet-induced acidosis and cancer. Nutr Metab. 2012;9:72. doi: 10.1186/1743-7075-9-72
- Trinchieri A, Maletta A, Lizzano R, Marchesotti F. Potential renal acid load and the risk of renal stone formation in a case-control study. Eur J Clin Nutr. 2013;67:1077–1080.
- Remer T, Manz F. Potential renal acid load of foods and its influence on urine pH. J Am Diet Assoc. 1995;95:791–797.
- Frassetto L, Morris RC Jr, Sellmeyer DE, Todd K, Sebastian A. Diet, evolution and aging-the pathophysiologic effects of the post-agricultural inversion of the potassium-to-sodium and base-to-chloride ratios in the human diet. Eur J Nutr. 2001;40:200–213.
- Remer T. Influence of diet on acid-base balance. Semin Dial. 2000;13: 221–226.
- Engberink MF, Bakker SJ, Brink EJ, et al. Dietary acid load and risk of hypertension: The Rotterdam Study. Am J Clin Nutr. 2012;95:1438–1444.
- Frassetto LA, Lanham-New SA, Macdonald HM, Remer T. Standardizing terminology for estimating the diet-dependent net acid load to the metabolic system. J Nutr. 2007;137:1491–1492.
- Drygas W, Niklas A, Piwońska A, et al. Multi-center National Population Health Examination Survey (WOBASZ II study): Assumptions, methods and implementation. Kardiol Pol. 2016;74(7):681–690.
- Kunachowicz H, Nadolna I, Przygoda B, Iwanow K. Food Composition Tables. Warszawa: PZWL; 2005.
- Zhang L, Curhan GC, Forman JP. Diet-dependent net acid load and risk of incident hypertension in United States women. Hypertens. 2009;54:751–755.
- Murakami K, Sasaki S, Takahashi Y, Uenishi K. Japan Dietetic Students’ Study for Nutrition and Biomarkers Group: Association between dietary acid-base load and cardiometabolic risk factors in young Japanese women. Br J Nutr. 2008,100:642–651.
- Astrup A. The satiating power of protein − A key to obesity prevention? Am J Clin Nutr. 2005;82:1–2.
- Xu H, Jia T, Huang X, et al. Dietary acid load, insulin sensitivity and risk of type 2 diabetes in community-dwelling older men. Diabetologia. 2014;57:156–1568.
- Cameron MA, Maalouf NM, Adams-Huet B, Moe OW, Sakhaee K. Urine composition in type 2 diabetes: Predisposition to uric acid nephrolithiasis. J Am Soc Nephrol. 2006;17:1422–1428.
- Maalouf NM, Cameron MA, Moe OW, Adams-Huet B, Sakhaee K. Low urine pH: A novel feature of the metabolic syndrome. Clin J Am Soc Nephrol. 2007;2:883–888.
- Souto G, Donapetry C, Calvino J, Adeva MM. Metabolic acidosis-induced insulin resistance and cardiovascular risk. Metab Syndr Relat Disord. 2011;9:247–253.
- DeFronzo RA, Beckles AD. Glucose intolerance following chronic metabolic acidosis in man. Am J Physiol. 1979;236:328–334.
- Whittaker J, Cuthbert C, Hammond VA, Alberti KG. The effects of metabolic acidosis in vivo on insulin binding to isolated rat adipocytes. Metabolism. 1982;31:553–557.
- Rebolledo OR, Hernandez RE, Zanetta AC, Gagliardino JJ. Insulin secretion during acid-base alterations. Am J Physiol. 1978;234:426–429.
- Williams RS, Kozan P, Samocha-Bonet D. The role of dietary acid load and mild metabolic acidosis in insulin resistance in humans. Biochimie. 2016;124:171–177. doi: 10.1016/j.biochi.2015.09.012
- Livingstone MBE, Black AE. Markers of the validity of reported energy intake. J Nutr. 2003;133:895–920.
- Frassetto LA, Todd KM, Morris RC Jr, Sebastian A. Estimation of net endogenous noncarbonic acid production in humans from diet potassium and protein contents. Am J Clin Nutr. 1998;68:576–583