Effects of Dietary Phosphate and Calcium Intake on Fibroblast Growth Factor-23
Open accessAbstract
Summary: Background and objectives: Little is known about the influence of dietary phosphate intake on fibroblast growth factor-23 (FGF23) and its subsequent effects on vitamin D levels. This study addresses changes in intact FGF23 (iFGF23) and C-terminal FGF23 (cFGF23), phosphaturia, and levels of vitamin D on high and low phosphate and calcium intake. Design, setting, participants, & measurements: Ten healthy subjects adhered to a diet low or high in phosphate and calcium content for 36 hours each with a 1-week interval during which subjects adhered to their usual diet. Serum phosphate, calcium, vitamin D metabolites, parathyroid hormone (PTH), and FGF23 levels (cFGF23 and iFGF23) were measured several times a day. Phosphate, calcium, and creatinine excretion was measured in 24-hour urine on all study days. Results: Serum phosphate levels and urinary phosphate increased during high dietary phosphate intake (from 1.11 to 1.32 mmol/L, P < 0.0001 and 21.6 to 28.8 mmol/d, P = 0.0005, respectively). FGF23 serum levels increased during high dietary phosphate/calcium intake (cFGF23 from 60 to 72 RU/ml, P < 0.001; iFGF23 from 33 to 37 ng/L, P = 0.003), whereas PTH declined. 1,25-Dihydroxyvitamin D (1,25D) showed an inverse relation with FGF23. Conclusions: Variation in dietary phosphate and calcium intake induces changes in FGF23 (on top of a circadian rhythm) and 1,25D blood levels as well as in urinary phosphate excretion. These changes are detectable the day after the change in the phosphate content of meals. Higher FGF23 levels are associated with phosphaturia and a decline in 1,25D levels.
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Two to five days of high dietary Pi intake increases iFGF23 but not cFGF23.
“Two to five days of high dietary Pi intake increases iFGF23 but not cFGF23 [20, 25, 34, 58].”
From Controlled dietary phosphate loading in healthy young men elevates plasma phosphate and FGF23 levels (2025) · cites this paper as [58]
The Results report that both iFGF23 and cFGF23 increased during high dietary phosphate/calcium intake. The Discussion likewise states that both increased within a day, directly contrary to the claim that cFGF23 did not increase. (LLM, conf=0.90)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredControlled experiments in healthy humans examined periods of either a few hours or several weeks, and often varied dietary calcium intake.
“controlled experiments in healthy humans examined periods of either a few hours or several weeks, and often varied dietary calcium intake.”
From Controlled dietary phosphate loading in healthy young men elevates plasma phosphate and FGF23 levels (2025) · cites this paper as [58]
Materials and Methods reports a controlled dietary experiment in ten healthy subjects that varied calcium intake alongside phosphate intake. But the interventions lasted 36 hours each, within two three-day study periods—not a few hours or several weeks. The Introduction discusses other studies lasting 6–16 hours or five days, but does not establish the claimed several-week duration. (LLM, conf=0.88)
Experimental — accuracy not yet measuredIn mixed sex, intermediate-term studies, enteral and intravenous Pi loading increased serum Pi and PTH and decreased calcitriol.
“In mixed sex, intermediate-term studies, oral, enteral, or intravenous Pi loading increased iFGF23 and urinary Pi excretion, while enteral and intravenous Pi loading additionally increased serum Pi, and PTH, and decreased calcitriol [2, 20, 25, 50, 58].”
From Controlled dietary phosphate loading in healthy young men elevates plasma phosphate and FGF23 levels (2025) · cites this paper as [58]
The Methods describe a three-day study of phosphate- and calcium-enriched meals in participants of both sexes, not intravenous loading. The Results report increased serum phosphate and decreased 1,25D (calcitriol), but PTH decreased rather than increased. Page numbers are unavailable in our copy. (LLM, conf=0.88)
Experimental — accuracy not yet measuredIn mixed sex, intermediate-term studies, oral, enteral, or intravenous Pi loading increased iFGF23 and urinary Pi excretion.
“In mixed sex, intermediate-term studies, oral, enteral, or intravenous Pi loading increased iFGF23 and urinary Pi excretion, while enteral and intravenous Pi loading additionally increased serum Pi, and PTH, and decreased calcitriol [2, 20, 25, 50, 58].”
From Controlled dietary phosphate loading in healthy young men elevates plasma phosphate and FGF23 levels (2025) · cites this paper as [58]
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- Authors
- Vervloet, M. G., van Ittersum, F. J., Büttler, R. M., Heijboer, A. C., Blankenstein, M. A., & ter Wee, P. M.
- Affiliations
- Amsterdam UMC Location Vrije Universiteit Amsterdam (NL)
- Venue
- Clinical Journal of the American Society of Nephrology
- Published
- 2011-02
- Volume
- 6
- Issue
- 2
- Pages
- 383-389
- ISSN
- 1555-9041 (ISSN-L)
- PMC
- PMC3052230
- OpenAlex
- W1973638806
- Cited by
- 218
- References
- 35
- Citations by year
- 2026: 7 · 2025: 3 · 2024: 10 · 2023: 11 · 2022: 12 · 2021: 27 · 2020: 11 · 2019: 13 · 2018: 13 · 2017: 14 · 2016: 16 · 2015: 13 · 2014: 15 · 2013: 27 · 2012: 18
- FWCI
- 13.21
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Clinical Journal of the American Society of Nephrology (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Pure Amsterdam UMC (submittedVersion)
- Topics
- Health Sciences › Medicine › Nephrology › Parathyroid Disorders and Treatments
- Health Sciences › Medicine › Pathology and Forensic Medicine › Vitamin D Research Studies
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone health and osteoporosis research
- Keywords
- fibroblast growth factor 23, dietary phosphorus, dietary calcium, vitamin D, 1,25-dihydroxyvitamin D, parathyroid hormone, phosphaturia, urinary phosphate excretion, serum phosphorus, circadian rhythm
- MeSH terms
- Fibroblast Growth Factor-23, Adult, Calcium, Dietary, Circadian Rhythm, Female, Fibroblast Growth Factors, Humans, Male, Netherlands, Parathyroid Hormone, Vitamin D, Biomarkers, Phosphorus, Dietary, Cross-Over Studies, Young Adult
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