Association between dietary acid load and the risk of cardiovascular disease: nationwide surveys (KNHANES 2008-2011)

Cardiovasc Diabetol. 2016 Aug 26;15(1):122. doi: 10.1186/s12933-016-0436-z.


Background: Acid-base imbalance has been reported to increase incidence of hypertension and diabetes. However, the association between diet-induced acid load and cardiovascular disease (CVD) risk in the general population has not been fully investigated.

Methods: This was a population-based, retrospectively registered cross-sectional study using nationally representative samples of 11,601 subjects from the Korea National Health and Nutrition Examination Survey 2008-2011. Individual CVD risk was evaluated using atherosclerotic cardiovascular disease (ASCVD) risk equations according to 2013 ACC/AHA guideline assessment in subjects aged 40-79 without prior CVD. Acid-base status was assessed with both the potential renal acid load (PRAL) and the dietary acid load (DAL) scores derived from nutrient intake.

Results: Individuals in the highest PRAL tertile had a significant increase in 10 year ASCVD risks (9.6 vs. 8.5 %, P < 0.01) and tended to belong to the high-risk (10 year risk >10 %) group compared to those in the lowest PRAL tertile (odds ratio [OR] 1.23, 95 % confidence interval [CI] 1.22-1.35). The association between higher PRAL score and high CVD risk was stronger in the middle-aged group. Furthermore, a multiple logistic regression analysis also demonstrated this association (OR 1.20 95 % CI 1.01-1.43). Subgroup analysis stratified obesity or exercise status; individuals in unhealthy condition with lower PRAL scores had comparable ASCVD risk to people in the higher PRAL group that were in favorable physical condition. In addition, elevated PRAL scores were associated with high ASCVD risk independent of obesity, exercise, and insulin resistance, but not sarcopenia. Similar trends were observed with DAL scores.

Conclusion: Diet-induced acid load was associated with increased risk of CVD, independent of obesity and insulin resistance.

Keywords: Atherosclerosis; Diet; Epidemiology; Risk factors.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acid-Base Equilibrium*
  • Acid-Base Imbalance / diagnosis
  • Acid-Base Imbalance / epidemiology*
  • Acid-Base Imbalance / physiopathology
  • Acids / adverse effects*
  • Adult
  • Aged
  • Cardiovascular Diseases / diagnosis
  • Cardiovascular Diseases / epidemiology*
  • Cardiovascular Diseases / physiopathology
  • Chi-Square Distribution
  • Comorbidity
  • Cross-Sectional Studies
  • Diet / adverse effects*
  • Female
  • Humans
  • Hydrogen-Ion Concentration
  • Logistic Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Nutrition Assessment
  • Nutrition Surveys
  • Odds Ratio
  • Republic of Korea
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Time Factors


  • Acids