Dietary Acid Load and Potassium Intake Associate with Blood Pressure and Hypertension Prevalence in a Representative Sample of the German Adult Population

Abstract

Diets rich in fruits and vegetables, like the Dietary Approaches to Stop Hypertension (DASH)-diet, are usually characterized by high potassium intake and reduced dietary acid load, and have been shown to reduce blood pressure (BP). However, the relevance of potential renal acid load (PRAL) for BP has not been compared with the relevance to BP of urinary biomarker (K-urine)- and dietary food frequency questionnaire (K-FFQ)-based estimates of potassium intake in a general adult population sample. For 6788 participants (aged 18–79 years) of the representative German Health-Interview and Examination Survey for Adults (DEGS1), associations of PRAL, K-urine, and K-FFQ with BP and hypertension prevalence were cross-sectionally examined in multivariable linear and logistic regression models. PRAL was significantly associated with higher systolic BP (p = 0.0002) and higher hypertension prevalence (Odds ratio [OR] high vs. low PRAL = 1.45, p = 0.0004) in models adjusted for age, sex, body mass index (BMI), estimated sodium intake, kidney function, relevant medication, and further important covariates. Higher estimates of K-FFQ and K-urine were related to lower systolic BP (p = 0.04 and p < 0.0001) and lower hypertension prevalence (OR = 0.82, p = 0.04 and OR = 0.77, p = 0.02) as well as a lower diastolic BP (p = 0.03 and p = 0.0003). Our results show, for the first time in a comparative analysis of a large representative population sample, significant relationships of BP and hypertension prevalence with questionnaire- and biomarker-based estimates of potassium intake and with an estimate of dietary acid load.

Dietary acid load, blood pressure, fasting blood sugar and biomarkers of insulin resistance among adults: Findings from an updated systematic review and meta‐analysis

“…Several other studies also reported similar results of higher prevalence of HTN or higher SBP and DBP values in highest vs lowest PRAL or NEAP groupings . Only one study reported inverse association between HTN prevalence among NEAP quartiles and several other studies found no difference . In the data analysis of Rotterdam study by Engberink et al, SBP in the highest tertile of PRAL was significantly higher than the lowest.…”

“…Table presents the summary of systematically reviewed studies evaluated the association between dietary acid load (eg PRAL or NEAP), blood pressure and hypertension prevalence. Totally, 20 studies reported the association between HTN, blood pressure and PRAL or NEAP among the systematically reviewed literature . In the study by Akter et al evaluating the association between dietary acid load and prevalence of HTN in the Furukawa Nutrition and Health Study the odds of HTN in subjects in the highest tertile of PRAL and NEAP was 31% and 40% more than individuals in lowest tertile (PRAL; OR: 1.31; CI: 1.01‐1.70; NEAP OR: 1.40; CI: 1.08‐1.82) among 2028 working Japanese population.…”

“…12,18,39,40 Only one study reported inverse association between HTN prevalence among NEAP quartiles 4 and several other studies found no difference. 7,15,19,22,[31][32][33][35][36][37][38]42 In the data analysis of Rotterdam study by Engberink et al, 33 SBP in the highest tertile of PRAL was significantly higher than the lowest.…”

Higher dietary acid load potentially increases serum triglyceride and obesity prevalence in adults: An updated systematic review and meta-analysis

“…In other study by Kucharska AM [35] examining the association between dietary acid load and cardio-metabolic risk factors among polish adults, only serum TG tended to increase across tertiels of NEAP only among men; while no significant difference among women or across PRAL tertiles were observed [35]. On the other hand, three studies reported lower TC or higher HDL concentrations in highest versus lowest categories of PRAL or NEAP [21, 34, 35]. Other studies reported no significant difference between lipids across NEAP or PRAL categories [11, 28, 31, 33, 35].…”

Prevalence and factors associated with hypertension among adults in rural Sylhet district of Bangladesh: a cross-sectional study

“…Imported fruits are costly and remain unaffordable to many people leading to a very low consumption of fruit 46. The benefit of fruits and vegetable consumption is primarily through increased intake of potassium 47 48. All vegetables may not contain high level of potassium and washing, and cooking may reduce potassium level 49.…”