Standardizing Terminology for Estimating the Diet-Dependent Net Acid Load to the Metabolic System

Frassetto, Lynda; Lanham-New, Susan A; Macdonald, Helen; Remer, Thomas; Sebastián, Anthony; Tucker, Katherine L.; Tylavsky, Frances A.

doi:10.1093/jn/137.6.1491

Cited by 103 publications

(117 citation statements)

References 14 publications

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“…6 In accordance, a significant association between intake of SAAs and NAE was found, the latter reflecting metabolic acid load. 19 Nevertheless, regarding systemic metabolic parameters, we observed no significant association of sulfate with blood pH and , which could suggest a favorable role for thiosulfate in acid-base homeostasis, given the large body of RTRs experiencing systemic acidosis. 6 The significance of and mechanism underlying this association are not yet clear and need further elucidation.…”

Section: Discussioncontrasting

confidence: 54%

Urinary Sulfur Metabolites Associate with a Favorable Cardiovascular Risk Profile and Survival Benefit in Renal Transplant Recipients

Berg

Pasch

Westendorp³

et al. 2014

Journal of the American Society of Nephrology

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In post-transplant conditions, sulfur may be protective by intermediate conversion to hydrogen sulfide and thiosulfate. However, sulfate, the end product of sulfur-containing amino acids (SAAs), contributes to metabolic acid load and may adversely influence acid-base homeostasis. We investigated the association of urinary sulfur metabolites with cardiometabolic parameters in renal transplant recipients (RTRs) and analyzed their predictive capacity for mortality. We studied urinary sulfate and thiosulfate excretion in 24-hour urine samples from 707 RTRs at a median 5.4 years (interquartile range, 1.9 to 12.2) after transplantation as well as from 110 controls. Diet was assessed for SAA content and various risk factors were measured. Urinary sulfate was similar, whereas thiosulfate was higher in RTRs versus controls. SAA intake was lower in RTRs compared with controls and correlated with sulfate but not thiosulfate excretion. Sulfate beneficially associated with eGFR, net acid excretion, systolic BP, high-sensitivity C-reactive protein, N-terminal probrain natriuretic peptide, and proteinuria (all P#0.01). Thiosulfate beneficially associated with eGFR, serum acidity, high-sensitivity C-reactive protein, and N-terminal probrain natriuretic peptide (all P#0.001). During a median 27 months (interquartile range, 22-36) of follow-up, 47 RTRs died. After adjustment for age, sex, and eGFR, hazard ratios for mortality were 0.87 (95% confidence interval, 0.82 to 0.92; P,0.001) for urinary sulfate and 0.60 (95% confidence interval, 0.41 to 0.59; P=0.01) for thiosulfate. Thus, despite the association of urinary sulfate with metabolic acid load, urinary sulfate and thiosulfate beneficially associated with survival in RTRs, possibly by influencing cardiovascular parameters. Intervention studies with exogenous sulfur are warranted to elucidate mechanisms underlying these promising associations in RTRs.

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Section: Discussioncontrasting

confidence: 54%

Urinary Sulfur Metabolites Associate with a Favorable Cardiovascular Risk Profile and Survival Benefit in Renal Transplant Recipients

Berg

Pasch

Westendorp³

et al. 2014

Journal of the American Society of Nephrology

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“…In conclusion, in addition to the PRAL-specific diet effects on NEAP [1][2][3][4], ingestion of particular plant foods and/or larger changes in consumption of protein may additionally add to the body's total acid load via increases in OAs. Future research is required to identify those fruits and vegetables for which apart from the established NEAP=PRAL+OA model, an additional -quantitatively relevant -plant food-specific OA contribution exists.…”

Section: Consequences For the Estimation Of Net Endogenous Acid Produmentioning

confidence: 99%

“…To maintain a constant energy intake, 33.4 mL olive oil (300 kcal), included in the regular lunch, were isocalorically replaced by the sweet potato test food. Calculated PRAL [1] was 8.3 mEq/d and -9.8 mEq/d for the basal diet and the sweet potato diet, respectively and mean OA excretion estimated from body surface area [1] was 41.7 mEq/d for the female participants. 24-h urine collections were performed on day 3 (basal diet) and day 4 (sweet potato meal).…”

Section: Modern-day Sweet Potato Consumption and Urinary Excretions Omentioning

confidence: 99%

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Acid Base Considerations in Stone-Age Farming Sweet Potato Eaters, Modern-Day Sweet Potato Eaters, and High-Protein Consumers

Berkemeyer¹,

Manz²

2008

TONUTRJ

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Net endogenous acid production (NEAP) can be estimated by a primarily anthropometry-dependent organic acid anion (OA) component and the particularly diet-dependent potential renal acid load (PRAL). However, there is evidence that certain foods may also impact on the OA component. Here, we discuss measurements of urinary 24-h OA excretion obtained in healthy subjects, against the background of relevant literature with a special focus on former Papuan New Guinea stone-age farmers eating predominantly highland sweet potatoes. Contrary to the reports in Papuans, we observed only modest increases of 5-12% in 24-h excretion rates of OAs (including the detoxification product of phenolic and benzoic acids, i.e., hippuric acid) in healthy adults consuming commonly available yellow-fleshed sweet potatoes. This and additional results on OA increases after higher protein intakes suggest that a specification of the NEAP=PRAL+OA model for estimating the diet-dependent acid load to the metabolic system might be useful regarding particular foods and their effects on the OA component.

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“…The nonvolatile acid load, also known as the net endogenous acid production (NEAP), is determined by the balance of acid and alkali precursors in the diet (14). Proteins are the major source of nonvolatile acid through metabolism to sulfates and other organic acids, whereas alkali is derived from potassium salts that naturally occur in fruits and vegetables (e.g.…”

Section: Introductionmentioning

confidence: 99%

Estimated Net Endogenous Acid Production and Serum Bicarbonate in African Americans with Chronic Kidney Disease

Scialla

Appel

Astor

et al. 2011

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Metabolic acidosis may contribute to morbidity and disease progression in patients with chronic kidney disease (CKD). The ratio of dietary protein, the major source of nonvolatile acid, to dietary potassium, which is naturally bound to alkali precursors, can be used to estimate net endogenous acid production (NEAP). We tested the association between estimated NEAP and serum bicarbonate in patients with CKD.Design, setting, participants, & measurements NEAP was estimated among 462 African American adults with hypertensive CKD using published equations:. Dietary protein and potassium intake were estimated from 24-hour urinary excretion of urea nitrogen and potassium, respectively. All of the eligible measurements during follow-up were modeled using generalized linear regression clustered by participant and adjusted for demographics, 24-hour urinary sodium, kidney function, and selected medications. ResultsHigher NEAP was associated with lower serum bicarbonate in a graded fashion (P trend Ͻ 0.001). Serum bicarbonate was 1.27 mEq/L lower among those in the highest compared with the lowest quartile of NEAP (P Ͻ 0.001). There was a greater difference in serum bicarbonate between the highest and lowest quartiles of NEAP among patients with stage 4/5 CKD (Ϫ2.43 mEq/L, P Ͻ 0.001) compared with those with stage 2/3 disease (Ϫ0.77 mEq/L, P ϭ 0.01; P-interaction ϭ 0.02). ConclusionsReducing NEAP, through reduction of dietary protein and increased intake of fruits and vegetables, may prevent metabolic acidosis in patients with CKD.

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Standardizing Terminology for Estimating the Diet-Dependent Net Acid Load to the Metabolic System

Cited by 103 publications

References 14 publications

Urinary Sulfur Metabolites Associate with a Favorable Cardiovascular Risk Profile and Survival Benefit in Renal Transplant Recipients

Urinary Sulfur Metabolites Associate with a Favorable Cardiovascular Risk Profile and Survival Benefit in Renal Transplant Recipients

Acid Base Considerations in Stone-Age Farming Sweet Potato Eaters, Modern-Day Sweet Potato Eaters, and High-Protein Consumers

Estimated Net Endogenous Acid Production and Serum Bicarbonate in African Americans with Chronic Kidney Disease

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