Impact of Poverty on Serum Phosphate Concentrations in the Third National Health and Nutrition Examination Survey

Gutiérrez, Orlando M.; Isakova, Tamara; Enfield, Gwen; Wolf, Myles

doi:10.1053/j.jrn.2010.03.001

Cited by 42 publications

(41 citation statements)

References 39 publications

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“…17 Income might also affect outcomes of kidney disease, since the probability of anemia, phosphatemia, disability, depression, and cardiovascular disease was greater among those patients with low income. [18][19][20][21][22][23][24] Our study adds to this body of evidence by providing new data relating AKI (which itself is both a risk factor for and an outcome of CKD 25,26 ) to low income.…”

Section: Discussionmentioning

confidence: 83%

Explaining the Racial Difference in AKI Incidence

Grams

Matsushita²,

Sang³

et al. 2014

Journal of the American Society of Nephrology

130

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African Americans face higher risk of AKI than Caucasians. The extent to which this increased risk is because of differences in clinical, socioeconomic, or genetic risk factors is unknown. We evaluated 10,588 African-American and Caucasian participants in the Atherosclerosis Risk in Communities study, a community-based prospective cohort of middle-aged individuals. Participants were followed from baseline study visit (1996)(1997)(1998)(1999) to first hospitalization for AKI (defined by billing code), ESRD, death, or December 31, 2010. African-American participants were slightly younger (61.7 versus 63.1 years, P,0.001), were more often women (64.5% versus 53.2%, P,0.001), and had higher baseline eGFR compared with Caucasians. Annual family income, education level, and prevalence of health insurance were lower among African Americans than Caucasians. The unadjusted incidence of hospitalized AKI was 7.4 cases per 1000 person-years among African Americans and 5.8 cases per 1000 person-years among Caucasians (P=0.002). The elevated risk of AKI among African Americans persisted after adjustment for demographics, cardiovascular risk factors, kidney markers, and time-varying number of hospitalizations (adjusted hazard ratio, 1.20; 95% confidence interval [95% CI], 1.01 to 1.43; P=0.04); however, accounting for differences in income and/or insurance by race attenuated the association (P.0.05). High-risk APOL1 variants did not associate with AKI among African Americans (demographic-adjusted hazard ratio, 1.07; 95% CI, 0.69 to 1.65; P=0.77). In summary, the higher risk of AKI among African Americans may be related to disparities in socioeconomic status.

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Section: Discussionmentioning

confidence: 83%

Explaining the Racial Difference in AKI Incidence

Grams

Matsushita²,

Sang³

et al. 2014

Journal of the American Society of Nephrology

130

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“…28 Furthermore, increasing poverty was independently associated with higher serum phosphate levels and greater likelihood of hyperphosphatemia in a cohort of over 14,000 adults with largely preserved kidney function in the Third National Health and Nutrition Examination Survey. 29 Collectively, these observations suggest that lower socioeconomic status may contribute to elevated serum phosphate concentrations by promoting excess dietary phosphorus intake. Whether this accounts for higher serum phosphate concentrations among blacks compared with whites with CKD is unclear.…”

mentioning

confidence: 98%

Low Socioeconomic Status Associates with Higher Serum Phosphate Irrespective of Race

Gutiérrez

Anderson

Isakova

et al. 2010

Journal of the American Society of Nephrology

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Hyperphosphatemia, which associates with adverse outcomes in CKD, is more common among blacks than whites for unclear reasons. Low socioeconomic status may explain this association because poverty both disproportionately affects racial and ethnic minorities and promotes excess intake of relatively inexpensive processed and fast foods enriched with highly absorbable phosphorus additives. We performed a cross-sectional analysis of race, socioeconomic status, and serum phosphate among 2879 participants in the Chronic Renal Insufficiency Cohort Study. Participants with the lowest incomes or who were unemployed had higher serum phosphate concentrations than participants with the highest incomes or who were employed (P Ͻ 0.001). Although we also observed differences in serum phosphate levels by race, income modified this relationship: Blacks had 0.11 to 0.13 mg/dl higher serum phosphate than whites in the highest income groups but there was no difference by race in the lowest income group. In addition, compared with whites with the highest income, both blacks and whites with the lowest incomes had more than twice the likelihood of hyperphosphatemia in multivariable-adjusted analysis. In conclusion, low socioeconomic status associates with higher serum phosphate concentrations irrespective of race. Given the association between higher levels of serum phosphate and cardiovascular disease, further studies will need to determine whether excess serum phosphate may explain disparities in kidney disease outcomes among minority populations and the poor.

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“…11 As reported, abject poverty has also been linked to high serum phosphate concentration and increased likelihood of phosphate toxicity due to limited food choices. 12 In examining the added phosphate contents of some food products, enhanced meat and poultry products were found to contain a high percentage of phosphate additives, 28.4% higher than the amount in other regular products, thus increasing the risk of excessive consumption and chronic diseases. 13 Dairy products and cereals containing phosphate additives have also been found to increase serum phosphate concentration, even when consumed less regularly than other foods with no phosphate additives.…”

Section: Socioeconomic Impactmentioning

confidence: 99%

Health implications of inorganic phosphate additives in food products: a systematic review

Anukam

Agu

2017

Int J Community Med Public Health

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Background: Evidence based data identifies phosphate additives in food products as a public health concern, especially in the progression of chronic kidney disease (CKD). However, there is limited public awareness of the risks associated with phosphate additives. This study focuses on a systematic review of findings on health implications of phosphate additives, with the aim of strengthening public health knowledge, insight, understanding and prevention of exposure to phosphate toxicity and chronic diseases.Methods: Studies with primary data on phosphate additives were identified using keyword electronic database search in PubMed and BMC. To meet the review criteria, articles needed to (1) be published in English (2) focus on phosphate additives (3) address the potential health risks associated with phosphate additives (4) identify existing health problems caused by phosphate additives (5) published between 2005 to 2017 to provide a more dynamic review and (6) hold a strong research evidence that confirms the associated risks of phosphate additives.Results: Findings from reviewed literature suggest a link between high phosphate content in food products and chronic renal failure, cardiovascular complications, accelerated aging process, allergic reactions and increased morality rate. The need to regulate the use of phosphates additives in food products and strengthen public health education is essential to minimise high exposure to phosphate additives.Conclusions: Further research, proper food labelling, strict regulation of unhealthy food additives, nutrition education and sensitisation of consumers are required to minimise exposure to phosphate additives and susceptibility to chronic diseases.

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Impact of Poverty on Serum Phosphate Concentrations in the Third National Health and Nutrition Examination Survey

Cited by 42 publications

References 39 publications

Explaining the Racial Difference in AKI Incidence

Explaining the Racial Difference in AKI Incidence

Low Socioeconomic Status Associates with Higher Serum Phosphate Irrespective of Race

Health implications of inorganic phosphate additives in food products: a systematic review

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