Phosphorus Content of Popular Beverages

Moser, Melissa; White, Karen; Henry, Bobbie; Oh, Susan; Miller, Edgar R.; Anderson, Cheryl A.M.; Benjamin, Jonathan; Charleston, Jeanne; Appel, Lawrence J.; Chang, Alexander R.

doi:10.1053/j.ajkd.2015.02.330

Cited by 36 publications

(21 citation statements)

References 8 publications

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“…Baseline phosphorus intake was marginally associated with ESRD (per 1 mg/kg/d increase in phosphorus intake: HR 1.10; 95% CI, 0.98–1.24; P = 0.1) and mortality (per 1 mg/kg/d increase in phosphorus intake: HR 1.19; 95% CI, 1.03–1.37; P = 0.02), even after adjustment for urea excretion. The weak correlation between phosphorus intake and 24-h urine phosphorus could reflect differences in renal phosphorus handling in moderate to severe CKD, errors in 24-h urine collections, or limitations of dietary databases, although prior studies have reported stronger correlations between dietary recalls and 24-h urine phosphorus (25, 102, 119, 156). Further, no follow-up 24-h urine phosphorus measurements were done during the trial period in this protein restriction trial, and reverse causation remains a concern.…”

Section: Urine Phosphorus Excretion and Adverse Outcomesmentioning

confidence: 97%

“…All these observational studies suffer from measurement error given the limitations of dietary databases to capture the contribution of phosphorus additives (25, 119, 135, 156). Further, dietary databases are unable to quantify bioavailable phosphorus, which varies across different sources of phosphorus (85–87, 139).…”

Section: Dietary Phosphorus Intake Risk Of Esrd and Deathmentioning

confidence: 99%

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Dietary Phosphorus Intake and the Kidney

Chang

Anderson

2017

Annu. Rev. Nutr.

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Although phosphorus is an essential nutrient required for multiple physiological functions, recent research raises concerns that high phosphorus intake could have detrimental effects on health. Phosphorus is abundant in the food supply of developed countries, occurring naturally in protein-rich foods and as an additive in processed foods. High phosphorus intake can cause vascular and renal calcification, renal tubular injury, and premature death in multiple animal models. Small studies in human suggest that high phosphorus intake may result in positive phosphorus balance and correlate with renal calcification and albuminuria. Although serum phosphorus is strongly associated with cardiovascular disease, progression of kidney disease, and death, limited data exist linking high phosphorus intake directly to adverse clinical outcomes. Further prospective studies are needed to determine whether phosphorus intake is a modifiable risk factor for kidney disease.

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Section: Urine Phosphorus Excretion and Adverse Outcomesmentioning

confidence: 97%

Section: Dietary Phosphorus Intake Risk Of Esrd and Deathmentioning

confidence: 99%

Dietary Phosphorus Intake and the Kidney

Chang

Anderson

2017

Annu. Rev. Nutr.

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“…This resulted in a difference in study product phosphorus content of 998 mg/d (Table 1). 24 Manufacturer-reported content of other macronutrients and micronutrients is shown in Table 1. Notably, study products with phosphorus additives contained 1050 mg/d of calcium whereas study products without phosphorus additives contained 800 mg/d of calcium.…”

Section: Methodsmentioning

confidence: 99%

Phosphorus Additives and Albuminuria in Early Stages of CKD: A Randomized Controlled Trial

Chang

Miller

Anderson

et al. 2017

American Journal of Kidney Diseases

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Background Little is known about the effects of phosphorus additives on patients with kidney disease. Study Design Randomized, double-blind, cross-over trial Setting & Participants 31 adults with early stages of presumed chronic kidney disease (estimated glomerular filtration rate [eGFR] ≥ 45 ml/min/1.73m2; urine albumin-creatinine ratio [ACR] sex-specific cut points: men ≥ 17 mg/g, women ≥ 25 mg/g). Intervention Higher vs lower phosphorus intake for 3 weeks. Higher phosphorus intake was achieved by addition of commercially available diet beverages and breakfast bars to diet. Outcomes Change in 24-hour urine albumin excretion and plasma fibroblast growth factor 23 Measurements Two 24-hour urine collections and a single fasting blood draw at the end of each period. Results Mean baseline values of phosphorus intake, 24-hour urine phosphorus excretion, and eGFR were 1113 ± 549 (SD) mg/d, 688 ± 300 mg/d, and 74.6 ± 22.0 ml/min/1.73m2. Median albuminuria was 82.7 (IQR, 39.6–174.1) mg/d. While phosphorus intake from study products increased by 993 mg/d (p<0.001) during the higher compared to lower phosphorus additive period, background phosphorus intake decreased by 151 mg/d (p=0.004). Higher phosphorus additive consumption increased 24-hour urine phosphorus excretion by 505 (95% CI, 381–629) mg/d (p<0.001), but did not significantly increase albuminuria (higher vs lower: 14.3%; 95% CI, −2.5% to 34.0%; p=0.1) or fibroblast growth factor 23 (higher vs lower: 3.4%; 95% CI, −5.9% to 13.6%; p=0.4). Limitations Small sample size, short duration of intervention, changes in background diet during the intervention Conclusions A 3-week consumption of higher phosphorus food additives did not significantly increase albuminuria. Further studies are needed to confirm these results.

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“…4 Several studies have demonstrated higher phosphorus content in foods containing phosphorus additives and inaccuracies in nutri-tional databases' reporting of the phosphorus content of these processed food and beverage products. 3,5,6 In Table 1, we present data from a recent study 6 examining phosphorus content in beverages containing phosphorusbased additives and compare measured values (Medallion Laboratories, Minneapolis, MN) with those reported by the Nutrient Data System for Research (NDSR) software version 2014. We also searched the USDA Standard Nutrient Reference Database, 7 manufacturer websites, 8-10 and 2 popular calorie tracking websites 11,12 to further investigate the extent of publically available data on phosphorus content for these beverages.…”

mentioning

confidence: 99%

“…Phosphorus content was underestimated by NDSR for 78% of the beverages analyzed. 6 The USDA Standard Nutrient Reference Database only had productspecific information for 11% 5 of the beverages. Neither MyFitnessPal nor CalorieKingÔ had any productspecific information on any of the products.…”

mentioning

confidence: 99%