The association of dietary phosphorus with blood pressure: results from a secondary analysis of the PREMIER trial

Abstract

Inconsistent findings exist for the association between dietary phosphorus intake and blood pressure (BP). We examined the longitudinal association between urinary excretion and dietary intake of phosphorus (total, plant, animal, and added) with BP. This is a secondary analysis of PREMIER, a randomized behavioral intervention study in adults (25–79 years) with BP, measured at 6 months, as the primary outcome. We classified total phosphorus intake from dietary recalls into plant, animal, and added phosphorus. We modeled 6-month change of phosphorus intake (from 24 h dietary recalls, N = 622) and excretion (from 24 h urine collection, N = 564) on BP, using linear regression crude and adjusted for intervention, age, race, sex, income, education, study site, and change in energy intake (kcal/day), sodium intake (mg/day), fitness (heart rate, bpm), and DASH diet index. Baseline phosphorus intake was 1154 mg/day (95% CI 1126, 1182) with 38%, 53%, and 10% from plant, animal, and added phosphorus, respectively. Total phosphorus intake was not associated with significant changes in BP. Increased urinary phosphorus excretion was associated with a significant increase in DBP [0.14 mmHg/100 mg (0.01, 0.28), adjusted]. In several analyses, phosphorus type (plant, animal, or added) significantly modified the association between phosphorus intake and BP. For example, added phosphorus (but not plant or animal) was associated with increases in SBP and DBP, 1.24 mmHg/100 mg (0.36, 2.12) and 0.83 mmHg/100 mg (0.22, 1.44), respectively, crude. These findings suggest that the type of phosphorus may modify the association between phosphorus intake and BP. Trial registration NCT00000616 (clinicaltrials.gov).

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References

  1. 1.

    Alonso A, Nettleton JA, Ix JH, De Boer IH, Folsom AR, Bidulescu A, et al. Dietary phosphorus, blood pressure, and incidence of hypertension in the atherosclerosis risk in communities study and the multi-ethnic study of atherosclerosis. Hypertension. 2010;55:776–84. https://doi.org/10.1161/HYPERTENSIONAHA.109.143461

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  2. 2.

    Elliott P, Kesteloot H, Appel LJ, Dyer AR, Ueshima H, Chan Q, et al. Dietary phosphorus and blood pressure: International study of macro- and micro-nutrients and blood pressure. Hypertension. 2008;51:669–75. https://doi.org/10.1161/HYPERTENSIONAHA.107.103747

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  3. 3.

    Olivo RE, Hale SL, Diamantidis CJ, Bhavsar NA, Tyson CC, Tucker KL, et al. Dietary phosphorus and ambulatory blood pressure in African Americans: The Jackson Heart Study. Am J Hypertens. 2018. https://doi.org/10.1093/ajh/hpy126

  4. 4.

    McClure ST, Rebholz CM, Medabalimi S, Hu EA, Xu Z, Selvin E, et al. Dietary phosphorus intake and blood pressure in adults: a systematic review of randomized trials and prospective observational studies. Am J Clin Nutr. 2019;109:1264–72.

    Article  Google Scholar 

  5. 5.

    Palomino HL, Rifkin DE, Anderson C, Criqui MH, Whooley MA, Ix JH. 24-hour urine phosphorus excretion and mortality and cardiovascular events. Clin J Am Soc Nephrol. 2013;8:1202–10. https://doi.org/10.2215/CJN.11181012

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  6. 6.

    Mohammad J, Scanni R, Bestmann L, Hulter HN, Krapf R. A controlled increase in dietary phosphate elevates BP in healthy human subjects. J Am Soc Nephrol. 2018;29:2089. https://doi.org/10.1681/ASN.2017121254

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  7. 7.

    Yamamoto KT, Robinson-Cohen C, de Oliveira MC, Kostina A, Nettleton Ja, Ix JH, et al. Dietary phosphorus is associated with greater left ventricular mass. Kidney Int. 2013;83:707–14. https://doi.org/10.1038/ki.2012.303

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  8. 8.

    Nishi T, Shuto E, Ogawa M, Ohya M, Nakanishi M, Masuda M, et al. Excessive dietary phosphorus intake impairs endothelial function in young healthy men: a time- and dose-dependent study. J Med Investig. 2015;62:167–72. https://doi.org/10.2152/jmi.62.167

    Article  Google Scholar 

  9. 9.

    Shuto E, Taketani Y, Tanaka R, Harada N, Isshiki M, Sato M, et al. Dietary phosphorus acutely impairs endothelial function. J Am Soc Nephrol. 2009;20:1504–12. https://doi.org/10.1681/ASN.2008101106

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  10. 10.

    Itkonen ST, Karp HJ, Kemi VE, Kokkonen EM, Saarnio EM, Pekkinen MH, et al. Associations among total and food additive phosphorus intake and carotid intima-media thickness–a cross-sectional study in a middle-aged population in Southern Finland. Nutr J. 2013;12:94. https://doi.org/10.1186/1475-2891-12-94. PG-94

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  11. 11.

    Chang AR, Lazo M, Appel LJ, Gutiérrez OM, Grams ME, Chang AR, et al. High dietary phosphorus intake is associated with all-cause mortality: results from NHANES III. Am J Clin Nutr. 2014;99:320–7. https://doi.org/10.3945/ajcn.113.073148

    CAS  Article  PubMed  Google Scholar 

  12. 12.

    Gutiérrez OM, Luzuriaga-mcpherson A, Lin Y, Gilbert LC, Ha S, Beck GR. Impact of phosphorus-based food additives on bone and mineral metabolism. J Clin Endocrinol Metab. 2015;100:4264–71. https://doi.org/10.1210/jc.2015-2279

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  13. 13.

    Karp H, Ekholm P, Kemi V, Hirvonen T, Lamberg-Allardt C. Differences among total and in vitro digestible phosphorus content of meat and milk products. J Ren Nutr. 2012;22:344–9. https://doi.org/10.1053/j.jrn.2011.07.004

    CAS  Article  PubMed  Google Scholar 

  14. 14.

    Ravindran V, Ravindran G, Sivalogan S. Total and phytate phosphorus contents of various foods and feedstuffs of plant origin. Food Chem. 1994;50:133–6. https://doi.org/10.1016/0308-8146(94)90109-0

    CAS  Article  Google Scholar 

  15. 15.

    Lee JW, Underwood EJ. The total phosphorus, phytate phosphorus and inorganic phosphorus of bread and the destruction of phytic acid in bread making. Aust J Exp Biol Med Sci. 1949;27:99–104. https://doi.org/10.1038/icb.1948.42

    CAS  Article  PubMed  Google Scholar 

  16. 16.

    Karp H, Ekholm P, Kemi V, Itkonen S, Hirvonen T, Närkki S, et al. Differences among total and in vitro digestible phosphorus content of plant foods and beverages. J Ren Nutr. 2012;22:416–22. https://doi.org/10.1053/j.jrn.2011.04.004

    CAS  Article  PubMed  Google Scholar 

  17. 17.

    Lampila LE. Applications and functions of food-grade phosphates. Ann N Y Acad Sci. 2013;1301:37–44. https://doi.org/10.1111/nyas.12230

    CAS  Article  PubMed  Google Scholar 

  18. 18.

    Svetkey LP, Harsha DW, Vollmer WM, Stevens VJ, Obarzanek E, Elmer PJ, et al. Premier: a clinical trial of comprehensive lifestyle modification for blood pressure control: rationale, design and baseline characteristics. Ann Epidemiol. 2003;13:462–71. https://doi.org/10.1016/S1047-2797(03)00006-1

    Article  PubMed  Google Scholar 

  19. 19.

    Appel LJ, Champagne CM, Harsha DW, Cooper LS, Obarzanek E, Elmer PJ, et al. Effects of comprehensive lifestyle modification on blood pressure control: main results of the PREMIER clinical trial. J Am Med Assoc. 2003;289:2083–93. https://doi.org/10.1001/jama.289.16.2083

    Article  Google Scholar 

  20. 20.

    US Department of Agriculture, Agricultural Research Service NDL. USDA Branded Food Products Database. http://www.ars.usda.gov/nutrientdata

  21. 21.

    Lin P-H, Wang Y, Grambow SC, Goggins W, Almirall D. Dietary saturated fat intake is negatively associated with weight maintenance among the PREMIER participants. Obesity. 2012;20:571–5. https://doi.org/10.1038/oby.2011.17

    CAS  Article  PubMed  Google Scholar 

  22. 22.

    Willett WC, Howe GR, Kushi LH. Adjustment for total energy intake in epidemiologic studies. Am J Clin Nutr. 1997;65:1220S–8S. https://doi.org/10.1093/ajcn/65.4.1220S

  23. 23.

    Fung TT, Chiuve SE, McCullough ML, Rexrode KM, Logroscino G, Hu FB. Adherence to a DASH-style diet and risk of coronary heart disease and stroke in women. Arch Intern Med. 2008;168:713–20. https://doi.org/10.1001/archinte.168.7.713

    Article  PubMed  Google Scholar 

  24. 24.

    McClure ST, Rebholz CM, Phillips KM, Champagne CM, Selvin E, Appel LJ. The percentage of dietary phosphorus excreted in the urine varies by dietary pattern in a randomized feeding study in adults. J Nutr. 2019;149:816–23.

    Article  Google Scholar 

  25. 25.

    Morimoto Y, Sakuma M, Ohta H, Suzuki A, Matsushita A, Umeda M, et al. Estimate of dietary phosphorus intake using 24-h urine collection. J Clin Biochem Nutr. 2014;55:62–66. https://doi.org/10.3164/jcbn.14-15

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  26. 26.

    Sakuma M, Morimoto Y, Suzuki Y, Suzuki A, Noda S, Nishino K, et al. Availability of 24-h urine collection method on dietary phosphorus intake estimation. J Clin Biochem Nutr. 2017;60:125–9. https://doi.org/10.3164/jcbn.16-50

    CAS  Article  PubMed  Google Scholar 

  27. 27.

    Shinozaki N, Murakami K, Asakura K, Uechi K, Kobayashi S, Masayasu S, et al. Dietary phosphorus intake estimated by 4-day dietary records and two 24-hour urine collections and their associated factors in Japanese adults. Eur J Clin Nutr. 2018;72:517–25. https://doi.org/10.1038/s41430-018-0114-1

    CAS  Article  PubMed  Google Scholar 

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Acknowledgements

STM was supported by the NIH/National Heart, Lung, and Blood Institute grant T32 HL007024. CMR was supported by a Mentored Research Scientist Development Award from the National Institute of Diabetes and Digestive and Kidney Diseases (K01 DK107782). ES was supported by NIH/NIDDK grants K24DK106414 and R01DK089174.

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McClure, S.T., Rebholz, C.M., Mitchell, D.C. et al. The association of dietary phosphorus with blood pressure: results from a secondary analysis of the PREMIER trial. J Hum Hypertens 34, 132–142 (2020). https://doi.org/10.1038/s41371-019-0231-x

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