ArticleOsteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA2017
Dietary acid load, trabecular bone integrity, and mineral density in an ageing population: the Rotterdam study.
Article in Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers, 2 of them syntheses that pooled it.
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Who cites it
17 citing papers in PubMed, 2 syntheses or guidelines pooled it, 26 citations in OpenAlex.
- Association between dietary acid load and risk of osteoporotic fractures in adults: a systematic review and meta-analysis of observational studies.BMC musculoskeletal disorders · 2025Pooled it
- Dietary Acid Load and Bone Health: A Systematic Review and Meta-Analysis of Observational Studies.Frontiers in nutrition · 2022Pooled it
- Dietary Inflammatory Potential and Bone Outcomes in Midwestern Post-Menopausal Women.Nutrients · 2023Trial
- Dietary acidity and bone mass in minority children and adolescents: a cross-sectional analysis from the MetA-Bone trial.Archives of osteoporosis · 2025Article
- Summatory Effects of Anaerobic Exercise and a 'Westernized Athletic Diet' on Gut Dysbiosis and Chronic Low-Grade Metabolic Acidosis.Microorganisms · 2024Review
- Dietary acid load in health and disease.Pflugers Archiv : European journal of physiology · 2024Review
- The Impact of Plant-Based Diets on Dietary Acid Load Metrics in Venezuela: A Cross-Sectional Study.Nutrients · 2023Article
- Association between Dietary Acid Load and Hyperuricemia in Chinese Adults: Analysis of the China Health and Nutrition Survey (2009).Nutrients · 2023Article
- The association of dietary acid load (DAL) with estimated skeletal muscle mass and bone mineral content: a cross-sectional study.BMC nutrition · 2023Article
- Dietary acid load is associated with primary osteoporosis in postmenopausal women aged 50-65 years: A cross-sectional study.Food science & nutrition · 2023Article
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- Targeting Sirt1, AMPK, Nrf2, CK2, and Soluble Guanylate Cyclase with Nutraceuticals: A Practical Strategy for Preserving Bone Mass.International journal of molecular sciences · 2022Review
- No Interaction Effect between Interleukin-6 Polymorphisms and Acid Ash Diet with Bone Resorption Marker in Postmenopausal Women.International journal of environmental research and public health · 2021Article
- Dietary Acid-Base Balance in High-Performance Athletes.International journal of environmental research and public health · 2020Article
- Dietary acid load and bone turnover during long-duration spaceflight and bed rest.The American journal of clinical nutrition · 2018Article
- The Rotterdam Study: 2018 update on objectives, design and main results.European journal of epidemiology · 2017Article
Corrections and comments
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Authors and funding
7 authors at 2 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
We studied the relation between a diet that is high in acid-forming nutrients (e.g. proteins) and low in base-forming nutrients (e.g. potassium) and bone structure. We showed a negative relation, which was more prominent if proteins were of animal rather than of vegetable origin and if intake of dietary fibre was high.
introductionStudies on dietary acid load (DAL) and fractures have shown inconsistent results. Associations between DAL, bone mineral density (BMD) and trabecular bone integrity might play a role in these inconsistencies and might be influenced by renal function and dietary fibre intake. Therefore, our aim was to study (1) associations of DAL with BMD and with the trabecular bone score (TBS) and (2) the potential influence of renal function and dietary fibre in these associations.
methodsDutch individuals aged 45 years and over (n = 4672) participating in the prospective cohort of the Rotterdam study were included. Based on food frequency questionnaires, three indices of DAL were calculated: the net endogenous acid production (NEAP) and the ratios of vegetable or animal protein and potassium (VegPro/K and AnPro/K). Data on lumbar spinal TBS and BMD were derived from dual-energy X-ray absorptiometry measurements.
resultsIndependent of confounders, NEAP and AnPro/K, but not VegPro/K, were associated with low TBS (standardized β (95%) = -0.04 (-0.07, -0.01) and -0.08 (-0.11, -0.04)) but not with BMD. Associations of AnPro/K and VegPro/K with TBS were non-linear and differently shaped. Unfavourable associations between NEAP, BMD and TBS were mainly present in subgroups with high fibre intake.
conclusionsHigh NEAP was associated with low TBS. Associations of AnPro/K and VegPro/K and TBS were non-linear and differently shaped. No significant associations of DAL with BMD were observed, nor was there any significant interaction between DAL and renal function. Mainly in participants with high intake of dietary fibre, DAL might be detrimental to bone.
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