Association between Dietary Acid Load and Blood Pressure: A Systematic Review and Meta-analysis
Abstract
Background: Existing data on the association between dietary acid load and blood pressure are not conclusive. This systematic review and meta-analysis aimed to combine findings of evidence regarding the association between dietary acid load and blood pressure.
Methods: MEDLINE and EMBASE databases were searched for studies published up to November 2016. Effect sizes of eligible studies were pooled using random-effects models. Heterogeneity was tested using Cochrane’s Q test. Subgroup analyses were done according to the method used for estimating dietary acid load.
Results: Of 7033 records, 8 articles (7 cross-sectional, 1 longitudinal) were eligible for inclusion. Higher dietary acid load was associated with high systolic blood pressure (SBP) (mean difference [MD] = 0.84 mm Hg; 95% CI, 0.04 to 1.64; I2 = 98.4%; p= 039) and diastolic blood pressure (DBO) (MD = 0.75 mm Hg; 95% CI, 0.27 to 1.24; I2 = 75.1%; p=002). Subgroup analyses showed that the type of populations involved and participant sex were sources of heterogeneity for both SBP and DBP, while baseline blood pressure and age were heterogeneity sources exclusively for DBP.
Conclusion: High dietary acid load is associated with greater blood pressure. Further studies are needed to explore the precise impact of low dietary acid load on blood pressure in patients with hypertension.
1. Murray CJ, Lopez AD. Measuring the global burden of disease. New England Journal of Medicine. 2013;369(5):448-57.
2. Lawes CM, Vander Hoorn S, Rodgers A. Global burden of blood-pressure-related disease, 2001. The Lancet. 2008;371(9623):1513-8.
3. He J, Whelton PK. Elevated systolic blood pressure and risk of cardiovascular and renal disease: overview of evidence from observational epidemiologic studies and randomized controlled trials. American heart journal. 1999;138(3):S211-S9.
4. Forman JP, Stampfer MJ, Curhan GC. Diet and lifestyle risk factors associated with incident hypertension in women. Jama. 2009;302(4):401-11.
5. Dickinson HO, Mason JM, Nicolson DJ, Campbell F, Beyer FR, Cook JV, et al. Lifestyle interventions to reduce raised blood pressure: a systematic review of randomized controlled trials. Journal of hypertension. 2006;24(2):215-33.
6. Adeva MM, Souto G. Diet-induced metabolic acidosis. Clinical nutrition. 2011;30(4):416-21.
7. van den Berg E, Engberink MF, Brink EJ, van Baak MA, Joosten MM, Gans RO, et al. Dietary acid load and metabolic acidosis in renal transplant recipients. Clinical Journal of the American Society of Nephrology. 2012;7(11):1811-8.
8. Frassetto LA, Todd KM, Morris R, Sebastian A. Estimation of net endogenous noncarbonic acid production in humans from diet potassium and protein contents. The American journal of clinical nutrition. 1998;68(3):576-83.
9. Remer T. Influence of nutrition on acid-base balance–metabolic aspects. European journal of nutrition. 2001;40(5):214-20.
10. Remer T, Manz F. Estimation of the renal net acid excretion by adults consuming diets containing variable amounts of protein. The American journal of clinical nutrition. 1994;59(6):1356-61.
11. Remer T, Manz F. Potential renal acid load of foods and its influence on urine pH. Journal of the American Dietetic Association. 1995;95(7):791-7.
12. Maurer M, Riesen W, Muser J, Hulter HN, Krapf R. Neutralization of Western diet inhibits bone resorption independently of K intake and reduces cortisol secretion in humans. American Journal of Physiology-Renal Physiology. 2003;284(1):F32-F40.
13. Sicuro A, Mahlbacher K, Hulter HN, Krapf R. Effect of growth hormone on renal and systemic acid-base homeostasis in humans. American Journal of Physiology-Renal Physiology. 1998;274(4):F650-F7.
14. Resnick LM, Gupta RK, Sosa RE, Corbett ML, Laragh JH. Intracellular pH in human and experimental hypertension. Proceedings of the National Academy of Sciences. 1987;84(21):7663-7.
15. Sharma AM, Kribben A, Schattenfroh S, Cetto C, Distler A. Salt sensitivity in humans is associated with abnormal acid-base regulation. Hypertension. 1990;16(4):407-13.
16. Remer T, Dimitriou T, Manz F. Dietary potential renal acid load and renal net acid excretion in healthy, free-living children and adolescents. The American journal of clinical nutrition. 2003;77(5):1255-60.
17. GONICK HC, Goldberg G, Mulcare D. Reexamination of the acid-ash content of several diets. The American journal of clinical nutrition. 1968;21(9):898-903.
18. Fagherazzi G, Vilier A, Bonnet F, Lajous M, Balkau B, Boutron-Ruault M-C, et al. Dietary acid load and risk of type 2 diabetes: the E3N-EPIC cohort study. Diabetologia. 2014;57(2):313-20.
19. Bahadoran Z, Mirmiran P, Khosravi H, Azizi F. Associations between dietary acid-base load and cardiometabolic risk factors in adults: the Tehran Lipid and Glucose Study. Endocrinology and Metabolism. 2015;30(2):201-7.
20. Vezzoli G, Dogliotti E, Terranegra A, Arcidiacono T, Macrina L, Tavecchia M, et al. Dietary style and acid load in an Italian population of calcium kidney stone formers. Nutrition, Metabolism and Cardiovascular Diseases. 2015;25(6):588-93.
21. Zhang L, Curhan GC, Forman JP. Diet-dependent net acid load and risk of incident hypertension in United States women. Hypertension. 2009;54(4):751-5.
22. Krupp D, Shi L, Maser-Gluth C, Pietzarka M, Remer T. 11β Hydroxysteroid dehydrogenase type 2 and dietary acid load are independently associated with blood pressure in healthy children and adolescents. The American journal of clinical nutrition. 2013;97(3):612-20.
23. Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS med. 2009;6(7):e1000097.
24. Williams RS, Kozan P, Samocha-Bonet D. The role of dietary acid load and mild metabolic acidosis in insulin resistance in humans. Biochimie. 2016;124:171-7.
25. Luis D, Huang X, Riserus U, Sjögren P, Lindholm B, Arnlöv J, et al. Estimated dietary acid load is not associated with blood pressure or hypertension incidence in men who are approximately 70 years old. The Journal of nutrition. 2015;145(2):315-21.
26. Haghighatdoost F, Najafabadi MM, Bellissimo N, Azadbakht L. Association of dietary acid load with cardiovascular disease risk factors in patients with diabetic nephropathy. Nutrition (Burbank, Los Angeles County, Calif). 2015;31(5):697-702.
27. Iwase H, Tanaka M, Kobayashi Y, Wada S, Kuwahata M, Kido Y, et al. Lower vegetable protein intake and higher dietary acid load associated with lower carbohydrate intake are risk factors for metabolic syndrome in patients with type 2 diabetes: Post‐hoc analysis of a cross‐sectional study. Journal of diabetes investigation. 2015;6(4):465-72.
28. Moghadam SK, Bahadoran Z, Mirmiran P, Tohidi M, Azizi F. Association between dietary acid load and insulin resistance: Tehran Lipid and Glucose Study. Preventive nutrition and food science. 2016;21(2):104.
29. Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. European journal of epidemiology. 2010;25(9):603-5.
30. Akter S, Eguchi M, Kurotani K, Kochi T, Pham NM, Ito R, et al. High dietary acid load is associated with increased prevalence of hypertension: The Furukawa Nutrition and Health Study. Nutrition (Burbank, Los Angeles County, Calif). 2015;31(2):298-303.
31. Krupp D, Strohle A, Remer T. Dietary acid load and risk of hypertension. The American journal of clinical nutrition. 2012;96(4):942-3; author reply 3-4.
32. Murakami K, Sasaki S, Takahashi Y, Uenishi K, Yamasaki M, Hisatomi Y, et al. Association between dietary acid-base load and cardiometabolic risk factors in young Japanese women. British Journal of Nutrition. 2008;100(3):642-51.
33. Rebholz CM, Coresh J, Grams ME, Steffen LM, Anderson CA, Appel LJ, et al. Dietary Acid Load and Incident Chronic Kidney Disease: Results from the ARIC Study. American journal of nephrology. 2015;42(6):427-35.
34. van den Berg E, Engberink MF, Brink EJ, van Baak MA, Joosten MM, Gans ROB, et al. Dietary acid load and metabolic acidosis in renal transplant recipients. Clinical Journal of the American Society of Nephrology. 2012;7(11):1811-8.
35. van den Berg E, Hospers FA, Navis G, Engberink MF, Brink EJ, Geleijnse JM, et al. Dietary acid load and rapid progression to end-stage renal disease of diabetic nephropathy in Westernized South Asian people. Journal of nephrology. 2011;24(1):11-7.
36. Engberink MF, Bakker SJ, Brink EJ, van Baak MA, van Rooij FJ, Hofman A, et al. Dietary acid load and risk of hypertension: the Rotterdam Study. The American journal of clinical nutrition. 2012;95(6):1438-44.
37. Nowson CA, Patchett A, Wattanapenpaiboon N. The effects of a low-sodium base-producing diet including red meat compared with a high-carbohydrate, low-fat diet on bone turnover markers in women aged 4575 years. British Journal of Nutrition. 2009;102(8):1161-70.
38. Adeva MM, Souto G. Diet-induced metabolic acidosis. Clinical nutrition (Edinburgh, Scotland). 2011;30(4):416-21.
39. Han E, Kim G, Hong N, Lee Y-h, Kim DW, Shin HJ, et al. Association between dietary acid load and the risk of cardiovascular disease: nationwide surveys (KNHANES 2008–2011). Cardiovascular diabetology. 2016;15(1):122.
40. Murakami K, Sasaki S, Takahashi Y, Uenishi K. Association between dietary acid–base load and cardiometabolic risk factors in young Japanese women. British journal of nutrition. 2008;100(03):642-51.
41. Cappuccio FP, Kalaitzidis R, Duneclift S, Eastwood JB. Unravelling the links between calcium excretion, salt intake, hypertension, kidney stones and bone metabolism. Journal of nephrology. 2000;13(3):169-77.
42. Oshima T, Young EW, editors. Systemic and cellular calcium metabolism and hypertension. Seminars in nephrology; 1995.
43. Taylor EN, Mount DB, Forman JP, Curhan GC. Association of prevalent hypertension with 24-hour urinary excretion of calcium, citrate, and other factors. American journal of kidney diseases. 2006;47(5):780-9.
44. Sebastian A, Frassetto LA, Sellmeyer DE, Merriam RL, Morris RC. Estimation of the net acid load of the diet of ancestral preagricultural Homo sapiens and their hominid ancestors. The American journal of clinical nutrition. 2002;76(6):1308-16.
45. Simpson D. Citrate excretion: a window on renal metabolism. American Journal of Physiology-Renal Physiology. 1983;244(3):F223-F34.
46. Hunt KJ, Lukanova A, Rinaldi S, Lundin E, Norat T, Palmqvist R, et al. A potential inverse association between insulin-like growth factor I and hypertension in a cross-sectional study. Annals of epidemiology. 2006;16(7):563-71.
2. Lawes CM, Vander Hoorn S, Rodgers A. Global burden of blood-pressure-related disease, 2001. The Lancet. 2008;371(9623):1513-8.
3. He J, Whelton PK. Elevated systolic blood pressure and risk of cardiovascular and renal disease: overview of evidence from observational epidemiologic studies and randomized controlled trials. American heart journal. 1999;138(3):S211-S9.
4. Forman JP, Stampfer MJ, Curhan GC. Diet and lifestyle risk factors associated with incident hypertension in women. Jama. 2009;302(4):401-11.
5. Dickinson HO, Mason JM, Nicolson DJ, Campbell F, Beyer FR, Cook JV, et al. Lifestyle interventions to reduce raised blood pressure: a systematic review of randomized controlled trials. Journal of hypertension. 2006;24(2):215-33.
6. Adeva MM, Souto G. Diet-induced metabolic acidosis. Clinical nutrition. 2011;30(4):416-21.
7. van den Berg E, Engberink MF, Brink EJ, van Baak MA, Joosten MM, Gans RO, et al. Dietary acid load and metabolic acidosis in renal transplant recipients. Clinical Journal of the American Society of Nephrology. 2012;7(11):1811-8.
8. Frassetto LA, Todd KM, Morris R, Sebastian A. Estimation of net endogenous noncarbonic acid production in humans from diet potassium and protein contents. The American journal of clinical nutrition. 1998;68(3):576-83.
9. Remer T. Influence of nutrition on acid-base balance–metabolic aspects. European journal of nutrition. 2001;40(5):214-20.
10. Remer T, Manz F. Estimation of the renal net acid excretion by adults consuming diets containing variable amounts of protein. The American journal of clinical nutrition. 1994;59(6):1356-61.
11. Remer T, Manz F. Potential renal acid load of foods and its influence on urine pH. Journal of the American Dietetic Association. 1995;95(7):791-7.
12. Maurer M, Riesen W, Muser J, Hulter HN, Krapf R. Neutralization of Western diet inhibits bone resorption independently of K intake and reduces cortisol secretion in humans. American Journal of Physiology-Renal Physiology. 2003;284(1):F32-F40.
13. Sicuro A, Mahlbacher K, Hulter HN, Krapf R. Effect of growth hormone on renal and systemic acid-base homeostasis in humans. American Journal of Physiology-Renal Physiology. 1998;274(4):F650-F7.
14. Resnick LM, Gupta RK, Sosa RE, Corbett ML, Laragh JH. Intracellular pH in human and experimental hypertension. Proceedings of the National Academy of Sciences. 1987;84(21):7663-7.
15. Sharma AM, Kribben A, Schattenfroh S, Cetto C, Distler A. Salt sensitivity in humans is associated with abnormal acid-base regulation. Hypertension. 1990;16(4):407-13.
16. Remer T, Dimitriou T, Manz F. Dietary potential renal acid load and renal net acid excretion in healthy, free-living children and adolescents. The American journal of clinical nutrition. 2003;77(5):1255-60.
17. GONICK HC, Goldberg G, Mulcare D. Reexamination of the acid-ash content of several diets. The American journal of clinical nutrition. 1968;21(9):898-903.
18. Fagherazzi G, Vilier A, Bonnet F, Lajous M, Balkau B, Boutron-Ruault M-C, et al. Dietary acid load and risk of type 2 diabetes: the E3N-EPIC cohort study. Diabetologia. 2014;57(2):313-20.
19. Bahadoran Z, Mirmiran P, Khosravi H, Azizi F. Associations between dietary acid-base load and cardiometabolic risk factors in adults: the Tehran Lipid and Glucose Study. Endocrinology and Metabolism. 2015;30(2):201-7.
20. Vezzoli G, Dogliotti E, Terranegra A, Arcidiacono T, Macrina L, Tavecchia M, et al. Dietary style and acid load in an Italian population of calcium kidney stone formers. Nutrition, Metabolism and Cardiovascular Diseases. 2015;25(6):588-93.
21. Zhang L, Curhan GC, Forman JP. Diet-dependent net acid load and risk of incident hypertension in United States women. Hypertension. 2009;54(4):751-5.
22. Krupp D, Shi L, Maser-Gluth C, Pietzarka M, Remer T. 11β Hydroxysteroid dehydrogenase type 2 and dietary acid load are independently associated with blood pressure in healthy children and adolescents. The American journal of clinical nutrition. 2013;97(3):612-20.
23. Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS med. 2009;6(7):e1000097.
24. Williams RS, Kozan P, Samocha-Bonet D. The role of dietary acid load and mild metabolic acidosis in insulin resistance in humans. Biochimie. 2016;124:171-7.
25. Luis D, Huang X, Riserus U, Sjögren P, Lindholm B, Arnlöv J, et al. Estimated dietary acid load is not associated with blood pressure or hypertension incidence in men who are approximately 70 years old. The Journal of nutrition. 2015;145(2):315-21.
26. Haghighatdoost F, Najafabadi MM, Bellissimo N, Azadbakht L. Association of dietary acid load with cardiovascular disease risk factors in patients with diabetic nephropathy. Nutrition (Burbank, Los Angeles County, Calif). 2015;31(5):697-702.
27. Iwase H, Tanaka M, Kobayashi Y, Wada S, Kuwahata M, Kido Y, et al. Lower vegetable protein intake and higher dietary acid load associated with lower carbohydrate intake are risk factors for metabolic syndrome in patients with type 2 diabetes: Post‐hoc analysis of a cross‐sectional study. Journal of diabetes investigation. 2015;6(4):465-72.
28. Moghadam SK, Bahadoran Z, Mirmiran P, Tohidi M, Azizi F. Association between dietary acid load and insulin resistance: Tehran Lipid and Glucose Study. Preventive nutrition and food science. 2016;21(2):104.
29. Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. European journal of epidemiology. 2010;25(9):603-5.
30. Akter S, Eguchi M, Kurotani K, Kochi T, Pham NM, Ito R, et al. High dietary acid load is associated with increased prevalence of hypertension: The Furukawa Nutrition and Health Study. Nutrition (Burbank, Los Angeles County, Calif). 2015;31(2):298-303.
31. Krupp D, Strohle A, Remer T. Dietary acid load and risk of hypertension. The American journal of clinical nutrition. 2012;96(4):942-3; author reply 3-4.
32. Murakami K, Sasaki S, Takahashi Y, Uenishi K, Yamasaki M, Hisatomi Y, et al. Association between dietary acid-base load and cardiometabolic risk factors in young Japanese women. British Journal of Nutrition. 2008;100(3):642-51.
33. Rebholz CM, Coresh J, Grams ME, Steffen LM, Anderson CA, Appel LJ, et al. Dietary Acid Load and Incident Chronic Kidney Disease: Results from the ARIC Study. American journal of nephrology. 2015;42(6):427-35.
34. van den Berg E, Engberink MF, Brink EJ, van Baak MA, Joosten MM, Gans ROB, et al. Dietary acid load and metabolic acidosis in renal transplant recipients. Clinical Journal of the American Society of Nephrology. 2012;7(11):1811-8.
35. van den Berg E, Hospers FA, Navis G, Engberink MF, Brink EJ, Geleijnse JM, et al. Dietary acid load and rapid progression to end-stage renal disease of diabetic nephropathy in Westernized South Asian people. Journal of nephrology. 2011;24(1):11-7.
36. Engberink MF, Bakker SJ, Brink EJ, van Baak MA, van Rooij FJ, Hofman A, et al. Dietary acid load and risk of hypertension: the Rotterdam Study. The American journal of clinical nutrition. 2012;95(6):1438-44.
37. Nowson CA, Patchett A, Wattanapenpaiboon N. The effects of a low-sodium base-producing diet including red meat compared with a high-carbohydrate, low-fat diet on bone turnover markers in women aged 4575 years. British Journal of Nutrition. 2009;102(8):1161-70.
38. Adeva MM, Souto G. Diet-induced metabolic acidosis. Clinical nutrition (Edinburgh, Scotland). 2011;30(4):416-21.
39. Han E, Kim G, Hong N, Lee Y-h, Kim DW, Shin HJ, et al. Association between dietary acid load and the risk of cardiovascular disease: nationwide surveys (KNHANES 2008–2011). Cardiovascular diabetology. 2016;15(1):122.
40. Murakami K, Sasaki S, Takahashi Y, Uenishi K. Association between dietary acid–base load and cardiometabolic risk factors in young Japanese women. British journal of nutrition. 2008;100(03):642-51.
41. Cappuccio FP, Kalaitzidis R, Duneclift S, Eastwood JB. Unravelling the links between calcium excretion, salt intake, hypertension, kidney stones and bone metabolism. Journal of nephrology. 2000;13(3):169-77.
42. Oshima T, Young EW, editors. Systemic and cellular calcium metabolism and hypertension. Seminars in nephrology; 1995.
43. Taylor EN, Mount DB, Forman JP, Curhan GC. Association of prevalent hypertension with 24-hour urinary excretion of calcium, citrate, and other factors. American journal of kidney diseases. 2006;47(5):780-9.
44. Sebastian A, Frassetto LA, Sellmeyer DE, Merriam RL, Morris RC. Estimation of the net acid load of the diet of ancestral preagricultural Homo sapiens and their hominid ancestors. The American journal of clinical nutrition. 2002;76(6):1308-16.
45. Simpson D. Citrate excretion: a window on renal metabolism. American Journal of Physiology-Renal Physiology. 1983;244(3):F223-F34.
46. Hunt KJ, Lukanova A, Rinaldi S, Lundin E, Norat T, Palmqvist R, et al. A potential inverse association between insulin-like growth factor I and hypertension in a cross-sectional study. Annals of epidemiology. 2006;16(7):563-71.
| Files | ||
| Issue | Vol 4, No 3 (Summer 2018) | |
| Section | Review Article(s) | |
| Keywords | ||
| Dietary acid load Systolic blood pressure Diastolic blood pressure | ||
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How to Cite
1.
Fatahi S, Aslani Z, Djafarian K. Association between Dietary Acid Load and Blood Pressure: A Systematic Review and Meta-analysis. J Nutr Sci & Diet. 2018;4(3):95-103.
