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Acid Balance, Dietary Acid Load, and Bone Effects—A Controversial Subject
Open AccessFeature PaperArticle

Dietary Acid Load and Mental Health Outcomes in Children and Adolescents: Results from the GINIplus and LISA Birth Cohort Studies

Department of Child and Adolescent Psychiatry, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
Dr. von Hauner Children’s Hospital, University Hospital, LMU of Munich, 80337 Munich, Germany
Institute of Epidemiology, Helmholtz Zentrum München—German Research Centre for Environmental Health, 85764 Neuherberg, Germany
Department of Environmental Immunology/Core Facility Studies, Helmholtz Centre for Environmental Research—UFZ, 04318 Leipzig, Germany
Charitè—Universitätsmedizin Berlin, 10117 Berlin, Germany
Berlin Institute of Health, 10178 Berlin, Germany
Department of Pediatrics, Technical University of Munich, 80804 Munich, Germany
IUF—Leibniz Research Institute for Environmental Medicine, 40225 Düsseldorf, Germany
Research Institute, Department of Pediatrics, Marien-Hospital Wesel, 46483 Wesel, Germany
Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Inner City Clinic, University Hospital of Munich (LMU), 80336 Munich, Germany
Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, VIC 3010, Australia
Author to whom correspondence should be addressed.
These authors contributed equally.
Nutrients 2018, 10(5), 582;
Received: 30 March 2018 / Revised: 29 April 2018 / Accepted: 6 May 2018 / Published: 8 May 2018
(This article belongs to the Special Issue Nutritional Prevention and Acid Base Status)
High dietary acid load may have detrimental effects on mental health during childhood and adolescence. We examined cross-sectional and prospective associations of dietary acid load and mental health problems in a population-based sample, using data from the German birth cohort studies GINIplus (German Infant Nutritional Intervention plus environmental and genetic influences on allergy development) and LISA (Influences of lifestyle-related factors on the immune system and the development of allergies in childhood). These studies included detailed assessments of dietary intake through a food frequency questionnaire (FFQ), mental health outcomes measured through the Strengths and Difficulties Questionnaire (SDQ), and covariates. Using logistic regression, cross-sectional associations between dietary acid load measured as potential renal acid load (PRAL) and SDQ subscales were assessed at age 10 years (N = 2350) and 15 years (N = 2061). Prospective associations were assessed, considering PRAL at 10 years as exposure and SDQ subscales at 15 years as outcome (N = 1685). Results indicate that children with a diet higher in PRAL have more emotional problems (OR = 1.33 (95% CI = 1.15; 1.54); p < 0.001), and show hyperactivity more often (1.22 (1.04; 1.43); p = 0.014) at 10 years. No significant associations were present either cross-sectionally at age 15 years, nor prospectively. Results were confirmed in sensitivity analyses. These findings reveal first evidence for potential relationships between PRAL and mental health in childhood, although we cannot exclude reverse causality, i.e., that dietary behavior and PRAL are influenced by mental status. Future studies should address confirmation and identify biological mechanisms. View Full-Text
Keywords: PRAL; acid base balance; low grade metabolic acidosis; SDQ; emotional problems; hyperactivity PRAL; acid base balance; low grade metabolic acidosis; SDQ; emotional problems; hyperactivity
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Bühlmeier, J.; Harris, C.; Koletzko, S.; Lehmann, I.; Bauer, C.-P.; Schikowski, T.; Von Berg, A.; Berdel, D.; Heinrich, J.; Hebebrand, J.; Föcker, M.; Standl, M.; Libuda, L. Dietary Acid Load and Mental Health Outcomes in Children and Adolescents: Results from the GINIplus and LISA Birth Cohort Studies. Nutrients 2018, 10, 582.

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