This review explores the potential adverse impact of the increasing
phosphorus content in the American diet on renal, cardiovascular, and bone health of the general population. Increasingly, studies show that
phosphorus intakes in excess of the nutrient needs of a healthy population may significantly disrupt the hormonal regulation of
phosphate,
calcium, and
vitamin D, which contributes to disordered
mineral metabolism,
vascular calcification, impaired kidney function, and bone loss. Moreover, large epidemiologic studies suggest that mild elevations of serum
phosphate within the normal range are associated with
cardiovascular disease (CVD) risk in healthy populations without evidence of
kidney disease. However, few studies linked high
dietary phosphorus intake to mild changes in serum
phosphate because of the nature of the study design and inaccuracies in the nutrient composition databases. Although
phosphorus is an essential nutrient, in excess it could be linked to tissue damage by a variety of mechanisms involved in the endocrine regulation of extracellular
phosphate, specifically the secretion and action of
fibroblast growth factor 23 and
parathyroid hormone. Disordered regulation of these
hormones by high
dietary phosphorus may be key factors contributing to
renal failure, CVD, and
osteoporosis. Although systematically underestimated in national surveys,
phosphorus intake seemingly continues to increase as a result of the growing consumption of highly processed foods, especially restaurant meals, fast foods, and convenience foods. The increased cumulative use of ingredients containing
phosphorus in food processing merits further study given what is now being shown about the potential toxicity of
phosphorus intake when it exceeds nutrient needs.