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Association of dietary acid load with anthropometric indices in children and adolescents

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Abstract

Purpose

High dietary acid load (DAL) may have an influence on anthropometric indices. Given that there was no study on the association between DAL and anthropometric indices children and adolescents, the current study was aimed to examine the association between DAL and anthropometric indices in Iranian children and adolescents.

Methods

Students aged 6–18 years were recruited using a multi-stage, cluster sampling method from 30 provinces of Iran. Dietary intake was assessed through a validated food frequency questionnaire. Height (Ht), weight (Wt), neck circumference (NC), waist circumference (WC), wrist circumference, and hip circumference (HC) were measured. WC-to-HC ratio (WHR), WC-to-Ht ratio (WHtR), body mass index (BMI) z-score, tri-ponderal mass index (TMI), and parental BMI were computed. Potential renal acid load (PRAL) and net endogenous acid production (NEAP) were used to estimate DAL. The association between DAL and anthropometric indices was evaluated using linear regression models.

Results

In total, 5326 students (46.92% girls), with mean (standard deviations (SD)) age of 12.50 (3.14) years participated in the study (response rate: 98.13%). After adjusting for confounders, there was a significant association between NEAP and NC (P < 0.05). Also, an inverse association was observed between PRAL and NEAP with parental BMI (P < 0.05).

Conclusion

Our findings showed a direct association between diet-induced acid load and NC and an inverse association between DAL indices and parental BMI. More well-designed clinical studies are warranted to confirm our results and the underlying mechanisms.

Level of evidence

Level V, cross-sectional descriptive study.

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Data availability

Data supporting our conclusions can be found at the Child Growth and Development Research Center, Isfahan University of Medical Sciences, Isfahan, Iran and Alborz University of Medical Sciences, Karaj, Iran.

Abbreviations

ANOVA:

Analysis of variance

BP:

Blood pressure

BMI:

Body mass index;

CASPIAN-IV:

Childhood and Adolescence Surveillance and PreventIon of Adult Non-communicable disease-IV

DAL:

Dietary acid load

DBP:

Diastolic blood pressure

FFM:

Fat-free mass

FFQ:

Food Frequency Questionnaire

Ht:

Height

HDL-C:

High-density lipoprotein cholesterol

HC:

Hip circumference

HTN:

Hypertension

IQR:

Interquartile range

LDL-C:

Low-density lipoprotein cholesterol

NC:

Neck circumference

NEAP:

Net endogenous acid production

PC:

Personal computer

PCA:

Principle component analysis

PA:

Physical activity

PAQ-A:

Physical Activity Questionnaire for Adolescents

PRAL:

Potential renal acid load

ST:

Screen time

SES:

Socioeconomic status

SBP:

Systolic blood pressure

TC:

Total cholesterol

TG:

Triglyceride

TMI:

Tri-ponderal mass index

WC:

Waist circumference

Wt:

Weight

WHR:

WC-to-HC ratio

WHtR:

WC-to-Ht ratio

WHO-GSHS:

World Health Organization Global School-based Student Health Survey

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Acknowledgements

This large observational study was performed with the cooperation of the Ministry of Health and Medical Education, Ministry of Education and Training, Child Growth and Development Research Center, Isfahan University of Medical Sciences, and Alborz University of Medical Sciences.

Funding

None.

Author information

Author notes

  1. Mostafa Qorbani and Roya Kelishadi have contributed equally to this work.

Authors and Affiliations

  1. Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran

    Zahra Aslani

  2. Students Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran

    Zahra Aslani

  3. Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran

    Maryam Bahreynian, Mohammad Ali Pourmirzaei & Roya Kelishadi

  4. Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran

    Maryam Bahreynian

  5. Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran

    Nazli Namazi

  6. Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC, USA

    Nitin Shivappa & James R. Hébert

  7. Cancer Prevention and Control Program, University of South Carolina, Columbia, SC, USA

    Nitin Shivappa & James R. Hébert

  8. Connecting Health Innovations, LLC, Columbia, SC, USA

    Nitin Shivappa & James R. Hébert

  9. Department of Medical Emergencies, Qom University of Medical Sciences, Qom, Iran

    Hamid Asayesh

  10. Department of Pediatrics, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran

    Mohammad Esmaeil Motlagh

  11. Hematology-Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran

    Amir Kasaeian

  12. Hematologic Malignancies Research Center, Tehran University of Medical Sciences, Tehran, Iran

    Amir Kasaeian

  13. Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran

    Armita Mahdavi-Gorabi

  14. Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran

    Mostafa Qorbani

  15. Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran

    Mostafa Qorbani

Authors
  1. Zahra Aslani
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  2. Maryam Bahreynian
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  3. Nazli Namazi
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Contributions

Conception and design of the study: MQ, RK and MEM. Data collection: AK, HA and AM-G. Analysis and interpretation of data: MQ, ZA, MB and NN. Drafting or revision of the manuscript: ZA, MB, NN, MQ, RK, NS, JR and MEM. Approval of the final version of the manuscript: all authors.

Corresponding author

Correspondence to Mostafa Qorbani.

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Conflict of interest

Authors mention that there is no conflict of interest in this study.

Ethics approval

The study was approved by the ethical committee of Isfahan and Alborz University of Medical Sciences. Participants were thoroughly explained about aims and protocols of the study, and were assured that their responses would remain anonymous and confidential. Participation in the study was voluntary, and participants were aware of their right to withdraw from the study at any time.

Informed consent

Oral assent and written informed consent were obtained (prior to inclusion in the study) from students and one of their parents, respectively.

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Aslani, Z., Bahreynian, M., Namazi, N. et al. Association of dietary acid load with anthropometric indices in children and adolescents. Eat Weight Disord 26, 555–567 (2021). https://doi.org/10.1007/s40519-020-00883-x

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