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The association of diet-dependent acid load with gastrointestinal cancer risk in the Cancer Screenee Cohort in Korea

European Journal of Clinical Nutrition volume 79, pages 921–927 (2025)Cite this article

Subjects

Abstract

Background/objectives

Diet-induced acidosis is a determinant of gastrointestinal (GI) cancer susceptibility. However, the current evidence remains insufficient to establish a link between an acidogenic diet and cancer because the majority of previous studies were restricted to a case‒control design. We investigated whether the dietary acid load is involved in GI carcinogenicity.

Subjects/methods

We conducted a prospective cohort study of 10,741 participants who attended check-ups from October 2007 to December 2020 at the National Cancer Center, Korea. The participants were followed up until December 2020 to determine incident GI cancer cases. A Cox proportional hazards regression model was used to examine the dietary acid load, as reflected by the potential renal acid load (PRAL), the net endogenous acid production (NEAP), and net acid excretion (NAE), in relation to GI cancer risk.

Results

A total of 208 incident GI cancer cases were identified during the follow-up period. We observed a significantly increased GI cancer risk among male participants with high PRAL, NEAP, and NAE scores (hazard ratios (HRs) = 1.53 (95% confidence interval (CI): 1.05–2.22), 1.51 (1.04–2.19), and 1.73 (1.18–2.53), respectively). Importantly, acidogenic foods seem to have detrimental effects even in individuals who are not obese.

Conclusions

Our findings add substantial evidence to the argument that diet-dependent acid load plays certain roles in GI carcinogenesis, especially in males. Thus, attention should be given to the dietary acid‒base load for the prevention of GI cancer.

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Fig. 1: Flowchart of the study participants.

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Data availability

Data analyzed in this study are available from the corresponding author on reasonable request.

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Author information

Authors and Affiliations

  1. Department of Cancer AI & Digital Health, Graduate School of Cancer Science and Policy, Goyang-si, Gyeonggi-do, South Korea

    Tao Thi Tran, Madhawa Gunathilake, Jeonghee Lee & Jeongseon Kim

  2. Faculty of Public Health, University of Medicine and Pharmacy, Hue University, Hue city, Vietnam

    Tao Thi Tran

Authors
  1. Tao Thi Tran
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  2. Madhawa Gunathilake
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Contributions

Formal analysis, TTT, JL; Preparation of original draft, TT.T.; Writing-review and editing, MG, JK; Data curation, JL, JK; Investigation, JL; Methodology, JL, JK; Funding acquisition, JK; Project administration, JK; Supervision, JK All authors have critically reviewed and approved the final version of the manuscript submitted for publication.

Corresponding author

Correspondence to Jeongseon Kim.

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The authors declare no competing interests.

Ethics approval and consent to participate

This research was performed in accordance with the Declaration of Helsinki. We obtained written informed consent from all participants and approval for the study protocol from the institutional review board of the National Cancer Center (No. NCCNCS-07-077).

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Thi Tran, T., Gunathilake, M., Lee, J. et al. The association of diet-dependent acid load with gastrointestinal cancer risk in the Cancer Screenee Cohort in Korea. Eur J Clin Nutr 79, 921–927 (2025). https://doi.org/10.1038/s41430-025-01612-2

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