Dietary acid load berhubungan dengan sindrom metabolik dan kesehatan mental pada mahasiswi obesitas

Firdananda Fikri Jauharany(1*), Martha Irene Kartasurya(2), Apoina Kartini(3), Fillah Fithra Dieny(4), Dian Ratna Sawitri(5), Etika Ratna Noer(6)

(1) Departemen Ilmu Gizi, Fakultas Kedokteran, Universitas Diponegoro, Semarang
(2) Departemen Gizi Kesehatan Masyarakat, Fakultas Kesehatan Masyarakat, Universitas Diponegoro, Semarang
(3) Departemen Gizi Kesehatan Masyarakat, Fakultas Kesehatan Masyarakat, Universitas Diponegoro, Semarang
(4) Departemen Ilmu Gizi, Fakultas Kedokteran, Universitas Diponegoro, Semarang
(5) Fakultas Psikologi, Universitas Diponegoro, Semarang
(6) Departemen Ilmu Gizi, Fakultas Kedokteran, Universitas Diponegoro, Semarang
(*) Corresponding Author


The dietary acid load was associated with metabolic syndrome and mental health among obese college students

Background: The prevalence of metabolic syndrome has been increasing every year in the young population. The western diet is one of the causes that makes excess acid in the body called a dietary acid load. On the other hand, the high dietary acid load was associated with decreased mental health status.

Objective: To examine the association between dietary acid load and the risk of metabolic syndrome and mental health.

Methods: This was a cross-sectional study conducted with 115 female students in Semarang aged 18-22 years. The dietary acid load was evaluated through a potential renal acid load (PRAL), the risk score for metabolic syndrome was calculated by Metabolic syndrome risk score. Mental health status was assessed through levels of self-esteem and levels of anxiety. The level of self-esteem was measured by the Rosenberg Self-Esteem Scale questionnaire, while the level of anxiety was measured by the State Anxiety Inventory questionnaire. Multiple linear regression models with adjustment for a potential cofounding variable were used to evaluate the association between dietary acid load with metabolic syndrome scores, self-esteem scores, and anxiety scores.

Results: The mean PRAL score was 6.11 ± 9.72 mEq/day indicated the intake of the subjects was the dietary acid load. 13% of subjects had metabolic syndrome, and 87% had a pre-metabolic syndrome. 36.5% of the subjects have low self-esteem scores. The anxiety level score calculation shows that 59.1% of the subjects are at high risk of anxiety. Pearson test showed that PRAL scores were correlated with anxiety scores (r=0,669; p<0,001). The linear regression test showed that PRAL scores were correlated with metabolic syndrome scores (β=0.899; p<0.001) and self-esteem scores (β =-0.069; p=0.047).

Conclusions: High dietary acid load may be a risk factor related to the development of metabolic disorders and decreased mental health status in females with obesity.


anxiety; dietary acid load; metabolic syndrome; obesity; self-esteem

Full Text:



  1. Roth GA, Johnson C, Abajobir A, Abd-Allah F, Abera SF, Murray C, et al. Global, regional, and national burden of cardiovascular diseases for 10 causes, 1990 to 2015. J Am Coll Cardiol. 2017;70(1):1-25. doi: 10.1016/j.jacc.2017.04.052
  2. Alberti KGMM, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, et al. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation. 2009;120(16):1640-5. doi: 10.1161/CIRCULATIONAHA.109.192644
  3. Alberti KGMM, Zimmet P, Shaw J, IDF Epidemiology Task Force Consensus Group. The metabolic syndrome--a new worldwide definition. Lancet. 2005;366(9491):1059-62. doi: 10.1016/S0140-6736(05)67402-8
  4. Soewondo P, Purnamasari D, Oemardi M. Prevalence of metabolic syndrome using NCEP/ATP III criteria in Jakarta, Indonesia: the Jakarta primary non-communicable disease risk factors surveillance 2006. Acta Med Indones. 2010;42(4):199-203.
  5. Utami AP, Probosari E, Binar P. Faktor risiko status obesitas terhadap kejadian gangguan psikososial pada remaja putri di Semarang. Media Penelitian dan Pengembangan Kesehatan. 2018;28(1):57-68. doi: 10.22435/mpk.v28i1.7941.57-68
  6. Jorm AF, Korten AE, Christensen H, Jacomb PA, Rodgers B, Parslow RA. Association of obesity with anxiety, depression and emotional well-being: a community survey. Aust N Z J Public Health. 2003;27(4):434-40. doi: 10.1111/j.1467-842x.2003.tb00423.x
  7. Mental Health Foundation. Food for thought: mental health and nutrition briefing. [series online] 2017 [cited 2020 Jul 27]. Available from: URL:
  8. Scialla JJ, Anderson CAM. Dietary acid load: a novel nutritional target in chronic kidney disease? Adv Chronic Kidney Dis. 2013;20(2):141-9. doi: 10.1053/j.ackd.2012.11.001
  9. Remer T, Dimitriou T, Manz F. Dietary potential renal acid load and renal net acid excretion in healthy, free-living children and adolescents. Am J Clin Nutr. 2003;77(5):1255-60. doi: 10.1093/ajcn/77.5.1255
  10. Williams RS, Kozan P, Samocha-Bonet D. The role of dietary acid load and mild metabolic acidosis in insulin resistance in humans. Biochimie. 2016;124:171-7. doi: 10.1016/j.biochi.2015.09.012
  11. Fraser R, Ingram MC, Anderson NH, Morrison C, Davies E, Connell JMC. Cortisol effects on body mass, blood pressure, and cholesterol in the general population. Hypertension. 1999;33(6):1364-8. doi: 10.1161/01.hyp.33.6.1364
  12. Bühlmeier J, Harris C, Koletzko S, Lehmann I, Bauer C-P, Schikowski T, et al. Dietary acid load and mental health outcomes in children and adolescents: results from the GINIplus and LISA Birth Cohort Studies. Nutrients. 2018;10(5):582. doi: 10.3390/nu10050582
  13. Akter S, Eguchi M, Kuwahara K, Kochi T, Ito R, Kurotani K, et al. High dietary acid load is associated with insulin resistance: The Furukawa Nutrition and Health Study. Clin Nutr. 2016;35(2):453-9. doi: 10.1016/j.clnu.2015.03.008
  14. Murakami K, Sasaki S, Takahashi Y, Uenishi K, Japan Dietetic Students’ Study for Nutrition and Biomarkers Group. Association between dietary acid-base load and cardiometabolic risk factors in young Japanese women. Br J Nutr. 2008;100(3):642-51. doi: 10.1017/S0007114508901288
  15. Bahadoran Z, Mirmiran P, Khosravi H, Azizi F. Associations between dietary acid-base load and cardiometabolic risk factors in adults: The Tehran Lipid and Glucose Study. Endocrinol Metab. 2015;30(2):201-7. doi: 10.3803/EnM.2015.30.2.201
  16. Jauharany FF, Widyastuti N. Keseimbangan asam-basa tubuh dan kejadian sindrom metabolik pada remaja obesitas. Jurnal Gizi Klinik Indonesia. 2017;14(1):36-44. doi: 10.22146/ijcn.24811
  17. Remer T, Manz F. Potential renal acid load of foods and its influence on urine pH. J Am Diet Assoc. 1995;95(7):791-7. doi: 10.1016/S0002-8223(95)00219-7
  18. Shafiee G, Kelishadi R, Heshmat R, Qorbani M, Motlagh ME, Aminaee T, et al. First report on the validity of a continuous metabolic syndrome score as an indicator for metabolic syndrome in a national sample of paediatric population — the CASPIAN-III study. Endokrynol Pol. 2013;64(4):278-84. doi: 10.5603/ep.2013.0006
  19. Pratiwi ZA, Hasanbasri M, Huriyati E. Penentuan titik potong skor sindroma metabolik remaja dan penilaian validitas diagnostik parameter antropometri: analisis Riskesdas 2013. Jurnal Gizi Klinik Indonesia. 2017;14(2):80-9. doi: 10.22146/ijcn.25590
  20. Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA, et al. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation. 2005;112(17):2735-52. doi: 10.1161/CIRCULATIONAHA.105.169404
  21. Petersen W. Society and the adolescent self-image. Morris Rosenberg. Science. 1965;148(3671):804. doi: 10.1126/science.148.3671.804
  22. Spielberger C, Gorsuch R, Lushene R, Vagg P, Jacobs G. Manual for the state-trait anxiety inventory (Form Y1 – Y2). California: Consulting Psychologists Press; 1983.
  23. Forde C. Scoring the international physical activity questionnaire (IPAQ). [series online] 2018 [cited 2020 Jul 27]. Available from: URL:
  24. Han E, Kim G, Hong N, Lee Y-H, Kim DW, Shin HJ, et al. Association between dietary acid load and the risk of cardiovascular disease: nationwide surveys (KNHANES 2008-2011). Cardiovasc Diabetol. 2016;15(1):122. doi: 10.1186/s12933-016-0436-z
  25. Dawson-Hughes B, Harris SS, Ceglia L. Alkaline diets favor lean tissue mass in older adults. Am J Clin Nutr. 2008;87(3):662-5. doi: 10.1093/ajcn/87.3.662
  26. Osuna-Padilla IA, Leal-Escobar G, Garza-García CA, Rodríguez-Castellanos FE. Dietary acid load: mechanisms and evidence of its health repercussions. Nefrología (English Edition). 2019;39(4):343-54. doi: 10.1016/j.nefro.2018.10.005
  27. Esche J, Krupp D, Mensink GB, Remer T. Dietary potential renal acid load is positively associated with serum uric acid and odds of hyperuricemia in the German adult population. J Nutr. 2018;148(1):49-55. doi: 10.1093/jn/nxx003
  28. Wang J, Qin T, Chen J, Li Y, Wang L, Huang H, et al. Hyperuricemia and risk of incident hypertension: a systematic review and meta-analysis of observational studies. PLoS ONE. 2014;9(12):e114259. doi: 10.1371/journal.pone.0114259
  29. Jayedi A, Shab-Bidar S. Dietary acid load and risk of type 2 diabetes: a systematic review and dose-response meta-analysis of prospective observational studies. Clin Nutr ESPEN. 2018;23:10-8. doi: 10.1016/j.clnesp.2017.12.005
  30. Ma H, Patti ME. Bile acids, obesity, and the metabolic syndrome. Best Pract Res Clin Gastroenterol. 2014;28(4):573-83. doi: 10.1016/j.bpg.2014.07.004
  31. Vrieze A, Van Nood E, Holleman F, Salojärvi J, Kootte RS, Bartelsman JFWM, et al. Transfer of intestinal microbiota from lean donors increases insulin sensitivity in individuals with metabolic syndrome. Gastroenterology. 2012;143(4):913-916.e7. doi: 10.1053/j.gastro.2012.06.031
  32. Shab-Bidar S, Hosseini-Esfahani F, Mirmiran P, Hosseinpour-Niazi S, Azizi F. Metabolic syndrome profiles, obesity measures and intake of dietary fatty acids in adults: Tehran Lipid and Glucose Study. J Hum Nutr Diet. 2014;27(Suppl 2):98-108. doi: 10.1111/jhn.12117
  33. Julibert A, Bibiloni M, Bouzas C, Martínez-González M, Salas-Salvadó J, Corella D, et al. Total and subtypes of dietary fat intake and its association with components of the metabolic syndrome in a Mediterranean population at high cardiovascular risk. Nutrients. 2019;11(7):1493. doi: 10.3390/nu11071493
  34. Wang H, Peng D-Q. New insights into the mechanism of low high-density lipoprotein cholesterol in obesity. Lipids Health Dis. 2011;10:176. doi: 10.1186/1476-511X-10-176
  35. Knox E, Muros JJ. Association of lifestyle behaviours with self-esteem through health-related quality of life in Spanish adolescents. Eur J Pediatr. 2017;176(5):621-8. doi: 10.1007/s00431-017-2886-z
  36. Galanakis MJ, Palaiologou A, Patsi G, Velegraki I-M, Darviri C. A literature review on the connection between stress and self-esteem. Psychology. 2016;7:687-94. doi: 10.4236/psych.2016.75071
  37. Liu SY, Wrosch C, Miller GE, Pruessner JC. Self-esteem change and diurnal cortisol secretion in older adulthood. Psychoneuroendocrinology. 2014;41:111-20. doi: 10.1016/j.psyneuen.2013.12.010
  38. Milajerdi A, Keshteli AH, Haghighatdoost F, Azadbakht L, Esmaillzadeh A, Adibi P. Dietary acid load in relation to depression and anxiety in adults. J Hum Nutr Diet. 2020;33(1):48-55. doi: 10.1111/jhn.12658
  39. Jacka FN, Pasco JA, Mykletun A, Williams LJ, Hodge AM, O’Reilly SL, et al. Association of western and traditional diets with depression and anxiety in women. Am J Psychiatry. 2010;167(3):305-11. doi: 10.1176/appi.ajp.2009.09060881
  40. Weng T-T, Hao J-H, Qian Q-W, Cao H, Fu J-L, Sun Y, et al. Is there any relationship between dietary patterns and depression and anxiety in Chinese adolescents? Public Health Nutr. 2012;15(4):673-82. doi: 10.1017/S1368980011003077
  41. Coryell MW, Ziemann AE, Westmoreland PJ, Haenfler JM, Kurjakovic Z, Zha X, et al. Targeting ASIC1a reduces innate fear and alters neuronal activity in the fear circuit. Biol Psychiatry. 2007;62(10):1140–8. doi: 10.1016/j.biopsych.2007.05.008
  42. Ziemann AE, Allen JE, Dahdaleh NS, Drebot II, Coryell MW, Wunsch AM, et al. The amygdala is a chemosensor that detects carbon dioxide and acidosis to elicit fear behavior. Cell. 2009;139(5):1012-21. doi: 10.1016/j.cell.2009.10.029
  43. Wemmie JA, Zha X, Welsh MJ. Acid-sensing ion channels (ASICs) and pH in synapse physiology. In: Hell JW, Ehlers MD, editors. Structural and functional organization of the synapse. [series online] 2008 [cited 2020 Jul 27]. Available from: URL:
  44. Maurer M, Riesen W, Muser J, Hulter HN, Krapf R. Neutralization of western diet inhibits bone resorption independently of K intake and reduces cortisol secretion in humans. Am J Physiol Renal Physiol. 2003;284(1):F32-40. doi: 10.1152/ajprenal.00212.2002
  45. Herane Vives A, De Angel V, Papadopoulos A, Strawbridge R, Wise T, Young AH, et al. The relationship between cortisol, stress and psychiatric illness: new insights using hair analysis. J Psychiatr Res. 2015;70:38-49. doi: 10.1016/j.jpsychires.2015.08.007
  46. Zorn JV, Schür RR, Boks MP, Kahn RS, Joëls M, Vinkers CH. Cortisol stress reactivity across psychiatric disorders: a systematic review and meta-analysis. Psychoneuroendocrinology. 2017;77:25-36. doi: 10.1016/j.psyneuen.2016.11.036
  47. de Nadai TR, de Nadai MN, Albuquerque AAS, de Carvalho MTM, Celotto AC, Evora PRB. Metabolic acidosis treatment as part of a strategy to curb inflammation. Int J Inflam. 2013;2013:601424. doi: 10.1155/2013/601424
  48. Najjar S, Pearlman DM, Alper K, Najjar A, Devinsky O. Neuroinflammation and psychiatric illness. J Neuroinflammation. 2013;10:43. doi: 10.1186/1742-2094-10-43


Article Metrics

Abstract views : 4426 | views : 5035


  • There are currently no refbacks.

Copyright (c) 2021 Jurnal Gizi Klinik Indonesia

Creative Commons License
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.

Jurnal Gizi Klinik Indonesia (JGKI) Indexed by:

web stats View My Stats