Association between dietary acid load and the risk of cardiovascular disease: nationwide surveys (KNHANES 2008–2011)

Abstract

BackgroundAcid–base imbalance has been reported to increase incidence of hypertension and diabetes. However, the association between diet-induced acid load and cardiovascular disease (CVD) risk in the general population has not been fully investigated.MethodsThis was a population-based, retrospectively registered cross-sectional study using nationally representative samples of 11,601 subjects from the Korea National Health and Nutrition Examination Survey 2008–2011. Individual CVD risk was evaluated using atherosclerotic cardiovascular disease (ASCVD) risk equations according to 2013 ACC/AHA guideline assessment in subjects aged 40–79 without prior CVD. Acid–base status was assessed with both the potential renal acid load (PRAL) and the dietary acid load (DAL) scores derived from nutrient intake.ResultsIndividuals in the highest PRAL tertile had a significant increase in 10 year ASCVD risks (9.6 vs. 8.5 %, P < 0.01) and tended to belong to the high-risk (10 year risk >10 %) group compared to those in the lowest PRAL tertile (odds ratio [OR] 1.23, 95 % confidence interval [CI] 1.22–1.35). The association between higher PRAL score and high CVD risk was stronger in the middle-aged group. Furthermore, a multiple logistic regression analysis also demonstrated this association (OR 1.20 95 % CI 1.01–1.43). Subgroup analysis stratified obesity or exercise status; individuals in unhealthy condition with lower PRAL scores had comparable ASCVD risk to people in the higher PRAL group that were in favorable physical condition. In addition, elevated PRAL scores were associated with high ASCVD risk independent of obesity, exercise, and insulin resistance, but not sarcopenia. Similar trends were observed with DAL scores.ConclusionDiet-induced acid load was associated with increased risk of CVD, independent of obesity and insulin resistance.

Dietary acid load, blood pressure, fasting blood sugar and biomarkers of insulin resistance among adults: Findings from an updated systematic review and meta‐analysis

“…In the study by Akter, no association between PRAL, NEAP and FBS or HbA 1 C was reported. Similar findings were also observed in several other studies . Akter et al reported that men in the highest quartiles of PRAL had 61% higher odds of developing diabetes compared with the lowest quartile; while no association was observed among women.…”

“…In the study by Akter et al evaluating the association between dietary acid load and prevalence of HTN in the Furukawa Nutrition and Health Study the odds of HTN in subjects in the highest tertile of PRAL and NEAP was 31% and 40% more than individuals in lowest tertile (PRAL; OR: 1.31; CI: 1.01‐1.70; NEAP OR: 1.40; CI: 1.08‐1.82) among 2028 working Japanese population. Several other studies also reported similar results of higher prevalence of HTN or higher SBP and DBP values in highest vs lowest PRAL or NEAP groupings . Only one study reported inverse association between HTN prevalence among NEAP quartiles and several other studies found no difference .…”

“…We did not observe any association between PRAL, NEAP and markers of glucose homoeostasis including FBS, HbA 1 C and HOMA‐IR values. Higher FBS concentrations in higher PRAL categories were reported in the Haghighatdoost et al study although this association did not achieve significant threshold, while other studies reported no significant difference . The current meta‐analysis has several limitations and strengths; the current meta‐analysis included the results of observational studies with the cross‐sectional or cohort design which makes the causal inference impossible; although, the studies were large population‐based studies with acceptable quality.…”

“…Table presents the summary of systematically reviewed studies evaluated the association between dietary acid load (eg PRAL or NEAP), blood pressure and hypertension prevalence. Totally, 20 studies reported the association between HTN, blood pressure and PRAL or NEAP among the systematically reviewed literature . In the study by Akter et al evaluating the association between dietary acid load and prevalence of HTN in the Furukawa Nutrition and Health Study the odds of HTN in subjects in the highest tertile of PRAL and NEAP was 31% and 40% more than individuals in lowest tertile (PRAL; OR: 1.31; CI: 1.01‐1.70; NEAP OR: 1.40; CI: 1.08‐1.82) among 2028 working Japanese population.…”

“…In fact, diet is responsible for more than 10‐fold difference in endogenous acid production in different individuals . The diet‐induced acid load is estimated according to potential renal acid load (PRAL) and net‐endogenous acid production (NEAP) according to information about ingested protein, potassium, calcium, phosphorous and magnesium . The PRAL calculation is based on the formula first suggested by Remer et al as follows: PRAL (mEq/d) = 0.4888 × protein intake (g/d) + 0.0366 × phosphorus (mg/d) − 0.0205 × potassium (mg/d) − 0.0125 × calcium (mg/d) − 0.0263 × magnesium (mg/d).…”