Association of dietary acid load with diabetes and glucose metabolism index in Chinese adults: a cross-sectional study

Shengqi Jia; Yuqin Shi; Xiang Ma; Qiuying Chen; Weijia Huang; Yulan Zeng; Ping Wang

doi:10.29219/fnr.v70.13470

Shengqi Jia Department of Respiratory and Critical Care Medicine, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
Yuqin Shi Department of Respiratory and Critical Care Medicine, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
Xiang Ma Department of Endocrinology, Institute of Geriatric Medicine, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
Qiuying Chen Department of Respiratory and Critical Care Medicine, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
Weijia Huang Department of Geriatrics, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
Yulan Zeng Department of Respiratory and Critical Care Medicine, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
Ping Wang Department of Respiratory and Critical Care Medicine, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China

DOI: https://doi.org/10.29219/fnr.v70.13470

Keywords: dietary acid load, diabetes, insulin resistance, China Health and Nutrition Survey (CHNS), National Health and Nutrition Examination Survey (NHANES)

Abstract

Background: Dietary acid load (DAL) has been proven to be associated with hypertension, chronic kidney disease, gout, and the prevalence of type 2 diabetes in several countries. However, its relationship with the prevalence of prediabetes and diabetes in the Chinese population, as well as with fasting blood glucose, fasting insulin levels, and insulin resistance-related indicators, remains unclear.

Method: This is a cross-sectional study based on the China Health and Nutrition Survey (CHNS), which uses Potential Renal Acid Load (PRAL) and Net Endogenous Acid Production (NEAP) to assess DAL. Logistic regression was employed to analyze the relationship between DAL and prediabetes as well as diabetes. Linear regression was used to examine the associations between DAL and fasting blood glucose, fasting insulin levels, estimated glucose disposal rate (eGDR), Homeostasis Model Assessment of Insulin Resistance (HOMA-IR), and the TyG index in the affected population. Restricted cubic spline (RCS) curves were utilized to explore potential nonlinear relationships, and mediation analysis was conducted to investigate the mediating role of insulin resistance in the effects of DAL on fasting blood glucose and insulin. Finally, the findings were validated and compared using data from the National Health and Nutrition Examination Survey (NHANES).

Results: Higher PRAL (odds ratio [OR]: 1.004, 95% confidence interval [CI]: 1.002–1.006) and NEAP (OR: 1.009, 95% CI: 1.005–1.012) were associated with an increased prevalence of diabetes and prediabetes. Elevated levels of PRAL and NEAP were also correlated with higher fasting blood glucose levels and a lower eGDR. Moreover, eGDR played a significant mediating role in the effect of DAL on fasting blood glucose (PRAL: 69.74%, P = 0.048; NEAP: 65.75%, P = 0.004). However, this phenomenon was not significant in the US population, indicating differences between Chinese and American populations.

Conclusion: High DAL is significantly associated with an increased prevalence of diabetes and prediabetes in the Chinese population, and it influences fasting blood glucose levels in affected individuals by reducing the eGDR. These findings highlight the clinical importance of regulating acid-producing diets to help manage blood glucose levels in individuals with diabetes.

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