The DOI matches its Crossref record; 48 of the 48 references it cites were found in a registry or an index.
High dietary phosphorus intake is associated with all-cause mortality: results from NHANES III
Open accessAbstract
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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In the citing paper
“may therefore be a health risk, as higher serum Pi levels are associated with cardiovascular risk in the general population.”
From Controlled dietary phosphate loading in healthy young men elevates plasma phosphate and FGF23 levels (2025) · cites this paper as [9]
In the citing paper
“High dietary Pi intake has been associated with higher hazard ratios for cardiovascular disease and mortality in the general population [9, 15, 16].”
From Controlled dietary phosphate loading in healthy young men elevates plasma phosphate and FGF23 levels (2025) · cites this paper as [9]
In the citing paper
“further association studies suggest that higher blood Pi levels are associated with higher all-cause and cardiovascular mortality and with lower bone mass [9, 15, 16, 25, 55].”
From Controlled dietary phosphate loading in healthy young men elevates plasma phosphate and FGF23 levels (2025) · cites this paper as [9]
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FGF23 induces left ventricular hypertrophy
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Self-citationRelation Between Serum Phosphate Level and Cardiovascular Event Rate in People With Coronary Disease
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Fibroblast Growth Factor 23 and Left Ventricular Hypertrophy in Chronic Kidney Disease
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Ko, G.-J., Rhee, C. M., Kalantar-Zadeh, K., & Joshi, S. (2020) · Journal of the American Society of Nephrology · doi:10.1681/asn.2020010028 · Cited by 345
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Buchanan, S. J., Combet, E., Stenvinkel, P., & Shiels, P. G. (2020) · Frontiers in Endocrinology · doi:10.3389/fendo.2020.00560 · Cited by 250
Roles of phosphate and fibroblast growth factor 23 in cardiovascular disease
Scialla, J. J., & Wolf, M. S. (2014) · Nature Reviews Nephrology · doi:10.1038/nrneph.2014.49 · Cited by 201
Importance of Dietary Phosphorus for Bone Metabolism and Healthy Aging
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Covic, A. C., Vervloet, M. G., Massy, Z. A., Ureña, P., Goldsmith, D. J. A., Brandenburg, V. M., Mazzaferro, S., Evenepoel, P., Bover, J., Apetrii, M., et al. (2017) · The Lancet Diabetes & Endocrinology · doi:10.1016/s2213-8587(17)30310-8 · Cited by 164
Metadata
- 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)
- 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)
- 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
- bronze
- doi.org
- 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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