A Review of Current Evidence on the Relationship between Phosphate Metabolism and Metabolic Syndrome

Abstract

Phosphorus, present as phosphate in biological systems, is an essential mineral for various biological activities and biochemical processes. Numerous studies have indicated that disturbed phosphate balance may contribute to the development of metabolic syndrome (MetS). However, no consistent result was found on the association between phosphorus intake and serum phosphate concentration with MetS. It is believed that both positive and negative impacts of phosphorus/phosphate co-exist in parallel during MetS condition. Reduced phosphate level contributed to the development of obesity and hyperglycaemia. Low phosphate is believed to compromise energy production, reduce exercise capacity, increase food ingestion, and impair glucose metabolism. On the other hand, the effects of phosphorus/phosphate on hypertension are rather complex depending on the source of phosphorus and subjects’ health conditions. Phosphorus excess activates sympathetic nervous system, renin-angiotensin-aldosterone system, and induces hormonal changes under pathological conditions, contributing to the blood pressure-rising effects. For lipid metabolism, adequate phosphate content ensures a balanced lipid profile through regulation of fatty acid biosynthesis, oxidation, and bile acid excretion. In conclusion, phosphate metabolism serves as a potential key feature for the development and progression of MetS. Dietary phosphorus and serum phosphate level should be under close monitoring for the management of MetS.

Serum phosphate levels and the development of sepsis associated acute kidney injury: evidence from two independent databases

“…Patients in the SAKI subgroup had higher body weight (p < 0.01). The proportions of chronic pulmonary diseases and liver diseases were lower in the SAKI subgroup (all p = 0.001), while the SOFA score was higher (6 [3,8] vs. 3 [2,6], p < 0.001). Similarly, levels of serum WBC, potassium, creatinine, and BUN were higher in patients with SAKI, while platelets and sodium were decreased (all p < 0.05).…”

“…Phosphate is a mineral that is widely distributed in nature and is the second most abundant mineral in the human body, accounting for approximately 1% of total body weight (7). It serves as a vital structural component of bones, teeth and DNA/RNA, making lipid membranes and circulating lipoproteins bipolar (8). Additionally, phosphate plays key roles in different biological processes such as energy generation and storage (formation of a phosphate bond in ATP), pH buffering in blood, regulation of gene expression, enzyme activation, molecule modification, and subsequently affecting a variety of organ functions from renal excretion to immune response (8).…”

Independent associations of serum calcium with or without albumin adjustment and serum phosphorus with nonalcoholic fatty liver disease: results from NHANES 1999-2018

“…Therefore, it can be speculated that abnormalities in serum phosphorus levels, whether elevated or decreased, are associated with metabolic dysregulation. Low serum phosphorus may impair energy metabolism, whereas excess phosphorus may contribute to elevated blood pressure ( 36 ). These mechanisms may explain the U-shaped relationship between serum phosphorus and NAFLD (the hepatic manifestation of MetS) found in our study.…”

Calcium, Phosphate, and Vitamin D in Children and Adolescents with Chronic Diseases: A Cross-Sectional Study

“…However, the eutrophic group had more patients with hypophosphatemia than other groups. Regulation of food intake, thermogenesis, PA capacity, and EE mediate the negative relationship between P level and weight gain [149]. Hypophosphatemic patients had higher WA, HA, and FFM kg A than subjects with normal serum P. Similarly, in 1676 postmenopausal women and 323 community-dwelling men without active disease informed an inverse association between serum P and BMI and FM [150].…”