The association of dietary acid load (DAL) with estimated skeletal muscle mass and bone mineral content: a cross-sectional study

Gholami, Fatemeh; Bahrampour, Niki; Samadi, Mahsa; Rasaei, Niloufar; Yarizadeh, Habib; Naghshi, Sina; Mirzaei, Khadijeh

doi:10.1186/s40795-022-00658-w

Cited by 5 publications

(2 citation statements)

References 74 publications

(86 reference statements)

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“…On the other hand, consuming potassium-rich foods, such as fruits and vegetables, may favor muscle preservation, while acidosis may impair protein synthesis, increase proteolysis, and enhance amino acid oxidation, leading to a greater loss of muscle mass 61 . The relation between DAL and skeletal muscle mass has also been observed previously 62 . Preserving skeletal muscle could improve survival in patients with cirrhosis 63 , 64 .…”

Section: Discussionsupporting

confidence: 76%

Dietary acid load and cirrhosis-related mortality: a prospective cohort study

Pashayee-Khamene,

Heidari,

Fotros

et al. 2024

Sci Rep

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As a global health concern, cirrhosis contributes significantly to morbidity and mortality. This prospective cohort study aimed to investigate the association between dietary acid load (DAL) and cirrhosis-related mortality. Present study was conducted on 121 patients with newly diagnosed cirrhosis who were followed up for 48 months. Anthropometric measures, nutritional status and dietary intakes were assessed and DAL was estimated based on potential renal acid load (PRAL) and net endogenous acid production (NEAP) scores. Crude and multivariable-adjusted hazard ratios (HR) with 95% confidence intervals (CI) were estimated using Cox proportional hazard analyses. Participants in the high PRAL and NEAP scores had significantly higher intakes of grains and lower intakes of fruits and vegetables. Also, the intake of dairy products and legumes, nuts and seeds decreased significantly with increasing NEAP score. After adjustment of all the confounders, the risk of mortality in the second and third tertiles of PRAL was 5.9 times and 10.97 higher than those in the first tertile, respectively (P trend: 0.006). Similarly, comparing the risk of mortality in the second and third tertiles with the first tertile of NEAP showed a 4.46-fold and 12.3-fold increased risk, respectively (P trend: 0.010). Our findings suggested that DAL was significantly associated with cirrhosis-related mortality and highlight the need for further research to understand the underlying mechanisms and establish optimal DAL levels in cirrhotic patients.

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Section: Discussionsupporting

confidence: 76%

Dietary acid load and cirrhosis-related mortality: a prospective cohort study

Pashayee-Khamene,

Heidari,

Fotros

et al. 2024

Sci Rep

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“…Skeletal muscle protein is the major source of glutamine for NH 4 + excretion in response to H + challenges [90]. Oral mineral H + in healthy volunteers was associated with stimulated protein degradation in skeletal muscle [91], highly H + -producing diets were associated with decreased skeletal muscle mass [92], and the treatment of chronic metabolic acidosis with mineral alkali was associated with increased skeletal muscle mass [74]. These data suggest that the kidneys' net H + excretion mechanisms in response to chronic H + challenges threaten patient skeletal muscle mass.…”

Section: Kidney Mechanisms Mediating the Excretion Of Dietary H + Tha...mentioning

confidence: 99%

Pathophysiology of Diet-Induced Acid Stress

Goraya,

Wesson

2024

IJMS

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Diets can influence the body’s acid–base status because specific food components yield acids, bases, or neither when metabolized. Animal-sourced foods yield acids and plant-sourced food, particularly fruits and vegetables, generally yield bases when metabolized. Modern diets proportionately contain more animal-sourced than plant-sourced foods, are, thereby, generally net acid-producing, and so constitute an ongoing acid challenge. Acid accumulation severe enough to reduce serum bicarbonate concentration, i.e., manifesting as chronic metabolic acidosis, the most extreme end of the continuum of “acid stress”, harms bones and muscles and appears to enhance the progression of chronic kidney disease (CKD). Progressive acid accumulation that does not achieve the threshold amount necessary to cause chronic metabolic acidosis also appears to have deleterious effects. Specifically, identifiable acid retention without reduced serum bicarbonate concentration, which, in this review, we will call “covert acidosis”, appears to cause kidney injury and exacerbate CKD progression. Furthermore, the chronic engagement of mechanisms to mitigate the ongoing acid challenge of modern diets also appears to threaten health, including kidney health. This review describes the full continuum of “acid stress” to which modern diets contribute and the mechanisms by which acid stress challenges health. Ongoing research will develop clinically useful tools to identify stages of acid stress earlier than metabolic acidosis and determine if dietary acid reduction lowers or eliminates the threats to health that these diets appear to cause.

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Many foods are more acid-forming than acid-alkaline formulas indicate

McMullen

2023

Nutr Health

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Foods contain substances impacting the acid-base balance. The Western diet is often viewed as being overly acid due to its high-level of animal-based protein and low-level of vegetable intake. Meanwhile, with ageing the ability to excrete acid compounds is reduced as kidney function declines and so there is a risk of acid retention and subsequent interstitial acidosis. Two systems used for calculating the Dietary Acid Load (DAL): the potential acid load of foods (PRAL) and the net endogenous acid production (NEAP). This report outlines weaknesses in these formulas and concludes that dietitians and nutritionists lack the necessary tools to research the acid-base hypothesis. Additionally, the report emphasizes the importance of food selection in the ageing population. Background: Foods contain substances impacting the acid-base balance. The Western diet is often viewed as being overly acid due to its high-level of animal-based protein and low-level of vegetable intake. There are concerns that the disproportionate acid intake promotes low-grade metabolic acidosis in the interstitial fluid, interstitial acidosis, and may lead to chronic disease. Two formulas are used for calculating the DAL: the PRAL and the NEAP. Both PRAL and NEAP are based on levels of protein and minerals. Aim: To identify additional food constituents that impact DAL. Methods: Review of the literature concerning the acid-forming and alkaline-forming constituents of foods. Results: Five additional food constituents were identified as potentially having a meaningful impact on DAL. The oxidation of taurine and the metabolism of fructose and purines increase acidity, whereas organic acids increase alkalinity. Additionally, polyphenols affect the microbiota which break down uric acid excreted in the intestinal tract. Conclusions: Neither PRAL nor NEAP provides complete assessments of the impact of foods on DAL. These formulas could be improved by the inclusion of dietary amino acids rather than protein, taurine, purines, fructose, organic acids and polyphenols. Currently, dietitians and nutritionists lack the necessary tools both to research the acid-base hypothesis and recommend managed diets. Managed diets are of particular importance for the elderly because of their reduced kidney function which increases the risk of acid retention and subsequent interstitial acidosis.

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The association of dietary acid load (DAL) with estimated skeletal muscle mass and bone mineral content: a cross-sectional study

Cited by 5 publications

References 74 publications

Dietary acid load and cirrhosis-related mortality: a prospective cohort study

Dietary acid load and cirrhosis-related mortality: a prospective cohort study

Pathophysiology of Diet-Induced Acid Stress

Many foods are more acid-forming than acid-alkaline formulas indicate

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