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Dietary acid load, insulin sensitivity and risk of type 2 diabetes in community-dwelling older men

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Abstract

Aims/hypothesis

We tested the hypothesis that dietary acid load may increase the risk of type 2 diabetes, and studied the association between acid load and insulin sensitivity as a possible mechanism involved.

Methods

An observational survey with prospective follow-up including 911 non-diabetic Swedish men aged 70–71 years was carried out. The gold standard euglycaemic–hyperinsulinaemic clamp technique and the OGTT were used to determine insulin sensitivity and beta cell function, respectively. Diabetes incidence was assessed during 18 years of follow-up. Renal function was estimated from serum cystatin C concentrations. Dietary acid load was calculated as potential renal acid load (PRAL) and net endogenous acid production (NEAP) algorithms from 7 day food records. Adequate dietary reporters were identified by Goldberg cut-offs.

Results

PRAL and NEAP were not associated with insulin sensitivity or beta cell function. Underlying kidney function or consideration of dietary adequate reporters did not modify these null findings. During follow-up, 115 new cases of diabetes were validated. Neither PRAL nor NEAP was associated with diabetes incidence.

Conclusions/interpretation

Our results do not support the hypothesis that dietary acid load influences insulin sensitivity, beta cell function or diabetes risk. Interventional studies modifying acid–base dietary intake are needed to further elucidate a possible role of acid load in the development of type 2 diabetes.

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Abbreviations

CVD:

Cardiovascular disease

eGFR:

Estimated GFR

IGI:

Insulinogenic Index

IS:

Insulin sensitivity

MUFA:

Monounsaturated fatty acid

NEAP:

Net endogenous acid production

PRAL:

Potential renal acid load

PUFA:

Polyunsaturated fatty acid

SFA:

Saturated fatty acids

UAER:

Urinary albumin excretion rate

ULSAM:

Uppsala Longitudinal Study of Adult Men

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Acknowledgements

We are indebted to all participants in the study and are grateful to the ULSAM group for their assiduous and thorough data collection.

Funding

This work was supported by the grants from the Swedish Research Council and the Westman Foundation. Baxter Novum is the result of a grant from the Baxter Healthcare Corporation to Karolinska Institutet.

Duality of interest

BL is affiliated with Baxter Healthcare Corporation. All other authors declare that there is no duality of interest associated with their contribution to this manuscript.

Contribution statement

HX carried out the studies and data analyses and drafted the manuscript. JJC conceived the study, participated in its design and coordination, and helped to draft the manuscript. The other authors participated in its design and contributed to developing the manuscript to its final form. All authors approved the final version. JJC is guarantor of this work.

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Authors and Affiliations

  1. Divisions of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska University Hospital K56, Karolinska Institutet, 14186, Stockholm, Sweden

    Hong Xu, Ting Jia, Xiaoyan Huang, Bengt Lindholm & Juan-Jesús Carrero

  2. Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China

    Hong Xu

  3. Division of Nephrology, Peking University Shenzhen Hospital, Peking University, Shenzhen, China

    Xiaoyan Huang

  4. Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden

    Ulf Risérus, Tommy Cederholm & Per Sjögren

  5. Department of Public Health and Caring Sciences, Section of Geriatrics, Uppsala University, Uppsala, Sweden

    Johan Ärnlöv

  6. School of Health and Social Studies, Dalarna University, Falun, Sweden

    Johan Ärnlöv

  7. Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden

    Juan-Jesús Carrero

Authors
  1. Hong Xu
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  2. Ting Jia
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Corresponding author

Correspondence to Juan-Jesús Carrero.

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Xu, H., Jia, T., Huang, X. et al. Dietary acid load, insulin sensitivity and risk of type 2 diabetes in community-dwelling older men. Diabetologia 57, 1561–1568 (2014). https://doi.org/10.1007/s00125-014-3275-z

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  • DOI: https://doi.org/10.1007/s00125-014-3275-z

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