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Cited by 262Parathyroid Disorders and TreatmentsNutritional Studies and DietNutrition and Health Studies

High dietary phosphorus intake is associated with all-cause mortality: results from NHANES III

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Chang, Alex R, Lazo, Mariana, Appel, Lawrence J, Gutiérrez, Orlando M, Grams, Morgan E·2014·The American Journal of Clinical Nutrition
DOI 10.3945/ajcn.113.073148PMC PMC3893724
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Abstract

Background Elevated serum phosphorus is associated with all-cause mortality, but little is known about risk associated with dietary phosphorus intake. Objective We investigated the association between phosphorus intake and mortality in a prospective cohort of healthy US adults (NHANES III; 1998-1994). Design Study participants were 9686 nonpregnant adults aged 20-80 y without diabetes, cancer, or kidney or cardiovascular disease. Exposure to dietary phosphorus, which was assessed by using a 24-h dietary recall, was expressed as the absolute intake and phosphorus density (phosphorus intake divided by energy intake). All-cause and cardiovascular mortality was assessed through 31 December 2006. Results Median phosphorus intake was 1166 mg/d (IQR: 823-1610 mg/d); median phosphorus density was 0.58 mg/kcal (0.48-0.70 mg/kcal). Individuals who consumed more phosphorus-dense diets were older, were less often African American, and led healthier lifestyles (smoking, physical activity, and Healthy Eating Index). In analyses adjusted for demographics, cardiovascular risk factors, kidney function, and energy intake, higher phosphorus intake was associated with higher all-cause mortality in individuals who consumed >1400 mg/d [adjusted HR (95% CI): 2.23 (1.09, 4.5) per 1-unit increase in ln(phosphorus intake); P = 0.03]. At <1400 mg/d, there was no association. A similar association was seen between higher phosphorus density and all-cause mortality at a phosphorus density amount >0.35 mg/kcal [adjusted HR (95% CI): 2.27 (1.19, 4.33) per 0.1-mg/kcal increase in phosphorus density; P = 0.01]. At <0.35 mg/kcal (approximately the fifth percentile), lower phosphorus density was associated with increased mortality risk. Phosphorus density was associated with cardiovascular mortality [adjusted HR (95% CI): 3.39 (1.43, 8.02) per 0.1 mg/kcal at >0.35 mg/kcal; P = 0.01], whereas no association was shown in analyses with phosphorus intake. Results were similar by subgroups of diet quality and in analyses adjusted for sodium and saturated fat intakes. Conclusions High phosphorus intake is associated with increased mortality in a healthy US population. Because of current patterns in phosphorus consumption in US adults, these findings may have important public health implications.

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Authors
Chang, A. R., Lazo, M., Appel, L. J., Gutiérrez, O. M., & Grams, M. E.
Affiliations
  • Johns Hopkins University (US)
  • University of Alabama at Birmingham (US)
ORCID
Venue
The American Journal of Clinical Nutrition
Publisher
Elsevier BV
Published
2014-02
Volume
99
Issue
2
Pages
320-327
ISSN
0002-9165 (ISSN-L)
DOI
10.3945/ajcn.113.073148
PMC
PMC3893724
OpenAlex
W2115391512
Cited by
262
References
48
Citations by year
2026: 13 · 2025: 19 · 2024: 20 · 2023: 19 · 2022: 13 · 2021: 31 · 2020: 27 · 2019: 11 · 2018: 21 · 2017: 32 · 2016: 15 · 2015: 26 · 2014: 15
FWCI
14.15
Type
journal article
Language
en
Update notices
erratum (2017-04-01)
Open access
Licence
Locations
  • American Journal of Clinical Nutrition (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Institutes of Health (UL1TR001079)
  • National Institute of Diabetes and Digestive and Kidney Diseases (T32DK007732)
  • National Center for Advancing Translational Sciences
Topics
  • Health Sciences › Medicine › Nephrology › Parathyroid Disorders and Treatments
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutrition and Health Studies
Keywords
dietary phosphorus intake, all-cause mortality, cardiovascular mortality, NHANES III, dietary assessment, energy intake, diet quality, Healthy Eating Index, serum phosphorus
MeSH terms
Adult, Aged, Aged, 80 and over, Energy Intake, Cardiovascular Diseases, Dose-Response Relationship, Drug, Fatty Acids, Feeding Behavior, Female, Follow-Up Studies, Humans, Male, Middle Aged, Mortality, Motor Activity, Nutrition Surveys, Prospective Studies, Mental Recall, Risk Factors, Socioeconomic Factors, Sodium, Dietary, Stress, Psychological, United States, Proportional Hazards Models, Phosphorus, Dietary, Young Adult, Food, Organic

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