High dietary acid load is associated with insulin resistance: The Furukawa Nutrition and Health Study

Akter, Shamima; Eguchi, M.; Kuwahara, Keisuke; Kochi, Takeshi; Ito, Rie; Kurotani, Kayo; Tsuruoka, Hiroko; Nanri, Akiko; Kabe, Isamu; Mizoue, Tetsuya

doi:10.1016/j.clnu.2015.03.008

Cited by 74 publications

(89 citation statements)

References 27 publications

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“…The mechanism linking diet-induced acid load and metabolic disease incidence is mainly reported as insulin resistance [7, 9]. Toward that end, insulin binding affinity to its receptor was markedly decreased in individuals with metabolic acidosis [37].…”

Section: Discussionmentioning

confidence: 99%

“…Previously, the correlation between diet-acid load and metabolic disease was stronger in non-obese individuals, suggesting that it is independent of adiposity [7, 9]. We evaluated the PRAL score and ACC/AHA ASCVD risk according to BMI as well as insulin resistance.…”

Section: Discussionmentioning

confidence: 99%

“…However, a Western diet induces an acid load that overwhelms the base production from vegetables, leading to chronic metabolic acidosis [6]. Recently, acid–base imbalance was suggested to be a risk factor for metabolic disorders [7–9]; higher dietary acid load increased the incidence of type 2 diabetes and hypertension in prospective studies [7, 8] and was associated with insulin resistance [9]. …”

Section: Introductionmentioning

confidence: 99%

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

Han

Kim

Hong

et al. 2016

Cardiovasc Diabetol

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Han

Kim

Hong

et al. 2016

Cardiovasc Diabetol

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“…10 Likewise, in epidemiologic studies of populations with predominantly normal GFR, serum bicarbonate was positively associated with insulin sensitivity and lower risk of incident diabetes, and greater dietary acid intake (quantified as NEAP and PRAL) was associated with higher homeostasis model of assessment insulin resistance score and increased risk of incident diabetes. 9,35–37 …”

Section: Discussionmentioning

confidence: 99%

Dietary Acid Load is Associated With Serum Bicarbonate but not Insulin Sensitivity in Chronic Kidney Disease

Ikizler

Zelnick

Ruzinski

et al. 2016

Journal of Renal Nutrition

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Objective In chronic kidney disease (CKD), dietary acid may promote metabolic acidosis and insulin resistance, which in turn may contribute to adverse clinical health outcomes. We examined associations between dietary acid load, serum bicarbonate, and insulin sensitivity in CKD. Design In a cross-sectional study, we collected 3-day prospective food diaries to quantify dietary acid load as net endogenous acid production (NEAP, the nonvolatile acid load produced by the diet’s acid balance) and potential renal acid load (PRAL). We measured urine net acid excretion (NAE) in 24-hour urine samples. Insulin sensitivity was measured by hyperinsulinemic euglycemic clamp. Subjects 42 patients with CKD stages 3–5 attending nephrology clinics in the Pacific Northwest and 21 control subjects (eGFR ≥60mL/min/1.73m2). Main outcome measures Serum bicarbonate and insulin sensitivity (SIclamp). Results Mean age was 60.8±13.6 years and 54% of participants were men. Mean eGFR and serum bicarbonate concentrations were 34.4±13.1 mL/min/1.73m2 and 24.1±2.9 mEq/L for participants with CKD and 88.6±14.5 mL/min/1.73m2 and 26.3±1.8 mEq/L for control subjects, respectively. Mean NEAP, PRAL, and NAE were 58.2±24.3, 9.7±18.4, and 32.1±19.8 mEq/day, respectively. Considering all participants, dietary acid load was significantly, inversely associated with serum bicarbonate, adjusting for age, sex, race, eGFR, BMI, and diuretic use: −1.2 mEq/L per SD NEAP (95% CI −1.8, −0.6, p<0.0001); −0.9 mEq/L bicarbonate per SD PRAL (95% CI −1.5, −0.4, p=0.0005); −0.7 mEq/L bicarbonate per SD NAE (95% CI −1.2, −0.1, p=0.01). These associations were similar in participants with and without CKD. However, neither NEAP, PRAL, nor NAE was significantly associated with SIclamp. Serum bicarbonate was also not significantly associated with SIclamp. Conclusions In CKD, dietary acid load is associated with serum bicarbonate, suggesting that acidosis may be improved by dietary changes, but not with insulin sensitivity. Practical application We observed that a diet with a greater acid load was associated with lower serum bicarbonate but not insulin resistance in patients with chronic kidney disease. It may be beneficial to limit dietary acid in patients with chronic kidney disease to improve metabolic acidosis and its long-term adverse health effects, but additional, experimental studies are needed to establish the safety and usefulness of such interventions.

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“…Acid load was estimated by calculating both PRAL (Potential Renal Acid Load) and NEAP but no correlation with the risk of developing insulin resistance or B-cells dysfunction was found (Xu et al 2014). A recent study carried out on 1720 workers showed a significant statistical association of acid load with HOMA-IR but not with HbA1c or fasting glucose levels (Akter et al 2016).…”

Section: Glucose Metabolismmentioning

confidence: 99%

Diet-induced acidosis and alkali supplementation

Guardia

Roggi

Cena

2016

International Journal of Food Sciences and Nutrition

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Western diet, high in protein-rich foods and poor in vegetables, is likely to be responsible for the development of a moderate acid excess leading to metabolism deregulation and the onset or worsening of chronic disturbances. Available findings seem to suggest that diets with high protein/vegetables ratio are likely to induce the development of calcium lithiasis, especially in predisposed subjects. Moreover, some evidence supports the hypothesis of bone metabolism worsening and enhanced bone loss following acid-genic diet consumption although available literature seems to lack direct and conclusive evidence demonstrating pathological bone loss. According to other evidences, diet-induced acidosis is likely to induce or accelerate muscle wasting or sarcopenia, especially among elderlies. Furthermore, recent epidemiological findings highlight a specific role of dietary acid load in glucose metabolism deregulation and insulin resistance. The aim of this review is to investigate the role of acid-genic diets in the development of the mentioned metabolic disorders focusing on the possible clinical improvements exerted by alkali supplementation.

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High dietary acid load is associated with insulin resistance: The Furukawa Nutrition and Health Study

Cited by 74 publications

References 27 publications

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

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

Dietary Acid Load is Associated With Serum Bicarbonate but not Insulin Sensitivity in Chronic Kidney Disease

Diet-induced acidosis and alkali supplementation

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