title: Dietary acid load in early life and bone health in childhood: the Generation R Study.
abstract: BACKGROUND
  Dietary contribution to acid-base balance in early life may influence subsequent bone mineralization. Previous studies reported inconsistent results regarding the associations between dietary acid load and bone mass.
  
  
  OBJECTIVE
  We examined the associations of dietary acid load in early life with bone health in childhood.
  
  
  METHODS
  In a prospective, multiethnic, population-based cohort study of 2850 children, we estimated dietary acid load as dietary potential renal acid load (dPRAL), based on dietary intakes of calcium, magnesium, phosphorus, potassium, and protein, and as a protein intake to potassium intake ratio (Pro:K) at 1 y of age and in a subgroup at 2 y of age : Bone mineral density, bone mineral content (BMC), area-adjusted BMC, and bone area were assessed by dual-energy X-ray absorptiometry at the median age of 6 y. Data were analyzed by using multivariable linear regression models.
  
  
  RESULTS
  After adjusting for relevant maternal and child factors, dietary acid load estimated as either dPRAL or Pro:K ratio was not consistently associated with childhood bone health. Associations did not differ by sex, ethnicity, weight status, or vitamin D supplementation. Only in those children with high protein intake in our population (i.e., >42 g/d), a 1-unit increase in dPRAL (mEq/d) was inversely associated with BMC (difference: -0.32 g; 95% CI: -0.64, -0.01 g).
  
  
  CONCLUSIONS
  Dietary acid load in early life was not consistently associated with bone health in childhood. Further research is needed to explore the extent to which dietary acid load in later childhood may affect current and future bone health.
authors.affiliation: Department of Epidemiology, The Generation R Study Group.
authors.forename: Audry H
authors.initials: AH
authors.lastname: Garcia
authors.affiliation: Department of Epidemiology, o.franco@erasmusmc.nl.
authors.forename: Oscar H
authors.initials: OH
authors.lastname: Franco
authors.affiliation: Department of Epidemiology, The Generation R Study Group.
authors.forename: Trudy
authors.identifier: http://orcid.org/0000-0003-2830-6813
authors.initials: T
authors.lastname: Voortman
authors.affiliation: Department of Epidemiology, Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.
authors.forename: Ester A L
authors.initials: EA
authors.lastname: de Jonge
authors.affiliation: Department of Epidemiology.
authors.forename: Noelia G
authors.initials: NG
authors.lastname: Gordillo
authors.affiliation: Department of Epidemiology, The Generation R Study Group, Department of Pediatrics, and.
authors.forename: Vincent W V
authors.identifier: http://orcid.org/0000-0003-2939-0041
authors.initials: VW
authors.lastname: Jaddoe
authors.affiliation: Department of Epidemiology, The Generation R Study Group, Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.
authors.forename: Fernando
authors.identifier: http://orcid.org/0000-0001-9435-9441
authors.initials: F
authors.lastname: Rivadeneira
authors.affiliation: Department of Epidemiology, The Generation R Study Group.
authors.forename: Edith H
authors.initials: EH
authors.lastname: van den Hooven
mesh_terms: D000137:Acid-Base Imbalance / Q000209:etiology* / Q000503:physiopathology; D000143:Acids / Q000009:adverse effects*; D000465:Algorithms; D015519:Bone Density; D002113:Calcification, Physiologic; D002136:Calcium, Dietary / Q000008:administration & dosage / Q000627:therapeutic use; D002657:Child Development; D002675:Child, Preschool; D015331:Cohort Studies; D004032:Diet / Q000009:adverse effects*; D004044:Dietary Proteins / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007223:Infant; D007227:Infant Nutritional Physiological Phenomena; D008297:Male; D009426:Netherlands; D010024:Osteoporosis / Q000209:etiology* / Q000517:prevention & control; D017419:Potassium, Dietary / Q000008:administration & dosage / Q000627:therapeutic use; D011446:Prospective Studies
chemical_list: D000143:Acids; D002136:Calcium, Dietary; D004044:Dietary Proteins; D017419:Potassium, Dietary
keywords: bone development; bone mineral density; children; cohort; dietary acid load