Abstract
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.
Highlights
Acid–base imbalance has been reported to increase incidence of hypertension and diabetes
Diet‐induced acid load and baseline characteristics In total, 11,601 individuals free from cardiovascular disease (CVD) were analyzed in the present study (Fig. 1)
Mean Body mass index (BMI), low density lipoprotein (LDL), and high density lipoprotein (HDL) cholesterol and the proportions of Chronic kidney disease (CKD) were similar across the potential renal acid load (PRAL) tertiles
Summary
Acid–base imbalance has been reported to increase incidence of hypertension and diabetes. The association between diet-induced acid load and cardiovascular disease (CVD) risk in the general population has not been fully investigated. The diet-induced acid load is estimated using a formula that accounts for organic compounds, including the potential renal acid load (PRAL), dietary acid load (DAL), and net endogenous acid production (NEAP). In comparison with NEAP, which is calculated from the ratio of ingested protein and potassium, PRAL and DAL calculations include other materials (calcium, phosphorus, and magnesium) along with protein and potassium. This discrepancy accounts for the bioavailability of nutrients, enabling PRAL and DAL scores to give more accurate predictions of dietary effects on body acidity [10, 11]. Negative values of PRAL and lower DAL values indicate base-forming potential, while positive PRAL scores and higher DAL scores reflect acid-forming potential [12]
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