Higher Dietary Acid Load Might Be a Potent Derivative Factor for Multiple Sclerosis: The Results from a Case–Control Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Ethical Considerations
2.2. Study Participants
2.3. Demographic and Anthropometric Data
2.4. Dietary Assessments
2.5. Dietary Acid Load
2.6. Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Variables 2 | Healthy Controls (n = 130) | Patients with Multiple Sclerosis (n = 109) | p-Value |
---|---|---|---|
Age (years) | 35 (29, 42) | 33 (29, 38) | 0.040 |
Sex, female, frequency (percentages) | 92 (70.8) | 84 (77.1) | 0.271 |
Body mass index, Kg/m2, Mean (SD) | 26.92 ± 3.52 | 25.18 ± 3.86 | <0.001 |
Total calorie intake (Kcal/day) | 2303.04 (1857.29, 2663.53) | 2542.49 (2143.03, 3109.57) | <0.001 |
Protein (gr/day) | 82.14 ± 25.33 | 85.65 ± 26.59 | 0.298 |
Carbohydrates (gr/day) | 289.49 (225.25, 350.44) | 331.06 (281.07, 426.16) | <0.001 |
Fat (gr/day) | 88.53 (72.64, 112.04) | 100.07 (83.44, 128.11) | 0.002 |
Cholesterol (mg/day) | 270.78 (202.89, 377.31) | 319.59 (243.18, 397.73) | 0.055 |
Saturated fatty acids (gr/day) | 30.08 (23.63, 36.64) | 35.89 (27.12, 48.39) | <0.001 |
Sodium (mg/day) | 3468.27 (2724.48, 4414.04) | 7764.76 (5058.46, 9057.54) | <0.001 |
Fiber (gr/day) | 23.18 (19.10, 31.23) | 19.61 (15.80, 26.79) | 0.001 |
Trans fatty acids (gr/day) | 2.31 (1.45, 7.68) | 2.94 (1.93, 5.23) | 0.555 |
Poly unsaturated fatty acids (gr/day) | 28.38 (22.13, 35.71) | 27.55 (22.62, 32.83) | 0.227 |
Iron (mg/day) | 17.02 (13.35, 22.20) | 15.71 (12.86, 19.13) | 0.053 |
Calcium (mg/day) | 1002.45 ± 380.51 | 952.22 ± 330.81 | 0.282 |
Folate (mcg/day) | 416.04 (327.31, 531.16) | 300.90 (242.53, 361.99) | <0.001 |
Sugar (gr/day) | 83.06 (65.56, 110.00) | 105.98 (80.30, 140.59) | <0.001 |
Glucose (gr/day) | 10.95 (7.91, 16.16) | 19.02 (12.35, 29.14) | <0.001 |
Vitamin A (RAE/day) | 1287.93 (915.67, 2212.71) | 879.30 (625.63, 1301.77) | <0.001 |
Vitamin D (mcg/day) | 1.12 (0.40, 2.27) | 1.05 (0.40, 1.63) | 0.346 |
Vitamin C (mg/day) | 141.89 (97.06, 202.01) | 117.90 (88.96, 162.63) | 0.034 |
Vitamin E (mg/day) | 3.92 (3.02, 5.60) | 5.02 (3.88, 6.21) | <0.001 |
Beta carotene (mg/day) | 649.17 (368.51, 1325.09) | 250.40 (127.84, 403.39) | <0.001 |
Mono unsaturated fatty acids (gr/day) | 32.84 (26.11, 40.35) | 39.48 (31.24, 49.20) | <0.001 |
Phosphorus (mg/day) | 1201.42 (912.80, 1567.49) | 1101.12 (901.42, 1362.15) | 0.028 |
Magnesium (mg/day) | 298.85 (233.58, 376.01) | 233.17 (198.20, 274.09) | <0.001 |
Potassium (mg/day) | 3770.32 (2956.91, 4581.18) | 2976.51 (2500.05, 3593.60) | <0.001 |
Zinc (mg/day) | 9.99 (7.68, 12.17) | 9.82(7.90, 11.92) | 0.885 |
Copper (mg/day) | 1.63 (1.13, 2.36) | 1.38 (1.08, 1.81) | 0.025 |
Manganese (mg/day) | 3.52 (2.84, 4.48) | 2.66 (2.17, 3.43) | <0.001 |
Selenium (µmol/day) | 0.58 (0.34, 1.09) | 1.12 (0.63, 1.19) | <0.001 |
Vitamin B1 (mg/day) | 10.29 (8.14, 13.25) | 8.74 (6.91, 11.01) | <0.001 |
Vitamin B2 (mg/day) | 1.72 (1.31, 2.18) | 1.54 (1.27, 1.82) | 0.015 |
Vitamin B3 (mg/day) | 1.61 (1.09, 2.06) | 1.46 (1.12, 1.81) | 0.111 |
Vitamin B6 (mg/day) | 18.82 (14.03, 23.65) | 20.65 (16.73, 25.70) | 0.016 |
Vitamin B12 (mcg/day) | 1.32 (1.03, 1.79) | 1.19 (1.00, 1.52) | 0.027 |
Vitamin B5 (mg/day) | 5.28 (3.42, 7.61) | 5.81 (3.87, 9.03) | 0.152 |
Vitamin B8 (mcg/day) | 5.50 (4.13, 6.94) | 4.82 (4.10, 5.60) | 0.004 |
Vitamin K (mcg/day) | 21.05 (16.53, 28.10) | 20.01 (16.28, 25.93) | 0.271 |
Caffeine (mg/day) | 173.64 (101.00, 252.93) | 55.71 (42.25, 82.16) | <0.001 |
PRAL | −13.62 (−25.37, −4.60) | −0.01 (−14.92, 9.29) | <0.001 |
NEAP | 35.59 (30.23, 42.73) | 48.09 (37.16, 63.15) | <0.001 |
Protein/potassium | 0.021 (0.019, 0.024) | 0.027 (0.022, 0.034) | <0.001 |
Tertiles of PRAL | T1 (n = 57; Cases = 14) | T2 (n = 68; Cases = 24) | T3 (n = 114; Cases = 71) | p-Value |
---|---|---|---|---|
Age (years) | 35 (29.5, 42) | 35 (29, 43.75) | 32 (29, 39) | 0.102 |
Body mass index | 27.83 (24.79, 30.49) | 26.52 (23.03, 29.61) | 24.68 (22.84, 27.36) | <0.001 |
Total calorie intake (Kcal/day) | 2455.61 (1923.21, 2764.37) | 2179.55 (1787.31, 2649.86) | 2489.45 (2115.30, 3064.67) | 0.009 |
Protein (gr/day) | 84.48 (65.51, 100.43) | 71.81 (57.18, 89.03) | 90.69 (72.08, 106.32) | <0.001 |
Carbohydrates (gr/day) | 334.05 (234.74, 413.91) | 298.32 (232.52, 361.86) | 317.73 (256.07, 395.17) | 0.283 |
Fat (gr/day) | 90.87 (74.19, 108.71) | 88.45 (71.73, 106.73) | 103.95 (81.39, 126.31) | 0.002 |
Cholesterol (mg/day) | 253.75 (195.76, 361.65) | 270.84 (196.16, 354.20) | 322.65 (249.41, 425.16) | 0.002 |
Saturated fatty acids (gr/day) | 29.27 (23.45, 34.97) | 28.92 (22.72, 36.70) | 36.67 (27.43, 44.75) | <0.001 |
Sodium (mg/day) | 4404.13 (3018.33, 6912.04) | 4291.07 (3387.02, 7211.30) | 5187.42 (3361.90, 8632.02) | 0.126 |
Fiber (gr/day) | 31.44 (25.64, 38.09) | 21.71 (18.87, 26.45) | 18.70 (15.03, 23.16) | <0.001 |
Trans fatty acids (gr/day) | 2.05 (1.33, 5.49) | 2.31 (1.34, 6.14) | 3.36 (1.96, 6.82) | 0.026 |
Poly unsaturated fatty acids (gr/day) | 29.61 (22.26, 36.67) | 28.51 (20.49, 33.25) | 27.77 (23.34, 33.67) | 0.517 |
Iron (mg/day) | 19.08 (13.89, 23.93) | 14.96 (12.22, 18.86) | 16.00 (12.98, 19.98) | 0.060 |
Calcium (mg/day) | 1129.71 (932.33, 1386.36) | 854.27 (714.04, 1032.45) | 956.18 (712.14, 1165.62) | <0.001 |
Folate (mcg/day) | 448.29 (376.26, 595.81) | 353.07 (294.81, 411.45) | 305.94 (234.99, 385.30) | <0.001 |
Sugar (gr/day) | 110.89 (85.48, 143.11) | 83.61 (69.34, 122.10) | 91.28 (67.52, 111.28) | 0.003 |
Glucose (gr/day) | 16.13 (11.82, 25.24) | 12.21 (8.72, 20.43) | 14.41 (9.27, 23.50) | 0.085 |
Vitamin A (RAE/day) | 1691.52 (1132.61, 2498.88) | 1039.54 (745.08, 1617.16) | 943.72 (600.93, 1334.02) | <0.001 |
Vitamin D (mcg/day) | 1.65 (0.67, 2.40) | 0.75 (0.36, 1.36) | 0.95 (0.40, 1.71) | 0.001 |
Vitamin C (mg/day) | 214.97 (169.30, 263.73) | 144.07 (109.42, 176.59) | 101.28 (74.09, 130.19) | <0.001 |
Vitamin E (mg/day) | 5.10 (3.62, 6.43) | 3.83 (3.06, 5.68) | 4.51 (3.65, 5.59) | 0.008 |
Beta carotene (mg/day) | 967.67 (451.67, 1637.04) | 466.47 (308.46, 726.69) | 270.82 (130.35, 497.51) | <0.001 |
Mono unsaturated fatty acids (gr/day) | 34.77 (26.96, 41.78) | 35.60 (25.38, 41.59) | 38.38 (30.06, 47.03) | 0.019 |
Phosphorus (mg/day) | 1397.21 (1024.42, 1646.48) | 981.50 (846.87, 1215.95) | 1161.92 (897.13, 1460.60) | <0.001 |
Magnesium (mg/day) | 358.06 (291.29, 434.20) | 248.59 (206.39, 298.06) | 234.08 (192.43, 296.33) | <0.001 |
Potassium (mg/day) | 4828.35 (3851.84, 5584.11) | 3199.99 (2780.45, 3915.69) | 2922.91 (2371.45, 3606.47) | <0.001 |
Zinc (mg/day) | 10.62 (8.70, 12.44) | 8.44 (7.14, 10.37) | 10.68 (8.05, 12.85) | 0.001 |
Copper (mg/day) | 1.78 (1.35, 2.67) | 1.30 (1.03, 1.80) | 1.42 (1.08, 1.96) | <0.001 |
Manganese (mg/day) | 3.95 (3.12, 4.92) | 3.13 (2.40, 3.64) | 2.91 (2.13, 3.56) | <0.001 |
Selenium (µmol/day) | 1.08 (0.37, 1.14) | 0.67 (0.36, 1.14) | 0.69 (0.49, 1.14) | 0.664 |
Vitamin B1 (mg/day) | 1.74 (1.38, 2.21) | 1.53 (1.23, 1.90) | 1.59 (1.29, 2.02) | 0.084 |
Vitamin B2 (mg/day) | 1.83 (1.33, 2.20) | 1.28 (1.03, 1.69) | 1.53 (1.15, 1.98) | 0.001 |
Vitamin B3 (mg/day) | 18.71 (14.54, 23.49) | 17.55 (13.43, 22.75) | 21.39 (17.31, 26.12) | <0.001 |
Vitamin B6 (mg/day) | 1.63 (1.29, 1.99) | 1.20 (1.00, 1.62) | 1.15 (0.94, 1.41) | <0.001 |
Vitamin B12 (mcg/day) | 4.63 (2.90, 7.16) | 4.11 (3.20, 6.00) | 6.26 (4.67, 9.40) | <0.001 |
Vitamin B5 (mg/day) | 6.25 (4.99, 7.21) | 4.59 (3.87, 5.77) | 5.06 (4.09, 5.97) | <0.001 |
Vitamin B8 (mcg/day) | 24.56 (19.77, 33.70) | 18.08 (15.12, 23.65) | 20.64 (16.46, 25.43) | <0.001 |
Vitamin K (mcg/day) | 233.58 (114.81, 315.09) | 118.22 (71.45, 166.93) | 60.84 (44.64, 94.09) | <0.001 |
Caffeine (mg/day) | 148.11 (98.80, 251.17) | 126.20 (82.35, 199.95) | 105.22 (62.22, 160.64) | 0.011 |
Tertiles of NEAP | T1 (n = 58; Cases = 15) | T2 (n = 64; Cases = 20) | T3 (n = 117; Cases = 74) | p-Value |
---|---|---|---|---|
Age (years) | 35.5 (28, 42) | 34.5 (29, 43.75) | 32 (29, 38.5) | 0.165 |
Body mass index | 27.83 (25.37, 30.81) | 25.55 (22.95, 29.19) | 24.84 (23.03, 27.62) | 0.001 |
Total calorie intake (Kcal/day) | 2151.90 (1704.43, 2662.15) | 2351.30 (1908.86, 2741.66) | 2501.55 (2184.21, 3062.24) | 0.001 |
Protein (gr/day) | 70.66 (54.13, 89.85) | 74.88 (58.50, 98.22) | 90.82 (74.10, 106.63) | <0.001 |
Carbohydrates (gr/day) | 290.18 (223.21, 367.43) | 309.01 (249.65, 374.67) | 324.74 (261.85, 402.44) | 0.082 |
Fat (gr/day) | 83.20 (67.58, 107.73) | 86.68 (74.19, 113.26) | 101.76 (86.07, 126.64) | <0.001 |
Cholesterol (mg/day) | 235.58 (173.85, 319.09) | 269.32 (205.38, 368.94) | 333.99 (255.98, 425.46) | <0.001 |
Saturated fatty acids (gr/day) | 27.42 (21.21, 33.39) | 30.03 (23.73, 38.38) | 35.76 (28.62, 44.97) | <0.001 |
Sodium (mg/day) | 4293.05 (2913.74, 6711.94) | 4238.50 (3424.67, 6948.42) | 5639.32 (3575.15, 8714.47) | 0.006 |
Fiber (gr/day) | 28.38 (20.44, 35.21) | 26.33 (20.99, 33.25) | 28.20 (24.42, 33.89) | 0.453 |
Trans fatty acids (gr/day) | 14.75 (11.96, 20.49) | 16.22 (12.81, 21.78) | 16.78 (13.23, 20.88) | 0.429 |
Poly unsaturated fatty acids (gr/day) | 1019.86 (712.88, 1228.20) | 920.18 (736.53, 1094.66) | 970.13 (735.62, 1174.99) | 0.603 |
Iron (mg/day) | 413.44 (318.10, 569.96) | 385.24 (297.55, 462.05) | 318.03 (253.99, 387.57) | <0.001 |
Calcium (mg/day) | 27.37 (21.69, 37.11) | 22.68 (18.41, 31.73) | 19.41 (15.62, 24.58) | <0.001 |
Folate (mcg/day) | 2.21 (1.22, 7.64) | 2.31 (1.44, 5.44) | 3.30 (1.92, 6.43) | 0.052 |
Sugar (gr/day) | 105.89 (70.07, 135.07) | 93.65 (71.05, 123.20) | 90.94 (69.54, 115.28) | 0.254 |
Glucose (gr/day) | 14.33 (10.46, 22.88) | 12.32 (8.84, 20.43) | 14.46 (9.30, 23.61) | 0.415 |
Vitamin A (RAE/day) | 1368.27 (942.98, 2384.53) | 1192.73 (745.08, 1751.19) | 958.90 (668.98, 1342.54) | 0.001 |
Vitamin D (mcg/day) | 1.36 (0.22, 2.32) | 0.96 (0.39, 1.59) | 1.16 (0.47, 1.84) | 0.668 |
Vitamin C (mg/day) | 198.96 (135.44, 261.79) | 152.12 (102.24, 193.02) | 104.49 (79.05, 136.63) | <0.001 |
Vitamin E (mg/day) | 4.00 (3.26, 6.35) | 4.45 (3.63, 5.82) | 4.52 (3.51, 5.60) | 0.899 |
Beta carotene (mg/day) | 794.79 (362.98, 1573.57) | 486.78 (283.64, 822.95) | 296.63 (131.24, 529.22) | <0.001 |
Mono unsaturated fatty acids (gr/day) | 31.31 (25.92, 41.61) | 35.90 (27.31, 40.17) | 38.30 (30.27, 47.07) | 0.009 |
Phosphorus (mg/day) | 1195.65 (913.93, 1600.80) | 1048.96 (831.67, 1408.12) | 1168.35 (922.96, 1438.67) | 0.494 |
Magnesium (mg/day) | 298.61 (241.57, 427.25) | 264.88 (212.73, 345.52) | 244.25 (199.62, 296.85) | <0.001 |
Potassium (mg/day) | 4012.29 (3151.91, 5448.55) | 3469.59 (2691.21, 4463.24) | 3000.35 (2460.01, 3616.19) | <0.001 |
Zinc (mg/day) | 9.00 (7.36, 11.99) | 9.47 (7.14, 11.96) | 10.64 (8.40, 12.32) | 0.072 |
Copper (mg/day) | 1.52 (1.23, 2.53) | 1.57 (1.07, 2.05) | 1.41 (1.09, 1.94) | 0.389 |
Manganese (mg/day) | 3.48 (2.65, 4.92) | 3.38 (2.62, 3.82) | 2.91 (2.15, 3.60) | 0.001 |
Selenium (µmol/day) | 1.09 (0.38, 1.14) | 0.65 (0.36, 1.13) | 0.81 (0.50, 1.14) | 0.478 |
Vitamin B1 (mg/day) | 1.56 (1.24, 2.03) | 1.67 (1.32, 2.04) | 1.63 (1.31, 2.04) | 0.590 |
Vitamin B2 (mg/day) | 1.59 (1.03, 1.94) | 1.35 (1.04, 1.92) | 1.55 (1.18, 1.96) | 0.401 |
Vitamin B3 (mg/day) | 16.78 (12.39, 20.90) | 18.08 (14.64, 23.43) | 21.51 (18.06, 26.24) | <0.001 |
Vitamin B6 (mg/day) | 1.51 (1.15, 1.91) | 1.28 (0.95, 1.78) | 1.19 (0.99, 1.43) | 0.001 |
Vitamin B12 (mcg/day) | 3.90 (2.53, 6.23) | 4.29 (3.46, 8.01) | 6.20 (4.71, 9.36) | <0.001 |
Vitamin B5 (mg/day) | 5.58 (3.95, 6.86) | 4.88 (4.14, 6.48) | 5.13 (4.11, 5.98) | 0.299 |
Vitamin B8 (mcg/day) | 22.20 (16.11, 32.56) | 20.69 (16.56, 27.49) | 20.04 (16.53, 25.52) | 0.518 |
Vitamin K (mcg/day) | 186.04 (96.52, 292.34) | 128.38 (70.81, 209.20) | 62.76 (44.90, 103.02) | <0.001 |
Caffeine (mg/day) | 116.13 (97.46, 253.81) | 147.84 (99.31, 199.95) | 106.41 (63.70, 170.85) | 0.067 |
Indexes of Dietary Acid Load | Odds Ratio of Dietary Indexes of Acid Load (95% Confidence Interval) | |||
---|---|---|---|---|
1st | 2nd | 3rd | p for Trend | |
Total plant-based protein (gr/day) | ||||
No. cases/no. controls | 44/43 | 36/44 | 29/43 | |
Base model b | 1.00 (Ref.) | 0.85 (0.45, 1.58) | 0.73 (0.38, 1.40) | 0.339 |
Model 1 c | 1.00 (Ref.) | 0.29 (0.13, 0.63) | 0.08 (0.03, 0.23) | <0.001 |
Model 2 d | 1.00 (Ref.) | 0.29 (0.10, 0.90) | 0.07 (0.01, 0.38) | 0.002 |
Total animal-based protein (gr/day) | ||||
No. cases/no. controls | 24/43 | 34/44 | 51/43 | |
Base model b | 1.00 (Ref.) | 1.47 (0.74, 2.93) | 2.28 (1.18, 4.41) | 0.013 |
Model 1 c | 1.00 (Ref.) | 1.11 (0.53, 2.30) | 0.87 (0.38, 2.01) | 0.745 |
Model 2 d | 1.00 (Ref.) | 1.41 (0.47, 4.22) | 0.88 (0.24, 3.26) | 0.833 |
PRAL (mEq/day) | ||||
No. cases/no. controls | 14/43 | 24/44 | 71/43 | |
Base model b | 1.00 (Ref.) | 1.68 (0.76, 3.69) | 4.88 (2.38, 10.02) | <0.001 |
Model 1 c | 1.00 (Ref.) | 1.83 (0.79, 4.21) | 4.16 (1.94, 8.91) | <0.001 |
Model 2 d | 1.00 (Ref.) | 0.50 (0.13, 1.74) | 0.86 (0.23, 3.18) | 0.884 |
NEAP (mEq/day) | ||||
No. cases/no. controls | 15/43 | 20/44 | 74/43 | |
Base model b | 1.00 (Ref.) | 1.31 (0.59, 2.91) | 5.03 (2.47, 10.26) | <0.001 |
Model 1 c | 1.00 (Ref.) | 1.01 (0.43, 2.36) | 3.57 (1.69, 7.53) | <0.001 |
Model 2 d | 1.00 (Ref.) | 0.41 (0.12, 1.46) | 0.91 (0.25, 3.31) | 0.800 |
Protein/potassium ratio | ||||
No. cases/no. controls | 15/43 | 20/44 | 74/43 | |
Base model b | 1.00 (Ref.) | 1.31 (0.59, 2.91) | 5.03 (2.47, 10.26) | <0.001 |
Model 1 c | 1.00 (Ref.) | 1.01 (0.43, 2.36) | 3.57 (1.69, 7.53) | <0.001 |
Model 2 d | 1.00 (Ref.) | 0.41 (0.12, 1.46) | 0.91 (0.25, 3.31) | 0.800 |
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Saeedirad, Z.; Ariyanfar, S.; Noormohammadi, M.; Ghorbani, Z.; Naser Moghadasi, A.; Shahemi, S.; Ghanaatgar, M.; Rezaeimanesh, N.; Hekmatdoost, A.; Ghaemi, A.; et al. Higher Dietary Acid Load Might Be a Potent Derivative Factor for Multiple Sclerosis: The Results from a Case–Control Study. Nutrients 2023, 15, 3311. https://doi.org/10.3390/nu15153311
Saeedirad Z, Ariyanfar S, Noormohammadi M, Ghorbani Z, Naser Moghadasi A, Shahemi S, Ghanaatgar M, Rezaeimanesh N, Hekmatdoost A, Ghaemi A, et al. Higher Dietary Acid Load Might Be a Potent Derivative Factor for Multiple Sclerosis: The Results from a Case–Control Study. Nutrients. 2023; 15(15):3311. https://doi.org/10.3390/nu15153311
Chicago/Turabian StyleSaeedirad, Zahra, Shadi Ariyanfar, Morvarid Noormohammadi, Zeinab Ghorbani, Abdorreza Naser Moghadasi, Sahar Shahemi, Milad Ghanaatgar, Nasim Rezaeimanesh, Azita Hekmatdoost, Amir Ghaemi, and et al. 2023. "Higher Dietary Acid Load Might Be a Potent Derivative Factor for Multiple Sclerosis: The Results from a Case–Control Study" Nutrients 15, no. 15: 3311. https://doi.org/10.3390/nu15153311
APA StyleSaeedirad, Z., Ariyanfar, S., Noormohammadi, M., Ghorbani, Z., Naser Moghadasi, A., Shahemi, S., Ghanaatgar, M., Rezaeimanesh, N., Hekmatdoost, A., Ghaemi, A., & Razeghi Jahromi, S. (2023). Higher Dietary Acid Load Might Be a Potent Derivative Factor for Multiple Sclerosis: The Results from a Case–Control Study. Nutrients, 15(15), 3311. https://doi.org/10.3390/nu15153311