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Estimates of daily net endogenous acid production in the elderly UK population: analysis of the National Diet and Nutrition Survey (NDNS) of British adults aged 65 years and over

  • Richard H. T. Gannon (a1), D. Joe Millward (a1), Jonathan E. Brown (a1), Helen M. Macdonald (a2), David P. Lovell (a3), Lynda A. Frassetto (a4), Thomas Remer (a5) and Susan A. Lanham-New (a1)...


Dietary intake has been shown to influence acid–base balance in human subjects under tightly controlled conditions. However, the net effect of food groups on alkali/acid loading in population groups is unclear. The aims of the present study were to: (1) quantify estimates of daily net endogenous acid production (NEAP) (mEq/d) in a representative group of British elderly aged 65 years and older; (2) compare and characterise NEAP by specific nutrients and food groups likely to influence dietary acid loading; (3) determine whether geographical location influenced NEAP. The National Diet and Nutrition Survey dataset, consisting of a 4 d weighed record and anthropometric data, was used to estimate dietary acidity. Dietary under-reporters were excluded by analysing only subjects with energy intakes ≥ 1·2 × BMR. NEAP was estimated as the dietary potential renal acid load+organic acid excretion, the latter as a multiple of estimated body surface area. NEAP was lower in women compared with men (P < 0·001), and lower than values reported in a Swedish elderly cohort. Lower dietary acidity was significantly associated with higher consumption of fruit and potatoes and lower consumption of meat, bread and eggs (P < 0·02 to P < 0·001). Lower intakes of fish and cheese were associated with lower NEAP in men only (P < 0·01 to P < 0·001). There were regional differences for NEAP, with higher intakes in Scotland/Northern regions compared with Central/South-Western and London/South-Eastern regions (P = 0·01). These data provide an insight into the acid-generating potential of the diet in the British elderly population, which may have important consequences in this vulnerable group.


Corresponding author

*Corresponding author: Mr Richard Gannon, fax +44 1483 686401, email


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1 Greenhaff, PL, Gleeson, M & Maughan, RJ (1988) Diet-induced metabolic acidosis and the performance of high intensity exercise in man. Eur J Appl Physiol Occup Physiol 57, 583590.
2 Remer, T, Dimitriou, T & Manz, F (2003) Dietary potential renal acid load and renal net acid excretion in healthy, free-living children and adolescents. Am J Clin Nutr 77, 12551260.
3 Manz, F (2001) History of nutrition and acid–base physiology. Eur J Nutr 40, 189199.
4 Mitch, WE & Du, J (2004) Cellular mechanisms causing loss of muscle mass in kidney disease. Semin Nephrol 24, 484487.
5 Wachman, A & Bernstein, DS (1968) Diet and osteoporosis. Lancet i, 958959.
6 Barzel, US (1995) The skeleton as an ion exchange system: implications for the role of acid–base imbalance in the genesis of osteoporosis. J Bone Miner Res 10, 14311436.
7 Arnett, T (2003) Regulation of bone cell function by acid–base balance. Proc Nutr Soc 62, 511520.
8 Arnett, TR & Dempster, DW (1986) Effect of pH on bone resorption by rat osteoclasts in vitro. Endocrinology 119, 119124.
9 Frassetto, L, Morris, RC Jr & Sebastian, A (1997) Potassium bicarbonate reduces urinary nitrogen excretion in postmenopausal women. J Clin Endocrinol Metab 82, 254259.
10 Frassetto, LA, Lanham-New, SA, Macdonald, HM, Remer, T, Sebastian, A, Tucker, KL & Tylavsky, FA (2007) Standardizing terminology for estimating the diet-dependent net acid load to the metabolic system. J Nutr 137, 14911492.
11 Frassetto, LA, Todd, KM, Morris, RC Jr & Sebastian, A (1998) Estimation of net endogenous noncarbonic acid production in humans from diet potassium and protein contents. Am J Clin Nutr 68, 576583.
12 Remer, T & Manz, F (1994) Estimation of the renal net acid excretion by adults consuming diets containing variable amounts of protein. Am J Clin Nutr 59, 13561361.
13 Remer, T & Manz, F (1995) Potential renal acid load of foods and its influence on urine pH. J Am Diet Assoc 95, 791797.
14 Finch, S, Doyle, W, Lowe, C, Bates, CJ, Prentice, A, Smithers, G & Clarke, PC (1998) National Diet and Nutrition Survey: People Aged 65 Years and Over. London: HMSO.
15 Goldberg, GR, Black, AE, Jebb, SA, Cole, TJ, Murgatroyd, PR, Coward, WA & Prentice, AM (1991) Critical evaluation of energy intake data using fundamental principles of energy physiology. Eur J Clin Nutr 45, 569581.
16 James, WPT & Schofield, EC (1990) Human Energy Requirements: A Manual for Planners and Nutritionists. Oxford: Oxford Medical Publications.
17 Bates, CJ, Prentice, A, Cole, TJ, van der Pols, JC, Doyle, W, Finch, S, Smithers, G & Clarke, PC (1999) Micronutrients: highlights and research challenges from the 1994–5 National Diet and Nutrition Survey of people aged 65 years and over. Br J Nutr 82, 715.
18 Kleinman, JG & Lemann, J (1987) Acid Production, in Clinical Disorders of Fluid and Electrolyte Metabolism. New York: McGraw-Hill.
19 DuBois, D & DuBois, EF (1916) A formula to estimate the approximate surface area if height and weight be known. Arch Intern Med 17, 863871.
20 Department of Health (1991) Dietary Reference Values for Food Energy and Nutrients for the United Kingdom. Report of the Panel on Dietary Reference Values of the Committee on Medical Aspects of Food Policy. London: HM Stationery Office.
21 Berkemeyer, S & Remer, T (2006) Anthropometrics provide a better estimate of urinary organic acid anion excretion than a dietary mineral intake-based estimate in children, adolescents, and young adults. J Nutr 136, 12031208.
22 Hood, VL & Tannen, RL (1998) Protection of acid–base balance by pH regulation of acid production. N Engl J Med 339, 819826.
23 Lennon, EJ, Lemann, J Jr & Litzow, JR (1966) The effects of diet and stool composition on the net external acid balance of normal subjects. J Clin Invest 45, 16011607.
24 Kurtz, I, Maher, T, Hulter, HN, Schambelan, M & Sebastian, A (1983) Effect of diet on plasma acid–base composition in normal humans. Kidney Int 24, 670680.
25 Rylander, R, Remer, T, Berkemeyer, S & Vormann, J (2006) Acid–base status affects renal magnesium losses in healthy, elderly persons. J Nutr 136, 23742377.
26 Frassetto, LA, Todd, KM, Morris, RC Jr & Sebastian, A (2000) Worldwide incidence of hip fracture in elderly women: relation to consumption of animal and vegetable foods. J Gerontol A Biol Sci Med Sci 55, M585M592.
27 Prynne, CJ, Ginty, F, Paul, AA, Bolton-Smith, C, Stear, SJ, Jones, SC & Prentice, A (2004) Dietary acid–base balance and intake of bone-related nutrients in Cambridge teenagers. Eur J Clin Nutr 58, 14621471.
28 Lemann, J Jr (1999) Relationship between urinary calcium and net acid excretion as determined by dietary protein and potassium: a review. Nephron 81, Suppl. 1, 1825.
29 Black, AE, Prentice, AM, Goldberg, GR, Jebb, SA, Bingham, SA, Livingstone, MB & Coward, WA (1993) Measurements of total energy expenditure provide insights into the validity of dietary measurements of energy intake. J Am Diet Assoc 93, 572579.
30 Buclin, T, Cosma, M, Appenzeller, M, Jacquet, AF, Decosterd, LA, Biollaz, J & Burckhardt, P (2001) Diet acids and alkalis influence calcium retention in bone. Osteoporos Int 12, 493499.
31 Blatherwick, NR (1914) The specific role of foods in relation to the composition of the urine. Arch Intern Med 14, 419450.
32 Frassetto, LA, Morris, RC Jr & Sebastian, A (1996) Effect of age on blood acid–base composition in adult humans: role of age-related renal functional decline. Am J Physiol 271, F1114F1122.
33 Bushinsky, DA (2001) Acid–base imbalance and the skeleton. Eur J Nutr 40, 238244.
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British Journal of Nutrition
  • ISSN: 0007-1145
  • EISSN: 1475-2662
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