Dietary Phosphorus Health, Nutrition, and Regulatory Aspects

Phosphorus is an essential nutrient that occurs in almost all foods and is important for many normal physiological functions. In a typical Western diet, it is not harmful, but does adversely affect tissues in the body when consumed in excess or deficiency. This book provides a comprehensive review of various aspects of phosphorus in relation to human nutritional needs. Sections cover phosphorus nutrition and dietary issues; health risks associated with excess phosphorus intake that exceeds requirements; phosphorus intake in populations at risk; regulatory challenges and policy approaches; and environmental impacts of phosphates in the modern food supply. This book challenges the long held ideas that high dietary phosphorus intake beyond nutritional requirements is safe and the natural supply of phosphorus critical to agricultural and human food production is endless. Controversy surrounds the claim that largely unrestricted use of phosphorus in all aspects of food production from farm to fork increases dietary phosphorus intake and irretrievable environmental loss, both of which harm human and environmental health. The book editors have joined together experts in basic, medical, environmental, nutritional, and food science to explore the validity of these claims of harm from high intakes and the unchecked use of phosphorus in the global food supply. Despite the essential need for adequate phosphorus over all stages of plant, animal and human life, the growing evidence points to a worldwide increase in dietary phosphorus intake far beyond nutrient requirements, significant association with chronic disease risk even when renal function is not compromised, and the increase in environmental loss with crop run-off, animal husbandry, and unretrieved phosphorus from human waste. This current evidence alludes to a depleted, unsustainable natural supply of phosphorus, hazardous environmental pollution of lakes and waterways, and significant increases in the risk of kidney, skeletal, and other serious illnesses in humans in the future if action is not taken now.

Preface Editor Bios Contributors Section I Health Issues Associated with Dietary Phosphorus Intake Chapter 1 Overview of Chronic Health Risks Associated with Phosphorus Excess Swati Mehta and Jaime Uribarri Chapter 2 Preclinical Evidence of the Nonskeletal Adverse Health Effects of High Dietary Phosphorus George R. Beck, Jr. Chapter 3 Clinical and Preclinical Evidence of the Skeletal and Vascular Adverse Health Effects of High Dietary Phosphorus Jorge B. Cannata-Andía, Pablo Román-García, Natalia Carrillo-López, and Adriana S. Dusso Chapter 4 Associations between Phosphorus Intake and Mortality Andrea Galassi, Denis Fouque, and Mario Cozzolino Chapter 5 Phosphorus Intake and Whole-Body Phosphorus Homeostasis Jaime Uribarri and Man S. Oh Chapter 6 Endocrine Regulation of Phosphate Homeostasis Marta Christov and Harald Jüppner Chapter 7 Dietary Phosphorus Intake and Kidney Function Lili Chan and Jaime Uribarri Chapter 8 Dietary Phosphorus Intake and Cardiotoxicity Sven-Jean Tan and Nigel D. Toussaint Chapter 9 The Relationship between Phosphorus Intake and Blood Pressure Melissa M. Melough and Alex R. Chang Chapter 10 Phosphorus Intake Contribution to Dietary Acid·Base Balance and Bone Health Tanis R. Fenton and David A. Hanley Chapter 11 Dietary Phosphorus Regulation of Vitamin D Metabolism in the Kidneys Adriana S. Dusso, M. Vittoria Arcidiacono, Natalia Carrillo-López, and Jorge B. Cannata-Andía Section II Dietary Phosphorus Intake and Nutritional Needs Chapter 12 Phosphorus: An Essential Nutrient for Bone Health Throughout Life Jean-Philippe Bonjour Chapter 13 Dietary Phosphate Needs in Early Life and Adolescence Alicia M. Diaz-Thomas, Russell W. Chesney, and Craig B. Langman Chapter 14 Overview of Phosphorus-Wasting Diseases and Need for Phosphorus Supplements Carolyn M. Macica Chapter 15 Phosphate and Calcium Stone Formation Hans-Göran Tiselius Chapter 16 Impact of Socioeconomic Factors on Phosphorus Balance Orlando M. Gutiérrez Chapter 17 Bioavailability of Phosphorus Suvi T. Itkonen, Heini J. Karp, and Christel J. E. Lamberg-Allardt Chapter 18 Special Nutritional Needs of Chronic Kidney and End-Stage Renal Disease Patients: Rationale for the Use of Plant-Based Diets Ranjani N. Moorthi and Sharon M. Moe Section III Food and Environmental Use and Regulation of Phosphorus Chapter 19 The Regulatory Aspects of Phosphorus Intake: Dietary Guidelines and Labeling Mona S. Calvo and Susan J. Whiting Chapter 20 Dietary Guidelines for Safe Levels of Phosphorus Intake in North America and Europe Susan J. Whiting and Mona S. Calvo Chapter 21 Phosphorus Food Additive Use in the European Union Ray J. Winger Chapter 22 A European Perspective: Questionable Safety of Current Phosphorus Intakes in the General Healthy and Chronic Kidney Disease Populations Kai M. Hahn, Markus Ketteler, and Eberhard Ritz Chapter 23 Save the P(ee)! The Challenges of Phosphorus Sustainability and Emerging Solutions James J. Elser, Neng Ion Chan, Jessica R. Corman, and Jared Stolzfus Chapter 24 The Effects of Changing Global Food Choices on Human Health and a Sustainable Supply of Phosphorus Charles J. Ferro Index

Jaime Uribarri, MD Dr. Jaime Uribarri is a physician and clinical investigator. He was born in Chile and received his medical degree from the University of Chile School of Medicine. He did all his postgraduate training in the United States. He has been in The Icahn School of Medicine at Mount Sinai, New York, since 1990, where he is currently Professor of Medicine and Director of the Renal Clinic and the Home Dialysis Program at the Mount Sinai Hospital. In parallel with his clinical activities, Dr Uribarri has been very active in clinical investigation for the past 30 years. His main areas of research have been on acid–base and fluid and electrolyte disorders, as well as nutrition in chronic kidney disease and diabetic patients. He was one of the first to bring attention to the important role of food-derived advanced glycation end products (AGEs) in chronic diseases in humans. He has published over 150 peer-reviewed papers and written many chapters in books. He has lectured extensively on these research topics in New York City, as well as in national and international meetings. He serves as an ad hoc referee for numerous nutrition, medical, and other scientific journals, and he is an active member of several health organizations and professional associations, including The American Society of Nephrology, The American Society of Nutrition, The International Society of Nephrology, The New York Academy of Sciences, and The Maillard Society. Mona S. Calvo, PhD After earning a doctorate in Nutritional Sciences from the University of Illinois, Champaign-Urbana, Dr. Calvo pursued postdoctoral studies in the Endocrine Research Unit of the Mayo Clinic in Rochester, Minnesota. Recently retired from the Food and Drug Administration (FDA) after 28 years, her former position and title was that of Expert Regulatory Review Scientist and Research Principal Investigator at the FDA’s Center for Food Safety and Applied Nutrition. Her current and past research interests focus on dietary influences on the hormonal regulation of calcium, phosphorus, and vitamin D and their impact on bone and kidney disease and other chronic diseases of public health significance. These research interests have been the topics for over 150-peer-reviewed manuscripts, book chapters, government reports/guidelines, FDA regulations, and abstracts presented at national and international meetings. She serves as an Associate Editor for Public Health Nutrition; an ad hoc referee for numerous nutrition, medical, and other scientific journals; and is a member of the Endocrine Society, American Society for Nutrition, the Nutrition Society (UK), and the American Society for Bone and Mineral Research and serves as a member of the advisory board for ODIN, which seeks food-based solutions for optimal vitamin D nutrition and health through the life cycle.