Phosphorus is an essential mineral in human health and is required for various body functions that include structural roles in bone mineral, nucleic acids, and cell membranes; acid-base balance; and energy metabolism. Phosphorus is naturally widespread across the food supply and phosphate-containing food additives are widely used in food processing. Thus, excessive dietary intake is far more likely than dietary phosphorus deficiency in the United States. In fact, average dietary intakes are estimated as close to twice the RDA for phosphorus in most age groups. This is cause for some concern because, despite the essential roles of phosphorus in health, excessive serum phosphorus has been associated with cardiovascular disease, bone disease, and all-cause and cardiovascular mortality, particularly in those with impaired kidney function (about 10% of US adults), but also in the general population. Mechanisms to support these associations have been demonstrated in experimental models. Studies associating dietary phosphorus with such outcomes are sparser but do generally support the associations made for serum phosphorus. But, the effect of dietary phosphorus on serum phosphorus is not well-understood, and factors like dietary phosphorus bioavailability, kidney function, and the timing of blood draws (e.g. fasting versus postprandial) can affect this relationship. Nevertheless, because of the unfavorable relationships among serum phosphorus, cardiovascular disease, and mortality, there is growing interest in potentially limiting the use of phosphate-containing food additives and requiring phosphorus content on food labels. Whether or not these efforts would be of clinical benefit to patients with impaired kidney function, and further whether there would be broader benefit of such efforts to the general population, is an area of debate.

Dietary phosphorus in human health: Cause for concern?

2019 Fall National Meeting

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