Dietary Food-Additive Phosphate and Human Health Outcomes
Corresponding Author
Allison Cooke
Intl. Food Additives Council, 529 14th St. NW, Suite 750, Washington, DC, 20045 U.S.A
Direct inquiries to author Cooke (Email: [email protected]).Search for more papers by this authorCorresponding Author
Allison Cooke
Intl. Food Additives Council, 529 14th St. NW, Suite 750, Washington, DC, 20045 U.S.A
Direct inquiries to author Cooke (Email: [email protected]).Search for more papers by this authorAbstract
Dietary intake of phosphorus is required for human health, and dietary reference intakes for phosphorus have been established. Food-grade phosphates are used as additives to provide a wide range of technical functions in food production. Phosphates are often the most efficient ingredients to provide the required functionality in many applications, and in some cases, there are not effective and approved alternatives. However, many investigators have expressed concern about the quantities of phosphorus and food-additive phosphate present in the diets of many populations. This paper presents the outcome of an extensive review of 110 primary research articles focused on identifying evidence that substantiates or refutes associations of total dietary phosphorus and food-additive phosphate intake with health and disease in humans. The lack of conclusive evidence prevented the drawing of firm conclusions about the safety and possible risks of food-additive phosphate in the general population, which is consonant with the overall assessments of authoritative institutions who have concluded that available data are insufficient to make the required determinations. Despite the inadequacy of the evidence currently available, many of the authors of the publications reviewed for this paper expressed concerns about the quantities of phosphorus and food-additive phosphate in the diets of the populations and subpopulations they studied. At the same time, most of these authors offered only qualified conclusions and expressed themselves tentatively. In addition, authors of primary research publications, authors of review articles, and authoritative institutions have called for the conduct of further research.
REFERENCES
- Adatorwovor R, Roggenkamp K, Anderson JJ. 2015. Intakes of calcium and phosphorus and calculated calcium-to-phosphorus ratios of older adults: NHANES 2005-2006 data. Nutrients 7(11): 9633–9.
- Alonso A, Nettleton JA, Ix JH, de Boer IH, Folsom AR, Bidulescu A, Kesetenbaum BR, Chabmless LE, Jacobs DR Jr. 2010. Dietary phosphorus, blood pressure, and incidence of hypertension in the atherosclerosis risk in communities study and the multi-ethnic study of atherosclerosis. Hypertension 55(3): 776–84.
- Anderson JJ. 2013. Potential health concerns of dietary phosphorus: cancer, obesity, and hypertension. Ann N y Acad Sci 1301: 1–8.
- Antoniucci DM, Yamashita T, Portale AA. 2006 Dietary phosphorus regulates serum fibroblast growth factor-23 concentrations in healthy men. J Clin Endocrinol Metab 91(8): 3144–9.
- Bansal N, Katz R, de Boer IH, Kestenbaum B, Siscovick DS, Hoofnagle AN, Travy R, Laughlin GA, Criqui MH, Budoff MJ, Li D, Ix JH. 2013. Influence of estrogen therapy on calcium, phosphorus, and other regulatory hormones in postmenopausal women: the MESA study. J Clin Endocrinol Metab 98(12): 4890–8.
- Barsotti G, Cupisti A, Morelli E, Meola M, Cozza V, Barsotti M, Giovannetti S. 1998. Secondary hyperparathyroidism in severe chronic renal failure is corrected by very-low dietary phosphate intake and calcium carbonate supplementation. Nephron 79(2): 137–41.
- Becker GJ, Walker RG, Hewitson TD, Pedagogos E. 2009. Phosphate levels–time for a rethink? Nephrol Dial Transplant 24(8): 2321–4.
- Bounds W, Skinner J, Carruth BR, Ziegler P. 2005. The relationship of dietary and lifestyle factors to bone mineral indexes in children. J Am Diet Assoc 105(5): 735–41.
- Boutron MC, Faivre J, Marteau P, Couillault C, Senesse P, Quipourt V. 1996. Calcium, phosphorus, vitamin D, dairy products and colorectal carcinogenesis: a French case–control study. Br J Cancer 74(1): 145–51.
- Bouvard V, Loomis D, Guyton KZ, Grosse Y, Ghissassi FE, Benbrahim-Tallaa L, Guha N, Mattock H, Straif K, International Agency for Research on Cancer Monograph Working Group. 2015. Carcinogenicity of consumption of red and processed meat. Lancet Oncol 16(16): 1599–600.
- Brot C, Jørgensen N, Madsen OR, Jensen LB, Sørensen OH. 1999. Relationships between bone mineral density, serum vitamin D metabolites and calcium:phosphorus intake in healthy perimenopausal women. J Intern Med 245(5): 509–16.
- Burnett SM, Gunawardene SC, Bringhurst FR, Jüppner H, Lee H, Finkelstein JS. 2006. Regulation of C-terminal and intact FGF-23 by dietary phosphate in men and women. J Bone Miner Res 21(8): 1187–96.
- Calvo MS, Uribarri J. 2013. Public health impact of dietary phosphorus excess on bone and cardiovascular health in the general population. Am J Clin Nutr 98(1): 6–15.
- Calvo MS, Moshfegh AJ, Tucker KL. 2014. Assessing the health impact of phosphorus in the food supply: issues and considerations. Adv Nutr 5(1): 104–13.
- Carrigan A, Klinger A, Choquette SS, Luzuriaga-McPherson A, Bell EK, Darnell B, Gutierrez OM. 2014. Contribution of food additives to sodium and phosphorus content of diets rich in processed foods. J Ren Nutr 24(1): 13–9, 19e1.
- Chan JM, Giovannucci E, Andersson SO, Yuen J, Adami HO, Wolk A. 1998. Dairy products, calcium, phosphorous, vitamin D, and risk of prostate cancer (Sweden). Cancer Causes Control 9(6): 559–66.
- Chan JM, Pietinen P, Virtanen M, Malila N, Tangrea J, Albanes D, Albanes D, Virtamo J. 2000. Diet and prostate cancer risk in a cohort of smokers, with a specific focus on calcium and phosphorus (Finland). Cancer Causes Control 11(9): 859–67.
- Chang A, Batch BC, McGuire HL, Vollmer WM, Svetkey LP, Tyson CC, Sanguankeo A, Anderson C, Houston J, Appel LJ. 2013. Association of a reduction in central obesity and phosphorus intake with changes in urinary albumin excretion: the PREMIER study. Am J Kidney Dis 62(5): 900–7.
- Chang AR, Grams ME. 2014. Serum phosphorus and mortality in the Third National Health and Nutrition Examination Survey (NHANES III): effect modification by fasting. Am J Kidney Dis 64(4): 567–73.
- Chang AR, Lazo M, Appel LJ, Gutierrez OM, Grams ME. 2014. High dietary phosphorus intake is associated with all-cause mortality: results from NHANES III. Am J Clin Nutr 99(2): 320–7.
- Delgado-Andrade C, Seiquer I, Garcia MM, Galdo G, Navarro MP. 2011. Increased Maillard reaction products intake reduces phosphorus digestibility in male adolescents. Nutrition 27(1): 86–91.
- Dhingra R, Sullivan LM, Fox CS, Wang TJ, D'Agostino Sr RB, Gaziano JM, Vasan RS. 2007. Relations of serum phosphorus and calcium levels to the incidence of cardiovascular disease in the community. Arch Intern Med 167(9): 879–85.
- Dhingra R, Gona P, Benjamin EJ, Wang TJ, Aragam J, D'Agostino Sr RB, Kannel WB, Vasan RS. 2010. Relations of serum phosphorus levels to echocardiographic left ventricular mass and incidence of heart failure in the community. Eur J Heart Fail 12(8): 812–8.
- Ditscheid B, Keller S, Jahreis G. 2005. Cholesterol metabolism is affected by calcium phosphate supplementation in humans. J Nutr 135(7): 1678–82.
- Eeuwijk J, Oordt A, Vonk Noordegraaf-Shouten M. 2013. Literature search and review related to specific preparatory work in the establishment of Dietary Reference Values for Phosphorus, Sodium and Chloride. Supporting Publications. Vol. EN-502. 388 pp.
- Elliott P, Kesteloot H, Appel LJ, Dyer AR, Ueshima H, Chan Q, Brown IJ, Zhao L, Stamler J, INTERMAP Cooperative Research Group. 2008. Dietary phosphorus and blood pressure: international study of macro- and micro-nutrients and blood pressure. Hypertension 51(3): 669–75.
- Elmståhl S, Gullberg B, Janzon L, Johnell O, Elmståhl B. 1998. Increased incidence of fractures in middle-aged and elderly men with low intakes of phosphorus and zinc. Osteoporos Int 8(4): 333–40.
- European Food Safety Authority. 2005. Opinion of the Scientific Panel on Dietetic Products, Nutrition and Allergies on a request from the Commission related to the Tolerable Upper Intake Level of Phosphorus. EFSA J 233: 1–19.
- European Food Safety Authority. 2013. Assessment of one published review on health risks associated with phosphate additives in food. EFSA J 11(11): 3444.
- European Food Safety Authority. 2015. Scientific Opinion on Dietary Reference Values for phosphorus. EFSA J 13(7): 4185.
- Evenepoel P, Wolf M. 2013. A balanced view of calcium and phosphate homeostasis in chronic kidney disease. Kidney Int 83(5): 789–91.
- FDA. 2009. Guidance for Industry: Evidence-Based Review System for the Scientific Evaluation of Health Claims. Available from: http://www.fda.gov/Food/GuidanceRegulation/GuidanceDocumentsRegulatoryInformation/LabelingNutrition/ucm073332.htm. Accessed 2015 October 22.
- Foley RN, Collins AJ, Ishani A, Kalra PA. 2008. Calcium-phosphate levels and cardiovascular disease in community-dwelling adults: the Atherosclerosis Risk in Communities (ARIC) Study. Am Heart J 156(3): 556–63.
- Foley RN, Collins AJ, Herzog CA, Ishani A, Kalra PA. 2009. Serum phosphorus levels associate with coronary atherosclerosis in young adults. J Am Soc Nephrol 20(2): 397–404.
- Fuhrman E. Phosphates: highly functional, hard to replace. 2015 Available from: http://www.provisioneronline.com/articles/101323-phosphates-highly-functional-hard-to-replace; Accessed 2016 September 26. Accessed 16 September 2016.
- Fukumoto S. 2014. Phosphate metabolism and vitamin D. Bonekey Rep 3: 497.
- Galloway SD, Tremblay MS, Sexsmith JR, Roberts CJ. 1996. The effects of acute phosphate supplementation in subjects of different aerobic fitness levels. Eur J Appl Physiol Occup Physiol 72(3): 224–30.
- Goto S, Nakai K, Kono K, Yonekura Y, Ito J, Fujii H, Nishi S. 2014. Dietary phosphorus restriction by a standard low-protein diet decreased serum fibroblast growth factor 23 levels in patients with early and advanced stage chronic kidney disease. Clin Exp Nephrol 18(6): 925–31.
- Grimm M, Müller A, Hein G, Fünfstück R, Jahreis G. 2001. High phosphorus intake only slightly affects serum minerals, urinary pyridinium crosslinks and renal function in young women. Eur J Clin Nutr 55(3): 153–61.
- Gutierrez OM. 2013. The connection between dietary phosphorus, cardiovascular disease, and mortality: where we stand and what we need to know. Adv Nutr 4(6): 723–9.
- Gutiérrez OM, Anderson C, Isakova T, Scialla J, Negrea L, Anderson AH, Bellovich K, Chen J, Robinson N, Ojo A, Lash J, Feldman HI, Wolf M, CRIC Study Group. 2010. Low socioeconomic status associates with higher serum phosphate irrespective of race. J Am Soc Nephrol 21(11): 1953–60.
- Gutiérrez OM, Wolf M, Taylor EN. 2011. Fibroblast growth factor 23, cardiovascular disease risk factors, and phosphorus intake in the health professionals follow-up study. Clin J Am Soc Nephrol 6(12): 2871–8.
- Gutiérrez OM, Katz R, Peralta CA, de Boer IH, Siscovick D, Wolf M, Diez Rouz A, Kestenbaum, Nettleton JA, IX JH. 2012. Associations of socioeconomic status and processed food intake with serum phosphorus concentration in community-living adults: the Multi-Ethnic Study of Atherosclerosis (MESA). J Ren Nutr 22(5): 480–9.
- Haraikawa M, Tanabe R, Sogabe N, Sugimoto A, Kawamura Y, Michigami T, Hosoi T, Goseki-Sone M. 2012. A study of the association between serum bone-specific alkaline phosphatase and serum phosphorus concentration or dietary phosphorus intake. J Nutr Sci Vitaminol (Tokyo) 58(6): 442–5.
- Hartman ML, Groppo F, Ohnishi M, Goodson JM, Hasturk H, Tavares M, Floros C, Behbehani K, Razzaque MS. 2013. Can salivary phosphate levels be an early biomarker to monitor the evolvement of obesity? Contrib Nephrol 180: 138–48.
- Heaney RP. 2000. Dietary protein and phosphorus do not affect calcium absorption. Am J Clin Nutr 72(3): 758–61.
- Heaney RP, Nordin BE. 2002. Calcium effects on phosphorus absorption: implications for the prevention and co-therapy of osteoporosis. J Am Coll Nutr 21(3): 239–44.
- Heaney RP, Rafferty K. 2001. Carbonated beverages and urinary calcium excretion. Am J Clin Nutr 74(3): 343–7.
- Heimburger DC, Koethe JR, Nyirenda C, Bosire C, Chiasera JM, Blevins M, Shepherd BE, Potter D, Zulu I, Chisembele- Taylor A, Chi BH, Stringer JS, Kabagambe EK. 2010. Serum phosphate predicts early mortality in adults starting antiretroviral therapy in Lusaka, Zambia: a prospective cohort study. PLoS One 5(5): e10687.
- Herrington DM, Howard TD. 2003. From presumed benefit to potential harm–hormone therapy and heart disease. N Engl J Med 349(6): 519–21.
- Houston J, Smith K, Isakova T, Sowden N, Wolf M, Gutierrez OM. 2013. Associations of dietary phosphorus intake, urinary phosphate excretion, and fibroblast growth factor 23 with vascular stiffness in chronic kidney disease. J Ren Nutr 23(1): 12–20.
- Hsu CY, Chertow GM. 2002. Elevations of serum phosphorus and potassium in mild to moderate chronic renal insufficiency. Nephrol Dial Transplant 17(8): 1419–25.
- International Food Information Council Foundation, US Food and Drug Administration. Food Ingredients & Colors. 2010. Available at: https://www.fda.gov/downloads/Food/FoodIngredientsPackaging/UCM094249.pdfAccessed 2015 October 22.
- Isakova T, Wahl P, Vargas GS, Gutierrez OM, Scialla J, Xie H, Appleby B, Nessel L, Bellovich K, Chen J, Hamm L, Gadegbeku C, Horwitz E, Townsend RR, Anderson CA, Lash JP, Hsu CY, Leonard MB, Wolf M. 2011. Fibroblast growth factor 23 is elevated before parathyroid hormone and phosphate in chronic kidney disease. Kidney Int 79(12): 1370–8.
- Itkonen ST, Karp HJ, Kemi VE, Kokkonen EM, Saarnio EM, Pekkinen MH, Karkkainen MJ, Laitinen EK, Turanlahti MI, Lamberg-Allardt CJ. 2013. 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 12: 94.
- Ito N, Fukumoto S, Takeuchi Y, Takeda S, Suzuki H, Yamashita T, Fujita T. 2007. Effect of acute changes of serum phosphate on fibroblast growth factor (FGF)23 levels in humans. J Bone Miner Metab 25(6): 419–22.
- Ito S, Ishida H, Uenishi K, Murakami K, Sasaki S. 2011. The relationship between habitual dietary phosphorus and calcium intake, and bone mineral density in young Japanese women: a cross-sectional study. Asia Pac J Clin Nutr 20(3): 411–7.
- Ix JH, de Boer IH, Peralta CA, Adeney KL, Duprez DA, Jenny NS, Siscovick DS, Kestenbaum BR. 2009. Serum phosphorus concentrations and arterial stiffness among individuals with normal kidney function to moderate kidney disease in MESA. Clin J Am Soc Nephrol 4(3): 609–15.
- Ix JH, Anderson CA, Smits G, Persky MS, Block GA. 2014. Effect of dietary phosphate intake on the circadian rhythm of serum phosphate concentrations in chronic kidney disease: a crossover study. Am J Clin Nutr 100(5): 1392–7.
- Jones G, Riley MD, Dwyer T. 2000. Maternal diet during pregnancy is associated with bone mineral density in children: a longitudinal study. Eur J Clin Nutr 54(10): 749–56.
- Kakuris KK, Yerullis KB, Afoninos EA, Fedorov AK. 2007. Phosphate balance in phosphate supplemented and unsupplemented health subjects during and after hypokinesia. Clin Invest Med 30(5): E200–9.
- Kalantar-Zadeh K, Gutekunst L, Mehrotra R, Kovesdy CP, Bross R, Shinaberger CS, Noori N, Hirschberg R, Benner D, Nissenson AR, Kopple JD. 2010. Understanding sources of dietary phosphorus in the treatment of patients with chronic kidney disease. Clin J Am Soc Nephrol 5(3): 519–30.
- Kärkkäinen M, Lamberg-Allardt C. 1996. An acute intake of phosphate increases parathyroid hormone secretion and inhibits bone formation in young women. J Bone Miner Res 11(12): 1905–12.
- Karp HJ, Vaihia KP, Kärkkäinen MU, Niemisto MJ, Lamberg-Allardt CJ. 2007. Acute effects of different phosphorus sources on calcium and bone metabolism in young women: a whole-foods approach. Calcif Tissue Int 80(4): 251–8.
- Karp HJ, Kemi VE, Lamberg-Allardt CJ, Karkkainen MU. 2013. Mono- and polyphosphates have similar effects on calcium and phosphorus metabolism in healthy young women. Eur J Nutr 52(3): 991–6.
- Kemi VE, Kärkkäinen MU, Lamberg-Allardt CJ. 2006. High phosphorus intakes acutely and negatively affect Ca and bone metabolism in a dose-dependent manner in healthy young females. Br J Nutr 96(3): 545–52.
- Kemi VE, Kärkkäinen MU, Karp HJ, Laitinen KA, Lamberg-Allardt CJ. 2008. Increased calcium intake does not completely counteract the effects of increased phosphorus intake on bone: an acute dose-response study in healthy females. Br J Nutr 99(4): 832–9.
- Kemi VE, Rita HJ, Kärkkäinen MU, Viljakainen HT, Laaksonen MM, Outila TA, Lamberg-Allardt CJ. 2009. Habitual high phosphorus intakes and foods with phosphate additives negatively affect serum parathyroid hormone concentration: a cross-sectional study on healthy premenopausal women. Public Health Nutr 12(10): 1885–92.
- Kemi VE, Kärkkäinen MU, Rita HJ, Laaksonen MM, Outila TA, Lamberg-Allardt CJ. 2010. Low calcium:phosphorus ratio in habitual diets affects serum parathyroid hormone concentration and calcium metabolism in healthy women with adequate calcium intake. Br J Nutr 103(4): 561–8.
- Kesse E, Boutron-Ruault MC, Norat T, Riboli E, Clavel-Chapelon F. 2005. Dietary calcium, phosphorus, vitamin D, dairy products and the risk of colorectal adenoma and cancer among French women of the E3N-EPIC prospective study. Int J Cancer 117(1): 137–44.
- Kesse E, Bertrais S, Astorg P, Jaouen A, Arnault N, Galan P, Hercberg S. 2006. Dairy products, calcium and phosphorus intake, and the risk of prostate cancer: results of the French prospective SU.VI.MAX (Supplementation en Vitamines et Mineraux Antioxydants) study. Br J Nutr 95(3): 539–55.
- Kinney MA. 2002. Does consumption of cola beverages cause bone fractures in children? Mayo Clin Proc 77(9): 1005–6.
- Kristensen M, Jensen M, Kudsk J, Henriksen M, Mølgaard C. 2005. Short-term effects on bone turnover of replacing milk with cola beverages: a 10-day interventional study in young men. Osteoporos Int 16(12): 1803–8.
- Kwak SM, Kim JS, Choi Y, Chang Y, Kwon MJ, Jung JG, Jeong C, Ahn J, Kim HA, Shin H, Ryu S. 2014. Dietary intake of calcium and phosphorus and serum concentration in relation to the risk of coronary artery calcification in asymptomatic adults. Arterioscler Thromb Vasc Biol 34(8): 1763–9.
- Lampila LE. 2013. Applications and functions of food-grade phosphates. Ann N y Acad Sci 1301: 37–44.
- Larsson TE, Olauson H, Hagstrom E, Ingelsson E, Arnlov J, Lind L, Sundstrom J. 2010. Conjoint effects of serum calcium and phosphate on risk of total, cardiovascular, and noncardiovascular mortality in the community. Arterioscler Thromb Vasc Biol 30(2): 333–9.
- Lee KJ, Kim KS, Kim HN, Seo JA, Song SW. 2014. Association between dietary calcium and phosphorus intakes, dietary calcium/phosphorus ratio and bone mass in the Korean population. Nutr J 13(1): 114.
- Lichtenstein AH, Yetley EA, Lau J. 2008. Application of systematic review methodology to the field of nutrition. J Nutr 138(12): 2297–306.
- Lin HS, Lin JR, Hu SW, Kuo HC, Yang YH. 2014. Association of dietary calcium, phosphorus, and magnesium intake with caries status among schoolchildren. Kaohsiung J Med Sci 30(4): 206–12.
- López-Huertas E, Teucher B, Boza JJ, Martínez-Férez A, Majsak-Newman G, Baró L, Carrero JJ, Gonzalez-Santiago M, Fonolla J, Fairweather-Tait S. 2006. Absorption of calcium from milks enriched with fructo-oligosaccharides, caseinophosphopeptides, tricalcium phosphate, and milk solids. Am J Clin Nutr 83(2): 310–6.
- Lorenzo C, Hanley AJ, Rewers MJ, Haffner SM. 2014. Calcium and phosphate concentrations and future development of type 2 diabetes: the Insulin Resistance Atherosclerosis Study. Diabetologia 57(7): 1366–74.
- Lou-Arnal LM, Caverni-Munoz A, Arnaudas-Casanova L, Vercet-Tormo A, Gimeno-Orna JA, Sanz-Paris A, Caramelo-Gutierrez R, Alvarez-Lipe R, Sahdala-Santana L, Gracia-Garcia O, Luzon-Alonso M. 2013. The impact of processing meat and fish products on phosphorus intake in chronic kidney disease patients. Nefrologia 33(6): 797–807.
- Lynch KE, Lynch R, Curhan GC, Brunelli SM. 2011. Prescribed dietary phosphate restriction and survival among hemodialysis patients. Clin J Am Soc Nephrol 6(3): 620–9.
- Ma D, Jones G. 2004. Soft drink and milk consumption, physical activity, bone mass, and upper limb fractures in children: a population-based case-control study. Calcif Tissue Int 75(4): 286–91.
- Martinez I, Saracho R, Montenegro J, Llach F. 1997. The importance of dietary calcium and phosphorous in the secondary hyperparathyroidism of patients with early renal failure. Am J Kidney Dis 29(4): 496–502.
- Mataix J, Aranda P, López-Jurado M, Sánchez C, Planells E, Llopis J. 2006. Factors influencing the intake and plasma levels of calcium, phosphorus and magnesium in southern Spain. Eur J Nutr 45(6): 349–54.
- Mazariegos-Ramos E, Guerrero-Romero F, Rodríguez-Morán M, Lazcano-Burciaga G, Paniagua R, Amato D. 1995. Consumption of soft drinks with phosphoric acid as a risk factor for the development of hypocalcemia in children: a case-control study. J Pediatr 126(6): 940–2.
- Méndez RO, Gomez MA, Lopez AM, Gonzalez H, Wyatt CJ. 2002. Effects of calcium and phosphorus intake and excretion on bone density in postmenopausal women in Hermosillo, Mexico. Ann Nutr Metab 46(6): 249–53.
- Menon MC, Ix JH. 2013. Dietary phosphorus, serum phosphorus, and cardiovascular disease. Ann N y Acad Sci 1301: 21–6.
- Merritt MA, Tzoulaki I, Tworoger SS, de Vivo I, Hankinson SE, Fernandes J, Tsilidis KK, Weiderpass E, Tjonneland A, Petersen KE, Dahm CC, Overvad K, Dossus L, Boutron-Ruault MC, Fagherazzi G, Fortner TR, Kaaks R, Aleksandrova K, Boeing H, Trichopoulou A, Bamia C, Trichopoulos D, Palli D, Grioni S, Tumino R, Sacerdote C, Mattiello A, Bueno-de-Mesquita HB, Onland-Moret NC, Peeters PH, Gram IT, Skeie G, Quiros JR, Duell EJ, Sanchez MJ, Salmeron D, Barricarte A, Chamosa S, Ericson U, Sonestedt E, Nilsson LM, Idahl A, Khaw KT, Wareham N, Travis RC, Rinaldi S, Romieu I, Patel CJ, Riboli E, Gunter MJ. 2015. Investigation of dietary factors and endometrial cancer risk using a nutrient-wide association study approach in the EPIC and Nurses' Health Study (NHS) and NHSII. Cancer Epidemiol Biomarkers Prev 24(2): 466–71.
- Meyers AM. 2015. Significance, definition, classification and risk factors of chronic kidney disease in South Africa. S Afr Med J 105(3): 233–6.
- Michaud DS, Spiegelman D, Clinton SK, Rimm EB, Willett WC, Giovannucci E. 2000. Prospective study of dietary supplements, macronutrients, micronutrients, and risk of bladder cancer in US men. Am J Epidemiol 152(12): 1145–53.
- Moe SM, Zidehsarai MP, Chambers MA, Jackman LA, Radcliffe JS, Trevino LL, Donahue SE, Asplin JR. 2011. Vegetarian compared with meat dietary protein source and phosphorus homeostasis in chronic kidney disease. Clin J Am Soc Nephrol 6(2): 257–64.
- Moore LW, Nolte JV, Gaber AO, Suki WN. 2015. Association of dietary phosphate and serum phosphorus concentration by levels of kidney function. Am J Clin Nutr 102(2): 444–53.
- Moreno-Torres R, Ruiz-Lopez MD, Artacho R, Oliva P, Baena F, Baro L, Lopez C. 2001. Dietary intake of calcium, magnesium and phosphorus in an elderly population using duplicate diet sampling vs food composition tables. J Nutr Health Aging 5(4): 253–5.
- Murtaugh MA, Filipowicz R, Baird BC, Wei G, Greene T, Beddhu S. 2012. Dietary phosphorus intake and mortality in moderate chronic kidney disease: NHANES III. Nephrol Dial Transplant 27(3): 990–6.
- Muras K, Masajtis-Zagajewska A, Nowicki M. 2013. Diabetes modifies effect of high-phosphate diet on fibroblast growth factor-23 in chronic kidney disease. J Clin Endocrinol Metab 98(12): E1901–8.
- National Health and Nutrition Examination Survey (NHANES) (a). 2001-2004, 2004-2008 & 2009–2012 participants age 20 & older. Excel data file. Available from: http://www.usrds.org/2015/view/v1_01.aspx#Figure_1.1. Accessed 2016 February 12.
- National Health and Nutrition Examination Survey (NHANES) (b). What We Eat in America. 2011-2012; Available from: www.ars.usda.gov/nea/bhnrc/fsrg.Accessed 2016 February 12
- National Kidney Foundation. About Chronic Kidney Disease. Available from: https://www.kidney.org/kidneydisease/aboutckd. Accessed 2016 February 12.
- Navarro-Alarcon M, Zambrano E, Moreno-Montoro M, Agil A, Olalla M. 2012. Duplicate portion sampling combined with spectrophotometric analysis affords the most accurate results when assessing daily dietary phosphorus intake. Nutr Res 32(8): 573–80.
- Newsome B, Ix JH, Tighiouart H, Sarnak MJ, Levey AS, Beck GJ, Block G. 2013. Effect of protein restriction on serum and urine phosphate in the modification of diet in renal disease (MDRD) study. Am J Kidney Dis 61(6): 1045–6.
- Nishida Y, Taketani Y, Yamanaka-Okumura H, Imamura F, Taniguchi A, Sato T, Shuto E, Nashiki K, Arai H, Yamamoto H, Takeda E. 2006. Acute effect of oral phosphate loading on serum fibroblast growth factor 23 levels in healthy men. Kidney Int 70(12): 2141–7.
- Noori N, Kalantar-Zadeh K, Kovesdy CP, Bross R, Benner D, Kopple JD. 2010a. Association of dietary phosphorus intake and phosphorus to protein ratio with mortality in hemodialysis patients. Clin J Am Soc Nephrol 5(4): 683–92.
- Noori N, Sims JJ, Kopple JD, Shah A, Colman S, Shinaberger CS, Bross R, Mehrotra R, Kovesdy CP, Kalantar-Zadeh K. 2010b. Organic and inorganic dietary phosphorus and its management in chronic kidney disease. Iran J Kidney Dis 4(2): 89–100.
- Obeid OA, Dimachkie S, Hlais S. 2010. Increased phosphorus content of preload suppresses ad libitum energy intake at subsequent meal. Int J Obes (Lond) 34(9): 1446–68.
- Onufrak SJ, Bellasi A, Cardarelli F, Vaccarino V, Muntner P, Shaw LJ, Raggi P. 2009. Investigation of gender heterogeneity in the associations of serum phosphorus with incident coronary artery disease and all-cause mortality. Am J Epidemiol 169(1): 67–77.
- O'Seaghdha CM, Hwang SJ, Muntner P, Melamed ML, Fox CS. 2011. Serum phosphorus predicts incident chronic kidney disease and end-stage renal disease. Nephrol Dial Transplant 26(9): 2885–90.
- Otten JJ, Hellwig JP, Meyers LD. 2006. Dietary reference intakes: The Essential Guide to Nutrient Requirements. Institute of Medicine of the National Academies, The National Adacemies Press; Available at: http://nap.edu/11537. Accessed 2015 October 22.
- Palomino HL, Rifkin DE, Anderson C, Criqui MH, Whooley MA, Ix JH. 2013. 24-hour urine phosphorus excretion and mortality and cardiovascular events. Clin J Am Soc Nephrol 8(7): 1202–10.
- Pizzorno L. 2014. Canaries in the phosphate-toxicity coal mines. Integr Med (Encinitas) 13(6): 24–32.
- Portale AA, Halloran BP, Morris Jr RC, Lonergan ET. 1996. Effect of aging on the metabolism of phosphorus and 1,25-dihydroxyvitamin D in healthy men. Am J Physiol 270(3 Pt 1): E483–90.
- Poslusna K, Ruprich J, de Vries JH, Jakubikova M, van't Veer P. 2009. Misreporting of energy and micronutrient intake estimated by food records and 24 hour recalls, control and adjustment methods in practice. Br J Nutr 101 (Suppl. 2): S73–85.
- Ramezani Tehrani F, Moslehi N, Asghari G, Gholami R, Mirmiran P, Azizi F. 2013. Intake of dairy products, calcium, magnesium, and phosphorus in childhood and age at menarche in the Tehran Lipid and Glucose Study. PLoS One 8(2): e57696.
- Ritz E, Hahn K, Ketteler M, Kuhlmann MK, Mann J. 2012. Phosphate additives in food–a health risk. Dtsch Arztebl Int 109(4): 49–55.
- Ruel G, Shi Z, Zhen S, Zuo H, Kroger E, Sirois C, Levesque JF, Taylor AW. 2014. Association between nutrition and the evolution of multimorbidity: the importance of fruits and vegetables and whole grain products. Clin Nutr 33(3): 513–20.
- Saab G, Whooley MA, Schiller NB, Ix JH. 2010. Association of serum phosphorus with left ventricular mass in men and women with stable cardiovascular disease: data from the Heart and Soul Study. Am J Kidney Dis 56(3): 496–505.
- Scott D, Blizzard L, Fell J, Giles G, Jones G. 2010. Associations between dietary nutrient intake and muscle mass and strength in community-dwelling older adults: the Tasmanian Older Adult Cohort Study. J Am Geriatr Soc 58(11): 2129–34.
- Sharkey JR, Giuliani C, Haines PS, Branch LG, Busby-Whitehead J, Zohoori N. 2003. Summary measure of dietary musculoskeletal nutrient (calcium, vitamin D, magnesium, and phosphorus) intakes is associated with lower-extremity physical performance in homebound elderly men and women. Am J Clin Nutr 77(4): 847–56.
- Sherman RA, Mehta O. 2009. Phosphorus and potassium content of enhanced meat and poultry products: implications for patients who receive dialysis. Clin J Am Soc Nephrol 4(8): 1370–3.
- Shim JS, Oh K, Kim HC. 2014. Dietary assessment methods in epidemiologic studies. Epidemiol Health 36: e2014009.
- Shuto E, Taketani Y, Tanaka R, Harada N, Isshiki M, Sato M, Nashiki K, Amo K, Yamamoto H, Higashi Y, Nakaya Y, Takeda E. Dietary phosphorus acutely impairs endothelial function. J Am Soc Nephrol 2009; 20(7): 1504–12.
- Standing Committee on the Scientific Evaluation of Dietary Reference Intakes Food and Nutrition Board - Institute of Medicine. 1997. Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride. Available from: http://www.ncbi.nlm.nih.gov/books/NBK109825. Accessed 2016 February 12.
- St Sauver JL, Grossardt BR, Leibson CL, Yawn BP, Melton 3rd LJ, Rocca WA. 2012. Generalizability of epidemiological findings and public health decisions: an illustration from the Rochester Epidemiology Project. Mayo Clin Proc 87(2): 151–60.
- Sugiyama T, Murakami T, Shibata T, Goshima M, Narita N, Nakagaki H, Nishimuta M. 2009. Average daily intake of phosphorus in 3- to 5-year-old Japanese children as assessed by the duplicate-diet technique. Asia Pac J Clin Nutr 18(3): 335–43.
- Sullivan CM, Leon JB, Sehgal AR. 2007. Phosphorus-containing food additives and the accuracy of nutrient databases: implications for renal patients. J Ren Nutr 17(5): 350–4.
- Szajkowski Z. 1996. Magnesium, calcium and phosphorus contents in daily food rations in primary school children: questionnaire and analytic studies. Nahrung 40(6): 330–5.
- Tavani A, Bertuccio P, Bosetti C, Talamini R, Negri E, Franceschi S, Montella M, La Vecchia C. 2005. Dietary intake of calcium, vitamin D, phosphorus and the risk of prostate cancer. Eur Urol 48(1): 27–33.
- Taylor EN, Rimm EB, Stampfer MJ, Curhan GC. 2011. Plasma fibroblast growth factor 23, parathyroid hormone, phosphorus, and risk of coronary heart disease. Am Heart J 161(5): 956–62.
- Teegarden D, Lyle RM, McCabe GP, McCabe LD, Proulx WR, Michon K, Knight AP, Johnston CC, Weaver CM. 1998. Dietary calcium, protein, and phosphorus are related to bone mineral density and content in young women. Am J Clin Nutr 68(3): 749–54.
- Tonelli M, Sacks F, Pfeffer M, Gao Z, Curhan G. 2005. Relation between serum phosphate level and cardiovascular event rate in people with coronary disease. Circulation 112(17): 2627–33.
- Trachtman H, Chan JC, Boyle R, Farina D, Baluarte HJ, Chinchilli VM, Dresner IG, Feld LG. 1995. The relationship between calcium, phosphorus, and sodium intake, race, and blood pressure in children with renal insufficiency: a report of the Growth Failure in Children with Renal Diseases (GFRD) Study. J Am Soc Nephrol 6(1): 126–31.
- Trautvetter U, Jahreis G, Kiehntopf M, Glei M. 2016. Consequences of a high phosphorus intake on mineral metabolism and bone remodeling in dependence of calcium intake in healthy subjects - a randomized placebo-controlled human intervention study. Nutr J 15(1): 7.
- Tseng M, Breslow RA, Graubard BI, Ziegler RG. 2005. Dairy, calcium, and vitamin D intakes and prostate cancer risk in the National Health and Nutrition Examination Epidemiologic Follow-up Study cohort. Am J Clin Nutr 81(5): 1147–54.
- Tucker KL, Morita K, Qiao N, Hannan MT, Cupples LA, Kiel DP. 2006. Colas, but not other carbonated beverages, are associated with low bone mineral density in older women: The Framingham Osteoporosis Study. Am J Clin Nutr 84(4): 936–42.
- Tuttle KR, Short RA. 2009. Longitudinal relationships among coronary artery calcification, serum phosphorus, and kidney function. Clin J Am Soc Nephrol 4(12): 1968–73.
- United Nations Department of Economic and Social Affairs - Population Division. 2013. World Population Ageing. ST/ESA/SER.A/348. 2013. Available at: http://www.un.org/en/development/desa/population/publications/pdf/ageing/WorldPopulationAgeing2013.pdf. Accessed 2016 February 12.
- Uribarri J. 2013. Dietary phosphorus and kidney disease. Ann N y Acad Sci 1301: 11–9.
- Uribarri J, Calvo MS. 2013. Introduction to dietary phosphorus excess and health. Ann N y Acad Sci 1301: iii–iv.
- Uribarri J, Calvo MS. 2014. Dietary phosphorus intake and health1-3. Am J Clin Nutr 99(2): 247–8.
- U.S. Department of Health and Human Services. 2015. U.S. Department of Agriculture. 2015–2020 Dietary Guidelines for Americans. 8th Edition. Available from: http://health.gov/dietaryguidelines/2015/guidelines/. Accessed 2016 February 12.
- Vervloet MG, van Ittersum FJ, Buttler RM, Heijboer AC, Blankenstein MA, ter Wee PM. 2011. Effects of dietary phosphate and calcium intake on fibroblast growth factor-23. Clin J Am Soc Nephrol 6(2): 383–9.
- Waller S, Ridout D, Rees L. 2007. Bone mineral density in children with chronic renal failure. Pediatr Nephrol 22(1): 121–7.
- Welch AA, Fransen H, Jenab M, Boutron-Ruault MC, Tumino R, Agnoli C, Ericson U, Johansson I, Ferrari P, Engeset D, Lund E, Lentjes M, Key T, Touvier M, Niravong M, Larranaga N, Rodriguez L, Ocke MC, Peeters PH, Tjonneland A, Bjrregaard L, Vasilpoulou E, Dilis V, Lineisen J, Nothlings U, Riboli E, Silmani N, Bingham S. 2009. Variation in intakes of calcium, phosphorus, magnesium, iron and potassium in 10 countries in the European Prospective Investigation into Cancer and Nutrition study. Eur J Clin Nutr 63 (Suppl 4): S101–21.
- Wilson KM, Shui IM, Mucci LA, Giovannucci E. 2015. Calcium and phosphorus intake and prostate cancer risk: a 24-y follow-up study. Am J Clin Nutr 101(1): 173–83.
- Wulaningsih W, Michaelsson K, Garmo H, Hammar N, Jungner I, Walldius G, Holmberg L, Van Hemelrijck M. 2013. Inorganic phosphate and the risk of cancer in the Swedish AMORIS study. BMC Cancer 13: 257.
- Wyshak G. 2000. Teenaged girls, carbonated beverage consumption, and bone fractures. Arch Pediatr Adolesc Med 154(6): 610–3.
- Yamamoto KT, Robinson-Cohen C, de Oliveira MC, Kostina A, Nettleton JA, Ix JH, Ix JH, Nguyen H, Eng J, Lima JA, Siscovick DS, Weiss NS, Kestenbaum B. 2013. Dietary phosphorus is associated with greater left ventricular mass. Kidney Int 83(4): 707–14.
- Yin J, Dwyer T, Riley M, Cochrane J, Jones G. 2010. The association between maternal diet during pregnancy and bone mass of the children at age 16. Eur J Clin Nutr 64(2): 131–7.
- Zhang QL, Rothenbacher D. 2008. Prevalence of chronic kidney disease in population-based studies: systematic review. BMC Public Health 8: 117.
- Zhang ZW, Shimbo S, Miyake K, Watanabe T, Nakatsuka H, Matsuda-Inoguchi N, Moon CS, Higashikawa K, Ikeda M. 1999. Estimates of mineral intakes using food composition tables vs measures by inductively-coupled plasma mass spectrometry: part 1. Calcium, phosphorus and iron. Eur J Clin Nutr 53(3): 226–32.
- Zorbas YG, Kakurin VJ, Kuznetsov NA, Yarullin VL, Andreyev ID, Charapakhin KP. 2002. Phosphate deposition capacity of athletes during hypokinesia, phosphate loading, and ambulation. Biol Trace Elem Res 85(3): 211–26.