title: Association of dietary acid load with cardiovascular disease risk factors in patients with diabetic nephropathy.
abstract: OBJECTIVE
  An association between dietary acid load and cardiovascular disease risk has been reported in epidemiologic studies; however, there are no reports to our knowledge of this association in patients with diabetic nephropathy (DN). Therefore, the aim of this study was to examine the association between dietary acid load, based on potential renal acid load (PRAL) and protein:potassium ratio (Pro:K) scores, and cardiovascular disease risk factors in individuals with DN.
  
  
  METHODS
  In this cross-sectional study, we randomly enrolled 547 patients with DN. Dietary intake was assessed using a validated food frequency questionnaire. Biochemical and anthropometric measures were assessed using standard methods.
  
  
  RESULTS
  Participants had a mean age of 66.8 y and body mass index of 24 kg/m(2). After controlling for potential confounders, participants in the low PRAL group had lower hemoglobin (Hb)A1c (5.7% ± 0.5% versus 7.8% ± 0.5%; P = 0.01), triacylglycerols (246.9 ± 2.3 mg/dL versus 257.4 ± 2.3 mg/dL; P = 0.006), systolic blood pressure (103.6 ± 0.7 mm Hg versus 106.1 ± 0.7 mm Hg; P = 0.03), and lower creatinine and fasting blood sugar compared with the high PRAL group. Pro:K was positively related to HbA1c (5.8% ± 0.5% versus 7.6% ± 0.5%; P = 0.03), but inversely associated with low-density lipoprotein and waist circumference.
  
  
  CONCLUSIONS
  We found that both PRAL and Pro:K were positively related to HbA1c in the setting of DN, whereas other biochemical and kidney-related markers varied with PRAL and Pro:K status. Future studies are warranted to clarify the clinical outcomes of dietary acid load in older populations as well as in patients with chronic kidney disease.
authors.affiliation: Department of Community Nutrition, Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Fahimeh
authors.initials: F
authors.lastname: Haghighatdoost
authors.affiliation: Department of Nephrology, Isfahan Kidney Diseases Research Center, Isfahan, Iran.
authors.forename: Mojgan Mortazavi
authors.initials: MM
authors.lastname: Najafabadi
authors.affiliation: Faculty of Community Services, School of Nutrition, Ryerson University, Toronto, Canada.
authors.forename: Nick
authors.initials: N
authors.lastname: Bellissimo
authors.affiliation: Department of Community Nutrition, Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran. Electronic address: Azadbakht@hlth.mui.ac.ir.
authors.forename: Leila
authors.initials: L
authors.lastname: Azadbakht
mesh_terms: D000143:Acids / Q000008:administration & dosage* / Q000378:metabolism; D000368:Aged; D001786:Blood Glucose / Q000032:analysis; D001794:Blood Pressure; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000097:blood* / Q000178:diet therapy / Q000209:etiology; D003430:Cross-Sectional Studies; D003928:Diabetic Nephropathies / Q000097:blood* / Q000178:diet therapy; D004032:Diet; D004034:Diet Surveys / Q000379:methods; D004044:Dietary Proteins / Q000008:administration & dosage*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D008077:Lipoproteins, LDL / Q000097:blood; D008297:Male; D008875:Middle Aged; D017419:Potassium, Dietary / Q000008:administration & dosage*; D012307:Risk Factors; D014280:Triglycerides / Q000097:blood; D055105:Waist Circumference
chemical_list: D000143:Acids; D001786:Blood Glucose; D004044:Dietary Proteins; D006442:Glycated Hemoglobin; D008077:Lipoproteins, LDL; D017419:Potassium, Dietary; D014280:Triglycerides; C517652:hemoglobin A1c protein, human
keywords: Blood urea nitrogen; Cardiovascular disease; Creatinine; Diabetic nephropathy; Dietary acid load