High dietary phosphorus intake is associated with all-cause mortality: results from NHANES III.
BACKGROUND
Elevated serum phosphorus is associated with all-cause mortality, but little is known about risk associated with dietary phosphorus intake.


OBJECTIVE
We investigated the association between phosphorus intake and mortality in a prospective cohort of healthy US adults (NHANES III; 1998-1994).


METHODS
Study participants were 9686 nonpregnant adults aged 20-80 y without diabetes, cancer, or kidney or cardiovascular disease. Exposure to dietary phosphorus, which was assessed by using a 24-h dietary recall, was expressed as the absolute intake and phosphorus density (phosphorus intake divided by energy intake). All-cause and cardiovascular mortality was assessed through 31 December 2006.


RESULTS
Median phosphorus intake was 1166 mg/d (IQR: 823-1610 mg/d); median phosphorus density was 0.58 mg/kcal (0.48-0.70 mg/kcal). Individuals who consumed more phosphorus-dense diets were older, were less often African American, and led healthier lifestyles (smoking, physical activity, and Healthy Eating Index). In analyses adjusted for demographics, cardiovascular risk factors, kidney function, and energy intake, higher phosphorus intake was associated with higher all-cause mortality in individuals who consumed >1400 mg/d [adjusted HR (95% CI): 2.23 (1.09, 4.5) per 1-unit increase in ln(phosphorus intake); P = 0.03]. At <1400 mg/d, there was no association. A similar association was seen between higher phosphorus density and all-cause mortality at a phosphorus density amount >0.35 mg/kcal [adjusted HR (95% CI): 2.27 (1.19, 4.33) per 0.1-mg/kcal increase in phosphorus density; P = 0.01]. At <0.35 mg/kcal (approximately the fifth percentile), lower phosphorus density was associated with increased mortality risk. Phosphorus density was associated with cardiovascular mortality [adjusted HR (95% CI): 3.39 (1.43, 8.02) per 0.1 mg/kcal at >0.35 mg/kcal; P = 0.01], whereas no association was shown in analyses with phosphorus intake. Results were similar by subgroups of diet quality and in analyses adjusted for sodium and saturated fat intakes.


CONCLUSIONS
High phosphorus intake is associated with increased mortality in a healthy US population. Because of current patterns in phosphorus consumption in US adults, these findings may have important public health implications.
Division of Nephrology, Geisinger Health System, Danville, PA (ARC); the Welch Center for Prevention, Epidemiology, and Clinical Research (ARC, ML, LJA, and MEG) and Divisions of Nephrology (ARC and MEG) and General Internal Medicine (LJA), Johns Hopkins University, Baltimore, MD; and the Division of Nephrology, University of Alabama at Birmingham, Birmingham, AL (OMG).
Alex R
AR
Chang
Mariana
M
Lazo
Lawrence J
LJ
Appel
Orlando M
OM
Gutiérrez
Morgan E
ME
Grams
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality*; D004305:Dose-Response Relationship, Drug; D002149:Energy Intake; D005227:Fatty Acids / Q000008:administration & dosage; D005247:Feeding Behavior; D005260:Female; D005500:Follow-Up Studies; D058870:Food, Organic; D006801:Humans; D008297:Male; D011939:Mental Recall; D008875:Middle Aged; D009026:Mortality; D009043:Motor Activity; D009749:Nutrition Surveys; D016226:Phosphorus, Dietary / Q000008:administration & dosage* / Q000009:adverse effects*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors; D012982:Sodium, Dietary / Q000008:administration & dosage; D013315:Stress, Psychological; D014481:United States; D055815:Young Adult
D005227:Fatty Acids; D016226:Phosphorus, Dietary; D012982:Sodium, Dietary