Diet-Dependent Net Endogenous Acid Load of Vegan Diets in Relation to Food Groups and Bone Health-Related Nutrients: Results from the German Vegan StudyStröhle A.a · Waldmann A.b · Koschizke J.a · Leitzmann C.c · Hahn A.a
aNutrition Physiology and Human Nutrition Unit, Institute of Food Science and Human Nutrition, Leibniz University of Hannover, Hannover, bInstitute of Clinical Epidemiology, UKSH Campus Lübeck, Lübeck, and cInstitute of Nutrition Science, Justus Liebig University Giessen, Giessen, Germany
Do you have an account?
- Rent for 48h to view
- Buy Cloud Access for unlimited viewing via different devices
- Synchronizing in the ReadCube Cloud
- Printing and saving restrictions apply
Rental: USD 8.50
Cloud: USD 20.00
Article / Publication Details
Background/Aims:Dietary composition has been shown to affect acid-base homeostasis and bone health in humans. We investigated the potential renal acid load (PRAL) and the estimated diet-dependent net acid load (net endogenous acid production, NEAP) in adult vegans and evaluated the relationships between NEAP, food groups and intake of bone health-related nutrients. Methods: The German Vegan Study (GVS) is a cross-sectional study. Data from healthy men (n = 67) and women (n = 87), aged 21–75 years, who fulfilled the study criteria (vegan diet for ≧1 year prior to study start; age ≧18 years, and no pregnancy/childbirth during the last 12 months) were included in the analysis. NEAP values were calculated from diet composition using two models: one based on the protein/potassium quotient and another taking into account an anthropometry-based loss of urinary organic anions. Results:Mean daily intakes of phosphorus, potassium, sodium, magnesium and vitamin C were above, and vitamin D and calcium below Dietary Reference Intake (DRI). Regardless of the model used, the diet in the GVS was characterized by a nearly neutral NEAP. A strong correlation was observed between the NEAP values of the two models (rs = 0.873, p < 0.001). Only the consumption of fruits decreased constantly across the increasing quartiles of NEAP. Conclusions: It can be hypothesized that vegan diets do not affect acid-base homeostasis. With respect to bone health, the significance of this finding needs further investigation.
© 2011 S. Karger AG, Basel
Sherman HC, Gettler AO: The balance of acid-forming and base-forming elements in foods, and its relation to ammonia metabolism. J Biol Chem 1912;11:323–338.
- Blatherwick NR: The specific role of foods in relation to the composition of the urine. Arch Intern Med 1914;14:409–450.
- Frassetto LA, Todd KM, Morris RC Jr, et al: Estimation of net endogenous noncarbonic acid production in humans from diet potassium and protein contents. Am J Clin Nutr 1998;68:576–583.
- Remer T, Manz F: Potential renal acid load of foods and its influence on urine pH. J Am Diet Assoc 1995;95:791–797.
- Remer T, Manz F: Estimation of the renal net acid excretion by adults consuming diets containing variable amounts of protein. Am J Clin Nutr 1994;59:1356–1361.
Sebastian A, Frassetto LA, Morris RC Jr: The acid-base effects of the contemporary Western diet: an evolutionary perspective; in Alpern RJ, Hebert SC (eds): The Kidney: Physiology and Pathophysiology. Amsterdam, Elsevier, 2007, pp 1621–1644.
- Wynn E, Lanham-New SA, Krieg MA, et al: Low estimates of dietary acid load are positively associated with bone ultrasound in women older than 75 years of age with a lifetime fracture. J Nutr 2008;138:1349–1354.
- Welch AA, Bingham SA, Reeve J, et al: More acidic dietary acid-base load is associated with reduced calcaneal broadband ultrasound attenuation in women but not in men: results from the EPIC-Norfolk cohort study. Am J Clin Nutr 2007;85:1134–1141.
- Alexy U, Remer T, Manz F, et al: Long-term protein intake and dietary potential renal acid load are associated with bone modeling and remodeling at the proximal radius in healthy children. Am J Clin Nutr 2005;82:1107–1114.
- Macdonald HM, New SA, Fraser WD, et al: Low dietary potassium intakes and high dietary estimates of net endogenous acid production are associated with low bone mineral density in premenopausal women and increased markers of bone resorption in postmenopausal women. Am J Clin Nutr 2005;81:923–933.
- Meghji S, Morrison MS, Henderson B, et al: pH dependence of bone resorption: mouse calvarial osteoclasts are activated by acidosis. Am J Physiol Endocrinol Metab 2001;280:E112–E119.
- Arnett TR, Spowage M: Modulation of the resorptive activity of rat osteoclasts by small changes in extracellular pH near the physiological range. Bone 1996;18:277–279.
- New SA, MacDonald HM, Campbell MK, et al: Lower estimates of net endogenous non-carbonic acid production are positively associated with indexes of bone health in premenopausal and perimenopausal women. Am J Clin Nutr 2004;79:131–138.
- Fenton TR, Eliasziw M, Lyon AW, et al: Meta-analysis of the quantity of calcium excretion associated with the net acid excretion of the modern diet under the acid-ash diet hypothesis. Am J Clin Nutr 2008;88:1159–1166.
- New SA: Intake of fruit and vegetables: implications for bone health. Proc Nutr Soc 2003;62:889–899.
- Wynn E, Krieg MA, Aeschlimann JM, et al: Alkaline mineral water lowers bone resorption even in calcium sufficiency: alkaline mineral water and bone metabolism. Bone 2009;44:120–124.
- Sebastian A, Harris ST, Ottaway JH, et al: Improved mineral balance and skeletal metabolism in postmenopausal women treated with potassium bicarbonate. N Engl J Med 1994;330:1776–1781.
- Marangella M, Di Stefano M, Casalis S, et al: Effects of potassium citrate supplementation on bone metabolism. Calcif Tissue Int 2004;74:330–335.
Haddad EH, Tanzman JS: What do vegetarians in the United States eat? Am J Clin Nutr 2003;78(suppl 3):626S–632S.
- Waldmann A, Koschizke JW, Leitzmann C, et al: Dietary intakes and lifestyle factors of a vegan population in Germany: results from the German Vegan Study. Eur J Clin Nutr 2003;57:947–955.
- Waldmann A, Ströhle A, Koschizke JW, et al: Overall glycemic index and glycemic load of vegan diets in relation to plasma lipoproteins and triacylglycerols. Ann Nutr Metab 2007;51:335–344.
- Ho-Pham LT, Nguyen PL, Le TT, et al: Veganism, bone mineral density, and body composition: a study in Buddhist nuns. Osteoporos Int 2009;20:2087–2093.
- New SA: Do vegetarians have a normal bone mass? Osteoporos Int 2004;15:679–688.
- Sanders TA: DHA status of vegetarians. Prostaglandins Leukot Essent Fatty Acids 2009;81:137–141.
- Elmadfa I, Singer I: Vitamin B-12 and homocysteine status among vegetarians: a global perspective. Am J Clin Nutr 2009;89:1693S–1698S.
- Tonstad S, Butler T, Yan R, et al: Type of vegetarian diet, body weight, and prevalence of type 2 diabetes. Diabetes Care 2009;32:791–796.
- Chan J, Jaceldo-Siegl K, Fraser GE: Serum 25-hydroxyvitamin D status of vegetarians, partial vegetarians, and nonvegetarians: the Adventist Health Study-2. Am J Clin Nutr 2009;89:1686S–1692S.
- Robinson-O’Brien R, Perry CL, Wall MM, et al: Adolescent and young adult vegetarianism: better dietary intake and weight outcomes but increased risk of disordered eating behaviors. J Am Diet Assoc 2009;109:648–655.
- Fraser GE: Vegetarian diets: what do we know of their effects on common chronic diseases? Am J Clin Nutr 2009;89:1607S–1612S.
- Yen CE, Yen CH, Huang MC, et al: Dietary intake and nutritional status of vegetarian and omnivorous preschool children and their parents in Taiwan. Nutr Res 2008;28:430–436.
- de Bortoli MC, Cozzolino SM: Zinc and selenium nutritional status in vegetarians. Biol Trace Elem Res 2009;127:228–233.
- Karlic H, Schuster D, Varga F, et al: Vegetarian diet affects genes of oxidative metabolism and collagen synthesis. Ann Nutr Metab 2008;53:29–32.
- Nakamoto K, Watanabe S, Kudo H, et al: Nutritional characteristics of middle-aged Japanese vegetarians. J Atheroscler Thromb 2008;15:122–129.
- Ströhle A, Waldmann A, Wolters M, et al: Vegetarian nutrition: preventive potential and possible risks. Part 1. Plant foods. Wien Klin Wochenschr 2006;118:580–593.
- Ströhle A, Waldmann A, Wolters M, et al: Vegetarian nutrition: preventive potential and possible risks. Part 2. Animal foods and recommendations. Wien Klin Wochenschr 2006;118:728–737.
- Waldmann A, Dörr B, Koschizke JW, et al: Dietary intake of vitamin B6 and concentration of vitamin B6 in blood samples of German vegans. Public Health Nutr 2006;9:779–784.
- Waldmann A, Koschizke JW, Leitzmann C, et al: German Vegan Study: diet, life-style factors, and cardiovascular risk profile. Ann Nutr Metab 2005;49:366–372.
- Waldmann A, Koschizke JW, Leitzmann C, et al: Dietary intakes and blood concentrations of antioxidant vitamins in German vegans. Int J Vitam Nutr Res 2005;75:28–36.
- Waldmann A, Koschizke JW, Leitzmann C, et al: Homocysteine and cobalamin status in German vegans. Public Health Nutr 2004;7:467–472.
- Waldmann A, Koschizke JW, Leitzmann C, et al: Dietary iron intake and iron status of German female vegans: results of the German Vegan Study. Ann Nutr Metab 2004;48:103–108.
- Krajcovicová-Kudlácková M, Bucková K, Klimes I, et al: Iodine deficiency in vegetarians and vegans. Ann Nutr Metab 2003;47:183–185.
- Ausman LM, Oliver LM, Goldin BR, et al: Estimated net acid excretion inversely correlates with urine pH in vegans, lacto-ovo vegetarians, and omnivores. J Ren Nutr 2008;18:456–465.
- Prynne CJ, Ginty F, Paul AA, et al: Dietary acid-base balance and intake of bone-related nutrients in Cambridge teenagers. Eur J Clin Nutr 2004;58:1462–1471.
- Chan RS, Woo J, Chan DC, et al: Estimated net endogenous acid production and intake of bone health-related nutrients in Hong Kong Chinese adolescents. Eur J Clin Nutr 2009;63:505–512.
- Koebnick C, Strassner C, Hoffmann I, et al: Consequences of a long-term raw food diet on body weight and menstruation: results of a questionnaire survey. Ann Nutr Metab 1999;43:69–79.
- Frassetto LA, Lanham-New SA, Macdonald HM, et al: Standardizing terminology for estimating the diet-dependent net acid load to the metabolic system. J Nutr 2007;137:1491–1492.
- Remer T, Dimitriou T, Manz F: Dietary potential renal acid load and renal net acid excretion in healthy, free-living children and adolescents. Am J Clin Nutr 2003;77:1255–1260.
- Alexy U, Kersting M, Remer T: Potential renal acid load in the diet of children and adolescents: impact of food groups, age and time trends. Public Health Nutr 2008;11:300–306.
- Berkemeyer S, Remer T: Anthropometrics provide a better estimate of urinary organic acid anion excretion than a dietary mineral intake-based estimate in children, adolescents, and young adults. J Nutr 2006;136:1203–1208.
- Gannon RH, Millward DJ, Brown JE, et al: Estimates of daily net endogenous acid production in the elderly UK population: analysis of the National Diet and Nutrition Survey (NDNS) of British adults aged 65 years and over. Br J Nutr 2008;100:615–623.
Deutsche Gesellschaft für Ernährung, Österreichische Gesellschaft für Ernährung, Schweizer Gesellschaft für Ernährungsforschung, Schweizerische Vereinigung für Ernährung. Referenzwerte für die Nährstoffzufuhr. Frankfurt, Umschau/Braus, 2000.
- Vormann J, Daniel H: The role of nutrition in human acid-base homeostasis. Eur J Nutr 2001;40:187–188.
- Ströhle A, Hahn A, Sebastian A: Estimation of the diet-dependent net acid load in 229 worldwide historically studied hunter-gatherer societies. Am J Clin Nutr 2010;91:406–412.
- Rylander R, Remer T, Berkemeyer S, et al: Acid-base status affects renal magnesium losses in healthy, elderly persons. J Nutr 2006;136:2374–2377.
- Lanham-New SA: Is ‘vegetarianism’ a serious risk factor for osteoporotic fracture? Am J Clin Nutr 2009;90:910–911.
- Outila TA, Kärkkäinen MU, Seppänen RH, et al: Dietary intake of vitamin D in premenopausal, healthy vegans was insufficient to maintain concentrations of serum 25-hydroxyvitamin D and intact parathyroid hormone within normal ranges during the winter in Finland. J Am Diet Assoc 2000;100:434–441.
- Aloia JF, Patel M, Dimaano R, et al: Vitamin D intake to attain a desired serum 25-hydroxyvitamin D concentration. Am J Clin Nutr 2008;87:1952–1958.
- Cashman KD, Hill TR, Lucey AJ, et al: Estimation of the dietary requirement for vitamin D in healthy adults. Am J Clin Nutr 2008;88:1535–1542.
- Nettekoven S, Ströhle A, Trunz B, et al: Effects of antiepileptic drug therapy on vitamin D status and biochemical markers of bone turnover in children with epilepsy. Eur J Pediatr 2008;167:1369–1377.
- Holick MF: Vitamin D deficiency. N Engl J Med 2007;357:266–281.
- Craig WJ, Mangels AR, American Dietetic Association: Position of the American Dietetic Association: vegetarian diets. J Am Diet Assoc 2009;109:1266–1282.
- Bischoff-Ferrari HA, Shao A, Dawson-Hughes B, et al: Benefit-risk assessment of vitamin D supplementation. Osteoporos Int 2010;21:1121–1132.
- Davey GK, Spencer EA, Appleby PN, et al: EPIC-Oxford: lifestyle characteristics and nutrient intakes in a cohort of 33 883 meat-eaters and 31 546 non meat-eaters in the UK. Public Health Nutr 2003;6:259–269.
- Bischoff-Ferrari HA, Dawson-Hughes B, Baron JA, et al: Calcium intake and hip fracture risk in men and women: a meta-analysis of prospective cohort studies and randomized controlled trials. Am J Clin Nutr 2007;86:1780–1790.
- Xu L, McElduff P, D’Este C, et al: Does dietary calcium have a protective effect on bone fractures in women? A meta-analysis of observational studies. Br J Nutr 2004;91:625–634.
- Fenton TR, Lyon AW, Eliasziw M, et al: Phosphate decreases urine calcium and increases calcium balance: a meta-analysis of the osteoporosis acid-ash diet hypothesis. Nutr J 2009;8:41.
- Byers T: Food frequency dietary assessment: how bad is good enough? Am J Epidemiol 2001;154:1087–1088.
- Kristal AR, Peters U, Potter JD: Is it time to abandon the food frequency questionnaire? Cancer Epidemiol Biomarkers Prev 2005;14:2826–2828.
- Kelemen LE: Food frequency questionnaires: not irrelevant yet. Cancer Epidemiol Biomarkers Prev 2006;15:1054.
- Willett WC, Hu FB: Not the time to abandon the food frequency questionnaire: point. Cancer Epidemiol Biomarkers Prev 2006;15:1757–1758.
Article / Publication Details
Copyright / Drug Dosage / DisclaimerCopyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.