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Cited by 15Nutritional Studies and DietParathyroid Disorders and TreatmentsConsumer Attitudes and Food Labeling

Association of Total, Added, and Natural Phosphorus Intakes with Biomarkers of Health Status and Mortality in Healthy Adults in the United States

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Fulgoni, Kristin, Fulgoni, Victor L., Wallace, Taylor C.·2022·Nutrients
DOI 10.3390/nu14091738PMC PMC9104875
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Abstract

The Western diet is high in dietary phosphorus, partially due to added phosphorus, (i.e., phosphates) predominantly present in processed food products. Elevated serum phosphate levels, otherwise known as hyperphosphatemia, have been associated with changes in health status, of note detrimental effects on cardiovascular and renal health. However, the extent to which highly absorbed added phosphorus contributes to these changes is relatively unknown, due to its poor characterization among food composition databases. Industry-provided data on phosphorus source ingredients and ranges of added phosphorus present in food categories to enable a more accurate estimation of the total, added, and natural phosphorus intakes in the U.S. population. Using regression analyses, we then assessed relationships between estimated total, added, and natural phosphorus intakes on biomarkers of health status and mortality in individuals enrolled in the National Health and Nutrition Examination Survey (NHANES) 1988–1994 and 2001–2016 datasets. Total, added, and natural phosphorus intakes were associated with several biomarkers of health status. Added phosphorus intake was consistently inversely associated with HDL cholesterol in both men and women, whereas naturally occurring phosphorus intake was inversely correlated with the risk of elevated blood pressure. However, in most cases, the predicted impact of increases in phosphorus intake would result in small percentage changes in biomarkers. No meaningful associations between phosphorus and mortality were found, but indications of a correlation between mortality with quintiles of naturally occurring phosphorus were present, depending on covariate sets used. The disparate results for natural and added phosphorus intakes within the current study provide increased support for updating current food composition databases to more accurately account for dietary phosphorus intake as total, naturally occurring, and added phosphorus.

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  1. [1]Institute of Medicine (US) Standing Committee on the Scientific Evaluation of Dietary Reference Intakes Phosphorus Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride National Academies Press Washington, DC, USA 1997 Available online: https://www.ncbi.nlm.nih.gov/books/NBK109813/ (accessed on 23 February 2021) 23115811
  2. [3]McClure S.T. Chang A.R. Selvin E. Rebholz C.M. Appel L.J. Dietary Sources of Phosphorus among Adults in the United States: Results from NHANES 2001–2014 Nutrients 2017 9 95 10.3390/nu9020095 28146091 PMC5331526 · DOI
  3. [4]Calvo M.S. Moshfegh A.J. Tucker K.L. Assessing the Health Impact of Phosphorus in the Food Supply: Issues and Considerations Adv. Nutr. Int. Rev. J. 2014 5 104 113 10.3945/an.113.004861 24425729 PMC3884091 · DOI
  4. [6]EFSA FAF Panel (EFSA Panel on Food Additives and Flavourings) Younes M. Aquilina G. Castle L. Engel K. Fowler P. Fernandez M.J.F. Fürst P. Gürtler R. Husøy T. Re-evaluation of phosphoric acid–phosphates–di-, tri- and polyphosphates (E 338–341, E 343, E 450–452) as food additives and the safety of proposed extension of use EFSA J. 2019 17 e05674 10.2903/j.efsa.2019.5674 32626329 PMC7009158 · DOI
  5. [7]Turner N.N. Lameire N. Goldsmith D.J. Winearls C.G. Himmelfarb J. Remuzzi G. Oxford Textbook of Clinical Nephrology Oxford University Press Oxford, UK 2015
  6. [8]National Kidney Foundation K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease Am. J. Kidney Dis. 2003 42 (Suppl. S3) S1 S201 10.1016/S0272-6386(03)00905-3 14520607 · DOI
  7. [9]Sawin D.-A. Ma L. Stennett A. Ofsthun N. Himmele R. Kossmann R.J. Maddux F.W. Phosphates in medications: Impact on dialysis patients Clin. Nephrol. 2020 93 163 171 10.5414/CN109853 32049627 PMC7264818 · DOI
  8. [11]Goyal R. Jialal I. Hyperphosphatemia. StatPearls 2020 Available online: https://www.ncbi.nlm.nih.gov/books/NBK551586/ (accessed on 31 January 2021)
  9. [12]Schwarz S. Trivedi B.K. Kalantar-Zadeh K. Kovesdy C.P. Association of Disorders in Mineral Metabolism with Progression of Chronic Kidney Disease Clin. J. Am. Soc. Nephrol. 2006 1 825 831 10.2215/CJN.02101205 17699293 · DOI
  10. [13]Adeney K.L. Siscovick D.S. Ix J.H. Seliger S.L. Shlipak M.G. Jenny N.S. Kestenbaum B.R. Association of Serum Phosphate with Vascular and Valvular Calcification in Moderate CKD J. Am. Soc. Nephrol. 2008 20 381 387 10.1681/ASN.2008040349 19073826 PMC2637048 · DOI
  11. [14]Kestenbaum B. Sampson J.N. Rudser K.D. Patterson D.J. Seliger S.L. Young B. Sherrard D.J. Andress D.L. Serum Phosphate Levels and Mortality Risk among People with Chronic Kidney Disease J. Am. Soc. Nephrol. 2004 16 520 528 10.1681/ASN.2004070602 15615819 · DOI
  12. [15]Voormolen N. Noordzij M. Grootendorst D.C. Beetz I. Sijpkens Y.W. Van Manen J.G. Boeschoten E.W. Huisman R.M. Krediet R.T. Dekker F. High plasma phosphate as a risk factor for decline in renal function and mortality in pre-dialysis patients Nephrol. Dial. Transplant. 2007 22 2909 2916 10.1093/ndt/gfm286 17517792 · DOI
  13. [16]Block G.A. Klassen P.S. Lazarus J.M. Ofsthun N. Lowrie E.G. Chertow G.M. Mineral Metabolism, Mortality, and Morbidity in Maintenance Hemodialysis J. Am. Soc. Nephrol. 2004 15 2208 2218 10.1097/01.ASN.0000133041.27682.A2 15284307 · DOI
  14. [17]Ganesh S.K. Stack A.G. Levin N.W. Hulbert-Shearon T. Port F.K. Association of Elevated Serum PO4, Ca × PO4 Product, and Parathyroid Hormone with Cardiac Mortality Risk in Chronic Hemodialysis Patients J. Am. Soc. Nephrol. 2001 12 2131 2138 10.1681/ASN.V12102131 11562412 · DOI
  15. [18]Foley R.N. Collins A.J. Herzog C.A. Ishani A. Kalra P.A. Serum Phosphorus Levels Associate with Coronary Atherosclerosis in Young Adults J. Am. Soc. Nephrol. 2009 20 397 404 10.1681/ASN.2008020141 18987306 PMC2637043 · DOI
  16. [19]Dhingra R. Sullivan L. Fox C.S. Wang T.J. D’Agostino R.B. Gaziano J.M. Vasan R.S. Relations of Serum Phosphorus and Calcium Levels to the Incidence of Cardiovascular Disease in the Community Arch. Intern. Med. 2007 167 879 885 10.1001/archinte.167.9.879 17502528 · DOI · Paper page
  17. [20]Sherman R.A. Mehta O. Phosphorus and Potassium Content of Enhanced Meat and Poultry Products: Implications for Patients Who Receive Dialysis Clin. J. Am. Soc. Nephrol. 2009 4 1370 1373 10.2215/CJN.02830409 19628683 PMC2723964 · DOI
  18. [21]Lampila L.E. Applications and functions of food-grade phosphates Ann. N. Y. Acad. Sci. 2013 1301 37 44 10.1111/nyas.12230 24033359 · DOI
  19. [22]Moore L.W. Nolte J.V. Gaber A.O. Suki W.N. Association of dietary phosphate and serum phosphorus concentration by levels of kidney function Am. J. Clin. Nutr. 2015 102 444 453 10.3945/ajcn.114.102715 26040641 · DOI · Paper page
  20. [23]Parpia A.S. L’Abbé M. Goldstein M. Arcand J. Magnuson B. Darling P.B. The Impact of Additives on the Phosphorus, Potassium, and Sodium Content of Commonly Consumed Meat, Poultry, and Fish Products Among Patients with Chronic Kidney Disease J. Ren. Nutr. 2018 28 83 90 10.1053/j.jrn.2017.08.013 29146137 · DOI
  21. [24]León J.B. Sullivan C.M. Sehgal A.R. The Prevalence of Phosphorus-Containing Food Additives in Top-Selling Foods in Grocery Stores J. Ren. Nutr. 2013 23 265 270.e2 10.1053/j.jrn.2012.12.003 23402914 PMC3674209 · DOI
  22. [25]Carrigan A. Klinger A. Choquette S.S. Luzuriaga-McPherson A. Bell E.K. Darnell B. Gutiérrez O.M. Contribution of Food Additives to Sodium and Phosphorus Content of Diets Rich in Processed Foods J. Ren. Nutr. 2014 24 13 19.e1 10.1053/j.jrn.2013.09.003 24355818 PMC3869975 · DOI
  23. [26]Fulgoni K. Fulgoni V. Trends in Total, Added, and Natural Phosphorus Intake in Adult Americans, NHANES 1988–1994 to NHANES 2015–2016 Nutrients 2021 13 2249 10.3390/nu13072249 34210102 PMC8308364 · DOI · Paper page
  24. [28]Dwyer J. Picciano M.F. Raiten D.J. Members of the Steering Committee Collection of Food and Dietary Supplement Intake Data: What We Eat in America–NHANES J. Nutr. 2003 133 590S 600S 10.1093/jn/133.2.590S 12566509 · DOI
  25. [30]Moshfegh A.J. Rhodes D.G. Baer D.J. Murayi T. Clemens J.C. Rumpler W.V. Paul D.R. Sebastian R.S. Kuczynski K.J. Ingwersen L.A. The US Department of Agriculture Automated Multiple-Pass Method reduces bias in the collection of energy intakes Am. J. Clin. Nutr. 2008 88 324 332 10.1093/ajcn/88.2.324 18689367 · DOI
  26. [31]Tooze J.A. Midthune D. Dodd K.W. Freedman L.S. Krebs-Smith S.M. Subar A.F. Guenther P.M. Carroll R.J. Kipnis V. A New Statistical Method for Estimating the Usual Intake of Episodically Consumed Foods with Application to Their Distribution J. Am. Diet. Assoc. 2006 106 1575 1587 10.1016/j.jada.2006.07.003 17000190 PMC2517157 · DOI
  27. [32]Goff D.C. Jr. Lloyd-Jones D.M. Bennett G. Coady S. D’Agostino R.B. Gibbons R. Greenland P. Lackland D.T. Levy D. O’Donnell C.J. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Circulation 2013 129 S49 S73 10.1161/01.cir.0000437741.48606.98 24222018 · DOI · Paper page
  28. [34]Onufrak S.J. Bellasi A. Cardarelli F. Vaccarino V. Muntner P. Shaw L.J. Raggi P. Investigation of Gender Heterogeneity in the Associations of Serum Phosphorus with Incident Coronary Artery Disease and All-Cause Mortality Am. J. Epidemiol. 2008 169 67 77 10.1093/aje/kwn285 18980959 PMC2720702 · DOI
  29. [35]Itkonen S.T. Karp H.J. Kemi V.E. Kokkonen E.M. Saarnio E.M. Pekkinen M.H. Kärkkäinen M.U. Laitinen E.K.A. Turanlahti M.I. Lamberg-Allardt C.J. Associations among total and food additive phosphorus intake and carotid intima-media thickness—A cross-sectional study in a middle-aged population in Southern Finland Nutr. J. 2013 12 94 10.1186/1475-2891-12-94 23841978 PMC3711844 · DOI
  30. [36]Kim J. Burton-Pimentel K. Fleuti C. Blaser C. Scherz V. Badertscher R. Marmonier C. Lyon-Belgy N. Caille A. Pidou V. Microbiota and Metabolite Modifications after Dietary Exclusion of Dairy Products and Reduced Consumption of Fermented Food in Young and Older Men Nutrients 2021 13 1905 10.3390/nu13061905 34205926 PMC8228243 · DOI
  31. [37]Ebbeling C.B. Knapp A. Johnson A. Wong J.M.W. Greco K.F. Ma C. Mora S. Ludwig D.S. Effects of a low-carbohydrate diet on insulin-resistant dyslipoproteinemia—a randomized controlled feeding trial Am. J. Clin. Nutr. 2021 115 154 162 10.1093/ajcn/nqab287 PMC8755039 34582545 · DOI
  32. [38]Alonso A. Nettleton J.A. Ix J.H. De Boer I.H. Folsom A.R. Bidulescu A. Kestenbaum B.R. Chambless L.E. Jacobs D.R. Dietary phosphorus, blood pressure and incidence of hypertension in the Atherosclerosis Risk in Communities (ARIC) Study and the Multi-Ethnic Study of Atherosclerosis (MESA) Hypertension 2010 55 776 784 10.1161/HYPERTENSIONAHA.109.143461 20083730 PMC2825283 · DOI
  33. [39]Olivo R.E. Hale S.L. Diamantidis C.J. Bhavsar N.A. Tyson C.C. Tucker K.L. Carithers T. Kestenbaum B. Muntner P. Tanner R.M. Dietary Phosphorus and Ambulatory Blood Pressure in African Americans: The Jackson Heart Study Am. J. Hypertens. 2018 32 94 103 10.1093/ajh/hpy126 30107444 PMC6284751 · DOI
  34. [40]McClure S.T. Rebholz C.M. Medabalimi S. A Hu E. Xu Z. Selvin E. Appel L.J. Dietary phosphorus intake and blood pressure in adults: A systematic review of randomized trials and prospective observational studies Am. J. Clin. Nutr. 2019 109 1264 1272 10.1093/ajcn/nqy343 31051505 PMC6499505 · DOI
  35. [41]McClure S.T. Rebholz C.M. Mitchell D.C. Selvin E. Appel L.J. The association of dietary phosphorus with blood pressure: Results from a secondary analysis of the PREMIER trial J. Hum. Hypertens. 2019 34 132 142 10.1038/s41371-019-0231-x 31435005 PMC7031014 · DOI
  36. [42]Centeno P.P. Herberger A. Mun H.-C. Tu C.-L. Nemeth E.F. Chang W. Conigrave A.D. Ward D.T. Phosphate acts directly on the calcium-sensing receptor to stimulate parathyroid hormone secretion Nat. Commun. 2019 10 1 12 10.1038/s41467-019-12399-9 31619668 PMC6795806 · DOI
  37. [43]Jacob J.J. Chopra S. Cherian D. The thyroid hormone, parathyroid hormone and vitamin D associated hypertension Indian J. Endocrinol. Metab. 2011 15 354 360 10.4103/2230-8210.86979 PMC3230087 22145139 · DOI
  38. [45]Murakami K. Livingstone M.B.E. Prevalence and characteristics of misreporting of energy intake in US adults: NHANES 2003–2012 Br. J. Nutr. 2015 114 1294 1303 10.1017/S0007114515002706 26299892 · DOI

Cited by

Sorted by citations

Authors
Fulgoni, K., Fulgoni, V. L., & Wallace, T. C.
Affiliations
  • Nutrition Impact, LLC, Battle Creek, MI 49014, USA
  • George Mason University (US)
Corresponding author
Fulgoni, Victor L.
ORCID
Venue
Nutrients
Publisher
MDPI AG
Published
2022-04-22
Volume
14
Issue
9
Pages
1738
ISSN
2072-6643 (ISSN-L)
DOI
10.3390/nu14091738
PMC
PMC9104875
OpenAlex
W4224307644
Cited by
15
References
1
Citations by year
2026: 2 · 2025: 3 · 2024: 6 · 2023: 4
FWCI
2.87
Type
journal article
Language
en
Open access
Licence
Locations
  • Nutrients (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
  • Health Sciences › Medicine › Nephrology › Parathyroid Disorders and Treatments
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Consumer Attitudes and Food Labeling
Keywords
dietary phosphorus intake, hyperphosphatemia, HDL cholesterol, blood pressure, mortality, Western diet, processed foods, food composition tables, NHANES
MeSH terms
Adult, Diet, Female, Health Status, Humans, Male, Nutrition Surveys, Phosphorus, United States, Biomarkers, Phosphorus, Dietary

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