Impact of poverty on serum phosphate concentrations in the Third National Health and Nutrition Examination Survey.
OBJECTIVE
Increased serum phosphate is associated with adverse health outcomes. High intake of inexpensive processed and fast foods is common in impoverished communities, and is linked with excessive dietary phosphorus intake and elevated serum phosphate concentrations in chronic kidney disease patients. We examined the impact of socioeconomic status on dietary phosphorus intake and serum phosphate concentrations in the general population.


METHODS
Cross-sectional study.


METHODS
A total of 14,261 adult participants in the Third National Health and Nutrition Examination Survey. PREDICTORS AND OUTCOMES: Poverty to income ratio (PIR; family income indexed to the federal poverty level) was the primary index of socioeconomic status. Serum phosphate was the primary outcome variable.


RESULTS
Although estimated phosphorus intake decreased with decreasing quartiles of PIR (P < .001), serum phosphate was inversely associated with PIR (P = .003). The relationship between lower PIR and higher serum phosphate remained significant after adjustment for demographic, laboratory, and dietary intake characteristics (P = .02). Compared with participants in the highest PIR quartile (income >300% of the federal poverty level), participants in the lowest quartile (income < the federal poverty level) had more than twice the odds of hyperphosphatemia (≥ 4.4 mg/dL) in unadjusted and multivariable-adjusted logistic regression analyses (OR, 2.2; 95% CI, 1.5 to 3.2).


CONCLUSIONS
Although lower income was associated with decreased estimated phosphorus intake, increasing poverty was independently linked with increased serum phosphate and higher likelihood of hyperphosphatemia. These findings may indicate that conventional dietary instruments underestimate phosphorus intake, especially among impoverished individuals. Further studies are needed to explore these possibilities.
Division of Nephrology and Hypertension, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida 33136, USA.
Orlando M
OM
Gutiérrez
Tamara
T
Isakova
Gwen
G
Enfield
Myles
M
Wolf
D000328:Adult; D003430:Cross-Sectional Studies; D004032:Diet; D005260:Female; D006304:Health Status; D006801:Humans; D054559:Hyperphosphatemia / Q000453:epidemiology; D007182:Income; D007676:Kidney Failure, Chronic; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009749:Nutrition Surveys; D010710:Phosphates / Q000097:blood*; D010758:Phosphorus / Q000097:blood; D016226:Phosphorus, Dietary; D011203:Poverty; D012044:Regression Analysis; D012923:Social Class; D011795:Surveys and Questionnaires; D014481:United States
D010710:Phosphates; D016226:Phosphorus, Dietary; D010758:Phosphorus