Unit of Oncology and Radiotherapy, Pereira Rossell Women's Hospital, Montevideo, Uruguay.
Academic Unit on Radiation Protection, Faculty of Medicine, University of the Republic, Montevideo, Uruguay.
Thorac Cancer. 2022 Oct;13(19):2759-2766. doi: 10.1111/1759-7714.14612. Epub 2022 Aug 21.
A high dietary acid load (DAL) can produce metabolic acidosis, which is linked to cancer development through mechanisms of inflammation and cell transformation. There is limited epidemiological evidence linking DAL and cancer risk; however, none of the published studies focused on DAL and esophageal cancer (EC) risk in particular. Therefore, we sought to explore this association in the present study.
A case-control study was performed in 1295 male patients (185 squamous cell EC cases and 1110 age-frequency and urban/rural residence matched controls) through a multitopic inquiry, including a food frequency questionnaire. Food-derived nutrients were calculated from available databases. The DAL was calculated based on two validated measures: Potential renal acid load (PRAL) score and net endogenous acid production (NEAP) score. Odds ratios (OR) and their 95% confidence intervals (95% CI) were estimated by unconditional logistic regression, adjusting for confounders.
We found direct, significant associations between dietary acid load and EC risk: (OR = 2.28, 95% CI: 1.44-3.61, ptrend <0.0001) and (OR = 2.17, 95% CI: 1.38-3.41, ptrend <0.0001) for highest PRAL and NEAP tertiles, respectively. Our data raise the possibility that a high DAL may contribute to EC development. Both acid load scores were directly associated with animal-based foods (mainly meat) and inversely associated with the intake of plant-based foods.
To the best of our knowledge, this is the first epidemiological case-control study analyzing associations of DAL and squamous cell EC risk. Further research is warranted to confirm our findings.
高膳食酸负荷（DAL）可导致代谢性酸中毒，通过炎症和细胞转化机制与癌症发展有关。目前，流行病学证据有限，无法将 DAL 与癌症风险联系起来；然而，之前发表的研究都没有特别关注 DAL 与食管癌（EC）风险之间的关系。因此，我们旨在探讨这种关联。
通过多主题询问，包括食物频率问卷，对 1295 名男性患者（185 例鳞状细胞 EC 病例和 1110 名年龄频率和城乡居住匹配的对照）进行了病例对照研究。从现有数据库中计算食物来源的营养素。基于两种经过验证的衡量标准：潜在肾酸负荷（PRAL）评分和净内源性酸产生（NEAP）评分，计算酸负荷。通过无条件逻辑回归，调整混杂因素后，估计比值比（OR）及其 95%置信区间（95%CI）。
我们发现膳食酸负荷与 EC 风险之间存在直接、显著的关联：（OR=2.28，95%CI：1.44-3.61，ptrend <0.0001）和（OR=2.17，95%CI：1.38-3.41，ptrend <0.0001），最高 PRAL 和 NEAP 三分位数分别对应。我们的数据提出了这样一种可能性，即高 DAL 可能导致 EC 的发展。两种酸负荷评分都与动物源性食物（主要是肉类）直接相关，与植物性食物的摄入呈负相关。
据我们所知，这是第一项分析 DAL 与鳞状细胞 EC 风险关联的流行病学病例对照研究。需要进一步的研究来证实我们的发现。
