Dietary acid load and risk of hypertension: the Rotterdam Study

Engberink, M.F.; Bakker, Stephan J. L.; Brink, Elizabeth J.; Baak, Marleen A. van; Rooij, Frank J.A. van; Hofman, Albert; Witteman, Jacqueline C. M.; Geleijnse, Johanna M.

doi:10.3945/ajcn.111.022343

Cited by 121 publications

(143 citation statements)

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“…To our knowledge, this is the first prospective study to evaluate the risk of type 2 diabetes associated with scores reflecting the acid load of the diet, such as PRAL or NEAP. In the Nurses' Health Study II, a high NEAP score was found to be associated with a higher risk of hypertension [11], while this was not confirmed in a recent study using both the PRAL and NEAP scores [3]. In the latter report, based on the Rotterdam Study with 2,241 participants, the multivariate HR comparing the third with the first PRAL tertile was 1.02.…”

Section: Discussionmentioning

confidence: 80%

“…Moreover, type 2 diabetes incidence and glucose intolerance have been shown to be higher in people with a lower urinary pH than in those with a higher urinary pH [9]. Other studies that investigated the effect of an acid/base imbalance on health focused mainly on bone health, kidney stones [9,10] and hypertension; a positive association between hypertension and acid/base imbalance was reported in the Nurses' Health Study II [11], while a more recent prospective study in older Dutch adults from the Rotterdam Study failed to find any association [3].…”

Section: Introductionmentioning

confidence: 91%

“…It has recently been suggested that acid/base imbalance may play an important role in some cardiometabolic abnormalities [3][4][5]. Markers of diet-induced metabolic acidosis have been associated with insulin resistance, but only in crosssectional studies [6][7][8], preventing any conclusions in terms of causality.…”

Section: Introductionmentioning

confidence: 98%

“…The potential renal acid load (PRAL) score takes into account the intestinal absorption rates of contributing nutrient ionic balances for protein, potassium, calcium and magnesium and the dissociation of phosphate at pH 7.4 [12,13]. A negative PRAL value reflects a base (or alkaline)-forming potential, whereas a positive value reflects an acid-forming potential [3]. Frassetto et al [2] developed the net endogenous acid production (NEAP) score, based on total protein and potassium intake as the main components involved in acid production; the NEAP score ranged from 34 to 76 mEq/day in a US population-based report [11].…”

Section: Introductionmentioning

confidence: 99%

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Dietary acid load and risk of type 2 diabetes: the E3N-EPIC cohort study

et al. 2013

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Aims/hypothesis The objective of this study was to evaluate the prospective relationship between dietary acid load, assessed with both the potential renal acid load (PRAL) and the net endogenous acid production (NEAP) scores, and type 2 diabetes risk. Methods A total of 66,485 women from the E3N-EPIC cohort were followed for incident diabetes over 14 years. PRAL and NEAP scores were derived from nutrient intakes. HRs for type 2 diabetes risk across quartiles of the baseline PRAL and NEAP scores were estimated with multivariate Cox regression models. Results During follow-up, 1,372 cases of incident type 2 diabetes were validated. In the overall population, the highest PRAL quartile, reflecting a greater acid-forming potential, was associated with a significant increase in type 2 diabetes risk, compared with the first quartile (HR 1.56, 95% CI 1.29, 1.90). The association was stronger among women with BMI <25 kg/m 2 (HR 1.96, 95% CI 1.43, 2.69) than in overweight women (HR 1.28, 95% CI 1.00, 1.64); statistically significant trends in risk across quartiles were observed in both groups ( p trend <0.0001 and p trend =0.03, respectively). The NEAP score provided similar findings. Conclusions/interpretationWe have demonstrated for the first time in a large prospective study that dietary acid load was positively associated with type 2 diabetes risk, independently of other known risk factors for diabetes. Our results need to be validated in other populations, and may lead to promotion of diets with a low acid load for the prevention of diabetes. Further research is required on the underlying mechanisms.

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Section: Discussionmentioning

confidence: 80%

Section: Introductionmentioning

confidence: 91%

Section: Introductionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

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Dietary acid load and risk of type 2 diabetes: the E3N-EPIC cohort study

et al. 2013

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“…Therefore, reducing the dietary acid load may offer one solution to improve health outcomes in patients with diabetes. Moreover, several cross-sectional and longitudinal studies have found a positive association between dietary acid load and increased risk for various chronic diseases, including diabetes, IR, nonalcoholic fatty liver, and cardiometabolic factors [8][9][10][11], but not hypertension [12].…”

Section: Introductionmentioning

confidence: 99%

Association of dietary acid load with cardiovascular disease risk factors in patients with diabetic nephropathy

et al. 2015

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Reduced dietary acid load in U.S. vegetarian adults: Results from the National Health and Nutrition Examination Survey

Storz

Ronco

2022

Food Science & Nutrition

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Dietary acid load (DAL) is an important determinant of systemic pH and acid–base homeostasis. Diets abundant in acidogenic foods, such as meat and meat products, induce a low‐grade metabolic acidosis state that has been associated with cardiovascular disease, type‐2‐diabetes, and an increased cancer risk. Fruits and vegetables have alkalizing properties and beneficially affect DAL. It has thus been suggested that a plant‐based diet (restricting or excluding animal products) may be a powerful tool in reducing DAL; yet studies in that particular field are scarce. To explore these associations in greater detail, we examined DAL in self‐identified vegetarians from the United States National Health and Nutrition Examination Survey (2007–2010). We compared dietary intake and two widely used markers of DAL (PRAL (potential renal acid load) and NEAP (net endogenous acid production; NEAPF and NEAPR)) among 8,398 nonvegetarians and 191 lacto‐ovo‐vegetarians with reliable dietary intake aged 18 years or older. Vegetarians had a more favorable body mass index and consumed fewer calories (1862.31 kcal/d) than nonvegetarians (2041.12 kcal/d). Vegetarians consumed fewer protein (34.17 g/1000 kcal) and phosphorus compared to nonvegetarians (39.50 g of protein/1000 kcal) but had a higher intake of magnesium and potassium. Nonvegetarians exhibited higher median DAL scores (PRAL: 11.90 mEq/d, NEAPF: 53.59 mEq/d, NEAPR: 55.67 mEq/d) than vegetarians (PRAL: −0.44 mEq/d, NEAPF: 39.60 mEq/d, NEAPR: 41.30 mEq/d). Vegetarians had more favorable DAL scores compared to nonvegetarians in this descriptive epidemiologic study. Future (interventional) trials are warranted to examine the varying acid load in different plant‐based dietary patterns.

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Dietary acid load and risk of hypertension: the Rotterdam Study

Abstract: The findings from this prospective cohort study provided no evidence of an association between dietary acid load and risk of hypertension in older adults.

Cited by 121 publications

References 32 publications

Dietary acid load and risk of type 2 diabetes: the E3N-EPIC cohort study

Dietary acid load and risk of type 2 diabetes: the E3N-EPIC cohort study

Association of dietary acid load with cardiovascular disease risk factors in patients with diabetic nephropathy

Reduced dietary acid load in U.S. vegetarian adults: Results from the National Health and Nutrition Examination Survey

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