Longitudinal relationships between diet-dependent renal acid load and blood pressure development in healthy children

Abstract

Diets high in sulfur-rich protein and low in fruits and vegetables affect human acid-base balance adversely. Corresponding subclinical forms of metabolic acidosis have been linked to hypertension in adults. We longitudinally examined relations of dietary acid load with blood pressure in 257 healthy prepuberty children with 3 or more parallel 3-day weighed dietary records, 24-h urine, and blood pressure measurements. Urinary net acid excretion and the potential renal acid load (PRAL), determined as the difference of major urinary nonbicarbonate anions and mineral cations, were used to predict dietary acid load. PRAL was also calculated from dietary data. In repeated-measures regression analyses, adjusted for body size and dietary fiber, an intraindividual increase of 10 mEq above the 'usual' net acid excretion or urine PRAL were each significantly related to a 0.6-0.7 mm Hg increased systolic blood pressure. Differences in urine PRAL among the children also significantly predicted between-person differences in systolic blood pressure. A higher individual net acid excretion or urine PRAL and intraindividual increase in urine PRAL were significantly related to higher diastolic blood pressure. Blood pressure associations were nonsignificant for dietary PRAL and urinary sodium. Thus, in healthy children, renal biomarker analyses reveal an association of proton load with higher blood pressure. Especially for systolic blood pressure, a more alkalizing nutrition may be beneficial for blood pressure development within a given individual. Experimental confirmation of a causal acid load-blood pressure link is required.

Increased protein intake and corresponding renal acid load under a concurrent alkalizing diet regime

“…As expected, the authors found a significantly higher renal acid load after 4 weeks on the protein supplement compared to 4 weeks on maltodextrin. 24-h renal acid load was determined as urinary PRAL (uPRAL), a biomarker that characterizes the mineral component (including sulfate from sulfur-containing amino acids) of total renal net acid excretion (NAE) without considering the organic acid component (Krupp et al 2014). Unexpectedly, the observed uPRAL difference after 4 weeks on higher protein ingestion versus baseline was only about 15 mEq/day.…”

Urinary pH reflects dietary acid load in patients with type 2 diabetes

“…(13) In addition, metabolic acidosis is associated with development of insulin resistance and type 2 diabetes. (14) Moreover, urinary pH values of patients with diabetes are lower than that of a general population. (15) Therefore, there is a possibility that the metabolism of acid-base equilibrium of patients with type 2 diabetes was difference from that of general population.…”

Is Dietary Red Meat Kidney Toxic?

“…10 High dietary acid induced by animal-sourced protein has been associated with subsequent development of hypertension, a CKD risk factor, in children. 11 Furthermore, high intake of animal-sourced protein is also associated with an increased risk of type 2 diabetes, 12 another CKD risk factor. On the other hand, substituting plantbased for animal-based dietary protein promotes gut flora which produce metabolites considered less kidney toxic than flora promoted by animal-sourced protein.…”