[, Yamamoto KT, Robinson-Cohen C, de Oliveira MC, et al. Special nutritional needs of chronic kidney disease and end-stage renal disease patients: rationale for the use of plant-based diets. Hospital Practice 2018;46:121-7. Phosphorus can interact with certain medications, and some medications can have an adverse effect on phosphate levels. Updated: June 4, 2020 History of changes to this fact sheet, U.S. Department of Health & Human Services, Strengthening Knowledge and Understanding of Dietary Supplements, My Dietary Supplement and Medicine Record, How To Evaluate Health Information on the Internet, NIH Consortium for Advancing Research on Botanical and Other Natural Products (CARBON) Program, Analytical Methods and Reference Materials (AMRM), Dietary Supplement Ingredient Database (DSID), Computer Access to Research on Dietary Supplements (CARDS) Database. Is controlling phosphorus by decreasing dietary protein intake beneficial or harmful in persons with chronic kidney disease? Washington, DC: National Academies Press; 2001. Nanotechnology for angiogenesis: opportunities and challenges. [. Antacids A meta-analysis of 9 cohort studies in 199,289 patients aged 50–73 years with end-stage renal disease showed, for example, that patients on dialysis with the highest phosphate levels (greater than 5.2–7.5 mg/dL, depending on the study) had a 39% greater risk of all-cause mortality during 12 to 97.6 months of follow-up than those with normal phosphate levels (defined in the analysis as 3.0–5.5 mg/dL, depending on the study) . Boca Raton, Florida: CRC Press; 2018:221-33. Rare genetic disorders of phosphorus metabolism include X-linked hypophosphatemic rickets . The kidneys, bones, and intestines regulate phosphorus homeostasis, which requires maintenance of urinary losses at equivalent levels to net phosphorus absorption and ensuring that equal amounts of phosphorus are deposited and resorbed from bone [1,7,8]. Estimated Average Requirement (EAR): Average daily level of intake estimated to meet the requirements of 50% of healthy individuals; usually used to assess the nutrient intakes of groups of people and to plan nutritionally adequate diets for them; can also be used to assess the nutrient intakes of individuals. Phosphorus is a mineral that the body uses for repair and growth of body cells and tissues. It`s mostly eliminated through the urine and less through the stool. [. Phosphorus is available in dietary supplements containing only phosphorus, supplements containing phosphorus in combination with other ingredients, and a few multivitamin/multimineral products . The kidney is a major regulator of Pi homeostasis and can increase or decrease its Pi reabsorptive capacity to accommodate Pi need. EFSA Panel on Dietetic Products N, Allergies. Epub 2020 Jun 15. Functions of Phosphorus in the Body. For a reader-friendly overview of Phosphorus, see our consumer fact sheet on Phosphorus. 2000 Oct 25;168(1-2):41-51. doi: 10.1016/s0303-7207(00)00310-5. Of this amount, 85% is in bones and teeth, and the other 15% is distributed throughout the blood and soft tissues . [, Selamet U, Tighiouart H, Sarnak MJ, Beck G, Levey AS, Block G, et al. [. High phosphorus intakes might be signs of diets that are unhealthy in other ways, for example . Pediatr Nephrol 2012;27:1477-87. Get the latest research information from NIH: https://www.nih.gov/coronavirus, Have a question? For example, an analysis of 14,675 participants (55% women) without atrial fibrillation found, based on almost 20 years of follow-up, that each 1 mg/dL increase in serum phosphate was associated with a 13% higher risk of atrial fibrillation . Association of dietary phosphate and serum phosphorus concentration by levels of kidney function. NIH In addition, phosphorus plays key roles in regulation of gene transcription, activation of enzymes, maintenance of normal pH in extracellular fluid, and intracellular energy storage. The human response to acute enteral and parenteral phosphate loads. U.S. Department of Agriculture, Agricultural Research Service. Phosphorus Intake of Americans: What We Eat in American, NHANES 2011-2012. Cochrane Database Syst Rev 2015:Cd010350. Nutrients 2018;10. Institute of Medicine, Food and Nutrition Board. Inorganic phosphate homeostasis and the role of dietary phosphorus. Semin Dial 2013;26:54-61. Antacids containing calcium carbonate (Rolaids, Tums, Maalox) also decrease instestinal absorption of dietary phosphorus . J Nutr. In fact, phosphorus is regularly noted as the second most profuse mineral in the human body, and is the second most important element when it comes to maintaining bone health and integrity, behind calcium . It is the second most abundant element in an animal body after calcium, with 80% of phosphorus found in the bones and teeth, and the remainder located in the body fluids and soft tissue. FDA Drug Safety Communication: FDA warns of possible harm from exceeding recommended dose of over-the-counter sodium phosphate products to treat constipation. | [, Group KDIGOC-MUW. Because human intestines lack the phytase enzyme, much phosphorus in this form is unavailable for absorption . Phosphorous is a widely distributed in the body The human body contains about 1 kg of phosphorous Body distribution: About 80% of phosphorous is found in bones & teeth in combination with calcium About 15% of phosphorous is present in soft tissues In the soft tissues most phosphate is organic, as … J Endocr Soc 2017;1:407-14. J Ren Nutr 2013;23:265-70.e2. In: Uribarri J, Calvo MS, eds. 1996 Apr;49(4):1027-32. doi: 10.1038/ki.1996.149. Causes of malnutrition that can lead to refeeding syndrome include chronic diseases (e.g., cancer, chronic obstructive pulmonary disease, or cirrhosis), very low birthweight, cachexia, low body weight, anorexia nervosa, excessive alcohol intake, and chewing or swallowing problems. PHOSPHOROUS METABOLISM 1. [, Cheungpasitporn W, Thongprayoon C, Mao MA, et al. Chem Soc Rev. 2002 Jun;444(3):317-26. doi: 10.1007/s00424-002-0839-4. Many different types of foods contain phosphorus, including dairy products, meats and poultry, fish, eggs, nuts, legumes, vegetables, and grains [13,14]. Phosphorus is the second most abundant element in the human body (second to calcium). Phex cDNA cloning from rat bone and studies on phex mRNA expression: tissue-specificity, age-dependency, and regulation by insulin-like growth factor (IGF) I in vivo. Other rare genetic disorders of phosphorus regulation associated with rickets include autosomal-dominant and autosomal-recessive hypophosphatemic rickets and hereditary hypophosphatemic rickets with hypercalciuria . Some laxatives, such as Fleet Prep Kit #1, contain sodium phosphate, and ingesting these products can increase serum phosphate levels . Many proteins and sugars in the body are phosphorylated. Phosphate ions play very important roles in the body as Phosphate ions are found in the ATP, AMP, 2,3 DPG and proteins. [, McClure ST, Chang AR, Selvin E, et al. FDA required manufacturers to use these new labels starting in January 2020, but companies with annual sales of less than $10 million may continue to use the old labels that list a phosphorus DV of 1,000 mg until January 2021 [27,28]. For example, an analysis of NHANES III (1988-1994) data on 1,105 adults (mean age 67–71 years, depending on their phosphate intake tertile) with moderate CKD found that serum phosphate levels were very similar, regardless of phosphate intake—3.6 mg/dL in the lowest tertile of phosphorus intake (532 mg/day) and 3.5 mg/dL in the highest intake tertile (1,478 mg/day)—and that high phosphorus intakes were not associated with increased mortality rates over 6–12 years, possibly because these patients did not have severe CKD . J Infus Nurs 2014;37:197-202. Phosphorylation and dephosphorylation of proteins regulate cell functions. eCollection 2020 Jul. According to one analysis of data on healthy U.S. adults using NHANES III data collected in 1988–1994, high phosphorus intakes (1,000 mg/day or more) were associated with increased rates of all-cause and cardiovascular mortality in adults through 2006 . Replacing phosphorus-containing food additives with foods without additives reduces phosphatemia in end-stage renal disease patients: a randomized clinical trial. People with severe protein or calorie malnutrition can develop refeeding syndrome, also known as refeeding hypophosphatemia, within 2 to 5 days of starting enteral or parenteral nutrition because of the shift in metabolism from a catabolic to an anabolic state [42,43]. [, Moe S, Drueke T, Cunningham J, et al. Clin Perinatol 2018;45:129-41. New York, New York: Springer-Verlag; 2017:11-28. Ask ODS FDA does not require food labels to list phosphorus content unless phosphorus has been added to the food. In addition, phosphorus and calcium make up hydroxyapatite, the main structural component in bones and tooth enamel . A meta-analysis of data from four prospective cohort studies with 13,515 participants (with percentages of male participants ranging, depending on the study, from 44 to 100% and mean ages from 43 to 74 years) followed for 6–29 years showed a 36% higher risk of cardiovascular mortality in those with the highest phosphate concentration (2.79–4.0 mg/dL) compared with participants with a phosphate concentration of 0.61–3.28 mg/dL . J Ren Nutr 2017;27:97-105. 2.1.3 The revised phosphorus regulation: direct phosphorus ceilings at farm level As a consequence of the changes in regulation, according to the latest political agreement on Food and Agriculture (section 1.2), a revised regulation addressing phosphorus is introduced in 2017. Antacids that contain aluminum hydroxide, such as Maalox HRF and Rulox, bind phosphorus in the intestines, and their chronic use for 3 months or longer can therefore lead to hypophosphatemia [1,71]. The connection between dietary phosphorus, cardiovascular disease, and mortality: where we stand and what we need to know. Serum Pi level is maintained within a narrow range through a complex interplay between intestinal absorption, exchange with intracellular and bone storage pools, and renal tubular reabsorption. Intake recommendations for phosphorus and other nutrients are provided in the Dietary Reference Intakes (DRIs) developed by the Food and Nutrition Board (FNB) at the National Academies of Sciences, Engineering, and Medicine . Includes a variety of vegetables, fruits, whole grains, fat-free or low-fat milk and milk products, and oils. [. Because two-thirds of fetal bone mineral content is acquired during the third trimester of pregnancy, preterm infants are born with low stores of calcium and phosphorus in their bones . [, Calvo MS, Lamberg-Allardt CJ. Takeda E, Yamamoto H, Nashiki K, Sato T, Arai H, Taketani Y. J Cell Mol Med. Hypophosphatemic rickets: etiology, clinical features and treatment. For infants from birth to 12 months, the FNB established an AI for phosphorus that is equivalent to the mean intake of phosphorus in healthy, breastfed infants. KDIGO 2017 Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD),. [, Shinaberger CS, Greenland S, Kopple JD, et al. The restriction of phosphorus intake seems to be important under low calcium intake to keep QOL on high level. Dietary phosphorus is readily absorbed in the small intestine, and in healthy individuals, excess phosphorus is excreted by the kidneys under the regulatory action of the endocrine hormones: parathyroid hormone (PTH), vitamin D, and fibroblast growth factor-23 (FGF-23). Very high phosphorus intakes over short periods (e.g., two 6,600 mg doses of sodium phosphate taken in one day) can cause hyperphosphatemia [69,70]. Phosphorus undergoes passive absorption in the small intestine, although some is absorbed by active transport . Scientific Opinion on Dietary Reference Values for phosphorus. In addition to rickets, patients with this disease develop osteomalacia, pseudofractures (formation of new bone and thickened connective tissue over injured bone), enthesopathy (mineralization of ligaments and tendons), and dental damage. Institute of Medicine, Food and Nutrition Board. Clinical Aspects of Natural and Added Phosphorus in Foods. Any mention in this publication of a specific product or service, or recommendation from an organization or professional society, does not represent an endorsement by ODS of that product, service, or expert advice. The table below shows just some of the foods that contain calcium, vitamin D and phosphorus. [, Calvo MS, Uribarri J. The ULs do not apply to individuals who are receiving supplemental phosphorus under medical supervision. [, Casais MN, Rosa-Diez G, Perez S, et al. Phosphorus is an essential mineral primarily used for growth and repair of body cells and tissues. Am J Clin Nutr 2014;99:320-7. Get the latest public health information from CDC: https://www.coronavirus.gov, Get the latest research information from NIH: https://www.nih.gov/coronavirus, Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. Chronic kidney disease Am J Cardiol 2013;111:857-62. [, Malberti F. Hyperphosphataemia: treatment options. [, Tonelli M, Sacks F, Pfeffer M, et al. Arq Bras Endocrinol Metabol 2006;50:802-13. In adults, normal phosphate concentration in serum or plasma is 2.5 to 4.5 mg/dL (0.81 to 1.45 mmol/L) . Phosphate additives (e.g., phosphoric acid, sodium phosphate, and sodium polyphosphate) are present in many foods, especially processed food products. Some experts question whether the dietary data collection instruments used by NHANES and other large population-based studies capture true dietary phosphorus intakes because these surveys do not account for the additional contributions of phosphate additives in foods [33,34]. HHS Several hormones, including estrogen and adrenaline, also affect phosphorus homeostasis. Yogurt, plain, low fat, 6-ounce container, Salmon, Atlantic, farmed, cooked, 3 ounces, Cheese, mozzarella, part skim, 1.5 ounces, Beef patty, ground, 90% lean meat, broiled, 3 ounces, Potatoes, Russet, flesh and skin, baked, 1 medium. Calvo MS, Uribarri J. Cochrane Database Syst Rev 2017;2:Cd003310. These values, which vary by age and sex, include: Table 1 lists the current RDAs for phosphorus . Most (about 85%) of the phosphorus contained in phosphate is found in bones. 2020 Jul 21;49(14):5008-5057. doi: 10.1039/c8cs01021h. J Clin Endocrinol Metab 2015;100:4264-71. 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