The Associations of Dietary Acid Load with Insulin Resistance and Type 2 Diabetes: A Systematic Review of Existing Human Studies

Emamat, Hadi; Tangestani, Hadith; Bahadoran, Zahra; Khalili‐Moghadam, Sajjad; Mirmiran, Parvin

doi:10.2174/2212798410666180924142222

Cited by 9 publications

(11 citation statements)

References 49 publications

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“…This relationship indicates both higher diet acidity and diet alkalinity were associated with higher mortality. In the recent two decades, the relationship between diet-induced acidosis and some chronic diseases such as diabetes [14], hypertension [25], insulin resistance [26] and osteoporosis [27] have been investigated [28]; however, we found only two studies evaluating the association between dietary acid load and mortality from CVD and other specific causes of death. In a Swedish population, Xu et al found that high diet acidity as well as diet alkalinity may increase the risk of mortality (a U-shaped relationship) (4), which is in line with our study results.…”

Section: Discussionmentioning

confidence: 96%

Dietary acid load and mortality from all causes, CVD and cancer: results from the Golestan Cohort Study

et al. 2021

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Given the limited studies, and controversial results on association between dietary acid load and mortality from cardiovascular disease (CVD) and cancers, we aimed to investigate this association in a large population cohort study in Middle-East, with a wide range of dietary acid load. The study was conducted on the platform of the Golestan Cohort Study (GCS), which enrolled 50,045 participants in 2004-2008. Dietary intake was assessed using a validated food frequency questionnaire (FFQ). Dietary potential renal acid load (PRAL) score was calculated from nutrient intake. Death and its causes were identified, and confirmed by two or three physicians. Cox proportional hazards regression was used to estimate HRs and 95% CIs for total and cause specific mortalities. Then, the associations were modeled using restricted cubic splines. PRAL range was -57.36 to +53.81 mEq/d for men and -76.70 to +49.08 for women. During 555,142 person-years of follow-up, we documented 6830 deaths, including 3070 cardiovascular deaths, 1502 cancer deaths and 2258 deaths from other causes. For overall deaths, in final model after adjustment for confounders, participants in the first and 5th quintiles of PRAL had a higher risk of mortality compared to the second quintile of PRAL (HR: 1.08; 95% CI:1.01-1.16 and HR: 1.07; 95% CI: 1.01-1.15, respectively); P for trend <0.05). Participants in the first and 5th quintiles of PRAL had a 12% higher risk of CVD mortality compared to the Q2 of PRAL (HR: 1.12; 95% CI: 1.01-1.25 and HR: 1.12; 95% CI: 1.01-1.26, respectively; P for trend <0.05). We found that all-cause and CVD mortality rates were higher in the lowest and highest PRAL values, in an approximately U-shaped relation (P-values for the overall association and the non-linear association of energy-adjusted PRAL with total mortality were <0.001 and <0.001, and with CVD mortality were 0.008 and 0.003, respectively). Our results highlight unfavorable associations of high acidity and alkalinity of diet with the increased total and CVD mortality risk. It may be important to consider a balanced acid-base diet as a protective strategy to prevent premature death, especially from CVD.

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Section: Discussionmentioning

confidence: 96%

Dietary acid load and mortality from all causes, CVD and cancer: results from the Golestan Cohort Study

et al. 2021

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“…The PRAL score is comprised of dietary magnesium, potassium, phosphorus, calcium, and protein [ 7 ], and NEAP formula is based on dietary intake of protein and potassium [ 8 ]. Both scores are associated with the prevalence of type 2 diabetes [ 9 , 10 ] and hypertension [ 11 – 14 ]. PRAL alone is linked to the incidence of insulin resistance [ 15 , 16 ], metabolic syndrome [ 17 ], and progression of chronic kidney disease [ 18 , 19 ].…”

Section: Introductionmentioning

confidence: 99%

“…Both scores are associated with the prevalence of type 2 diabetes [ 9 , 10 ] and hypertension [ 11 – 14 ]. PRAL alone is linked to the incidence of insulin resistance [ 15 , 16 ], metabolic syndrome [ 17 ], and progression of chronic kidney disease [ 18 , 19 ].…”

Section: Introductionmentioning

confidence: 99%

Dietary acid load and risk of cardiovascular disease: a prospective population-based study

Mirmiran

Houshialsadat

Bahadoran

et al. 2021

BMC Cardiovasc Disord

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Background and aim Considering the inconsistencies in the cardiovascular effects of dietary acid load and the impact of dietary acidity on the acid–base homeostasis within the body, we aimed to assess the association of dietary acid load and the risk of cardiovascular disease (CVD) in a prospective community-based study. Materials and methods Participants (n = 2369) free of CVD at baseline (2006–2008) were included from the Tehran Lipid and Glucose Study (TLGS) and followed up for a mean of 6.7 ± 1.4 years. Dietary intakes of the participants were assessed using a semi-quantitative food frequency questionnaire (FFQ). The dietary acid load was evaluated by Potential Renal Acid Load (PRAL) and Net Endogenous Acid Production (NEAP) scores. Both scores have used the macronutrient and micronutrient data of the Food Frequency Questionnaires. Multivariate Cox proportional hazard regression models were used to estimate the 6-years incident risk of CVDs across tertiles of PRAL and NEAP scores. Results Mean age and body mass index of participants were 38.5 ± 13.3 years and 26.6 ± 4.8 kg/m2 at baseline. Within 6.7 ± 1.4 years of follow-up, 79 cases of cardiovascular events were reported. NEAP was significantly associated with the incidence of CVDs (HRs = 0.50, CI 0.32–0.96; P for trend = 0.032); however, after adjusting for potential confounders, no significant associations were observed between PRAL and NEAP scores and the risk of CVDs. Conclusions This study failed to obtain independent associations between dietary acid load and the incidence of CVDs among an Asian population.

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“…Other mediators of metabolic acidosis and hypertension include the reduced excretion of citrate, increased releasing of calcium and cortisol, and the quality and the quantity of the dietary protein [46]. Moreover, the previous studies have shown that high dietary acid load and chronic metabolic acidosis are closely linked to reduced a nity of the insulin to its receptor, increased risk of insulin resistance and subsequently, hyperglycemia [6,11,18]. CVD can be autonomously promoted from insulin resistance through various pathways, including coronary microcirculatory dysfunction [47] and increased arrhythmogenesis [48].…”

Section: Discussionmentioning

confidence: 99%

“…Protein-rich animal food resources can raise the acidifying potentials of a diet [2,3] and negatively affect the metabolic and physiologic states [1,2]. As the acidic dietary patterns became more prevalent within the global dietary transition [4], the burden of the CVDs and the epidemic of the Cardiometabolic diseases have been on the rise in the past two decades [5,6]. Dietary acid load is usually estimated by the two indicators of the potential renal acid load (PRAL) and net endogenous acid production (NEAP).…”

Section: Introductionmentioning

confidence: 99%

Dietary Acid Load and the Risk of Cardiovascular Disease: A Prospective Population-based Study

Mirmiran

Houshialsadat

Bahadoran

et al. 2021

Preprint

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Background: Considering the established association between the dietary acid load and cardiovascular outcomes, as well as the existing inconstancies in the previous studies, we aimed to assess the association between the dietary acid load and the risk of cardiovascular diseases in the framework of the Tehran Lipid and Glucose Study. Methods: Eligible participants (n= 2369, 19- 70 years old, 43.5% men) with no cardiovascular diseases at baseline (2006-2008) were recruited and followed up for a mean period of 6.7 ± 1.4 years. Potential Renal Acid Load and Net Endogenous Acid Production, as the two indexes of dietary acid load, were calculated based on the macronutrient and micronutrient constitutions. The Cox proportional hazard regression model was used to report the association between tertiles of Potential Renal Acid Load and Net Endogenous Acid Production, and 6-years incident risk of cardiovascular diseases.Results: The mean age and body mass index of the participants were 38.5 ± 13.3 years and 26.6 ± 4.8 kg/m2 at baseline, respectively. The incident rate of cardiovascular diseases was reported as 3.3% (79 cases). No significant associations were detected between the Potential Renal Acid Load and the cardiovascular diseases incidence in the crude or the adjusted models (HRs= 0.63; CI: 0.36-1.17; P trend= 0.10). Meanwhile, the Net Endogenous Acid Production index was marginally significantly associated with the crude model (HR= 0.57; CI: 0.33-0.99, P trend= 0.048). Conclusions: Data from the current study were not in favor of an independent association between the dietary acid load and the incidence of cardiovascular diseases within the Iranian population.

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The Associations of Dietary Acid Load with Insulin Resistance and Type 2 Diabetes: A Systematic Review of Existing Human Studies

Cited by 9 publications

References 49 publications

Dietary acid load and mortality from all causes, CVD and cancer: results from the Golestan Cohort Study

Dietary acid load and mortality from all causes, CVD and cancer: results from the Golestan Cohort Study

Dietary acid load and risk of cardiovascular disease: a prospective population-based study

Dietary Acid Load and the Risk of Cardiovascular Disease: A Prospective Population-based Study

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