Effect of low-carbohydrate high-protein diets on acid-base balance, stone-forming propensity, and calcium metabolism

Reddy, Shalini; Wang, Chia Ying; Sakhaee, Khashayar; Brinkley, Linda; Pak, Charles Y.C.

doi:10.1053/ajkd.2002.34504

Cited by 317 publications

(136 citation statements)

References 36 publications

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“…Previous studies (Magri et al, 1977;Remer and Manz, 1994;Manz et al, 2001;Reddy et al, 2002) have repeatedly demonstrated the inverse relationship between urinary pH and NAE. The present study confirms this and indicates that the variability of urinary free proton excretion can be explained by the variability in NAE to a comparable extent in healthy young adults and elderly.…”

Section: Discussionmentioning

confidence: 88%

“…The inverse correlation between body's acid load, quantifiable as the renal net acid excretion (NAE), and the urinary pH is well documented (Magri et al, 1977;Remer and Manz, 1994;Manz et al, 2001;Reddy et al, 2002). NAE is the summation of net endogenous acid production determined by the dietary intakes of protein and minerals on one hand, and endogenous components on the other.…”

Section: Introductionmentioning

confidence: 99%

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Muscularity and adiposity in addition to net acid excretion as predictors of 24-h urinary pH in young adults and elderly

Berkemeyer

Rylander

Vormann³

2006

Eur J Clin Nutr

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Objective: In patients with nephrolithiasis, an inverse relationship between 24-h urinary pH (24h-UpH) and body weight has been reported. Whether body composition indices and 24h-UpH are similarly associated in healthy subjects needs investigation. Design: Cross-sectional, retrospective analysis. Setting: Dortmund, Germany and Gothenburg, Sweden. Subjects: Healthy young adults (18-23 years; n ¼ 117) and elderly (55-75years; n ¼ 85) having a mean body mass index (BMI) of 22.8073.4 and 25.373.9 kg/m 2 , respectively. Methods: Anthropometric data, 24h-UpH, and 24-h urinary excretion rates of net acid (NAE), creatinine, and urea were determined. After adjusting for urea (reflecting protein intake), renal creatinine output was used as a biochemical marker for muscularity. The BMI served as a marker of adiposity. Results: NAE, body weight, and BMI were significantly (Po0.05) higher, and height and creatinine significantly lower in the elderly, whereas body-surface area (BSA) was not different.Step-wise multiple regression analysis using BSA-corrected urinary variables revealed NAE as the primary predictor of 24h-UpH (with R 2 values of 0.64 and 0.68 in young adults and elderly, respectively, Po0.0001), followed by urea (Po0.0001), creatinine (Po0.05), and BMI (Po0.05 for the young adults and P ¼ 0.12 for the elderly). These associations were negative for NAE and BMI, and positive for urea and creatinine. Conclusions: Muscularity (i.e. creatinine adjusted for urea) and particularly in the group of young adults, adiposity (i.e. BMI) proved to be modest, but significant predictors of 24h-UpH. Future research should focus on more obese subjects in whom insulin resistance and particular kidney functions should also be examined to further substantiate the role of obesity in low-urine pH-associated conditions, for example, nephrolithiasis.

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Section: Discussionmentioning

confidence: 88%

Section: Introductionmentioning

confidence: 99%

Muscularity and adiposity in addition to net acid excretion as predictors of 24-h urinary pH in young adults and elderly

Berkemeyer

Rylander

Vormann³

2006

Eur J Clin Nutr

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“…Other studies that investigated the effect of an acid/base imbalance on health focused on bone and kidney stones [9,10]. Associations between low serum bicarbonate, higher anion gap and low urine pH-all markers of metabolic acidosis-and insulin resistance have been reported [7,19,20].…”

Section: Discussionmentioning

confidence: 99%

“…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: 99%

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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“…This is in accordance with an evaluation of the dietary acid-base balance in British teenagers (nearly 170 mEq day 21 in boys and 154 mEq day 21 in girls) 13 . The impact of such dietary habits on health is no longer controversial; however, the effects on bone stability 6 , renal nitrogen wasting 14 and nephrolithiasis 7,8 appear to be at least partly moderate.…”

Section: Discussionmentioning

confidence: 99%

Potential renal acid load in the diet of children and adolescents: impact of food groups, age and time trends

Alexy¹,

Kersting²

2008

Public Health Nutr.

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Objective: The impact of acid-base balance on health is widely accepted. Here, we describe the potential renal acid load (PRAL) in the diet of healthy German children and adolescents. Design: The Dortmund Nutritional and Anthropometric Longitudinally Designed (DONALD) Study is an ongoing longitudinal (open cohort) study (start 1985) collecting detailed data on diet, growth, development and metabolism in infants, children and adolescents. Setting: Research Institute of Child Nutrition, Dortmund. Subjects: Seven hundred and twenty children and adolescents (351 boys and 369 girls), aged 3-18 years, provided 4187 yearly collected 3-day dietary records between 1995 and 2005. Results: Mean daily PRAL was positive in all age/sex groups (6-21 mEq day 21 ), and significantly higher in boys than in girls after the age of 8 years, even when calculated as mEq MJ 21 . Fruits, vegetables and potatoes had a negative impact on PRAL; cheese, dairy products, cereals/bread and meat/fish/eggs had a positive impact. In a mixed linear model, PRAL, expressed as mEq day 21 and mEq MJ 21 , remained stable during the study period, since time trends of PRAL-relevant food groups countervail each other. PRAL intake (mEq MJ 21 ) was significantly positively associated (P , 0.0001) with fat intake (% of energy intake, %E), but negatively with carbohydrate intake (%E; P , 0.0001). Conclusions: The analysis of dietary habits in our sample of German children and adolescents showed a moderate excess of acidity. Especially older boys should be encouraged to eat more potatoes and vegetables as good sources of dietary alkalinity. The PRAL concept is compatible with current concepts for a healthy diet.

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Effect of low-carbohydrate high-protein diets on acid-base balance, stone-forming propensity, and calcium metabolism

Cited by 317 publications

References 36 publications

Muscularity and adiposity in addition to net acid excretion as predictors of 24-h urinary pH in young adults and elderly

Muscularity and adiposity in addition to net acid excretion as predictors of 24-h urinary pH in young adults and elderly

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

Potential renal acid load in the diet of children and adolescents: impact of food groups, age and time trends

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