Calcium and phosphorus intakes, balances, and blood levels of adults consuming self-selected diets

Lakshmanan, Florence Lazicki; Rao, Rani B; Church, James P.

doi:10.1093/ajcn/40.6.1368

Cited by 16 publications

(4 citation statements)

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“…A phosphorus balance of zero was observed at both levels of protein intake. Lakshmanan et al (1984) assessed calcium and phosphorus balances in 13 men aged 22-49 years and in 16 women aged 20-53 years over a 1-year period, in which subjects consumed self-selected diets. An additional three men and two women participated in the study for one-to three-quarters of the year.…”

Section: 21mentioning

confidence: 99%

Scientific Opinion on Dietary Reference Values for phosphorus

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2015

EFS2

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Following a request from the European Commission, the Panel on Dietetic Products, Nutrition and Allergies derived Dietary Reference Values (DRVs) for phosphorus. The Panel considered data from balance studies, losses of phosphorus from the body and intestinal absorption for possible use in a factorial approach, and studies on phosphorus intake and long-term health outcomes. The Panel concluded that these data were insufficient for setting DRVs for phosphorus. Data on the calcium to phosphorus ratio in bones of healthy adults, adjusted for the proportion of phosphorus found outside bone, and data on whole-body calcium and phosphorus contents in Caucasian adults indicate that the calcium to phosphorus molar ratio in the body ranges from 1.4:1 to 1.9:1. Although the fractional absorption of phosphorus is higher than that of calcium, the Panel considered that the actual amounts of calcium and phosphorus that are available for absorption from the diet cannot be determined; therefore, the whole-body calcium to phosphorus ratio was used to set DRVs. The data were considered insufficient to derive Average Requirements and Population Reference Intakes. Based on the DRVs for calcium and considering a molar calcium to phosphorus ratio of 1.4:1 to 1.9:1, amounts of phosphorus were calculated. The Panel chose the lower bound of this range (a ratio of 1.4:1, which results in a higher phosphorus intake value) for setting an Adequate Intake (AI), taking into account estimated phosphorus intakes in Western countries, which are considerably higher than the values calculated. The AI is 160 mg/day for infants (7-11 months) and between 250 and 640 mg/day for children. For adults, the AI is 550 mg/day. Taking into consideration adaptive changes in phosphorus metabolism that occur during pregnancy and lactation, it was considered that the AI for adults also applies to pregnant and lactating women. Phosphorus is involved in many physiological processes, such as in the cell's energy cycle, in regulation of the body's acid-base balance, as a component of the cell structure, in cell regulation and signalling, and in the mineralisation of bones and teeth. About 85 % of the body's phosphorus is in bones and teeth, 14 % is in soft tissues, including muscle, liver, heart and kidney, and only 1 % is present in extracellular fluids. Phosphorus homeostasis is intricately linked to that of calcium because of the actions of calcium-regulating hormones, such as parathyroid hormone (PTH) and 1,25-dihydroxy-vitamin D (1,25(OH) 2 D), at the level of the bone, the gut and the kidneys. © EuropeanPhosphorus absorption occurs through passive diffusion and sodium-dependent active transport and via paracellular and cellular pathways. In adults, limited data suggest that net phosphorus absorption ranges from 55 to 80 % of intake. Phosphorus absorption is affected by the total amount of phosphorus in the diet and also by the type of phosphorus (organic versus inorganic), the food origin (animalversus plant-derived) and the ratio of phosphorus to oth...

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Section: 21mentioning

confidence: 99%

Scientific Opinion on Dietary Reference Values for phosphorus

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2015

EFS2

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“…The mean daily P intake of the hospital patients reported here (27.4 mmol in all twentyone patients and 29.3 mmol in balance-study patients) is similar to that reported in housebound elderly people (Bunker & Clayton, 1989), and both groups were in negative balance, though exceeding the USA recommended daily dietary allowance of 25.8 mmol (National Academy of Sciences, 1980). Although a wide range of P intakes is compatible with metabolic equilibrium some would consider the present recommendation too high (Marshall et al 1976), though negative metabolic balance has been reported in young adults consuming self-selected diets despite a high P intake (Lakshmanan et al 1984a), and a wide variation in Ca : P ratio does'not seem adversely to affect absorption and Ca status (Spencer et al 1984).…”

Section: Discussionmentioning

confidence: 70%

Calcium, magnesium and phosphorus status of elderly inpatients: dietary intake, metabolic balance studies and biochemical status

et al. 1989

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~~The calcium, magnesium and phosphorus status of a group of elderly inpatients was studied by use of duplicate meal analysis over a 5 d period and biochemical indices in twenty-one patients, and metabolic balance (5 d) in six of these. Mean daily Ca intake was lower than that of apparently healthy elderly subjects in metabolic equilibrium, although commensurate with present UK recommendations. Metabolic balance was negative for Ca. Mean daily M g intake was approximately half the US recommendation, and half the intake a t which metabolic balance has been observed in healthy elderly people. The five patients studied were in metabolic balance for Mg. Mean daily P intake was close to the UK recommendation, but negative metabolic balance was observed. The disparity between official recommendations for Ca intake, factors contributing to suboptimal Ca status, and measures that may improve Ca status in this group are discussed. Calcium : Magnesium : Phosphorus : Old age.Over the next decade in the UK there will be a 45 YO increase in the frailest section of the elderly population, those. aged 85 years and over (Office of Population Censuses and Surveys, 1985). In 1984 over one-third of all general medical and surgical beds, and over one-quarter of orthopaedic beds were occupied by elderly patients (Department of Health and Social Security, 1986). Old age, intercurrent illness and hospital admission may threaten the nutritional adequacy of dietary intake, and the elderly should probably be considered as a separate group with regard to recommendations for nutrient intake (Schneider et al. 1986).The optimal level of calcium intake in the elderly is disputed, and its relative importance in the aetiology of osteoporosis, whether in the achievement of peak adult bone mass or the decline to critical levels in old age, is unknown. There are few studies of magnesium status in the elderly, despite the existence of a number of factors which might lead to deficiency. Little is known of the importance of differing levels of phosphorus in the diet, much of the published work relating to inter-relations with other elements.In an earlier study of the nutrient content of hospital meals we found that the amounts of Ca and P in the food and drink offered to elderly people contained more Ca and less Mg than current recommendations (Thomas et al. 1986). We now report values for actual intake measured by duplicate meal analysis in twenty-one elderly long-stay patients, together with metabolic balance information on six of this number. Our findings are discussed with regard to improving the nutritional status of these elements in this group of old people. P A T I E N T S A N D METHODSTwenty-one inpatients of a geriatric long-stay and rehabilitation unit (seventeen women and four men) mean age 81.7 (range 63-89) years, were studied. None of the patients smoked, eighteen were edentulous and eleven reported problems with ill-fitting dentures that 9 N U T 62

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“…This observation illustrates why the serum calcium concentration cannot serve as a valid proxy for external calcium balance. After age 50, most adults are in slightly negative calcium balance [26] . Thus the state of calcium balance cannot be determined by simple measurement of serum calcium levels.…”

Section: Calcium Balance In Normal Adultsmentioning

confidence: 99%

Calcium Loading, Calcium Accumulation, and Associated Cardiovascular Risks in Dialysis Patients

Klemmer¹

2005

Blood Purif

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Calcium and phosphate imbalances are important mutable risk factors for cardiovascular disease in chronic kidney disease (CKD). Nearly all dialysis patients require phosphate binders. These include traditional calcium-based compounds and, more recently, the calcium-free, metal-free, non-absorbed agent, sevelamer hydrochloride. Both binder types reduce serum phosphorus, but differ with respect to calcium load and metabolism. Absorption from calcium-based agents very likely promotes positive total calcium balance in many patients. Positive calcium balance is inappropriate in adults and may promote or accelerate soft-tissue and vascular calcification even in the absence of hypercalcemia. Calcium accumulation in heart and vascular tissues contributes to rapidly progressive cardiovascular calcification – a strong predictor of cardiovascular and all-cause mortality in stage 5 CKD. More than two-thirds of stage 5 CKD patients have calcification scores above the 75th percentile for matched controls – scores associated with extremely high risk of cardiovascular events and death.

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Calcium and phosphorus intakes, balances, and blood levels of adults consuming self-selected diets

Cited by 16 publications

References 28 publications

Scientific Opinion on Dietary Reference Values for phosphorus

Scientific Opinion on Dietary Reference Values for phosphorus

Calcium, magnesium and phosphorus status of elderly inpatients: dietary intake, metabolic balance studies and biochemical status

Calcium Loading, Calcium Accumulation, and Associated Cardiovascular Risks in Dialysis Patients

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