Dietary acid load is associated with waist circumference in university students with low adherence to the Mediterranean diet: The potential role of ultra-processed foods

Jun 21, 2023Clinical nutrition ESPEN

Higher dietary acid load is linked to larger waist size in university students who eat few Mediterranean diet foods, possibly due to ultra-processed foods

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Abstract

Among 346 young adults with a Mediterranean diet score of 28.00 or lower, higher dietary acid load (DAL) is associated with increased central obesity.

Higher potential renal acid load (PRAL) and net acid production (NEAP) are negatively associated with waist circumference in individuals with lower adherence to the Mediterranean diet.
In subjects with medium to high ultra-processed food (UPF) intake, increased PRAL and NEAP are linked to central obesity.
Specific associations were observed for PRAL and NEAP in the second and third tertiles of UPF intake, indicating a potential connection to waist circumference.
PRAL and NEAP did not show significant predictive value for body mass index (BMI) in this study.

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BACKGROUND AND AIMS: Dietary acid load (DAL), as expressed by potential renal acid load (PRAL) and net acid production (NEAP), is connected to cardiometabolic disorders and obesity. Mediterranean diet relates to lower, while western diets to higher DAL values. The present study aimed to assess the association of PRAL and NEAP with adiposity measures in young adults (19.61 ± 3.15 years, mean ± standard deviation) and explore the implication of Mediterranean diet adherence and ultra-processed foods (UPF) intake in this relation.

METHODS: 346 students (269 women) participated. Anthropometry was performed, and a food frequency questionnaire was administered. The MedDietScore was calculated, UPF consumption was calculated based on the NOVA classification and PRAL/NEAP was estimated from published equations. Waist Circumference (WC) was transformed to WC(1/WC) in order to achieve normality and run linear regression models. -1

RESULTS: In subjects with MedDietScore ≤ 28.00, PRAL and NEAP were negatively associated with 1/WC (B = -1.594 × 10-5± 8 × 10-6, p = 0.044 for PRAL and B = -2.84 × 10-5 ± 1 × 10-5, p = 0.048 for NEAP). Moreover, in this subgroup, subjects with medium to high UPF intake i.e., in the 2nd or 3rd tertile of UPF intake representing more than 34.16% of energy, PRAL (2nd tertile B = -0.00007, SE = 0.00003, p = 0.018; 3rd tertile B = -0.00002, SE = 0.00001, p = 0.024) and NEAP (2nd tertile B = -0.00004, SE = 0.00002, p = 0.040; 3rd tertile B = -0.00007, SE = 0.00004, p = 0.055) were connected to central obesity. In similar models, PRAL and NEAP were not significant predictors of BMI.

CONCLUSION: The DAL may be related to central obesity, especially in individuals with worse dietary quality, as reflected by lower adherence to the Mediterranean diet, and high intake of UPF. Nutrition guidance aiming at the reduction of DAL may be useful in the reduction of central obesity in these subgroups.

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Dietary acid load is associated with waist circumference in university students with low adherence to the Mediterranean diet: The potential role of ultra-processed foods

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