Association between dietary acid load and risk of metabolic dysfunction-associated steatotic liver disease in patients with type 2 diabetes

ObjectiveConsidering the high prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) among patients with type 2 diabetes and its associated complications, this study aimed to investigate the relationship between dietary acid load (DAL) and the risk of MASLD in patients with d...

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Main Authors: Hesam Bakhshi, Niayesh Naghshi, Danial Fotros, Mohammadjavad Pasand, Azita Hekmatdoost, Marieh Salavatizadeh, Samira Soltanieh, Hossein Poustchi, Mohammad Ebrahim Khamseh, Zahra Yari
Format: Article
Language:English
Published: Frontiers Media S.A. 2025-05-01
Series:Frontiers in Nutrition
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Online Access:https://www.frontiersin.org/articles/10.3389/fnut.2025.1494617/full
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author Hesam Bakhshi
Niayesh Naghshi
Danial Fotros
Mohammadjavad Pasand
Azita Hekmatdoost
Marieh Salavatizadeh
Samira Soltanieh
Hossein Poustchi
Mohammad Ebrahim Khamseh
Zahra Yari
author_facet Hesam Bakhshi
Niayesh Naghshi
Danial Fotros
Mohammadjavad Pasand
Azita Hekmatdoost
Marieh Salavatizadeh
Samira Soltanieh
Hossein Poustchi
Mohammad Ebrahim Khamseh
Zahra Yari
author_sort Hesam Bakhshi
collection DOAJ
description ObjectiveConsidering the high prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) among patients with type 2 diabetes and its associated complications, this study aimed to investigate the relationship between dietary acid load (DAL) and the risk of MASLD in patients with diabetes.MethodsThis cross sectional study was conducted on 200 patients aged 18 to 70 with type 2 diabetes. Of whom, 133 participants were diagnosed with MASLD based on transit elastography (Fibroscan). For biochemical evaluation of liver enzymes, lipid profile, and fasting blood sugar, venous blood samples were collected after 10–12 h of fasting. Dietary acid load was determined using a 147-item food frequency questionnaire based on PRAL (potential renal acid load) and NEAP (net endogenous acid production).ResultsA total of 108 women and 92 men with an average age of 52.2 years and an average body mass index of 28.8 kg/m2 participated in the study. After adjusting for confounders, the risk of MASLD in the third tertile of PRAL was 3.1 times higher than the first tertile (OR = 3.1, 95% CI = 1.2–7.7). After adjusting for all confounding factors, participants in the highest tertile of NEAP had nearly seven times the chance of developing MASLD compared to those in the lowest tertile, which was statistically significant (OR = 7.3, 95% CI = 2.6–20.3). Overall, the data analysis revealed a significant direct relationship between both PRAL (P trend = 0.016) and NEAP (P trend < 0.001) with the risk of MASLD.ConclusionOur analysis revealed that a higher dietary acid load is associated with an increased risk of MASLD and liver steatosis in patients with type 2 diabetes.
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spelling doaj-art-d22a6050cdd34164a3ffb0aadaa7d7be2025-08-20T03:05:44ZengFrontiers Media S.A.Frontiers in Nutrition2296-861X2025-05-011210.3389/fnut.2025.14946171494617Association between dietary acid load and risk of metabolic dysfunction-associated steatotic liver disease in patients with type 2 diabetesHesam Bakhshi0Niayesh Naghshi1Danial Fotros2Mohammadjavad Pasand3Azita Hekmatdoost4Marieh Salavatizadeh5Samira Soltanieh6Hossein Poustchi7Mohammad Ebrahim Khamseh8Zahra Yari9Department of Clinical Nutrition and Dietetics, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, IranDepartment of Clinical Nutrition and Dietetics, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, IranDepartment of Clinical Nutrition and Dietetics, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, IranDepartment of Clinical Nutrition and Dietetics, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, IranDepartment of Clinical Nutrition and Dietetics, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, IranDepartment of Clinical Nutrition and Dietetics, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, IranDepartment of Nutrition and Food Science, Wayne State University, Detroit, MI, United StatesLiver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, IranEndocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, IranDepartment of Nutrition Research, National Nutrition and Food Technology Research Institute and Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, IranObjectiveConsidering the high prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) among patients with type 2 diabetes and its associated complications, this study aimed to investigate the relationship between dietary acid load (DAL) and the risk of MASLD in patients with diabetes.MethodsThis cross sectional study was conducted on 200 patients aged 18 to 70 with type 2 diabetes. Of whom, 133 participants were diagnosed with MASLD based on transit elastography (Fibroscan). For biochemical evaluation of liver enzymes, lipid profile, and fasting blood sugar, venous blood samples were collected after 10–12 h of fasting. Dietary acid load was determined using a 147-item food frequency questionnaire based on PRAL (potential renal acid load) and NEAP (net endogenous acid production).ResultsA total of 108 women and 92 men with an average age of 52.2 years and an average body mass index of 28.8 kg/m2 participated in the study. After adjusting for confounders, the risk of MASLD in the third tertile of PRAL was 3.1 times higher than the first tertile (OR = 3.1, 95% CI = 1.2–7.7). After adjusting for all confounding factors, participants in the highest tertile of NEAP had nearly seven times the chance of developing MASLD compared to those in the lowest tertile, which was statistically significant (OR = 7.3, 95% CI = 2.6–20.3). Overall, the data analysis revealed a significant direct relationship between both PRAL (P trend = 0.016) and NEAP (P trend < 0.001) with the risk of MASLD.ConclusionOur analysis revealed that a higher dietary acid load is associated with an increased risk of MASLD and liver steatosis in patients with type 2 diabetes.https://www.frontiersin.org/articles/10.3389/fnut.2025.1494617/fullMASLDdiabetesDALPRALNEAP
spellingShingle Hesam Bakhshi
Niayesh Naghshi
Danial Fotros
Mohammadjavad Pasand
Azita Hekmatdoost
Marieh Salavatizadeh
Samira Soltanieh
Hossein Poustchi
Mohammad Ebrahim Khamseh
Zahra Yari
Association between dietary acid load and risk of metabolic dysfunction-associated steatotic liver disease in patients with type 2 diabetes
Frontiers in Nutrition
MASLD
diabetes
DAL
PRAL
NEAP
title Association between dietary acid load and risk of metabolic dysfunction-associated steatotic liver disease in patients with type 2 diabetes
title_full Association between dietary acid load and risk of metabolic dysfunction-associated steatotic liver disease in patients with type 2 diabetes
title_fullStr Association between dietary acid load and risk of metabolic dysfunction-associated steatotic liver disease in patients with type 2 diabetes
title_full_unstemmed Association between dietary acid load and risk of metabolic dysfunction-associated steatotic liver disease in patients with type 2 diabetes
title_short Association between dietary acid load and risk of metabolic dysfunction-associated steatotic liver disease in patients with type 2 diabetes
title_sort association between dietary acid load and risk of metabolic dysfunction associated steatotic liver disease in patients with type 2 diabetes
topic MASLD
diabetes
DAL
PRAL
NEAP
url https://www.frontiersin.org/articles/10.3389/fnut.2025.1494617/full
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