Osteoporosis International

, Volume 28, Issue 12, pp 3451–3462 | Cite as

Gender-specific association between dietary acid load and total lean body mass and its dependency on protein intake in seniors

  • A. M. Faure
  • K. Fischer
  • B. Dawson-Hughes
  • A. Egli
  • H. A. Bischoff-FerrariEmail author
Original Article



Diet-related mild metabolic acidosis may play a role in the development of sarcopenia. We investigated the relationship between dietary acid load and total lean body mass in male and female seniors age ≥ 60 years. We found that a more alkaline diet was associated with a higher %TLM only among senior women.


The aim of this study was to determine if dietary acid load is associated with total lean body mass in male and female seniors age ≥ 60 years.


We investigated 243 seniors (mean age 70.3 ± 6.3; 53% women) age ≥ 60 years who participated in the baseline assessment of a clinical trial on vitamin D treatment and rehabilitation after unilateral knee replacement due to severe knee osteoarthritis. The potential renal acid load (PRAL) was assessed based on individual nutrient intakes derived from a food frequency questionnaire. Body composition including percentage of total lean body mass (%TLM) was determined using dual-energy X-ray absorptiometry. Cross-sectional analyses were performed for men and women separately using multivariable regression models controlling for age, physical activity, smoking status, protein intake (g/kg BW per day), energy intake (kcal), and serum 25-hydroxyvitamin D concentration. We included a pre-defined subgroup analysis by protein intake (< 1 g/kg BW day, > 1 g/kg BW day) and by age group (< 70 years, ≥ 70 years).


Adjusted %TLM decreased significantly across PRAL quartiles only among women (P trend = 0.004). Moreover, in subgroup analysis, the negative association between the PRAL and %TLM was most pronounced among women with low protein intake (< 1 g/kg BW per day) and age below 70 years (P = 0.002). Among men, there was no association between the PRAL and %TLM.


The association between dietary acid load and %TLM seems to be gender-specific, with a negative impact on total lean mass only among senior women. Therefore, an alkaline diet may be beneficial for preserving total lean mass in senior women, especially in those with low protein intake.


Lean body mass Mild metabolic acidosis Potential renal acid load Protein Sarcopenia 



This project was funded by a Swiss National Foundation Professorship (Swiss National Foundations Professorship Grant PP00B-114864) and the Baugarten Foundation Centre Grant.

Compliance with ethical standards

Conflict of interest


Supplementary material

198_2017_4220_Fig3_ESM.gif (21 kb)
Supplemental Fig. 1

PRAL and nutrients contributing to the PRAL by gender. Pearson correlation coefficients relating nutrients to PRAL among men and women. *, P < 0.05; **, P < 0.01; ***, P < 0.001. PRAL, potential renal acid load. (GIF 20 kb)

198_2017_4220_MOESM1_ESM.tif (55 kb)
High Resolution Image (TIFF 54 kb)


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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2017

Authors and Affiliations

  • A. M. Faure
    • 1
    • 2
  • K. Fischer
    • 1
    • 2
  • B. Dawson-Hughes
    • 3
  • A. Egli
    • 1
    • 2
  • H. A. Bischoff-Ferrari
    • 1
    • 2
    • 4
    Email author
  1. 1.Centre on Aging and MobilityUniversity Hospital Zurich and City Hospital WaidZurichSwitzerland
  2. 2.Department of Geriatrics and Aging ResearchUniversity Hospital Zurich and University of ZurichZurichSwitzerland
  3. 3.Jean Mayer USDA Human Nutrition Research Center on AgingTufts UniversityBostonUSA
  4. 4.University Clinic for Acute Geriatric Care, Waid City HospitalZurichSwitzerland

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