Association of dietary acid-base load and diabetic sensorimotor polyneuropathy in patients with type 2 diabetes mellitus: A case-control study

Abstract

Objectives: The higher acid-forming potential of a diet, could be associated with diabetes. No study has been done to investigate the association between Dietary Acid Load (DAL) and polyneuropathy in patients with diabetes. This study aimed to examine the linkage between the DAL and Diabetic Sensory-motor Polyneuropathy (DSPN) in a case-control study.

Method: This case-control study was performed at Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, in Kermanshah, Iran between April 2020 and August 2020. A total of 185 subjects with DSPN and 185 sex- and age-matched people in the control group (30-60 years old) participated in this study. Dietary intakes of all people were assessed using a validated food frequency questionnaire. DAL was evaluated through the Potential Renal Acid Load (PRAL) and Net Endogenous Acid Production (NEAP). Toronto clinical neuropathy score was applied to define DSPN. Anthropometrics data, and fasting blood glucose levels were measured.

Results: The Binary logistic regression was used to estimate the Odds Ratios (ORs) and 95% Confidence Intervals (95% CIs) of NEAP and PRAL in relation to DSPN. After adjustment for age, sex, energy people with higher DAL had increased odds for DSPN (OR_PRAL = 3.0; 95%CI: 1.8-5.1; p-trend <0.001 and OR_NEAP = 3.8; 95%CI: 2.2-6.5; p-trend <0.001). Additional adjustment for physical activity, education, smokers, and economic status strengthened the association (OR_PRAL = 3.3; 95%CI:1.9-5.8; p-trend <0.001 and OR_NEAP = 3.7; 95%CI: 2.2-6.5; p-trend<0.001). Finally, after additional adjustment for BMI in the full adjustment model, compared to people in the first tertile of DAL, participants in the third tertile had approximately 3.5 times significant greater odds for DSPN (OR_PRAL = 3.3; 95%CI: 1.9-5.7; p-trend <0.001 and OR_NEAP = 3.6; 95%CI: 2.2-6.2; p-trend<0.001).

Conclusion: Patients with a higher acidic diet had greater odds for DSPN compared to people with lower DAL.

Keywords: Diabetic sensory-motor polyneuropathy; Dietary acid load; Net endogenous acid production; Potential renal acid load.