Phosphorus Additives and Their Impact on Phosphorus Content in Foods-An Analysis of the USDAs Branded Foods Product Database

Phosphate-based additives in processed foods: is excess exposure a cause for concern? A cross-sectional examination of the United States packaged food supply

BACKGROUND

Limiting dietary phosphate intake to slow the progression of chronic kidney disease (CKD) to dialysis and death requires knowledge of the total quantity and forms of phosphate in food, information not currently required on United States food labels. Phosphate additives (P-additives) have more rapid/efficient absorption than naturally occurring dietary phosphate and are not accounted for in nutrient databases despite their greater contribution to total phosphorus intake.

OBJECTIVES

This study aims to examine the presence of P-additives in United States foods and beverages sold by the top 25 United States manufacturers in 2020.

METHODS

Cross-sectional ingredient data for all products from the top 25 manufacturers were sourced from Label Insight (a NielsenIQ company) in May 2021. The presence of inorganic or organic P-additives in each product was determined by reviewing ingredient lists. The number and proportion of products containing P-additives overall and for each phosphate class (inorganic or organic) and individual P-additives were calculated, as well as the revenue derived for each component examined. Sales-weighted proportions were also examined.

RESULTS

P-additives were present in 56% of 39,937 products from the top 25 United States food and beverage manufacturers representing >$120 billion in consumer purchases in 2020. Top P-additives in products included lecithin (32%), sodium phosphate (13%), calcium phosphate (11%), modified starches (10%), and sodium acid pyrophosphate (6%), whereas P-additive numbers per product ranged from 0 to 8 with 21% of foods containing >1 P-additive.

CONCLUSIONS

This study illustrates widespread exposure to P-additives in all packaged food and beverage categories in the United States, with sales-weighted data showing a high volume of purchases even in categories containing a lower percentage of products with P-additives. Research exploring the safety of excessive P-additive exposure in CKD and healthy populations requires the Food and Drug Administration to make labeling of the total phosphorus content on nutrition facts labels mandatory.

Potassium Food Additives and Dietary Management of Serum Potassium: Proposed Best-Practice Recommendations

The contribution of potassium food additives to total dietary potassium intake is unknown. This poses challenges for individuals living with kidney disease who may need to monitor their potassium intake. Additionally, different countries have varying regulations regarding the reporting of dietary potassium content in foods. This article examines the potential of published food databases to assist clinicians in helping individuals with kidney disease manage their serum potassium levels. It uses the United States Department of Agriculture's Branded Food Products Database as an example. Evidence for potassium additive content in database entries, along with their bioavailability, is discussed, and best-practice recommendations are made based on current evidence. Clinical practice and future research priorities are suggested.

Mediterranean Diet for Cardiovascular Risk Reduction in Chronic Kidney Disease

The Mediterranean diet is a plant-based healthy diet similar to the vegetarian and the Dietary Approaches to Stop Hypertension diets. Unlike vegetarian and Dietary Approaches to Stop Hypertension diets, the Mediterranean diet encourages a lifestyle associated with physical activity, and social connections. In addition, the Mediterranean diet is not based on restriction of nutrients but does limit intake of processed foods. Prospective studies have confirmed that the Mediterranean diet confers primary and secondary cardiovascular disease prevention in the general population. The benefits of the Mediterranean diet lifestyle include reducing the risk of diabetes mellitus, dyslipidemia, and lowers blood pressure. In adults with CKD, adherence to the Mediterranean diet is associated with a lower risk of CKD progression and its complications such as hyperphosphatemia and metabolic acidosis, and reduces production of uremic toxins and inflammatory mediators when compared to omnivore dietary patterns. Nevertheless, prospective studies are needed to confirm the cardiovascular disease prevention with the Mediterranean diet in adults with CKD. Medical nutrition therapy remains a cornerstone of CKD management, and the Mediterranean diet could be utilized to slow CKD progression and complications.

Industrial Use of Phosphate Food Additives: A Mechanism Linking Ultra-Processed Food Intake to Cardiorenal Disease Risk?

The consumption of ultra-processed food (UPF) keeps rising, and at the same time, an increasing number of epidemiological studies are linking high rates of consumption of UPF with serious health outcomes, such as cardiovascular disease, in the general population. Many potential mechanisms, either in isolation or in combination, can explain the negative effects of UPF. In this review, we have addressed the potential role of inorganic phosphate additives, commonly added to a wide variety of foods, as factors contributing to the negative effects of UPF on cardiorenal disease. Inorganic phosphates are rapidly and efficiently absorbed, and elevated serum phosphate can lead to negative cardiorenal effects, either directly through tissue/vessel calcification or indirectly through the release of mineral-regulating hormones, parathyroid hormone, and fibroblast growth factor-23. An association between serum phosphate and cardiovascular and bone disease among patients with chronic kidney disease is well-accepted by nephrologists. Epidemiological studies have demonstrated an association between serum phosphate and dietary phosphate intake and mortality, even in the general American population. The magnitude of the role of inorganic phosphate additives in these associations remains to be determined, and the initial step should be to determine precise estimates of population exposure to inorganic phosphate additives in the food supply.