title: Reexamining the Phosphorus-Protein Dilemma: Does Phosphorus Restriction Compromise Protein Status?
abstract: Dietary phosphorus restriction is recommended to help control hyperphosphatemia in hemodialysis patients, but many high-phosphorus foods are important sources of protein. In this review, we examine whether restricting dietary phosphorus compromises protein status in hemodialysis patients. Although dietary phosphorus and protein are highly correlated, phosphorus intakes can range up to 600 mg/day for a given energy and protein intake level. Furthermore, the collinearity of phosphorus and protein may be biased because the phosphorus burden of food depends on: (1) the presence of phosphate additives, (2) food preparation method, and (3) bioavailability of phosphorus, which are often unaccounted for in nutrition assessments. Ultimately, we argue that clinically relevant reductions in phosphorus intake can be made without limiting protein intake by avoiding phosphate additives in processed foods, using wet cooking methods such as boiling, and if needed, substituting high-phosphorus foods for nutritionally equivalent foods that are lower in bioavailable phosphorus.
authors.affiliation: Center for Healthful Behavior Change, Department of Population Health, New York University School of Medicine, New York, NY. Electronic address: davidstjules@gmail.com.
authors.forename: David E
authors.initials: DE
authors.lastname: St-Jules
authors.affiliation: Department of Nutrition, Food Studies, and Public Health, New York University Steinhardt, New York, NY.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Woolf
authors.affiliation: Center for Healthful Behavior Change, Department of Population Health, New York University School of Medicine, New York, NY.
authors.forename: Mary Lou
authors.initials: ML
authors.lastname: Pompeii
authors.affiliation: Division of Nephrology and Hypertension, Department of Medicine, University of California, Irvine, Irvine, CA.
authors.forename: Kamyar
authors.initials: K
authors.lastname: Kalantar-Zadeh
authors.affiliation: Center for Healthful Behavior Change, Department of Population Health, New York University School of Medicine, New York, NY.
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: Sevick
mesh_terms: D001682:Biological Availability; D003296:Cooking / Q000379:methods; D004044:Dietary Proteins / Q000008:administration & dosage*; D005503:Food Additives; D006801:Humans; D054559:Hyperphosphatemia / Q000517:prevention & control*; D015596:Nutrition Assessment; D009751:Nutritional Requirements; D010710:Phosphates; D016226:Phosphorus, Dietary / Q000008:administration & dosage* / Q000009:adverse effects* / Q000493:pharmacokinetics; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000628:therapy*
chemical_list: D004044:Dietary Proteins; D005503:Food Additives; D010710:Phosphates; D016226:Phosphorus, Dietary