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Nutrition & Diabetes Apr 2019Chronic kidney disease-mineral and bone disorder (CKD-MBD) is a common complication in patients experiencing end-stage renal disease (ESRD). It includes abnormalities in... (Review)
Review
Chronic kidney disease-mineral and bone disorder (CKD-MBD) is a common complication in patients experiencing end-stage renal disease (ESRD). It includes abnormalities in bone and mineral metabolism and vascular calcification. Hyperphosphatemia is a major risk factor leading to morbidity and mortality in patients with chronic kidney disease. Increased mortality has been observed in patients with ESRD, with serum phosphorus levels of >5.5 mg/dL. Therefore, control of hyperphosphatemia is a major therapeutic goal in the prevention and treatment of CKD-MBD. The treatment of hyperphosphatemia includes decreasing intestinal phosphorus load and increasing renal phosphorus removal. Decreasing the intestinal load of phosphorus plays a major role in the prevention and treatment of CKD-MBD. Among the dietary sources of phosphorus, some of the commonly prescribed medications have also been reported to contain phosphorus. However, drugs are often ignored even though they act as a potential source of phosphorus. Similarly, although proteins are the major source of dietary phosphorus, reducing protein intake can increase mortality in patients with CKD. Recently, the importance of phosphorus/protein ratio in food have been reported to be a sensitive marker for controlling dietary intake of phosphorus. This review summarizes the progress in the research on phosphate content in drugs as an excipient and the various aspects of dietary management of hyperphosphatemia in patients with CKD, with special emphasis on dietary restriction of phosphorus with low dietary phosphate/protein ratio.
Topics: Humans; Hyperphosphatemia; Phosphorus; Phosphorus, Dietary; Renal Insufficiency, Chronic
PubMed: 30944300
DOI: 10.1038/s41387-019-0080-2 -
Annals of the New York Academy of... Oct 2013
Topics: Bone and Bones; Fibroblast Growth Factor-23; Fibroblast Growth Factors; Food; Health; Humans; Kidney; Myocardium; Nutrition Policy; Parathyroid Hormone; Phosphates; Phosphorus, Dietary; Renal Insufficiency, Chronic
PubMed: 24472075
DOI: 10.1111/nyas.12302 -
Poultry Science Apr 2022The objective of this study was to investigate the effects of dietary P levels on the performance of rearing pigeons, and bone characteristics of squabs from 7 to 21 d...
The objective of this study was to investigate the effects of dietary P levels on the performance of rearing pigeons, and bone characteristics of squabs from 7 to 21 d of age. A total of 192 pairs of adult Silver King pigeons (40 wk of age) were used. The pigeons were randomly allocated to one of 4 treatment groups, each consisting of eight replicates of 6 pigeon pairs per replicate. Dietary treatments included the basal diet (containing 0.3% of P), the basal diet supplemented with 0.2, 0.4, or 0.8% inorganic P. And the dietary Ca content was kept at 1.40% across all treatments. The experimental diets were fed to parent pigeons as corn-soybean complete pellet feed, and squabs fed with crop milk secreted by parent pigeons. Pigeons in the group of 0.4% supplemental non-phytate phosphorus (NPP) had shorter (P = 0.045) oviposition interval than those in the control group and group of 0.8% NPP. When the diet was supplemented with 0.8% of NPP, the least average egg weight was observed (P = 0.006). Female breeding birds had much higher (P < 0.01) Ca, P, and ALP in serum than male ones. At 7-d of age, dietary P supplementation influenced P and Ca content in tibia ash of squabs (P < 0.05). The tibia ash Ca content in the group of 0.2% NPP was the highest among the treatments (P = 0.007). At d 21 of age, both the birds in the group of 0.4 and 0.8% NPP had higher tibia breaking strength (P < 0.01) and tibia ash contents (P < 0.001) compared to the ones in the control group. In conclusion, the P deficiency in the diet of parent pigeons could cause poor bone mineralization of squabs, especially impaired the bone-breaking strength and bone ash content. The 0.8% of NPP supplementation in the diet has a positive influence on mineralization of squabs although production depression was observed. Both P and Ca metabolism of female breeding birds were more active than male ones at earlier time points of rearing period. The desirable supplemental NPP level in diet for breeding pigeon was 0.4% according to the performance data in the present trial. The recommended Ca: P ratio for pigeons, which was different from the optimum value for broilers, needs to be studied in the future.
Topics: 6-Phytase; Animal Feed; Animal Nutritional Physiological Phenomena; Animals; Chickens; Columbidae; Diet; Dietary Supplements; Female; Male; Phosphorus; Phosphorus, Dietary; Phytic Acid; Plant Breeding
PubMed: 35220034
DOI: 10.1016/j.psj.2022.101744 -
Clinical Journal of the American... Jul 2018
Topics: Biomarkers; Diet; Humans; Phosphorus; Phosphorus, Dietary; Renal Insufficiency, Chronic
PubMed: 29921735
DOI: 10.2215/CJN.06260518 -
Journal of Renal Nutrition : the... Mar 2017Phosphorus bioavailability is an emerging topic of interest in the field of renal nutrition that has important research and clinical implications. Estimates of... (Review)
Review
Phosphorus bioavailability is an emerging topic of interest in the field of renal nutrition that has important research and clinical implications. Estimates of phosphorus bioavailability, based on digestibility, indicate that bioavailability of phosphorus increases from plants to animals to food additives. In this commentary, we examined the proportion of dietary phosphorus from plants, animals, and food additives excreted in urine from four controlled-feeding studies conducted in healthy adults and patients with chronic kidney disease. As expected, a smaller proportion of phosphorus from plant foods was excreted in urine compared to animal foods. However, contrary to expectations, phosphorus from food additives appeared to be incompletely absorbed. The apparent discrepancy between digestibility of phosphorus additives and the proportion excreted in urine suggests a need for human balance studies to determine the bioavailability of different sources of phosphorus.
Topics: Cheese; Diet; Food Additives; Humans; Meat; Phosphorus, Dietary; Plants, Edible; Renal Insufficiency, Chronic
PubMed: 27810171
DOI: 10.1053/j.jrn.2016.09.003 -
Iranian Journal of Kidney Diseases Apr 2010Dietary phosphorus control is often a main strategy in the management of patients with chronic kidney disease. Dietary protein is a major source of phosphorus intake....
Dietary phosphorus control is often a main strategy in the management of patients with chronic kidney disease. Dietary protein is a major source of phosphorus intake. Recent data indicate that imposed dietary phosphorus restriction may compromise the need for adequate protein intake, leading to protein-energy wasting and possibly to increased mortality. The two main sources of dietary phosphorus are organic, including animal and vegetarian proteins, and inorganic, mostly food preservatives. Animal-based foods and plant are abundant in organic phosphorus. Usually 40% to 60% of animal-based phosphorus is absorbed; this varies by degree of gastrointestinal vitamin-D-receptor activation, whereas plant phosphorus, mostly associated with phytates, is less absorbable by human gastrointestinal tract. Up to 100% of inorganic phosphorus in processed foods may be absorbed; ie, phosphorus in processed cheese and some soda (cola) drinks. A recent study suggests that a higher dietary phosphorus-protein intake ratio is associated with incremental death risk in patients on long-term hemodialysis. Hence, for phosphorus management in chronic kidney disease, in addition to absolute dietary phosphorus content, the chemical structure (inorganic versus organic), type (animal versus plant), and phosphorus-protein ratio should be considered. We recommend foods and supplements with no or lowest quantity of inorganic phosphorus additives, more plant-based proteins, and a dietary phosphorus-protein ratio of less than 10 mg/g. Fresh (nonprocessed) egg white (phosphorus-protein ratio less than 2 mg/g) is a good example of desirable food, which contains a high proportion of essential amino acids with low amounts of fat, cholesterol, and phosphorus.
Topics: Food Preservatives; Humans; Phosphorus, Dietary; Plant Proteins, Dietary; Renal Insufficiency, Chronic
PubMed: 20404416
DOI: No ID Found -
Annals of the New York Academy of... Oct 2013Phosphorus intake in excess of the nutrient needs of healthy adults is thought to disrupt hormonal regulation of phosphorus (P), calcium (Ca), and vitamin D,... (Review)
Review
Phosphorus intake in excess of the nutrient needs of healthy adults is thought to disrupt hormonal regulation of phosphorus (P), calcium (Ca), and vitamin D, contributing to impaired peak bone mass, bone resorption, and greater risk of fracture. Elevation of extracellular phosphorus due to excessive intake is thought to be the main stimulus disrupting phosphorus homeostasis in healthy individuals, as it is in renal disease even when intake is modest. If high serum phosphorus is the critical link to the effect of high phosphorus intake on bone health, the issue could be addressed through epidemiologic or dietary studies. However, several confounding factors, including problems estimating accurate phosphorus intake, the influence of a low dietary Ca:P ratio, the acidic nature of phosphorus, the rapid rate of absorption and greater phosphorus bioavailability from processed food such as cola drinks, and circadian fluctuation in serum phosphorus, make this question difficult to address using conventional study designs. These confounding factors are considered in this review, exploring whether phosphorus intake exceeding nutrient needs in healthy individuals disrupts phosphorus regulation and negatively affects bone accretion or loss. Specific attention is given to phosphorus intake from processed foods rich in phosphorus additives, which significantly contribute to phosphorus intake.
Topics: Bone Density; Bone Diseases; Bone Resorption; Bone and Bones; Calcium; Fibroblast Growth Factor-23; Food Additives; Humans; Phosphates; Phosphorus, Dietary; Renal Insufficiency, Chronic
PubMed: 24472074
DOI: 10.1111/nyas.12300 -
Animal : An International Journal of... Dec 2023To reduce P excretion and increase the sustainability of poultry farms, one needs to understand the mechanisms surrounding P metabolism and its close link with Ca...
To reduce P excretion and increase the sustainability of poultry farms, one needs to understand the mechanisms surrounding P metabolism and its close link with Ca metabolism to precisely predict the fate of dietary P and Ca and related requirements for birds. This study describes and evaluates a model developed to estimate the fate of Ca and P consumed by broilers. The Ca and P model relies on three modules: (1) digestion of Ca and P; (2) dynamics of Ca and P in soft tissue and feathers; and (3) dynamics of body ash. Exogenous phytase affects the availability of Ca and P; thus, to predict the absorption of those minerals, the model also accounts for the effect of phytase on Ca and P digestibility. We used a database to estimate the consequences of dietary Ca, P, and phytase over feed intake response. This study followed a four-step process: (1) Ca and P model development and its coupling with a growth broiler model; (2) model behavior assessment; (3) sensitivity analysis to identify the most influential parameters; and (4) external evaluation based on three databases. The proportion of P in body protein and the Ca to P ratio in bone are the most sensitive parameters of P deposition in soft tissue and bone, representing 91 and 99% of the total variation. The external evaluation results indicated that body water and protein had an overall mean square prediction error (rMSPE) of 7.22 and 12.3%, respectively. The prediction of body ash, Ca, and P had an rMSPE of 7.74, 11.0, and 6.56%, respectively, mostly errors of disturbances (72.5, 51.6, and 90.7%, respectively). The rMSPE for P balance was 13.3, 18.4, and 22.8%, respectively, for P retention, excretion, and retention coefficient, with respective errors due to disturbances of 69.1, 99.9, and 51.3%. We demonstrated a mechanistic model approach to predict the dietary effects of Ca and P on broiler chicken responses with low error, including detailed simulations to show the confidence level expected from the model outputs. Overall, this model predicts broilers' response to dietary Ca and P. The model could aid calculations to minimize P excretion and reduce the impact of broiler production on the environment. A model inversion is ongoing that will enable the calculation of Ca and P dietary quantities for a specific objective. This will simplify the use of the model and the feed formulation process.
Topics: Animals; Calcium, Dietary; Phosphorus; Chickens; 6-Phytase; Minerals; Diet; Phosphorus, Dietary; Proteins; Animal Feed; Dietary Supplements; Animal Nutritional Physiological Phenomena
PubMed: 37500377
DOI: 10.1016/j.animal.2023.100896 -
International Journal of Molecular... Feb 2024The management of hyperparathyroidism (intact parathyroid hormone (iPTH) serum levels > 585 pg/mL), frequently focuses on the appropriate control of mineral and bone... (Observational Study)
Observational Study
The management of hyperparathyroidism (intact parathyroid hormone (iPTH) serum levels > 585 pg/mL), frequently focuses on the appropriate control of mineral and bone markers, with the decrease in serum and dietary phosphorus as two of the targets. We aimed to investigate the association between iPTH, serum phosphorus levels and dietary intake. This was a cross-sectional, multicenter, observational study with 561 patients on hemodialysis treatment. Clinical parameters, body composition and dietary intake were assessed. For the analysis, patients were divided into three groups: (a) iPTH < 130, (b) iPTH between 130 and 585 and (c) iPTH > 585 pg/mL. The association between PTH, serum phosphorus and dietary intake was analyzed using linear regression models. In the whole sample, 23.2% of patients presented an iPTH > 585 pg/mL. Patients with higher iPTH levels were those with longer HD vintage and lower ages, higher serum phosphorus, serum calcium, Ca/P product, albumin and caffeine intake, and a lower dietary intake of phosphorus, fiber, riboflavin and folate. Higher serum phosphorus predicted higher iPTH levels, even in the adjusted model. However, lower dietary phosphorus and fiber intake were predictors of higher iPTH levels, including in the adjusted model. Our results bring new data to the relationship between dietary intake and iPTH values. Despite higher serum phosphorus being observed in patients with HPTH, an opposite association was noted regarding dietary phosphate and fiber.
Topics: Humans; Phosphorus; Phosphorus, Dietary; Calcium; Cross-Sectional Studies; Parathyroid Hormone; Hyperparathyroidism; Renal Dialysis; Eating
PubMed: 38396685
DOI: 10.3390/ijms25042006 -
Journal of Dairy Science Nov 2021Our aim was to evaluate the effects of a low or high dietary phosphorus (P) concentration during the dry period, followed by either a high or low dietary P concentration...
Our aim was to evaluate the effects of a low or high dietary phosphorus (P) concentration during the dry period, followed by either a high or low dietary P concentration during the first 8 wk of lactation, on plasma Ca concentrations, feed intake, and lactational performance of dairy cattle. Sixty pregnant multiparous Holstein Friesian dairy cows were assigned to a randomized block design with repeated measurements and dietary treatments arranged in a 2 × 2 factorial fashion. The experimental diets contained 3.6 (Dry-HP) or 2.2 (Dry-LP) g of P/kg of dry matter (DM) during the dry period, and 3.8 (Lac-HP) or 2.9 (Lac-LP) g of P/kg of DM during 56 d after calving period. In dry cows, plasma Ca concentrations were 3.3% greater when cows were fed 2.2 instead of 3.6 g of P/kg of DM. The proportion of cows being hypocalcemic (plasma Ca concentrations <2 mM) in the first week after calving was lowest with the low-P diets both during the dry period and lactation. Plasma Ca concentrations in wk 1 to 8 after calving were affected by dietary P level in the dry period and in the lactation period, but no interaction between both was present. Feeding Dry-LP instead of Dry-HP diets resulted in 4.1% greater plasma Ca values, and feeding Lac-LP instead of Lac-HP diets resulted in 4.0% greater plasma Ca values. After calving, plasma inorganic phosphate (Pi) concentrations were affected by a 3-way interaction between sampling day after calving, and dietary P levels during the dry period and lactation. From d 1 to d 7 postpartum, cows fed Lac-HP had increased plasma Pi concentrations, and the rate appeared to be greater in cows fed Dry-LP versus Dry-HP. In contrast, plasma Pi concentrations decreased from d 1 to d 7 postpartum in cows fed Lac-LP, and this decrease was at a higher rate for cows fed Dry-HP versus Dry-LP. After d 7, plasma Pi concentrations remained rather constant at 1.5 to 1.6 mM when cows received Lac-HP, whereas with Lac-LP plasma Pi concentrations reached stable levels (i.e., 1.3-1.4 mM) at d 28 after calving. Milk production, DM intake, and milk concentrations of P, Ca, fat, protein, and lactose were not affected by any interaction nor the levels of dietary P. It is concluded that the feeding of diets containing 2.2 g of P/kg of DM during the last 6 wk of the dry period and 2.9 g of P/kg of DM during early lactation increased plasma Ca levels when compared with greater dietary P levels. These low-P diets may be instrumental in preventing hypocalcemia in periparturient cows and do not compromise DM intake and milk production. Current results suggest that P requirements in dairy cows during dry period and early lactation can be fine-tuned toward lower values than recommended by both the National Research Council and the Dutch Central Bureau for Livestock Feeding. Caution however is warranted to extrapolate current findings to entire lactations because long-term effects of feeding low-P diets containing 2.9 of g/kg of DM on production and health needs further investigation.
Topics: Animal Feed; Animals; Calcium; Cattle; Diet; Eating; Female; Lactation; Milk; Phosphorus, Dietary; Postpartum Period; Pregnancy
PubMed: 34454751
DOI: 10.3168/jds.2021-20488