Effects of Sex and Postmenopausal Estrogen Use on Serum Phosphorus Levels: A Cross-sectional Study of the National Health and Nutrition Examination Survey (NHANES) 2003-2006

Effects of Age, Sex, and Estrogen on Serum Phosphorus: Role for Growth Hormone and Klotho?

New Findings from the Feeding Infants and Toddlers Study: Data to Inform Action

Association of Serum Phosphorus Concentration With Cardiovascular Risk

Association between folate and non-alcoholic fatty liver disease among US adults: a nationwide cross-sectional analysis.

Serum Phosphorus Concentrations in the Third National Health and Nutrition Examination Survey (NHANES III)

The mean dietary protein intake at different stages of chronic kidney disease is higher than current guidelines

Background and Aims Hyperparathyroidism (HPTH), classified when intact parathyroid hormone (iPTH) serum levels are above 585 pg/mL, is a common complication in patients undergoing maintenance hemodialysis (HD). Despite there is little evidence about the relationship between iPTH levels and nutritional status, the intervention frequently focusses on appropriate management of mineral and bone markers, being the decrease of serum and dietary phosphorus some of the targets. The aim of this study was to investigate the association between iPTH, serum phosphorus levels and dietary intake. Method This was a cross-sectional, multicenter, observational study with 561 patients on HD treatment from 37 dialysis centers across Portugal. Clinical parameters, body composition and dietary intake (obtained from a Food Frequency Questionnaire) were assessed. For the analysis, patients were divided in 3 groups depending on their iPTH levels: a) iPTH<130, b) iPTH between 130-585 and c) iPTH >585 pg/mL. The association between PTH, serum phosphorus and dietary intake was analyzed with linear regression models. A p-value lower than 0.05 was considered statistically significant. Results Patients’ mean age was 68 ± 14 years, median HD vintage was 65 (IQR: 43-106) months and 58.8% were men. From the whole sample, 13.9% presented a iPTH <130 pg/mL, 59.3% between 130-585 pg/mL and 23.2% >585 pg/mL. Patients with higher iPTH levels were those with longer HD vintage (p = 0.021) and lower age (p = 0.002). At the same time, showed higher serum phosphorus (p = 0.005), serum calcium (p = 0.027), Ca/P product (p < 0.001), albumin (p = 0.016) and caffeine intake (p = 0.009). In addition, a lower dietary intake of phosphorus (p = 0.044), fiber (p = 0.047), riboflavin (p = 0.031) and folate (p = 0.011) were observed in patients with higher iPTH levels. In the linear regression models, higher serum phosphorus predicted higher iPTH levels, even in the adjusted model (p = 0.019). However, a lower phosphorus intake was a predictor of higher iPTH levels, also in the model adjusted to age, gender, serum phosphorus, dialysis adequacy (Kt/V) and dialysis vintage (p = 0.035). The same result was observed when considering the dietary fiber intake in the model (p = 0.048). No significant differences in body composition parameters were found. Conclusion Our results bring new data on the relationship between dietary intake and iPTH values. Despite higher serum phosphorus was observed in patients with HPTH, an opposite association was noted regarding dietary phosphate and fiber as lower intakes predicted higher iPTH values. Moreover, a poorer dietary intake, considering riboflavin and folate was observed in the HPTH group.

BMI modifies the association between dietary intake and serum levels of PCBs.

BackgroundHyperphosphatemia, serum phosphorus ≥ 4.4 mg/dL, is associated with increased risk for chronic kidney disease and cardiovascular disease. Previous studies have shown a weak association between dietary phosphorus intake and serum phosphorus concentrations. While much less common in the general population, hypophosphatemia (< 2.5 mg/dL) may be associated with metabolic syndrome and obesity.MethodsUsing three cycles from the National Health and Nutrition Examination Survey (NHANES) (2005–2010), this study evaluated independent risk factors for hyperphosphatemia and hypophosphatemia.ResultsRisk factors for hyperphosphatemia included higher adjusted calcium (OR 2.90, 95% CI 2.43-3.45), increasing cholesterol (OR 1.003, 95% CI 1.001-1.005), female gender (OR 1.61, 95% CI 1.39-1.87) and low hemoglobin (OR 1.52, 95% CI 1.17-1.98). Advanced age was protective (OR 0.98, 95% CI 0.977-0.987). Models that included fasting serum glucose found lower body mass index (BMI) to be protective (OR 0.97, 95% CI 0.96-0.99) and adjusting for serum vitamin D and parathyroid hormone removed the association with low hemoglobin and BMI. Risk factors for hypophosphatemia included the following protective factors: higher albumin (OR 0.56, 95% CI 0.35-0.93), higher BUN (OR 0.90, 95% CI 0.86, 0.95), corrected calcium (OR 0.38, 95% CI 0.23-0.63) and female gender (OR 0.47, 95% 0.24-0.94). In men, higher fasting glucose levels increased risk (OR 1.01, 95% CI 1.0004-1.01).ConclusionThis study is the first to show an association between low hemoglobin levels and increased risk for hyperphosphatemia among individuals without chronic kidney disease. We did not find any association between diabetes mellitus, increasing BMI or fasting glucose levels and hypophosphatemia.

The management of hyperparathyroidism (intact parathyroid hormone (iPTH) serum levels > 585 pg/mL), frequently focuses on the appropriate control of mineral and bone markers, with the decrease in serum and dietary phosphorus as two of the targets. We aimed to investigate the association between iPTH, serum phosphorus levels and dietary intake. This was a cross-sectional, multicenter, observational study with 561 patients on hemodialysis treatment. Clinical parameters, body composition and dietary intake were assessed. For the analysis, patients were divided into three groups: (a) iPTH < 130, (b) iPTH between 130 and 585 and (c) iPTH > 585 pg/mL. The association between PTH, serum phosphorus and dietary intake was analyzed using linear regression models. In the whole sample, 23.2% of patients presented an iPTH > 585 pg/mL. Patients with higher iPTH levels were those with longer HD vintage and lower ages, higher serum phosphorus, serum calcium, Ca/P product, albumin and caffeine intake, and a lower dietary intake of phosphorus, fiber, riboflavin and folate. Higher serum phosphorus predicted higher iPTH levels, even in the adjusted model. However, lower dietary phosphorus and fiber intake were predictors of higher iPTH levels, including in the adjusted model. Our results bring new data to the relationship between dietary intake and iPTH values. Despite higher serum phosphorus being observed in patients with HPTH, an opposite association was noted regarding dietary phosphate and fiber.

ObjectiveUnsaturated fatty acids (UFA) may be related to glycometabolism. While associations between UFA intake (especially their subtype) and prediabetes or type 2 diabetes mellitus (T2DM) need to be further studied. In this study, we aimed to evaluate the potential relation of UFA with prediabetes and T2DM.MethodsA total of 16,290 adults aged older than 18 years from the National Health and Nutrition Examination Survey (NHANES) from 2005 to March 2020 were included in the present analysis. Dietary intake was assessed by two day, 24-hour dietary recalls and daily intake of total monounsaturated fatty acids (MUFA) and polyunsaturated fatty acids (PUFA); four specific fatty acids of MUFA and seven specific fatty acids of PUFA were calculated. Prediabetes and T2DM were diagnosed by fasting glucose, glycohemoglobin, and self-reported medication or insulin. Rao–Scott modified chi-square tests, the Taylor series linearization method, and multivariable logistic regression analyses were applied to analyze the associations of dietary MUFA and PUFA intake with diabetes risk.ResultsOf the participants, 44.34% had prediabetes and 13.16% had T2DM patients. From multivariate analysis, we found that intake of MUFA, PUFA, and some subtypes was negatively associated with the risk of prediabetes and T2DM in Americans. Compared with adults in the lowest tertile, those in the highest MUFA (PUFA) tertile had an approximately 50% (49%) and 69% (68%) lower risk of prediabetes and T2DM, respectively. Moreover, the effects of the subtypes of MUFA and PUFA on prediabetes and T2DM were different. Higher intakes of MFA 18:1, MFA 20:1, PFA 18:2, and PFA 18:3 and higher tertile intakes of MFA 16:1 and PFA 20:4 were related to a lower risk of prediabetes and T2DM. Similarly, the effects of MUFA, PUFA, and subtype on prediabetes and T2DM varied among different age groups, being weakened along with age.ConclusionOur study suggested that total MUFA and PUFA intake might be essential in preventing prediabetes and T2DM, especially in Americans. However, this protective effect may decrease with age. Moreover, the effects of the specific UFA on prediabetes and T2DM need further consideration.

Calibration of Cystatin C in the National Health and Nutrition Examination Surveys (NHANES)

An excessively high percentage of body fat can increase the risk of developing heart disease, diabetes, and other chronic diseases. This study examined two research questions: (1) What is the effect of serum phosphorus on the percentage of body fat? and (2) Does serum phosphorus have a different effect on the percentage of body fat in different parts of the body? This study investigated these questions using data from the National Health and Nutrition Examination Survey (NHANES). Nutritional and biochemical data were collected from the NHANES database from 2011 to 2018 on 15,653 participants, including 8,014 men and 7,639 women. Dual-energy X-ray absorptiometry (DXA) was used to assess the percentage of body fat of the study participants at the following body sites: the head, left arm, right arm, left leg, right leg, and trunk. Multivariate logistic regression was used to assess the odds ratios for excess fat percentages at several body sites in relation to serum phosphorus levels. The analyses found that high levels of serum phosphorus were associated with a smaller percentage of excess body fat in some areas of the body. Specifically, serum phosphorus levels exhibited a curvilinear association with increased body fat in the trunk, left arm, and right arm of females. As serum phosphorus levels increased in males, their percentage of body fat decreased in the trunk, left leg, right arm, and right leg.

Serum Phosphorus and Mortality in the Third National Health and Nutrition Examination Survey (NHANES III): Effect Modification by Fasting

Background: Recent guidelines have removed specific limitations of dietary cholesterol, which has raised considerable debate regarding the significance of cholesterol in the context of cerebrovascular disease (CBD). Furthermore, the relationship between the quantity and meal timing of dietary cholesterol intake and CBD mortality remains unclear. This study aims to explore the relationships between the quantity and meal timing of dietary cholesterol intake and CBD mortality among older adults using the U.S. National Health and Nutrition Examination Survey (NHANES) (2003-2018). Methods: In this prospective study of 7906 older adults aged over 50 years in the National Health and Nutrition Examination Survey (2003-2018), dietary intake was divided into quintiles, and meal timing was evaluated using two days of 24-hour dietary recall. Serum cholesterol levels were measured. The relationship between the quantity and meal timing of dietary cholesterol and mortality was examined with survey-weighted Cox regression models. Results: During a follow-up of 15 years, 107 participants died of CBD. Compared with participants with the lowest quintile of total cholesterol intake (CHO-T) and cholesterol at breakfast (CHO-B), no significant association between CHO-T and CHO-B and mortality (HRCHO-T 0.48; 95%CI 0.18-1.23 and HRCHO-B 0.98; 95%CI 0.37-2.47) was observed. For the difference of cholesterol at dinner (CHO-D) minus CHO-B (ΔCHO), which was related to lower CBD mortality (HR 0.45; 95%CI 0.21-0.97), 29-142 mg of ΔCHO was associated with lower CBD mortality in a non-linear manner and 29-112 mg of ΔCHO was associated with lower TC and LDL-C levels. Conclusions: Moderate consumption of dietary cholesterol at dinner rather than breakfast was associated with a lower risk of CBD mortality in a nonlinear manner, whereas the total quantity of dietary cholesterol throughout the day was not associated with CBD mortality.