Dietary acid load and risk of type 2 diabetes: the E3N-EPIC cohort study

Abstract

Aims/hypothesis The objective of this study was to evaluate the prospective relationship between dietary acid load, assessed with both the potential renal acid load (PRAL) and the net endogenous acid production (NEAP) scores, and type 2 diabetes risk. Methods A total of 66,485 women from the E3N-EPIC cohort were followed for incident diabetes over 14 years. PRAL and NEAP scores were derived from nutrient intakes. HRs for type 2 diabetes risk across quartiles of the baseline PRAL and NEAP scores were estimated with multivariate Cox regression models. Results During follow-up, 1,372 cases of incident type 2 diabetes were validated. In the overall population, the highest PRAL quartile, reflecting a greater acid-forming potential, was associated with a significant increase in type 2 diabetes risk, compared with the first quartile (HR 1.56, 95% CI 1.29, 1.90). The association was stronger among women with BMI <25 kg/m 2 (HR 1.96, 95% CI 1.43, 2.69) than in overweight women (HR 1.28, 95% CI 1.00, 1.64); statistically significant trends in risk across quartiles were observed in both groups ( p trend <0.0001 and p trend =0.03, respectively). The NEAP score provided similar findings. Conclusions/interpretationWe have demonstrated for the first time in a large prospective study that dietary acid load was positively associated with type 2 diabetes risk, independently of other known risk factors for diabetes. Our results need to be validated in other populations, and may lead to promotion of diets with a low acid load for the prevention of diabetes. Further research is required on the underlying mechanisms.

Intake of Carbohydrate to Fiber Ratio Is a Useful Marker for Metabolic Syndrome in Patients with Type 2 Diabetes: A Cross-Sectional Study

“…A previous study showed that an animal-based LCD was associated with all-cause mortality, whereas a LCD based on vegetable sources has a protective effect for all-cause mortality [8]. In this study, intake of carbohydrate to fiber ratio has a positive correlation with PRAL or NEAP, which has been known to be a risk factor for hypertension [24], type 2 diabetes [25, 26], and MetS [27]; and has a negative correlation with fruit and vegetable intake [28, 29], which has a protective effect on human health. On the other hand, the association between carbohydrate intake and this nutrition was not consistent.…”

Association of dietary acid load with cardiovascular disease risk factors in patients with diabetic nephropathy

“…Dietary acid load is estimated by different methods that have been validated in individuals with kidney disease [18]. To date, results have been mixed among the few studies that have assessed the association between dietary acid load and CVD risk factors [8][9][10][11][12]. Although some studies reported a significant adverse association [8][9][10][11], one did not confirm this association [12], or reported different results for either PRAL or Pro:K with cardiometabolic risk factors [8].…”

“…To date, results have been mixed among the few studies that have assessed the association between dietary acid load and CVD risk factors [8][9][10][11][12]. Although some studies reported a significant adverse association [8][9][10][11], one did not confirm this association [12], or reported different results for either PRAL or Pro:K with cardiometabolic risk factors [8]. For example, a cross-sectional study of 1136 young women showed a positive and independent association for PRAL (but not Pro:K) with TC and high-density lipoprotein cholesterol, whereas BMI and WC had significant correlation with only Pro:K [10].…”

“…Therefore, reducing the dietary acid load may offer one solution to improve health outcomes in patients with diabetes. Moreover, several cross-sectional and longitudinal studies have found a positive association between dietary acid load and increased risk for various chronic diseases, including diabetes, IR, nonalcoholic fatty liver, and cardiometabolic factors [8][9][10][11], but not hypertension [12].…”

Untitled

“…Mild metabolic acidosis, measured by plasma lactate, aligns with insulin resistance independent of obesity and is induced by short-term increases in energy and dietary acid load in healthy humans [129]. In large prospective cohort studies, a high dietary acid load was positively associated with T2DM risk and found to be independent of other known risk factors for diabetes [130][131][132]. Meta-analysis of the three prospective cohort studies further confirmed that, after adjustment for other diabetes risk factors, a higher dietary acid load is associated with an increased risk of T2DM [133].…”