Phosphorus is a chemical element that is considered a mineral when discussing nutrition. rus (fŏs′fər-əs) n. 1. Am J Kidney Dis 2014;64:567-73. In 7,895 adults (mean age 47 years, 52% Caucasian), participants with moderately reduced kidney function had significantly higher serum phosphate levels (4.12 ml/dL) than those with normal kidney function (3.74 mg/dL) [47]. Whole-grain breads and cereals contain more phosphorus than cereals and breads made from refined flour. (See Appendix 6.) Institute of Medicine, Food and Nutrition Board. Assessing the health impact of phosphorus in the food supply: issues and considerations. [, Gattineni J, Baum M. Genetic disorders of phosphate regulation. Phosphorus that has been added to food in the form of an additive or preservative (inorganic phosphorus) is found in foods such as fast foods, ready to eat foods, canned and bottled drinks, enhanced meats, and most processed foods. Food Sources of Phosphorus. In the form of phospholipids, phosphorus is also a component of cell membrane structure and of the body’s key energy source, ATP. Adults need about 800 mg daily. Several observational studies support a link between high phosphate levels and CVD risk in people with and without a history of CVD [58,59]. Although phosphorus status is not typically assessed, phosphate can be measured in both serum and plasma [10]. Mineral homeostasis and effects on bone mineralization in the preterm neonate. Meat, dairy, seafood and eggs are full of the mineral, but you'll also get phosphorus from plant-based foods, like legumes and nuts. [. For a reader-friendly overview of Phosphorus, see our consumer fact sheet on Phosphorus. Scientific Opinion on Dietary Reference Values for phosphorus. However, plasma and serum phosphate levels do not necessarily reflect whole-body phosphorus content [1,11]. The effects of hypophosphatemia can include anorexia, anemia, proximal muscle weakness, skeletal effects (bone pain, rickets, and osteomalacia), increased infection risk, paresthesias, ataxia, and confusion [1]. Am J Kidney Dis 2017;69:200-9. Am J Clin Nutr 2014;99:320-7. A diet that includes the right amounts of meal plan calcium and protein will also provide enough phosphorus. [, Cheungpasitporn W, Thongprayoon C, Mao MA, et al. Of this amount, 85% is in bones and teeth, and the other 15% is distributed throughout the blood and soft tissues [1]. Ann N Y Acad Sci 2013;1301:21-6. Phosphorus is an essential element in the diet; in the form of phosphates it is a major component of the mineral phase of bone and is involved in almost all metabolic processes. Known as "P" on the periodic chart, and in the N-P-K ratio found on fertilizer, ~ is a naturally occurring and essential element, commonly found in inorganic phosphate rocks. Here is a list of foods high in phosphorus to help as you navigate grocery shopping, cooking, and eating out. Pediatr Nephrol 2012;27:1477-87. Foods containing these additives have an average of 67 mg more phosphorus per serving than similar foods not containing the additives, and these additives contribute to overall phosphorus intakes in the United States [18,19]. This section focuses on two diseases in which phosphorus might play a role: chronic kidney disease (CKD) and cardiovascular disease (CVD). Deficiency of phosphorus causes older leaves to turn dark green. 2. [, Menon MC, Ix JH. However, high phosphate levels do not seem to have the same associations in people with milder CKD [52,53]. Phosphorus forms. J Am Coll Nutr 2002;21:239-44. In minerals, phosphorus generally occurs as phosphate. Adv Nutr 2015;6:860-2. In: Erdman JW, Macdonald IA, Zeisel SH, eds. Gutierrez OM. Association between dietary calcium and phosphorus intakes, dietary calcium/phosphorus ratio and bone mass in the Korean population. Some laxatives, such as Fleet Prep Kit #1, contain sodium phosphate, and ingesting these products can increase serum phosphate levels [73]. Because human intestines lack the phytase enzyme, much phosphorus in this form is unavailable for absorption [1]. J Ren Nutr 2013;23:265-70.e2. A subsequent study not included in this meta-analysis in 13,165 nonpregnant adult participants (mean age 43–45 years, 52% female) in NHANES III (1988–1994) followed for a median of 14.3 years found that for every 1 mg/dL increase in phosphate above 3.5 mg/dL, the risk of death rose by 35% and the risk of cardiovascular death increased by 45% [62]. Association of dietary phosphate and serum phosphorus concentration by levels of kidney function. DRI is the general term for a set of reference values used for planning and assessing nutrient intakes of healthy people. Am J Clin Nutr 2015;102:444-53. KDIGO 2017 Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD),. These intakes are twice the RDA for adults—less than daily intakes in many men (especially those who are white or Hispanic) and well below the UL. [, Calvo MS, Uribarri J. Phosphorus is the second most abundant mineral nutrient in the body, after calcium. ... Phosphorus used in foods or obtained from food. 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 [60]. According to one analysis, a very high calcium intake of 2,500 mg/day binds 0.61–1.05 g phosphorus [17]. Bioavailability of phosphorus. Nuts, seeds, and many vegetables are rich in phosphorus as well. Dietary supplements Phosphorus is found in almost every food, and as such, deficiency is rare. Many proteins and sugars in the body are phosphorylated. 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. In: Gutierrez OM, Kalantar-Zadeh K, Mehrotra R, eds. [, Chang AR, Grams ME. Since meats are restricted in a CKD diet, egg whites can be a good low-phosphorus source … Drugs 2013;73:673-88. It also plays an important role in cell metabolism. The prevalence of phosphorus-containing food additives in top-selling foods in grocery stores. In addition, phosphorus and calcium make up hydroxyapatite, the main structural component in bones and tooth enamel [3]. Semin Dial 2013;26:54-61. Several studies have shown an increased risk of mortality or disease progression in patients who have CKD and high phosphate levels [48-50]. Serum phosphorus and mortality in the Third National Health and Nutrition Examination Survey (NHANES III): effect modification by fasting. Your main energy-storage molecule, adenosine triphosphate (ATP) contains phosphorus. Dietary sources include almost all foods. Cochrane Database Syst Rev 2015:Cd010350. Phosphorus as phosphate is a major buffer of acid in urine by virtue of its monovalent, divalent and trivalent forms. What does Phosphorus mean? It has a concentration in the Earth's crust of about one gram per kilogram (compare copper at about 0.06 grams). Heaney RP. Serum calcium, phosphorus and cardiovascular events in post-menopausal women. Nutrients 2018;10. ... Foods in nutrient-dense forms contain essential vitamins and minerals and also dietary fiber and other naturally occurring substances that may have positive health effects. Meaning of phosphorus, dietary. [, Calvo MS, Park YK. Tolerable Upper Intake Level (UL): Maximum daily intake unlikely to cause adverse health effects. Foods providing 20% or more of the DV are considered to be high sources of a nutrient, but foods providing lower percentages of the DV also contribute to a healthful diet. The bioavailability of other forms of phosphorus in supplements has not been determined in humans. Washington, DC: National Academies Press; 1997. Hypophosphatemia is defined as serum phosphate concentrations lower than the low end of the normal range, whereas a concentration higher than the high end of the range indicates hyperphosphatemia. J Ren Nutr 2017;27:97-105. Serum Phosphate [, Liu Z, Su G, Guo X, et al. Dietary phosphorus is associated with greater left ventricular mass. Almost all foods contain phosphorus, but the amounts of phosphorus are greater in animal products and high-protein foods like meats, fowl, fish, eggs, and dairy. 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]. Phosphorus found in animal foods is absorbed more easily than phosphorus found in plant foods. [, Casais MN, Rosa-Diez G, Perez S, et al. It’s then cycled back to soil again. Dietitians of Canada: "Food Sources of Phosphorus." Prophylactic administration of phosphorus and thiamin in patients at risk of refeeding syndrome can prevent this condition [43]. Phosphorus and calcium are interrelated because hormones, such as vitamin D and parathyroid hormone (PTH), regulate the metabolism of both minerals. When trying to limit phosphorus, avoid foods that list terms with "phos" among the ingredients. Functions in bones and teeth and in cell energy production. The U.S. Department of Agriculture’s (USDA’s) FoodData Central [29] lists the nutrient content of many foods and provides a comprehensive list of foods containing phosphorus arranged by nutrient content. 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. Most refined oils, fruits, vegetables, and refined grains are low in phosphorus. Relation of serum phosphorus levels to the incidence of atrial fibrillation (from the Atherosclerosis Risk In Communities [ARIC] study). The combination of high phosphorus intakes with low calcium intakes increases serum PTH levels, but evidence is mixed on whether the increased hormone levels decrease bone mineral density [2,4-6]. [, Chang AR, Miller ER, Anderson CA, et al. High phosphorus intakes rarely produce adverse effects in healthy people. New York, New York: Springer-Verlag; 2017:47-76. [. J Endocr Soc 2017;1:407-14. [, Group KDIGOC-MUW. [, Chines A, Pacifici R. Antacid and sucralfate-induced hypophosphatemic osteomalacia: a case report and review of the literature. Nutrients 2017;9. In spite of the evidence supporting a link between increased phosphate levels and CVD risk, the literature offers no evidence on whether restricting phosphorus consumption can prevent CVD in healthy adults [64]. Serum levels of phosphorus, parathyroid hormone, and calcium and risks of death and cardiovascular disease in individuals with chronic kidney disease: a systematic review and meta-analysis. 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. USDA National Nutrient Database for Standard Reference, Legacy Release. What does phosphorus, dietary mean? The U.S. Food and Drug Administration (FDA) developed DVs to help consumers compare the nutrient contents of foods and dietary supplements within the context of a total diet. New York, New York: Springer-Verlag; 2017:11-28. Definition of phosphorus, dietary in the Definitions.net dictionary. J Clin Endocrinol Metab 2015;100:4264-71. Phosphorus is an essential element in the diet; in the form of phosphates it is a major component of the mineral phase of bone and is involved in almost all metabolic processes. The main food sources of phosphorus are meat, milk, and whole grains, nuts and seeds (though the phosphorus is in a bound form in these foods and is about 50 percent less bio-available than phosphorus from other meat and milk sources). Kidney Int 2006;69:1945-53. Washington, DC: National Academies Press; 2001. Kidney Int 2013;83:707-14. Patients with severe malnutrition Phosphorus in supplements is usually in the form of phosphate salts (e.g., dipotassium phosphate or disodium phosphate) or phospholipids (e.g., phosphatidylcholine or phosphatidylserine). Adv Nutr 2013;4:723-9. [, Friedli N, Stanga Z, Culkin A, et al. Phosphorus occurs naturally at low levels in water, plants, and animals. It mainly cycles through the soil, water, and sediments. Phosphorus is a required mineral. Circulation 2005;112:2627-33. Phosphorus is also commonly added to processed food as a thickening agent or taste enhancer, or to stop unwanted alterations in food color. Kidney Int Suppl (2011) 2017;7:1-59. Phosphorus is an essential nutrient required for bone health and many other bodily functions. Phosphorus additives in food are absorbed nearly 100% into your blood, whereas the phosphorus in more natural foods like meats, beans, and nuts are only absorbed 20-50%. 10th ed. This systemic condition is characterized by abnormal metabolism of phosphorus, calcium, PTH, and/or vitamin D; abnormal bone turnover, mineralization, volume, growth, or strength; and vascular or other soft-tissue calcification [46]. It also plays an important role in cell metabolism. Phosphate additives are estimated to contribute 300 to 1,000 mg to total daily phosphorus intakes [11,20], or about 10%–50% of phosphorus intakes in Western countries [21]. [, Dhingra R, Sullivan LM, Fox CS, et al. JAMA Internal Medicine 2003;163:803-8. These drugs can also aggravate existing phosphate deficiency. Food Gutierrez OM, Luzuriaga-McPherson A, Lin Y, et al. [, Chang AR, Lazo M, Appel LJ,et al. About 95 percent of the phosphate rock mined in the United States is used to make fertilizer or food supplements for animals. 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) [51]. Cochrane Database Syst Rev 2018;8:CD006023. Guidance for Industry: A Food Labeling Guide (14. Sodas and other drinks containing phosphoric acid may cause excessive amounts of phosphorus intake, which can interfere with proper calcium metabolism. Phosphorus is an essential macromineral, meaning to be healthy you must include this nutrient in your diet. Appendix F: Calculate the Percent Daily Value for the Appropriate Nutrients). We encourage you to talk to your healthcare providers (doctor, registered dietitian, pharmacist, etc.) Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. The following groups are most likely to have inadequate phosphorus status. Examples of phosphorus added to food include: [, Calvo MS, Uribarri J. Phosphate additives (e.g., phosphoric acid, sodium phosphate, and sodium polyphosphate) are present in many foods, especially processed food products. [. Phosphorus is a component of bones, teeth, DNA, and RNA [1]. Relationship of dietary phosphate intake with risk of end-stage renal disease and mortality in chronic kidney disease stages 3-5: The Modification of Diet in Renal Disease Study. [. Antacids [, Anderson JJB, Adatorwovor R, Roggenkamp K, Suchindran CM. Boca Raton, Florida: CRC Press; 2018:221-33. The optimum calcium to phosphorus ratio is approximately 1:1, but in the average American diet, that ratio commonly varies between 1:2 and 1:4. Phosphorus is essential for plant and animal growth, as well as the health of microbes inhabiting the soil, but is gradually depleted from the soil over time. Treatment typically consists of vitamin D and phosphorus supplementation from diagnosis until growth is complete [41]. Phosphorus deficiency and toxicity are not very predominant; excesses of phosphorus may alter calcium balance, and phosphorus deficiency may lead to energy and metabolic problems. 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]. The symbol for phosphorus is P. 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. The ULs do not apply to individuals who are receiving supplemental phosphorus under medical supervision. Calcium effects on phosphorus absorption: implications for the prevention and co-therapy of osteoporosis. [, Selamet U, Tighiouart H, Sarnak MJ, Beck G, Levey AS, Block G, et al. Most of the phosphorus is wasted on its journey from mining to being eaten by humans, and the wasted phosphorus ends up in waterways where it can cause algal blooms. Trautvetter U, Jahreis G, Kiehntopf M, Glei M. Consequences of a high phosphorus intake on mineral metabolism and bone remodeling in dependence of calcium intake in healthy subjects - a randomized placebo-controlled human intervention study. Present Knowledge in Nutrition. [, Pavone V, Testa G, Gioitta Iachino S, et al. 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 [61]. phosphorus (P) [fos´for-us] a chemical element, atomic number 15, atomic weight 30.974. Whole-grain breads and cereals contain more phosphorus than cereals and breads made from refined flour. Karpen HE. Helps synthesize protein and is part of phospholipids (fat molecules), such as lecithin, which cells use to make membranes. Nephrol Dial Transplant 2012;27:990-6. Ask ODS In adults, normal phosphate concentration in serum or plasma is 2.5 to 4.5 mg/dL (0.81 to 1.45 mmol/L) [10]. [, Murtaugh MA, Filipowicz R, Baird BC, Wei G, Greene T, Beddhu S. Dietary phosphorus intake and mortality in moderate chronic kidney disease: NHANES III. 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 [12]. The Regulatory Aspects of Phosphorus Intake: Dietary Guidelines and Labeling. U.S. Department of Agriculture, Agricultural Research Service. The main food sources are the protein food groups of meat and milk. [, Beloosesky Y, Grinblat J, Weiss A, et al. Dietary sources include almost all foods. Includes a variety of protein foods, including seafood, lean meats and poultry, eggs, legumes (beans and peas), nuts, seeds, and soy products. Its Greek name means light-bearer since it emits a faint glow when exposed to oxygen. The human response to acute enteral and parenteral phosphate loads. Land-based cycle transfers phosphorus from soil to plants, to animals. 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. Phosphorus is a chemical element that glows in the dark and in moist air. A post hoc analysis of data from 7,269 postmenopausal women, mean age 66 years, with osteoporosis found no association between higher serum phosphate levels and risk of cardiovascular outcomes during 4 years of follow-up [63]. As a result, PTH and fibroblast growth factor 23 lose their ability to suppress phosphorus resorption by the kidneys [45]. The federal government's 2015–2020 Dietary Guidelines for Americans notes that "Nutritional needs should be met primarily from foods. Eating foods high in phosphorus is a very good way to boost bone and teeth health, while also improving key metabolic functions.. Phosphorus Foods. JJ Am Soc Nephrol 2014;25:2730-9. Clin Chim Acta 2017;474:108-13. This mineral is part of all cells, especially cell membranes, and is essential to bone strength, because it’s the main structural component of bones and teeth, as calcium phosphate. Concerns have arisen about phosphorus use, however. Laxatives 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 [65]. Nutrition 2018;47:13-20. As kidney function declines, phosphate excretion becomes less efficient and serum phosphate concentration rises. Jama 2011;305:1119-27. The use of phosphate additives is rising, as are the amounts of these additives in foods [22,23]. Generally foods that are particularly rich in protein are also high in phosphorus. Boca Raton, Florida: CRC Press; 2018:249-66. The morning star; phosphor. In its clinical practice guideline for CKD mineral and bone disorder, the "Kidney Disease: Improving Global Outcomes" guidelines development group recommends that patients with stage 3–5 (more severe) CKD limit dietary phosphorus intake either alone or in combination with other treatments to reduce phosphate levels [57]. Data from the 2015–2016 National Health and Nutrition Examination Survey (NHANES) show that among children and teens aged 2–19 years, the average daily phosphorus intake from foods is 1,237 mg [31]. Arq Bras Endocrinol Metabol 2006;50:802-13. 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. (Science: chemistry) A poisonous nonmetallic element of the nitrogen group, obtained as a white, or yellowish, translucent waxy substance, having a characteristic disagreeable smell. Symbol P A highly reactive, poisonous, nonmetallic element occurring naturally in phosphates, especially apatite, and existing in three allotropic forms, white (or sometimes yellow), red, and black (or violet). Dietary Sources of Phosphorus among Adults in the United States: Results from NHANES 2001-2014. [, Leon JB, Sullivan CM, Sehgal AR. If you’ve taken biology or chemistry classes, you might remember phosphorus from the Periodic Table of Elements.. Phosphates are minerals our bodies need to maintain healthy teeth, bones, heart function, muscles and blood vessels. People with genetic phosphate regulation disorders To avoid phosphorus-containing additives, check the ingredients lists of packaged foods for anything with “phosph-” or “phosphate” in the name—such as phosphoric acid, pyrophosphate, dipotassium phosphate, hexametaphosphate or diammonium phosphate. Clinical Aspects of Natural and Added Phosphorus in Foods. People with chronic kidney disease (CKD) typically have to restrict and monitor their intake of phosphorus. Rare genetic disorders of phosphorus metabolism include X-linked hypophosphatemic rickets [39]. In utero physiology: role in nutrient delivery and fetal development for calcium, phosphorus, and vitamin D. Am J Clin Nutr 2007;85:604S-7S. The phosphorus cycle is the process by which phosphorus moves through the lithosphere, hydrosphere, and biosphere. 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]. The name of the element comes from the Greek word phosphoros , meaning “light bearing.” Scientists use symbols to stand for the chemical elements. Phosphate binders for preventing and treating chronic kidney disease-mineral and bone disorder (CKD-MBD). In: Uribarri J, Calvo MS, eds. 1. Public health impact of dietary phosphorus excess on bone and cardiovascular health in the general population. Heaney RP, Nordin BE. Definition of Phosphorus in the Definitions.net dictionary. This is a fact sheet intended for health professionals. CKD, which affects 5%–10% of the population worldwide, can lead to CVD and early death [44]. However, the group notes that clinical trial data showing that treatments that lower serum phosphate levels improve patient-centered outcomes are lacking, and it acknowledges that this recommendation is weak. Cardiovascular disease Am J Kidney Dis 2019;73:542-51. To prevent the complications of high phosphate levels in patients with CKD, clinicians sometimes encourage patients to limit their phosphorus intakes (e.g., by replacing most animal proteins in their diets with plant-based protein sources, whose phosphorus is less bioavailable) and eat more calcium-rich foods [9,54]. Am J Clin Nutr 2008;88:1511-8. [, Moore LW, Nolte JV, Gaber AO, Suki WN. phosphorus definition: 1. a poisonous chemical element that is usually yellowish-white or sometimes red or black in…. Not all observational data, however, support a link between serum phosphate concentrations and CVD risk. 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 [37]. [. The main effects of hyperphosphatemia include changes in the hormones that regulate calcium metabolism and calcification of nonskeletal tissues, especially in the kidney [2]. The benefits of providing extra phosphorus and calcium for bone health in preterm babies is not clear. phosphorus (P) [fos´for-us] a chemical element, atomic number 15, atomic weight 30.974. Clin Perinatol 2018;45:129-41. [, Tonelli M, Sacks F, Pfeffer M, et al. Washington, DC: Wiley-Blackwell; 2012:447-58. The implications of this analysis for the potential adverse effects of high phosphorus intakes are unclear. Conversely consuming too much phosphorus causes the body to send calcium from the bones to the blood in an attempt to restore balance. So, phosphorus can mainly be found as tiny dust particles in the atmosphere. Calvo MS, Uribarri J. Phosphorus in the modern food supply: Underestimation of exposure. [, McClure ST, Chang AR, Selvin E, et al. FDA does not require food labels to list phosphorus content unless phosphorus has been added to the food. Several hormones, including estrogen and adrenaline, also affect phosphorus homeostasis. Additional studies are needed on the link between phosphate concentrations and both CKD risk and morbidity in patients with CKD as well as the impact of dietary phosphorus restriction in patients with this disease. Am J Clin Nutr 2013;98:6-15. In adults aged 20 and older, the average daily phosphorus intake from foods is 1,189 mg for women and 1,596 mg for men. [, Ito S, Ishida H, Uenishi K, et al. [, Ruospo M, Palmer SC, Natale P, et al. Get the latest public health information from CDC: https://www.coronavirus.gov Dietary phosphorus, serum phosphorus, and cardiovascular disease. Phosphorus definition is - a phosphorescent substance or body; especially : one that shines or glows in the dark. 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]. This mineral is part of all cells, especially cell membranes, and is essential to bone strength, because it’s the […] Foods High in Phosphorus . Phosphorus Cycle Definition. Special nutritional needs of chronic kidney disease and end-stage renal disease patients: rationale for the use of plant-based diets. Am J Cardiol 2013;111:857-62. People should avoid eating meats which typically contain more easily absorbed phosphorus than found in plants. Many different types of foods contain phosphorus, including dairy products, meats and poultry, fish, eggs, nuts, legumes, vegetables, and grains [13,14]. The Dietary Guidelines for Americans describes a healthy eating pattern as one that: This fact sheet by the Office of Dietary Supplements provides information that should not take the place of medical advice. [, Da J, Xie X, Wolf M, et al. Phosphorus is the second most abundant inorganic element in the body and is a part of many important compounds, including deoxyribonucleic acid (DNA), ribonucleic acid (RNA), (S)-2-amino-3-[5-tert-butyl-3-(phosphonomethoxy)-4-isoxazolyl]propionic acid (ATPO), adenosine diphosphate (ADP), phospholipids and sugar phosphates. The main food sources are the protein food groups of meat and milk, as well as processed foods that contain sodium phosphate. Check food labels to see whether any ingredients contain "phos" in the term. Lee KJ, Kim KS, Kim HN, et al. The relationship between habitual dietary phosphorus and calcium intake, and bone mineral density in young Japanese women: a cross-sectional study. Phosphorus additives and albuminuria in early stages of CKD: a randomized controlled trial. It can be found in many foods, but is especially high in … Trautvetter U, Ditscheid B, Jahreis G, Glei M. Habitual intakes, food sources and excretions of phosphorus and calcium in three German study collectives. These additives are used for such purposes as preserving moisture or color and enhancing and stabilizing frozen foods [18]. In infants, phosphorus bioavailability ranges from 85%–90% for human milk to approximately 59% for soy-based formulas [2]. Calvo MS, Uribarri J. Dietary Phosphorus: Health, Nutrition, and Regulatory Aspects. Phosphorus Additives Many food products now contain phosphorus additives. [, Malberti F. Hyperphosphataemia: treatment options. [, Shinaberger CS, Greenland S, Kopple JD, et al. In: Uribarri J, Calvo MS, eds. In some cases, fortified foods and dietary supplements may be useful in providing one or more nutrients that otherwise may be consumed in less-than-recommended amounts.". [. The DV for phosphorus on the new Nutrition Facts and Supplement Facts labels and used for the values in Table 2 is 1,250 mg for adults and children age 4 years and older [26]. *Adequate Intake (AI) Sources of Phosphorus. Phosphorus is also an important element in energy production. Several large epidemiologic studies have also found associations between higher serum phosphate concentrations and risk of cardiovascular mortality in healthy adults. Two examples are provided below. Food Labeling: Revision of the Nutrition and Supplement Facts Labels and Serving Sizes of Foods That Can Reasonably Be Consumed at One Eating Occasion; Dual-Column Labeling; Updating, Modifying, and Establishing Certain Reference Amounts Customarily Consumed; Serving Size for Breath Mints; and Technical Amendments; Proposed Extension of Compliance Dates. For more information about building a healthy diet, refer to the Dietary Guidelines for Americans and the U.S. Department of Agriculture's ChooseMyPlate. Relation between serum phosphate level and cardiovascular event rate in people with coronary disease. Adequate Intake (AI): Intake at this level is assumed to ensure nutritional adequacy; established when evidence is insufficient to develop an RDA. Dental Health Services Victoria: "Calcium, vitamin D and phosphorus." Phosphorus. [, Lederer E. Regulation of serum phosphate. Food Labeling: Revision of the Nutrition and Supplement Facts Labels. However, restricting phosphorus intakes can also reduce protein intakes because many foods (e.g., fish, meats, and legumes) containing large amounts of phosphorus also contain large amounts of protein [56]. Phosphorus occurs unnaturally in fertilizers (used in agriculture), cleaners (used in industry) and wastewater (from household sewage). Hruska K. Overview of phosphorus homeostasis. Phosphorus: Essential Nutrition for All Body Cells, Boron: A Trace Mineral Necessary for Good Health, Calcium: Essential Nutrition for Teeth and Bones, Glycine for Helping Wounds Heal and Detoxifying. [, Moe S, Drueke T, Cunningham J, et al. 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 [53]. Phosphorus undergoes passive absorption in the small intestine, although some is absorbed by active transport [2]. World J Gastroenterol 2009;15:5960-5. Chronic kidney disease [, de Menezes Filho H, de Castro LC, Damiani D. Hypophosphatemic rickets and osteomalacia. The bioavailability of phosphate salts is approximately 70% [15,24]. Phosphorus Intake of Americans: What We Eat in American, NHANES 2011-2012. These values, which vary by age and sex, include: Table 1 lists the current RDAs for phosphorus [2]. Kidney Int 2016;89:176-84. [, Slinin Y, Blackwell T, Ishani A, Cummings SR, Ensrud KE. Furthermore, a Cochrane review of nine studies in 634 participants with CKD followed for 1–18 months found only limited, low-quality evidence indicating that dietary interventions might have a positive impact on CKD mineral and bone disorder [45]. High phosphorus intakes might be signs of diets that are unhealthy in other ways, for example [65]. Boca Raton, Florida: CRC Press; 2018:235-46. de Fornasari ML, Dos Santos Sens YA. Adv Nutr 2014;5:104-13. about your interest in, questions about, or use of dietary supplements and what may be best for your overall health. Phosphorus is a mineral that’s found in the bones and processed by the kidneys. Phosphorus deficiency is rare due to its abundance in food but can cause low bone density, compromised growth and poor tooth development, weakness, irritability, weak or stiff joints and bone pain. Electrolyte disorders following oral sodium phosphate administration for bowel cleansing in elderly patients. Individuals taking these and other medications on a regular basis should discuss their phosphorus status with their healthcare providers. Cochrane Database Syst Rev 2017;2:Cd003310. Phosphorus is an essential macromineral, meaning to be healthy you must include this nutrient in your diet. Products typically provide 10% or less of the DV for phosphorus, but a small proportion deliver more than 100% [30]. Int J Cardiol 2011;149:335-40. Phosphorus is essential for life, so you'll get it from just about every type of food. Additives that contain phosphorus include monopotassium phosphate, phosphoric acid, pyrophosphate polyphosphate, disodium phosphate and calcium phosphate. The connection between dietary phosphorus, cardiovascular disease, and mortality: where we stand and what we need to know. Calcium from foods and supplements can bind to some of the phosphorus in foods and prevent its absorption [1,17]. Phosphate helps to protect blood systemic acid/base balance… Includes a variety of vegetables, fruits, whole grains, fat-free or low-fat milk and milk products, and oils. In fact, 85 percent of the phosphorus found in the body resides in … [. Learn more. Dietary interventions for mineral and bone disorder in people with chronic kidney disease. Phosphorus is available in dietary supplements containing only phosphorus, supplements containing phosphorus in combination with other ingredients, and a few multivitamin/multimineral products [30]. Serum phosphorus and progression of CKD and mortality: a meta-analysis of cohort studies. Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride. Meaning of Phosphorus. Hypophosphatemic rickets: etiology, clinical features and treatment. Antacids containing calcium carbonate (Rolaids, Tums, Maalox) also decrease instestinal absorption of dietary phosphorus [72]. Food Many different types of foods contain phosphorus, including dairy products, meats and poultry, fish, eggs, nuts, legumes, vegetables, and grains [13,14].In the United States, dairy products contribute about 20% of total phosphorus intakes, and bakery products (e.g., breads, tortillas, and sweet bakery products) contribute 10% []. Walter K. Dodds, Matt R. Whiles, in Freshwater Ecology (Third Edition), 2020. Advances in Chronic Kidney Disease 2007;14:3-12. [, Harding JE, Wilson J, Brown J. Calcium and phosphorus supplementation of human milk for preterm infants. Phosphorus deficiency in preterm infants is one of the main causes, along with calcium deficiency, of osteopenia of prematurity (impaired bone mineralization) [36]. The ULs for phosphorus from food and supplements for healthy individuals are therefore based on intakes associated with normal serum phosphate concentrations [2]. After 13 reports of deaths associated with taking one dose that was higher than recommended on the label of a laxative containing sodium phosphate, the FDA issued a warning that these products are potentially dangerous if more than recommended doses are taken, especially in people with kidney disease, heart disease, or dehydration [74]. Replacing phosphorus-containing food additives with foods without additives reduces phosphatemia in end-stage renal disease patients: a randomized clinical trial. Phosphorus deficiency (hypophosphatemia) is rare in the United States and is almost never the result of low dietary intakes [1]. Arch Intern Med 2007;167:879-85. Phosphorus, an essential mineral, is naturally present in many foods and available as a dietary supplement. Clinical Aspects of Natural and Added Phosphorus in Foods. In: Gutierrez OM, Kalantar-Zadeh K, Mehrotra R, eds. [, Scanni R, vonRotz M, Jehle S, et al. Definition, evaluation, and classification of renal osteodystrophy: a position statement from Kidney Disease: Improving Global Outcomes (KDIGO). [, Yamamoto KT, Robinson-Cohen C, de Oliveira MC, et al. * Breast milk, formula, and food should be the only sources of phosphorus for infants. Get the latest research information from NIH: https://www.nih.gov/coronavirus, Have a question? Hyperphosphatemia after sodium phosphate laxatives in low risk patients: prospective study. Many different types of foods contain phosphorus, mainly in the form of phosphates and phosphate esters [1]. [, Calvo MS, Lamberg-Allardt CJ. J Nutr 1996;126:1168S-80S. While phosphorus is not usually listed on the nutrition facts label, it may be listed as an ingredient. Recommended Dietary Allowance (RDA): Average daily level of intake sufficient to meet the nutrient requirements of nearly all (97%–98%) healthy individuals; often used to plan nutritionally adequate diets for individuals. Moorthi RN, Moe SM. In humans, phosphorus makes up about 1 to 1.4% of fat-free mass. [, Abrams SA. More About this Book. Several food sources of phosphorus are listed in Table 2. High dietary phosphorus intake is associated with all-cause mortality: results from NHANES III. Nutr J 2016;15:7. Some evidence shows that replacing foods containing phosphorus additives with foods that lack these additives can reduce serum phosphate levels [55]. In their natural form phosphates are chemical compounds made of oxygen and phosphorus. [, Hou Y, Li X, Sun L, Qu Z, Jiang L, Du Y. Phosphorus and mortality risk in end-stage renal disease: A meta-analysis. Manufacturers may add phosphorus when processing foods to thicken them, improve taste, prevent discoloration or preserve them. Read the ingredients and look out for any beginning with “PHOS.” Changing phosphorus content of the U.S. diet: potential for adverse effects on bone. Phosphorus is a chemical element with the symbol P and atomic number 15. Because of this, foods with phosphorus additives should be avoided if you are trying to limit phosphorus. [, Calvo MS, Moshfegh AJ, Tucker KL. Management and prevention of refeeding syndrome in medical inpatients: An evidence-based and consensus-supported algorithm. [. Clin Chim Acta 2016;461:76-82. Institute of Medicine, Food and Nutrition Board. And yes, there is a difference. Dietary Phosphorus: Health, Nutrition, and Regulatory Aspects. Admission serum phosphate levels predict hospital mortality. Phosphorus is the second most abundant mineral nutrient in the body, after calcium. According to an analysis of 2013–2014 NHANES data, the average daily phosphorus intake from both foods and supplements is 1,301 mg for women and 1,744 mg for men [32]. Preterm newborns EFSA Panel on Dietetic Products N, Allergies. A diet that includes the right amounts of calcium and protein will also provide enough phosphorus. Eur J Orthop Surg Traumatol 2015;25:221-6. Relations of serum phosphorus and calcium levels to the incidence of cardiovascular disease in the community. Information and translations of Phosphorus in the most comprehensive dictionary definitions resource on the web. Phosphorus definition, a solid, nonmetallic element existing in at least three allotropic forms, one that is yellow, poisonous, flammable, and luminous in the dark, one that is red, less poisonous, and less flammable, and another that is black, insoluble in most solvents, and the least flammable. Calcif Tissue Int 1990;47:291-5. Am J Kidney Dis 2015;66:258-65. Phosphorus is a mineral that is part of every cell in your … [, Calvo MS, Sherman RA, Uribarri J. Dietary phosphate and the forgotten kidney patient: a critical need for FDA regulatory action. 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]. [, Lopez FL, Agarwal SK, Grams ME, et al. Elemental phosphorus exists in two major forms, white phosphorus and red phosphorus, but because it is highly reactive, phosphorus is never found as a free element on Earth. Lack of influence of calcium/phosphorus ratio on hip and lumbar bone mineral density in older Americans: NHANES 2005-2006 cross-sectional data. In the United States, dairy products contribute about 20% of total phosphorus intakes, and bakery products (e.g., breads, tortillas, and sweet bakery products) contribute 10% [13]. FDA Drug Safety Communication: FDA warns of possible harm from exceeding recommended dose of over-the-counter sodium phosphate products to treat constipation. Itkonen ST, Karp HJ, Lamberg-Allardt CJ. Other rare genetic disorders of phosphorus regulation associated with rickets include autosomal-dominant and autosomal-recessive hypophosphatemic rickets and hereditary hypophosphatemic rickets with hypercalciuria [40]. phosphorus Origin: L, the morning star, Gr, lit, light bringer; light – to bring. High phosphorus foods. 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]. An analysis of 2003–2006 NHANES data illustrates the association between CKD and phosphate levels. Phosphorus can interact with certain medications, and some medications can have an adverse effect on phosphate levels. That means there is a land-based phosphorus cycle and water-based phosphorus cycle. Most Americans consume more than the recommended amounts of phosphorus. Additional research is needed to address this issue. J Infus Nurs 2014;37:197-202. J Physiol 2014;592:3985-95. Hospital Practice 2018;46:121-7. In: Uribarri J, Calvo MS, eds. [, Moe SM, Drüeke T, Lameire N, Eknoyan G. Chronic kidney disease--mineral-bone disorder: a new paradigm. About 85% of phosphorus is found in the skeleton and teeth as calcium phosphate crystals, 14% in soft tissues, and the remaining 1% in body fluids. Contributions to total phosphorus intake: all sources considered. In most cases, hypophosphatemia is caused by medical conditions, such as hyperparathyroidism, kidney tubule defects, and diabetic ketoacidosis [35]. [, Palmer SC, Hayen A, Macaskill P, et al. 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. The absorption rate for the phosphorus naturally contained in food is 40%–70%; phosphorus from animal sources has a higher absorption rate than that from plants [15,16]. Information and translations of phosphorus, dietary in the most comprehensive dictionary definitions resource on the web. Join the ODS Email List. [, Parli SE, Ruf KM, Magnuson B. Pathophysiology, treatment, and prevention of fluid and electrolyte abnormalities during refeeding syndrome. Nutr J 2014;13:114. phosphorus meaning: 1. a poisonous chemical element that is usually yellowish-white or sometimes red or black in…. American Society for Bone and Mineral Research: "Bone Structure and Function." Dietary Phosphorus: Health, Nutrition, and Regulatory Aspects. 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. Asia Pac J Clin Nutr 2011;20:411-7. Phosphorus. Food manufacturers do not have to list the amount of phosphorus on labels. When kidney function declines, as in chronic kidney failure, the body cannot excrete phosphate efficiently, and serum levels rise [9]. Vegetables and chicken contribute 5% each. Learn more. The effects of refeeding syndrome can include impaired neuromuscular function, hypoventilation, respiratory failure, impaired blood clotting, confusion, coma, cardiac arrest, congestive heart failure, and death [43]. Encyclopedia of Healing Foods. (See Appendix 6.) Although some studies have found associations between high phosphorus intakes (1,000 mg/day or higher) and cardiovascular, kidney, and bone adverse effects as well as an increased risk of death [23,65,66], others have found no link between high intakes and increased disease risk [5,67,68]. Impact of phosphorus-based food additives on bone and mineral metabolism. However, milk fortified with higher amounts of these minerals and other nutritional components is typically recommended to support overall growth and development [37,38]. Phosphorus is found in water, solids (detritus), and in the bodies of biological organisms. However, phosphorus in seeds and unleavened breads is in the form of phytic acid, the storage form of phosphorus [2]. [, Bai W, Li J, Liu J. Serum phosphorus, cardiovascular and all-cause mortality in the general population: A meta-analysis. Is controlling phosphorus by decreasing dietary protein intake beneficial or harmful in persons with chronic kidney disease? The absorption rate for the phosphorus in phosphate additives is approximately 70% [24]. Increased phosphorus retention often leads to CKD mineral and bone disorder. *DV = Daily Value. Phosphorus-Containing Foods.
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