Table 3.
Characteristics of studies referring to the association between DAL, triacylglycerol (TAG), low-density lipoprotein (LDL-C), high-density lipoprotein (HDL-C), total cholesterol, triglyceride (TG).
| First Author/Country/Reference Number | Year | Study Design | Sample (n) | Gender/Age Range/Mean Age | DAL Assessment Method Related to the Result | Dietary Intake Assessment Tool | Result |
|---|---|---|---|---|---|---|---|
| Statistically significant positive association | |||||||
| Murakami et al./Japan [14] | 2008 | Cross-sectional | 1136 (dietetic students) |
Women, 18–22 y | PRAL, A:P | BDHQ | Total cholesterol, LDL-C significantly higher in the highest vs. lowest PRAL categories (1925.0 ± 21.0 mg/L vs. 1866.0 ± 21 mg/L; p = 0.042 for total cholesterol, 1103.0 ± 18.0 mg/L vs. 1043.0 ± 18 mg/L; p = 0.021 for LDL-C). |
| Haghighatdoost et al./Iran [4] * | 2015 | Cross-sectional | 547 (patients with diabetic nephropathy) |
Both, 66.8 y (mean age) | PRAL, A:P | FFQ | TAG significantly higher in the highest vs. lowest PRAL categories (257.4 ± 2.3 mg/dL vs. 146.9 ± 2.3 mg/dL; p = 0.006). |
| Bahadoran et al./Iran [17] * | 2015 | Cross-sectional | 5620 (general population) | Both, 19–70 y | PRAL, A:P | 147-item FFQ | PRAL and A:P positively associated with TG (β = 0.143, p < 0.01 for PRAL, β = 0.03, p < 0.05 for A:P). |
| Iwase et al./Japan [21] * | 2015 | Cross-sectional | 149 (patients with T2DM) |
Both, 65.7 ± 9.3 (mean age) |
PRAL, NEAP | BDHQ | LDL-C, TG higher in the highest vs. lowest PRAL tertile (2.7 ± 0.8 mmol/L vs. 2.5 ± 0.8 mmol/L; p = 0.05 for LDL-C, 1.7 ± 1.1 mmol/L vs. 1.3 ± 0.7 mmol/L; p = 0.03 for TG). TG higher in the highest vs. lowest NEAP tertile (1.7 ± 1.2 mmol/L vs. 1.3 ± 0.7 mmol/L; p = 0.005). |
| Han et al./Korea [5] * | 2016 | Cross-sectional | 11,601 (general population) |
Both, 40–79 y | PRAL, NEAP | 24HR | TG higher in the highest vs. lowest PRAL tertile (144.7 ± 113.5 mg/dL vs. 138.8 ± 102.7 mg/dL; p = 0.004). LDL-C higher in the highest vs. lowest PRAL tertile (119.0 ± 32.3 mg/dL vs. 119.0 ± 32.4 mg/dL; p = 0.043). TG higher in the highest vs. lowest NEAP tertile (148.7 ± 118.9 mg/dL vs. 137.4 ± 110.9 mg/dL; p < 0.001). |
| Kucharska et al./Poland * [23] | 2018 | Cross-sectional | 2760 (general population) |
Men, 49 y (mean age) | NEAP, PRAL | 24HR | |
| 3409 (general population |
Women, 52 y (mean age) | The prevalence of hypertriglyceridemia significantly higher in the highest vs. lowest quartile of NEAP (22.33% vs. 18.82%; p < 0.01). TG significantly higher in the highest vs. lowest NEAP categories (1.18 vs. 1.13 mmol/L; p < 0.05). |
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| Farhangi et al./Iran [46] * | 2019 | A systematic review and meta-analysis (17 observational studies) | 181,282 (general population) |
Both, >18 y | PRAL, NEAP | All mentioned assessment tools | High PRAL associated with serum TG concentrations higher by 3.47 mg/dL (WMD: 3.468; CI: −0.231, 7.166, p < 0.05). |
| Statistically significant inverse association | |||||||
| Haghighatdoost et al./Iran [4] * | 2015 | Cross-sectional | 547 (patients with diabetic nephropathy) |
Both, 66.8 y (mean age) | PRAL, A:P | FFQ | LDL-C significantly lower in the highest vs. lowest A:P categories (129.4 ± 1.6 mg/dL vs. 140.1 ± 1.6 mg/dL; p < 0.0001). |
| Bahadoran et al./Iran [17] * | 2015 | Cross-sectional | 5620 (general population) | Both, 19–70 y | PRAL, A:P | 147-item FFQ | PRAL and A:P inversely associated with HDL-C (β = –0.11, p < 0.01 for PRAL, β = −0.06, p < 0.01 for A:P). |
| Han et al./Korea [5] * | 2016 | Cross-sectional | 11,601 (general population) |
Both, 40–79 y | PRAL, NEAP | 24HR | HDL-C significantly lower in the highest vs. lowest NEAP tertiles (50.7 ± 12.3 mg/dL vs. 51.5 ± 12.4 mg/dL, p = 0.031). |
| Kucharska et al./Poland [23] * | 2018 | Cross-sectional | 2760 (general population) |
Men,49 y (mean age) | PRAL, NEAP | 24H | HDL-C significantly lower in the highest vs. lowest PRAL and NEAP categories (1.24 vs. 1.26 mmol/L; p < 0.01 for PRAL, 1.25 vs. 1.28 mmol/L; p < 0.05 for NEAP). |
| 3409 (general population |
Women, 52 y (mean age) | HDL-C significantly lower in the highest vs. lowest PRAL and NEAP categories (1.53 vs. 1.50 mmol/L; p < 0.05 for PRAL, 1.51 vs. 1.54 mmol/L; p < 0.05 for NEAP). | |||||
| Krupp et al./Germany [45] | 2018 | Cross-sectional | 6797 (general population) |
Both, >18 y | PRAL | FFQ | Total cholesterol significantly lower in the highest vs. lowest PRAL categories (192 mg/dL vs. 203.6 mg/dL; p < 0.0001). |
| No statistically significant association | |||||||
| Murakami et al./Japan [14] | 2008 | Cross-sectional | 1136 (dietetic students) |
Women, 18–22 y | PRAL, A:P | BDHQ | No significant association between HDL-C, TAG and dietary PRAL. No significant association between total cholesterol, HDL-C, LDL-C, TAG and dietary A:P. |
| Engberink et al./the Netherlands [8] | 2012 | Cross-sectional baseline data | 2241 (participants without hypertension at baseline) |
Both, ≥55 y | PRAL | FFQ | No significant association between total cholesterol, HDL-C and dietary PRAL. |
| van-den Berg et al./Denmark [25] | 2012 | Cross-sectional | 707 (renal transplant patients) |
Both, 53 y (mean age) | NAE | FFQ | No significant difference between the tertiles of NAE, HDL-C and TG. |
| Luis et al./Sweden [24] | 2014 | Cross-sectional | 673 (general population) |
Men, 70–71 y | PRAL | 7d-FD | No significant difference in the prevalence of hyperlipidemia between the tertiles of PRAL. |
| Haghighatdoost et al./Iran [4] * | 2015 | Cross-sectional | 547 (patients with diabetic nephropathy) |
Both, 66.8 y (mean age) | PRAL, A:P | FFQ | No significant association between total cholesterol, HDL-C and dietary PRAL. No significant association between TAG, total cholesterol and dietary A:P. |
| Iwase et al./Japan [21] * | 2015 | Cross-sectional | 149 (patients with T2DM) |
Both,65.7 ± 9.3 (mean age) |
PRAL, NEAP | BDHQ | No significant association between total cholesterol, LDL-C and dietary PRAL. |
| Han et al./Korea [5] * | 2016 | Cross-sectional | 11,601 (general population) |
Both, 40–79 y | PRAL, NEAP | 24HR | No significant association between LDL-C and dietary PRAL. No significant association between total cholesterol, LDL-C and dietary NEAP. |
| Moghadam et al./Iran [15] * | 2016 | Cross-sectional | 925 (general population) |
Both, 22–80 y | PRAL, NEAP | FFQ | No significant association between HDL-C, LDL-C, TG and dietary PRAL. |
| Xu et al./Sweden [26] | 2016 | Cross-sectional | 911 (general population) |
Both, 70–71 y | PRAL | 7-d FD | No significant difference in the prevalence of hypercholesterolemia between PRAL tertiles. |
| Ko et al./Korea [22] | 2017 | Cross-sectional | 1369 (general population) | Both, ≥65 y | NEAP | FFQ | No significant association between total cholesterol, TG and dietary NEAP. |
| Kucharska et al./Poland * [23] | 2018 | Cross-sectional | 2760 (general population) |
Men, 49 y (mean age) | NEAP, PRAL | 24HR | No significant differences in the prevalence of hypercholesterolemia and hypertriglyceridemia across the tertiles of PRAL and NEAP. No significant association between total cholesterol, LDL-C, TG and dietary PRAL, as well as NEAP. |
| 3409 (general population) |
Women, 52 y (mean age) | No significant differences in the prevalence of hypercholesterolemia and hypertriglyceridemia across the tertiles of PRAL. No significant differences across the tertiles of NEAP concerning the prevalence of hypercholesterolemia. No significant association between total cholesterol, LDL-C, TG and dietary PRAL. No significant association between total cholesterol, LDL-C and dietary NEAP. |
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| Daneshzad et al./Iran [28] | 2019 | A systematic review and meta-analysis of observational studies (16 cohort studies; 17 cross-sectional studies) | 92,478 (general population) |
Both, >1 y | NEAP, PRAL, NAE | All mentioned assessment tools | No significant association between total cholesterol, HDL-C, LDL-C, TAG and dietary PRAL, NAE, as well as NEAP. |
| Mozaffari et al./Iran [44] | 2019 | Cross-sectional | 371 (Iranian healthy women) |
Women, 20–50 y | NEAP, PRAL | FFQ | No significant association between total cholesterol, LDL-C, HDL-C, TG and dietary PRAL, as well as NEAP. |
| Farhangi et al./Iran [46] | 2019 | A systematic review and meta-analysis (17 observational studies) | 181,282 (general population) |
Both, >18 y | PRAL, NEAP | All mentioned assessment tools | No significant association between total cholesterol, LDL-C, HDL-C and dietary PRAL, as well as NEAP. No significant association between TG and dietary NEAP. |
Abbreviations: 24 HR, 24-h dietary recall questionnaire; A:P, animal-protein-to-potassium ratio; BDHQ, brief validated self-administered diet history questionnaire; TAG, triacylglycerol; LDL-C, low-density lipoprotein; HDL-C, high-density lipoprotein; TG, triglyceride; HR, hazard ratio; NEAP, net-endogenous acid production; PRAL, potential renal acid load; FD, food diary; FFQ, food frequency questionnaire; NAE, urine net acid excretion; BMI, body mass index; T2DM, type 2 diabetes mellitus; DAL, dietary acid load; WMD, weighted mean difference; CVD, cardiovascular disease. * Indicates consecutive outcomes that stemmed from one study, but differences in the significance of association between lipid metabolism values and DAL were obtained.