Dietary phosphorus intake and blood pressure in adults: a systematic review of randomized trials and prospective observational studies

Scott T. McClure, Casey Rebholz, Sibyl Medabalimi, Emily A. Hu, Zhe Xu, Elizabeth Selvin, Lawrence Appel

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Elevated blood pressure (BP) is a major cause of preventable disease in the United States and around the world. It has been postulated that phosphorus intake may affect BP, with some studies suggesting a direct and others an inverse association. OBJECTIVES: We systematically reviewed the literature on the association of dietary phosphorus with BP in adults and performed a qualitative synthesis. METHODS: We included randomized and nonrandomized behavioral intervention and feeding studies (intervention studies) and prospective observational studies that measured dietary phosphorus intake or urinary phosphorus excretion and BP. We excluded studies of supplements, children, or individuals with major medical conditions. We searched PubMed, Embase, Cochrane Trials, and clinicaltrials.gov on 1 June, 2017 and 22 August, 2018. We assessed studies' risk of bias in their assessment of phosphorus exposure and BP. RESULTS: We reviewed 4759 publications and included 14 intervention studies (2497 participants), 3 prospective observational cohorts (17,795 participants), and 2 ongoing trials. No included intervention studies were designed specifically to achieve a phosphorus contrast. Two studies found a significant positive association of dietary phosphorus with systolic BP, 4 a significant inverse association, and 8 no significant association. Four studies found a significant inverse association with diastolic BP and 10 no significant associations. Two cohorts found lower risk of incident hypertension comparing the highest with the lowest quintiles of phosphorus intake and 1 found no significant difference: HR: 0.86 (95% CI: 0.75, 0.98); HR: 0.83 (95% CI: 0.68, 1.02); and HR: 0.75 (95% CI: 0.45, 1.27), respectively. CONCLUSIONS: We found no consistent association between total dietary phosphorus intake and BP in adults in the published literature nor any randomized trials designed to examine this association. This trial was registered at www.crd.york.ac.uk/prospero/ as CRD42017062489.

Original languageEnglish (US)
Pages (from-to)1264-1272
Number of pages9
JournalThe American journal of clinical nutrition
Volume109
Issue number5
DOIs
StatePublished - May 1 2019

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Dietary Phosphorus
Observational Studies
Prospective Studies
Blood Pressure
Phosphorus
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Keywords

  • blood pressure
  • diet
  • phosphorus
  • systematic review
  • urinary excretion

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Nutrition and Dietetics

Cite this

Dietary phosphorus intake and blood pressure in adults : a systematic review of randomized trials and prospective observational studies. / McClure, Scott T.; Rebholz, Casey; Medabalimi, Sibyl; Hu, Emily A.; Xu, Zhe; Selvin, Elizabeth; Appel, Lawrence.

In: The American journal of clinical nutrition, Vol. 109, No. 5, 01.05.2019, p. 1264-1272.

Research output: Contribution to journalArticle

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abstract = "BACKGROUND: Elevated blood pressure (BP) is a major cause of preventable disease in the United States and around the world. It has been postulated that phosphorus intake may affect BP, with some studies suggesting a direct and others an inverse association. OBJECTIVES: We systematically reviewed the literature on the association of dietary phosphorus with BP in adults and performed a qualitative synthesis. METHODS: We included randomized and nonrandomized behavioral intervention and feeding studies (intervention studies) and prospective observational studies that measured dietary phosphorus intake or urinary phosphorus excretion and BP. We excluded studies of supplements, children, or individuals with major medical conditions. We searched PubMed, Embase, Cochrane Trials, and clinicaltrials.gov on 1 June, 2017 and 22 August, 2018. We assessed studies' risk of bias in their assessment of phosphorus exposure and BP. RESULTS: We reviewed 4759 publications and included 14 intervention studies (2497 participants), 3 prospective observational cohorts (17,795 participants), and 2 ongoing trials. No included intervention studies were designed specifically to achieve a phosphorus contrast. Two studies found a significant positive association of dietary phosphorus with systolic BP, 4 a significant inverse association, and 8 no significant association. Four studies found a significant inverse association with diastolic BP and 10 no significant associations. Two cohorts found lower risk of incident hypertension comparing the highest with the lowest quintiles of phosphorus intake and 1 found no significant difference: HR: 0.86 (95{\%} CI: 0.75, 0.98); HR: 0.83 (95{\%} CI: 0.68, 1.02); and HR: 0.75 (95{\%} CI: 0.45, 1.27), respectively. CONCLUSIONS: We found no consistent association between total dietary phosphorus intake and BP in adults in the published literature nor any randomized trials designed to examine this association. This trial was registered at www.crd.york.ac.uk/prospero/ as CRD42017062489.",
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