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Luzardo ML. Effects of higher dietary acid load: a narrative review with special emphasis in children. Pediatr Nephrol 2024:10.1007/s00467-024-06466-7. [PMID: 39093454 DOI: 10.1007/s00467-024-06466-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 07/05/2024] [Accepted: 07/08/2024] [Indexed: 08/04/2024]
Abstract
Metabolic effects of high diet acid load (DAL) have been studied for years in adults, although only recently in children. Contemporary diets, especially those of Western societies, owe their acidogenic effect to high animal-origin protein content and low contribution of base-forming elements, such as fruits and vegetables. This imbalance, where dietary acid precursors exceed the body's buffering capacity, results in an acid-retaining state known by terms such as "eubicarbonatemic metabolic acidosis," "low-grade metabolic acidosis," "subclinical acidosis," or "acid stress". Its consequences have been linked to chronic systemic inflammation, contributing to various noncommunicable diseases traditionally considered more common in adulthood, but now have been recognized to originate at much earlier ages. In children, effects of high DAL are not limited to growth impairment caused by alterations of bone and muscle metabolism, but also represent a risk factor for conditions such as obesity, insulin resistance, diabetes, hypertension, urolithiasis, and chronic kidney disease (CKD). The possibility that high DAL may be a cause of chronic acid-retaining states in children with growth impairment should alert pediatricians and pediatric nephrologists, since its causes have been attributed traditionally to inborn errors of metabolism and renal pathologies such as CKD and renal tubular acidosis. The interplay between DAL, overall diet quality, and its cascading effects on children's health necessitates comprehensive nutritional assessments and interventions. This narrative review explores the clinical relevance of diet-induced acid retention in children and highlights the potential for prevention through dietary modifications, particularly by increasing fruit and vegetable intake alongside appropriate protein consumption.
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Wieërs MLAJ, Beynon-Cobb B, Visser WJ, Attaye I. Dietary acid load in health and disease. Pflugers Arch 2024; 476:427-443. [PMID: 38282081 PMCID: PMC11006742 DOI: 10.1007/s00424-024-02910-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 01/07/2024] [Accepted: 01/09/2024] [Indexed: 01/30/2024]
Abstract
Maintaining an appropriate acid-base equilibrium is crucial for human health. A primary influencer of this equilibrium is diet, as foods are metabolized into non-volatile acids or bases. Dietary acid load (DAL) is a measure of the acid load derived from diet, taking into account both the potential renal acid load (PRAL) from food components like protein, potassium, phosphorus, calcium, and magnesium, and the organic acids from foods, which are metabolized to bicarbonate and thus have an alkalinizing effect. Current Western diets are characterized by a high DAL, due to large amounts of animal protein and processed foods. A chronic low-grade metabolic acidosis can occur following a Western diet and is associated with increased morbidity and mortality. Nutritional advice focusing on DAL, rather than macronutrients, is gaining rapid attention as it provides a more holistic approach to managing health. However, current evidence for the role of DAL is mainly associative, and underlying mechanisms are poorly understood. This review focusses on the role of DAL in multiple conditions such as obesity, cardiovascular health, impaired kidney function, and cancer.
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Affiliation(s)
- Michiel L A J Wieërs
- Department of Internal Medicine, Division of Nephrology and Transplantation, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Beverley Beynon-Cobb
- Department of Nutrition & Dietetics, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | - Wesley J Visser
- Department of Internal Medicine, Division of Nephrology and Transplantation, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Department of Internal Medicine, Division of Dietetics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Ilias Attaye
- Department of Internal Medicine, Division of Nephrology and Transplantation, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK.
- Amsterdam Cardiovascular Sciences, Diabetes & Metabolism, Amsterdam, The Netherlands.
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Yurtdaş Depboylu G, Kaner G, Özdemir Şimşek Ö, Turan KN, Kasap Demir B. Dietary acid load in children with chronic kidney disease: its association with nutritional status and health-related quality of life. Pediatr Nephrol 2023; 38:3417-3426. [PMID: 37145186 DOI: 10.1007/s00467-023-05991-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 04/08/2023] [Accepted: 04/12/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND This study aimed to determine the dietary acid load of children with chronic kidney disease (CKD) and to evaluate the relationship between dietary acid load, nutritional status, and health-related quality of life (HRQOL). METHOD A total of 67 children aged 3-18 years with a diagnosis of CKD stages II-V were included in the study. Anthropometric measurements (body weight, height, mid-upper arm circumference, waist, and neck circumference) and 3-day food consumption records were taken to evaluate the nutritional status. The net endogenous acid production (NEAP) score was calculated to determine the dietary acid load. "Pediatric Inventory of Quality of Life (PedsQL)" was used to assess the participants' HRQOL. RESULTS The mean NEAP was 59.2 ± 18.96 mEq/day. Stunted and malnourished children had significantly higher NEAP than those who were not (p < 0.05). There were no significant differences in terms of HRQOL scores according to NEAP groups. The multivariate logistic regression analysis showed that waist circumference (OR: 0.890, 95% CI: 0.794-0.997), serum albumin (OR: 0.252, 95% CI: 0.068-0.929), and glomerular filtration rate (GFR) (OR: 0.985, 95% CI: 0.970-1.000) were negatively associated with high NEAP. CONCLUSION This study shows that a diet shifted in an acidic direction in children with CKD and a higher dietary acid load are associated with lower serum albumin, GFR, and waist circumference, but not HRQOL. These results suggest that dietary acid load might affect nutritional status and CKD progression in children with CKD. Future studies with larger samples are needed to confirm these results and to understand underlying mechanisms. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Gamze Yurtdaş Depboylu
- Department of Nutrition and Dietetics, Faculty of Health Sciences, İzmir Katip Çelebi University, Çiğli Ana Yerleşkesi, Merkezi Ofisler 35620 Çiğli, İzmir, Turkey.
| | - Gülşah Kaner
- Department of Nutrition and Dietetics, Faculty of Health Sciences, İzmir Katip Çelebi University, Çiğli Ana Yerleşkesi, Merkezi Ofisler 35620 Çiğli, İzmir, Turkey
| | - Özgür Özdemir Şimşek
- Department of Pediatrics, Division of Nephrology, Izmir Tepecik Training and Research Hospital, University of Health Sciences, Izmir, Turkey
| | - Kübra Nur Turan
- Department of Nutrition and Dietetics, Faculty of Health Sciences, İzmir Katip Çelebi University, Çiğli Ana Yerleşkesi, Merkezi Ofisler 35620 Çiğli, İzmir, Turkey
| | - Belde Kasap Demir
- Department of Pediatrics, Division of Nephrology, Izmir Tepecik Training and Research Hospital, University of Health Sciences, Izmir, Turkey
- Department of Pediatrics, Division of Nephrology and Rheumatology, İzmir Katip Çelebi University, İzmir, Turkey
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Mansordehghan M, Daneshzad E, Basirat V, Gargari BP, Rouzitalab T. The association between dietary acid load and body composition in physical education students aged 18-25 years. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2022; 41:58. [PMID: 36529754 PMCID: PMC9761980 DOI: 10.1186/s41043-022-00340-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 12/07/2022] [Indexed: 06/17/2023]
Abstract
AIM To find the association between dietary acid load (DAL) and body composition in physical education students. METHODS This study was carried out on 207 students of both genders aged 18-25 years. DAL was calculated based on potential renal acid load (PRAL) and net endogenous acid production (NEAP) methods. Anthropometric indices were measured. Bioelectric impedance was used to assess body composition and other related items. RESULTS The mean score of NEAP and PRAL was 80.18 ± 31.30 and 33.94 ± 22.11, respectively. The mean weight and fat mass of subjects were 64.05 ± 9.72 kg and 20.28 ± 0.67 kg, respectively. Participants in the highest tertile of PRAL had a higher weight (64.56 ± 1.14 kg) in comparison with participants in the lowest tertile (61.65 ± 1.19 kg) (P = 0.027). After adjusting for confounders, a significant positive association was found between NEAP score and hip circumference (β = 0.206, P = 0.039), body mass index (β = 0.214, P = 0.031), fat mass (β = 0.218, P = 0.001) and body adiposity index (β = 0.182, P = 0.037). Furthermore, a statistically significant negative association was observed between total body water and NEAP score (β = - 0.217, P = 0.001) and the percentage of fat-free mass and NEAP (β = - 0.229, P = 0.001). CONCLUSION Individuals with a higher DAL score may have a higher weight, fat mass and hip circumference and a lower fat-free mass. In addition, there might be an association between DAL and obesity.
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Affiliation(s)
- Maryam Mansordehghan
- Department of Nutritional Sciences, School of Nutritional Sciences and Food Technology, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Elnaz Daneshzad
- Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Vahid Basirat
- Department of Gastroenterology, School of Medicine, Isfahan University of Medical Sciences and Health Services, Isfahan, Iran
| | - Bahram Pourghassem Gargari
- Department of Biochemistry and Diet Therapy, Nutrition Research Center, School of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Tohid Rouzitalab
- Department of Biochemistry and Diet Therapy, Nutrition Research Center, School of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
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Sorraya N, Arab A, Talebi S. The association between dietary acid load and adiposity measures among children and adolescents. BMC Pediatr 2022; 22:484. [PMID: 35962430 PMCID: PMC9375392 DOI: 10.1186/s12887-022-03541-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 07/29/2022] [Indexed: 11/25/2022] Open
Abstract
Background Childhood obesity is one of the most important health problems in the present century. It is imperative to plan preventive programs through risk factor identification. The present study was conducted to examine the association between the dietary acid load (DAL) and anthropometric indices in a sample of Iranian children and adolescents. Methods In the current survey, students aged 11–18 years were recruited. To assess usual dietary intake, a validated self-administered 168-item food frequency questionnaire was used. Potential renal acid load (PRAL) and net endogenous acid production (NEAP) was used to estimate DAL. The association between DAL and anthropometric indices was evaluated using logistic regression and reported as an odds ratio (OR) with a 95% confidence interval (CI). Results In total, 456 students (267 girls), with a mean age of 14.44 years participated in the current study. After controlling for potential confounders, the PRAL was positively associated with the risk of obesity (OR = 4.56, 95% CI: 2.26, 9.17), abdominal obesity (OR = 12.64, 95% CI: 3.05, 52.27), and adiposity based on the percent of body fat (PBF) (OR = 3.58, 95% CI: 1.83, 6.99). The NEAP was also significantly associated with the risk of obesity (OR = 5.17, 95% CI: 2.56, 10.43), abdominal obesity (OR = 15.08, 95% CI: 3.35, 67.81), and adiposity based on PBF (OR = 4.53, 95% CI: 2.30, 8.92). Conclusion Our findings suggest that higher adherence to the acidogenic diet, expressed as DAL, was associated with a higher risk of general and central obesity among children and adolescents.
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Affiliation(s)
- Nasim Sorraya
- Department of Community Nutrition, School of Nutrition and Food Science, Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Arman Arab
- Department of Community Nutrition, School of Nutrition and Food Science, Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shokoofeh Talebi
- Department of Clinical Nutrition, School of Nutrition and Food Science, Food Security Research Center, Isfahan University of Medical Sciences, Hezar Jerib street, Isfahan, 8174673461, Iran.
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Association between dietary acid load and metabolic health status in overweight and obese adolescents. Sci Rep 2022; 12:10799. [PMID: 35750714 PMCID: PMC9232519 DOI: 10.1038/s41598-022-15018-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 06/16/2022] [Indexed: 02/03/2023] Open
Abstract
The relationship between dietary acid load (DAL) and metabolic health status in adolescents has not been studied yet. We aimed to examine the association between DAL and metabolic health status in Iranian overweight/obese adolescents. This cross-sectional study included 203 overweight/obese adolescents selected by a multistage cluster random sampling method. Dietary intakes were assessed using a validated 147-item food frequency questionnaire (FFQ). Anthropometric indices and blood pressure values were measured. Fasting blood samples were obtained to determine glucose, insulin, and lipid profiles. Based on two methods (International Diabetes Federation (IDF) criteria and combination of IDF with Homeostasis Model Assessment Insulin Resistance (HOMA-IR)), participants were classified into metabolically healthy obese (MHO) or unhealthy obese (MUO). Adolescents in the highest tertile of potential renal acid load (PRAL) and net endogenous acid production (NEAP), compared with those in the lowest tertile, had 172% (95% CI 1.32–5.59) and 161% (95% CI 1.26–5.41) higher odds of MUO status, based on IDF criteria. This association was significant after adjustment for age, sex, and energy intake (PRAL: OR 2.42; 95% CI CI 1.13–5.15; NEAP: OR 2.52; 95% CI 1.17–5.41); but it disappeared after adjustment for other confounders. Based on IDF/HOMA-IR definition, there was a significant positive association between PRAL and being MUO only in the crude model (OR 2.37; 95% CI 1.13–4.96). The stratified analysis revealed that these associations for NEAP scores were stronger among overweight subjects than obese individuals, based on both metabolic status definitions. However, after adjustment for all potential confounders these relations were insignificant. Having higher DAL might be associated with higher odds of MUO phenotype in Iranian overweight/obese adolescents. More prospective studies are warranted to confirm this finding.
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The effects of diet quality and dietary acid load on insulin resistance in overweight children and adolescents. ENDOCRINOL DIAB NUTR 2022. [DOI: 10.1016/j.endinu.2021.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Caferoglu Z, Erdal B, Hatipoglu N, Kurtoglu S. The effects of diet quality and dietary acid load on insulin resistance in overweight children and adolescents. ENDOCRINOL DIAB NUTR 2022; 69:426-432. [PMID: 35817547 DOI: 10.1016/j.endien.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 07/28/2021] [Indexed: 06/15/2023]
Abstract
INTRODUCTION This study aimed to investigate the association of diet quality (DQ) and dietary acid load (DAL) with insulin resistance (IR) in overweight children and adolescents. MATERIALS AND METHODS The study was conducted on 135 overweight participants aged 6-17 years. DQ was assessed using the Healthy Eating Index 2015 (HEI-2015) and the HEI-2015-TUBER, revised in accordance with the Turkey Dietary Guidelines (TUBER). Estimation of DAL was made calculating the potential renal acid load (PRAL) and net endogenous acid production (NEAP) scores. RESULTS The HEI-2015-TUBER score was lower in those with IR than in those without IR (p=0.021). Higher PRAL and NEAP scores were found in those with IR (p=0.060 and p=0.044, respectively). Moreover, a one-unit increase in the HEI-2015-TUBER score and the DAL score was associated with a reduction of 4.2% and a rise of approximately 3% in IR risk, respectively. CONCLUSIONS Healthy eating habits in overweight paediatric groups may help to reduce the IR risk, improving DQ and decreasing DAL.
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Affiliation(s)
- Zeynep Caferoglu
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Erciyes University, Kayseri, Turkey.
| | - Busra Erdal
- Department of Nutrition and Dietetics, Institute of Health Sciences, Erciyes University, Kayseri, Turkey
| | - Nihal Hatipoglu
- Department of Paediatric Endocrinology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Selim Kurtoglu
- Department of Paediatric Endocrinology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
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