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Estimates of renal net acid excretion and their relationships with serum uric acid and hyperuricemia in a representative German population sample

European Journal of Clinical Nutrition volume 74, pages 63–68 (2020)Cite this article

Abstract

Background/Objective

Preliminary interventional data suggest that a reduction of dietary acid load raises renal uric acid excretion and decreases serum uric acid (SUA). In line with this, in a recent cross-sectional analysis of a representative adult population sample, a higher potential renal acid load (PRAL) was found to associate with higher SUA levels. Against this background, we re-examined the relationship of the body’s acid load with SUA and hyperuricemia using nutrition-derived estimates of renal net acid excretion (NAE).

Subjects/Methods

Cross-sectional analyses were performed in n = 6894 participants (18–79 y) of the German Health Interview and Examination Survey for Adults (DEGS1). Two different approaches were used to estimate NAE, one based on the sum of food frequency questionnaire (FFQ)-derived PRAL and body-surface area-derived organic acids (eNAEPRAL+OA) and the other based on FFQ-derived protein and potassium intake ratios (eNAEProt/K). The associations of eNAEPRAL+OA and eNAEProt/K with SUA were analyzed in multiple linear regression models. Multiple logistic regressions were used to calculate odds ratios (OR) for hyperuricemia comparing higher (T3) and lower (T1) tertiles of the NAE estimates.

Results

After adjusting for relevant confounders, eNAEPRAL+OA (p = 0.0048) and eNAEProt/K (p = 0.0023) were positively associated with SUA. In addition, participants with a higher eNAEPRAL+OA or eNAEProt/K had higher ORs for having hyperuricemia (OR: 1.73, 95% CI: 1.24–2.40, OR: 1.51, 95% CI: 1.10–2.08, respectively).

Conclusion

The results substantiate findings of a previous analysis that dietary acid load is a potential influencing factor on SUA. This implicates that a lower dietary acid load may have beneficial effects on SUA.

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Fig. 1: Multivariable odds ratios (95% CI) for hyperuricemia (yes/no) comparing high [T3] vs. low [T1] tertiles of eNAEPRAL+OA and eNAEProt/K in the total (n = 6894) and a reduced DEGS1 study sample (n = 5531).

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Funding

The present analysis was financially supported by grant of the German Federal Ministry of Food and Agriculture (BMEL) through the Federal Office for Agriculture and Food (BLE), grant number 2815HS006. DEGS1 is primarily funded by the German Ministry of Health. This article is published as part of a supplement sponsored by NuOmix-Research k.s. The conference was financially supported by Protina Pharmazeutische GmbH, Germany and Sirius Pharma, Germany, and organized by NuOmix-Research k.s. Neither company had any role in writing of the manuscript.

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Authors and Affiliations

  1. DONALD Study Center Dortmund, IEL - Nutritional Epidemiology, University of Bonn, Dortmund, Germany

    Jonas Esche, Danika Krupp & Thomas Remer

  2. Department of Epidemiology and Health Monitoring, Robert Koch-Institute, Berlin, Germany

    Gert BM Mensink

Authors
  1. Jonas Esche
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  2. Danika Krupp
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  3. Gert BM Mensink
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  4. Thomas Remer
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Contributions

TR, DK, and JE designed the research and were responsible for the project conception. JE was responsible for statistical analyses and interpretation of the results. JE drafted the manuscript, together with TR. TR (principal investigator) was responsible for conceiving the project and realizing it. GM took responsibility for the dietary assessment and the validation of the FFQ. All authors read and approved the final version of the manuscript.

Corresponding author

Correspondence to Thomas Remer.

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Conflict of interest

JE received consulting fees from Nutricia North America, Inc. The remaining authors declare that they have no conflict of interest.

Ethics

DEGS1 was approved by the ethical committee of Charité University Medicine, Berlin (No. EA2/047/08), and by the Federal and State Commissioners for Data Protection. Informed written consent was obtained from all participants [5]. DEGS1 is a nationally representative survey and part of the German health monitoring system at the RKI, Berlin. DEGS1 data are available for public use and have been requested from the RKI for this analysis.

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Esche, J., Krupp, D., Mensink, G.B. et al. Estimates of renal net acid excretion and their relationships with serum uric acid and hyperuricemia in a representative German population sample. Eur J Clin Nutr 74 (Suppl 1), 63–68 (2020). https://doi.org/10.1038/s41430-020-0688-2

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