Abstract
BackgroundBoth dietary and serum levels of inorganic phosphate (Pi) have been linked to development of cancer in experimental studies. This is the first population-based study investigating the relation between serum Pi and risk of cancer in humans.MethodsFrom the Swedish Apolipoprotein Mortality Risk (AMORIS) study, we selected all participants (> 20 years old) with baseline measurements of serum Pi, calcium, alkaline phosphatase, glucose, and creatinine (n = 397,292). Multivariable Cox proportional hazards regression analyses were used to assess serum Pi in relation to overall cancer risk. Similar analyses were performed for specific cancer sites.ResultsWe found a higher overall cancer risk with increasing Pi levels in men ( HR: 1.02 (95% CI: 1.00-1.04) for every SD increase in Pi), and a negative association in women (HR: 0.97 (95% CI: 0.96-0.99) for every SD increase in Pi). Further analyses for specific cancer sites showed a positive link between Pi quartiles and the risk of cancer of the pancreas, lung, thyroid gland and bone in men, and cancer of the oesophagus, lung, and nonmelanoma skin cancer in women. Conversely, the risks for developing breast and endometrial cancer as well as other endocrine cancer in both men and women were lower in those with higher Pi levels.ConclusionsAbnormal Pi levels are related to development of cancer. Furthermore, the in verse association between Pi levels and risk of breast, endometrial and other endocrine cancers may indicate the role of hormonal factors in the relation between Pi metabolism and cancer.
Highlights
Both dietary and serum levels of inorganic phosphate (Pi) have been linked to development of cancer in experimental studies
In the human body Pi is known to be mainly regulated by a set of hormonal and metabolic factors which tightly control calcium homeostasis, i.e. vitamin D and parathyroid hormone (PTH), and a recently identified Piregulating hormone, fibroblast growth factor 23 (FGF-23)
All participants were free from cancer at time of entry and none were diagnosed with cancer or died within three months after study entry
Summary
Both dietary and serum levels of inorganic phosphate (Pi) have been linked to development of cancer in experimental studies. This is the first population-based study investigating the relation between serum Pi and risk of cancer in humans. Besides being naturally present in raw food including meats, fish, eggs, dairy products and vegetables, Pi is found as an additive in processed food such as hamburgers and pizza, and as phosphoric acid in soda beverages [8] This Pi content is not listed as an ingredient per se, and it was reported that this ‘hidden’ Pi content of food with Pi-containing additives is nearly 70% higher than in food without additives [9]. Considering the emerging experimental evidence linking Pi and cancer, it is of interest to explore this relation in an observational population-based setting
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