Dietary Acid Load and Risk of Polycystic Ovary Syndrome: A Case–Control Study Publisher



M Karimi MAHYA ; G Eslamian GHAZALEH ; Sa Keshavarz Seyed ALI ; M Naghashzadeh MOTAHAREH
Source: Nutrire Published:2025

Abstract

Background: Polycystic ovary syndrome (PCOS) is a common endocrine disorder involving metabolic and hormonal disturbances. Emerging evidence suggests dietary factors, particularly dietary acid load (DAL), may influence PCOS development through insulin resistance mechanisms. This study examines the DAL-PCOS association in Iranian women. Methods: In this hospital-based case–control study, we recruited 120 newly diagnosed PCOS cases (Rotterdam criteria) and 120 age-matched healthy controls from outpatient clinics between February–May 2025. DAL was quantified using potential renal acid load (PRAL) and net endogenous acid production (NEAP) scores derived from a validated 168-item semi-quantitative food frequency questionnaire. Multivariable logistic regression models adjusted for BMI, physical activity, energy intake, and socioeconomic status evaluated the DAL-PCOS relationship. Results: Higher DAL showed a significant dose–response association with PCOS risk. In the fully adjusted model, women in the highest NEAP tertile had 94% greater odds of PCOS (OR 1.94; 95% CI 1.02–3.69; P-trend = 0.042) compared to the lowest tertile. Similarly, the highest PRAL tertile was associated with a 2.03-fold increased PCOS risk (95% CI 1.29–3.19; P-trend = 0.025). Conclusions: Our findings demonstrate that higher DAL, as measured by both PRAL and NEAP, is independently associated with increased PCOS odds in this observational study. While these results suggest a potential link between dietary acid–base balance and PCOS risk, further prospective and mechanistic studies are needed to establish causality. © 2025 Elsevier B.V., All rights reserved.