Relationship among dietary estimates of net endogenous acid production, bone mineral density and biochemical markers of bone turnover in an Iranian general population

Rahbar, Alireza; Larijani, Bagher; Nabipour, Iraj; Mohamadi, Mohamad Mehdi; Mirzaee, Kamran; Amiri, Zahra

doi:10.1016/j.bone.2009.07.006

Cited by 14 publications

(14 citation statements)

References 28 publications

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“…Another estimation of the diet acid load, the potential renal acid load (PRAL), was developed by Remer and Manz 1 using intakes of protein, phosphorus, and negative coefficients (representing greater alkaline contribution) for potassium, magnesium, and calcium 109 . The estimated NEAP and PRAL are adversely correlated with bone density 110,111 and broadband ultrasound attenuation of the heel, 112,113 as well as bone turnover markers, 110,111 though not in all studies 114 …”

Section: Protein and Bonementioning

confidence: 99%

Dietary protein and bone health: harmonizing conflicting theories

Thorpe

Evans

2011

Nutrition Reviews

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No clear consensus on the role of higher protein intakes has emerged, in spite of many decades of research. Protein unambiguously increases urinary calcium losses, which is completely attributable to the dietary acid load imposed by metabolism of sulfur containing amino acids into acid equivalents. Although alternate dietary sources of fixed acid cause demineralization of bone and apparent osteoporosis, this effect has not been consistently observed for protein, suggesting opposing, beneficial effects on bone. Specifically, protein may improve bone health through improving calcium absorption, increasing total circulating insulin-like growth factor 1 or by improving lean body mass which in turn increases bone growth. Although the notion of competing positive and negative pathways has been articulated theoretically, statistical mediation models of this "dual pathways" relationship have not been employed to quantify these relationships.In a cross-sectional investigation of postmenopausal women, protein intake is positively related to bone mineral density of the lumbar spine following adjustment for an accompanying negative effect mediated by the sulfur containing fraction of protein. In growing rats, an analogous and complementary pattern emerged: A negative association of protein intake with bone strength was suppressed by an opposing, positive effect of protein mediated by insulin-like growth factor 1. A second animal study assessed the influence of protein source on bone strength and bone mineral content of growing rats consuming isoenergetic, isonitrogenous diets. The influence of protein source was completely mediated by the corresponding changes in lean body mass.ii iii A randomized, controlled trial indicated a higher protein diet preserved bone density during weight loss compared to a conventional, MyPyramid based diet; however the protein diet also contained more calcium. A mathematical model of calcium availability in this trial suggested that this additional dietary calcium was not sufficient to explain differences in calcium accrual between groups unless calcium availability was also improved in the higher protein diet. Also, within this study, urine calcium (a surrogate of the diet acid load) exhibited a negative association with bone density change, in spite of its positive association with protein intake.The striking consistency of a dual pathway model across populations and experimental models lends credence to the notion that dietary protein may hold a positive or negative effect on bone health, depending on other factors in the diet. Specifically, we find support that the sulfur containing amino acid induced dietary acid load holds negative effects that may be opposed by positive influences of insulin-like growth factor 1, calcium availability or lean body mass. On average, this effect is probably null or too small to be of clinical importance.The effect may be of public health relevance, however, if the diet can be manipulated in order to uncouple positive and negative pathways. If correc...

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Section: Protein and Bonementioning

confidence: 99%

Dietary protein and bone health: harmonizing conflicting theories

Thorpe

Evans

2011

Nutrition Reviews

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“…Dietary acid load in human diets can be estimated by calculating the net endogenous acid production (NEAP) 8 or the potential renal acid load (PRAL) of the diet using information on dietary intakes. Several epidemiologic studies have used these measures to investigate the association of dietary acid load and bone mineral density (BMD), with mixed and inconsistent results (6)(7)(8)(9)(10)(11).…”

Section: Introductionmentioning

confidence: 99%

Dietary Acid Load Is Not Associated with Lower Bone Mineral Density Except in Older Men,

McLean¹,

Qiao²,

Broe³

et al. 2011

The Journal of Nutrition

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High dietary acid load may be detrimental to bone mineral density (BMD), although sufficient calcium intake might neutralize this effect. In observational studies, the association between BMD and dietary acid load, estimated by net endogenous acid production (NEAP) and potential renal acid load (PRAL), has been inconsistent, and the potential modifying effect of calcium intake has not been assessed. We therefore examined the cross-sectional associations of estimated NEAP and PRAL with BMD in the Framingham Osteoporosis Study. We hypothesized that higher estimated NEAP and PRAL would be associated with lower BMD, but only among those with total calcium intake < 800 mg/d. BMD of the femoral neck and lumbar spine was measured, and estimated NEAP and PRAL were calculated via FFQ among 1069 Framingham Original (1988-1989, 1992-1993; 62% women, mean age 76 y) and 2919 Offspring (1996-2001; 56% women, mean age 60 y) cohort participants. Cohort- and sex-specific ANCOVA was used to calculate multivariable-adjusted mean BMD for estimated NEAP and PRAL quartiles. Assuming no uncontrolled confounding, estimated NEAP, but not PRAL, was inversely associated with femoral neck BMD (P-trend = 0.04) in Original cohort men, whereas neither was associated with lumbar spine BMD. Estimated NEAP and PRAL were not associated with BMD at any site among Original cohort women or Offspring cohort men and women. There were no significant interactions between either estimated NEAP or PRAL and total calcium intake. These results suggest that, with a possible exception of older men, dietary acid load does not have a measureable negative effect on bone health, regardless of total calcium intake.

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“…This can potentially worsen the bone health [ 30 ]. The effects of high-protein diet with high endogenous acid production and chronic metabolic acidosis on BMD and fracture are controversial [ 32 , 33 ]. Plant rather than animal sources of proteins can help bone collagen without inducing more acid load.…”

Section: Nonpharmacological Approachmentioning

confidence: 99%

Bone Quality in Chronic Kidney Disease Patients: Current Concepts and Future Directions – Part II

et al. 2021

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Background: Patients with chronic kidney disease (CKD) have an increased risk of osteoporotic fractures, which is due not only to low bone volume and mass but also poor microarchitecture and tissue quality. The pharmacological and nonpharmacological interventions detailed, herein, are potential approaches to improve bone health in CKD patients. Various medications build up bone mass but also affect bone tissue quality. Antiresorptive therapies strikingly reduce bone turnover; however, they can impair bone mineralization and negatively affect the ability to repair bone microdamage and cause an increase in bone brittleness. On the other hand, some osteoporosis therapies may cause a redistribution of bone structure that may improve bone strength without noticeable effect on BMD. This may explain why some drugs can affect fracture risk disproportionately to changes in BMD. Summary: An accurate detection of the underlying bone abnormalities in CKD patients, including bone quantity and quality abnormalities, helps in institution of appropriate management strategies. Here in this part II, we are focusing on advancements in bone therapeutics that are anticipated to improve bone health and decrease mortality in CKD patients. Key Messages: Therapeutic interventions to improve bone health can potentially advance life span. Emphasis should be given to the impact of various therapeutic interventions on bone quality.

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Relationship among dietary estimates of net endogenous acid production, bone mineral density and biochemical markers of bone turnover in an Iranian general population

Cited by 14 publications

References 28 publications

Dietary protein and bone health: harmonizing conflicting theories

Dietary protein and bone health: harmonizing conflicting theories

Dietary Acid Load Is Not Associated with Lower Bone Mineral Density Except in Older Men,

Bone Quality in Chronic Kidney Disease Patients: Current Concepts and Future Directions – Part II

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