Kidney Week

Abstract: TH-PO932

Inorganic Phosphate Additives in US Household 2022 Product Sales from the Top 25 Grocery Store Food Manufacturers: An Existential, Pervasive Risk Factor for CKD

Session Information

• Health Maintenance, Nutrition, Metabolism - I
  November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Health Maintenance, Nutrition, and Metabolism

• 1500 Health Maintenance, Nutrition, and Metabolism

Authors

• Calvo, Mona S., Icahn School of Medicine at Mount Sinai, New York, New York, United States

Mona S. Calvo,

• Dunford, Elizabeth K., The George Institute for Global Health, Newtown, New South Wales, Australia

Elizabeth K. Dunford,

• Uribarri, Jaime, Icahn School of Medicine at Mount Sinai, New York, New York, United States

Jaime Uribarri,

Background

Restricting dietary phosphorus (P) intake is critical to managing CKD and is an important therapeutic personal action CKD patients can take to slow the progression of kidney failure, hyperphosphatemia and cardiovascular disease. Limiting dietary P intake is not a simple task of consuming less natural food sources rich in P (red meats, dairy) since the use of inorganic phosphate (PO₄) additives to process a variety of foods can contribute significant P hidden in processed food. Additives present a unique problem different from natural organic protein and lipid bound P in foods. PO₄ additive salts are rapidly dissociated in stomach acidity, absorbed quickly and can acutely disrupt serum P homeostasis and hormonal dysregulation linked to cardiovascular disease and mortality. Control of P intake is further complicated by the unknown extent of exposure to these PO₄ additives from packaged food and beverage products.

Methods

To estimate exposure to PO₄ additives, we examined ingredient labels of US household packaged products from the top 25 food and beverage manufacturers to identify the total number of food products containing PO₄ additives across USDA’s 23 food categories. USDA identifies 6 food categories contributing the majority of total P intake (81%); however, this is thought to be mostly natural P as additive contribution is rarely included.

Results

Using category-level sales data as a proxy for actual intake of foods with PO₄ additives, we show the % of foods that contained PO₄ additives in the 6 categories (Figure). More than 50% of bread, processed meats and ready meals contained PO₄ additives. USDA survey intakes of total P are thought to significantly underestimate total P when PO₄additive use is not included.

Conclusion

Our findings support this claim of underestimated total P intake, showing evidence of the wide spread use of PO₄additives in the foods contributing the most P to daily intake.