Dietary acid load and esophageal cancer risk: A case‐control study

Abstract

Background: A high dietary acid load (DAL) can produce metabolic acidosis, which is linked to cancer development through mechanisms of inflammation and cell transformation. There is limited epidemiological evidence linking DAL and cancer risk; however, none of the published studies focused on DAL and esophageal cancer (EC) risk in particular. Therefore, we sought to explore this association in the present study. Methods: A case-control study was performed in 1295 male patients (185 squamous cell EC cases and 1110 age-frequency and urban/rural residence matched controls) through a multitopic inquiry, including a food frequency questionnaire. Food-derived nutrients were calculated from available databases. The DAL was calculated based on two validated measures: Potential renal acid load (PRAL) score and net endogenous acid production (NEAP) score. Odds ratios (OR) and their 95% confidence intervals (95% CI) were estimated by unconditional logistic regression, adjusting for confounders. Results: We found direct, significant associations between dietary acid load and EC risk: (OR = 2.28, 95% CI: 1.44-3.61, ptrend <0.0001) and (OR = 2.17, 95% CI: 1.38-3.41, ptrend <0.0001) for highest PRAL and NEAP tertiles, respectively. Our data raise the possibility that a high DAL may contribute to EC development. Both acid load scores were directly associated with animal-based foods (mainly meat) and inversely associated with the intake of plant-based foods. Conclusion:To the best of our knowledge, this is the first epidemiological casecontrol study analyzing associations of DAL and squamous cell EC risk. Further research is warranted to confirm our findings.

The association between dietary acid load and odds and severity of irritable bowel syndrome in adults

“…However, the two latter scores were not significantly associated they tended to increase the odds. These different results were also shown in the previous research 19,39,40 . A case-control stusy by Ronco et al showed that the highest versus lowest quartile of the PRAL score but not the NEAP score significantly increased the risk of colorectal cancer 39 .…”

“…These different results were also shown in the previous research 19,39,40 . A case-control stusy by Ronco et al showed that the highest versus lowest quartile of the PRAL score but not the NEAP score significantly increased the risk of colorectal cancer 39 . A researcher also found similar results in a cross-sectional study of 3,501 Chinese participants on the association between dietary acid load and odds of hypertension 19 .…”

“…To date, as far as we know no study has looked into the relationship between dietary acid load and IBS; however, its association with other inflammation-related conditions has been investigated previously 19,[39][40][41][42] . Also, the result of an analysis of the Women's Healthy Eating and Living (WHEL) study including 3,402 breast cancer survivors showed a positive significant association between dietary acid load (the PRAL score) and serum C-reactive protein levels 23 .…”

Dietary acid load and the risk of cancer: a systematic review and dose-response meta-analysis of observational studies

“…Eight studies (Park et al , 2019; Mehranfar et al , 2020; Nasab et al ., 2021; Ronco et al , 2020; Safabakhsh et al , 2020; Ronco et al, 2021a,b; Shi et al , 2021) reported diet acidity load as PRAL, seven (Park et al , 2019; Mehranfar et al , 2020; Ronco et al , 2020; Safabakhsh et al , 2020; Ronco et al, 2021a,b; Shi et al , 2021) as NEAP, two as NAE (Wright et al , 2005; Park et al , 2019) and one as A:P (Park et al , 2019). All studies used a food frequency questionnaire for dietary assessment.…”

Observational and clinical evidence that plant-based nutrition reduces dietary acid load

“…DAL-induced low-grade mild metabolic acidosis promote tissue damage and inflammation (11,13,117,118) , which may initiate genomic instability on normal cells through the activation of cytokines, which may stimulate tumour invasion and metastases (119,120) . Positive associations between a high DAL and various cancers have been reported, including breast cancer (121,122) , prostate cancer (123) , lung cancer (124) , colorectal cancer (125) , pancreatic cancer (126) , gastric cancer (127) , oesophageal cancer (128) as well as head and neck cancers (129) . Two meta-analyses confirmed these associations: Keramati et al and Bahrami et al independently found higher odds for cancer in individuals with elevated DAL scores (130,131) .…”