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      The Percentage of Dietary Phosphorus Excreted in the Urine Varies by Dietary Pattern in a Randomized Feeding Study in Adults

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          ABSTRACT

          Background

          Urinary phosphorus excretion has been proposed as a recovery biomarker of dietary phosphorus intake. However, it is unclear whether phosphorus excretion is constant across a range of dietary and nondietary factors.

          Objective

          We assessed whether percentage urinary phosphorus excretion is constant across 3 dietary patterns in the Dietary Approaches to Stop Hypertension (DASH) trial.

          Methods

          DASH is a completed feeding study of 459 prehypertensive and stage 1 hypertensive adults (52% male, 56% black). After a 3-wk run-in on a typical American (control) diet, participants were randomly assigned to the control diet, a diet rich in fruits and vegetables (FV diet), or a diet rich in fruits, vegetables, and low-fat dairy with reduced saturated fat and cholesterol (DASH diet) for 8 wk. We estimated the percentage phosphorus excretion as urinary phosphorus excretion (from 24 h urine) divided by phosphorus intake (from analyzed food composites). Differences between group means for all 3 diets were compared by ANOVA followed by pairwise comparisons with Tukey's honest significant difference test.

          Results

          At the end of the intervention, the mean phosphorus intake was 1176 mg/d (95% CI: 1119, 1233 mg/d), 1408 mg/d (1352, 1464 mg/d), and 2051 mg/d (1994, 2107 mg/d) in the control, FV, and DASH diet, respectively (P < 0.001, all comparisons). The mean phosphorus excretion was 734 mg/d (682, 787 mg/d), 705 mg/d (654, 756 mg/d), and 872 mg/d (820, 923 mg/d) in the control, FV, and DASH diet, respectively (P = 0.74 control vs. FV, P < 0.001 all other comparisons). The mean percentage phosphorus excretion was 63% (60%, 67%), 51% (48%, 54%), and 43% (39%, 46%) in the control, FV, and DASH diet, respectively (P < 0.001, all comparisons).

          Conclusions

          These findings in prehypertensive and stage 1 hypertensive adults strongly suggest that urinary phosphorus excretion should not be used as a recovery biomarker for dietary phosphorus intake, given the wide range of urinary phosphorus excretion across dietary patterns. This trial is registered at clinicaltrials.gov as NCT0000054.

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          Most cited references27

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          Vegetarian compared with meat dietary protein source and phosphorus homeostasis in chronic kidney disease.

          Patients with advanced chronic kidney disease (CKD) are in positive phosphorus balance, but phosphorus levels are maintained in the normal range through phosphaturia induced by increases in fibroblast growth factor-23 (FGF23) and parathyroid hormone (PTH). This provides the rationale for recommendations to restrict dietary phosphate intake to 800 mg/d. However, the protein source of the phosphate may also be important. We conducted a crossover trial in nine patients with a mean estimated GFR of 32 ml/min to directly compare vegetarian and meat diets with equivalent nutrients prepared by clinical research staff. During the last 24 hours of each 7-day diet period, subjects were hospitalized in a research center and urine and blood were frequently monitored. The results indicated that 1 week of a vegetarian diet led to lower serum phosphorus levels and decreased FGF23 levels. The inpatient stay demonstrated similar diurnal variation for blood phosphorus, calcium, PTH, and urine fractional excretion of phosphorus but significant differences between the vegetarian and meat diets. Finally, the 24-hour fractional excretion of phosphorus was highly correlated to a 2-hour fasting urine collection for the vegetarian diet but not the meat diet. In summary, this study demonstrates that the source of protein has a significant effect on phosphorus homeostasis in patients with CKD. Therefore, dietary counseling of patients with CKD must include information on not only the amount of phosphate but also the source of protein from which the phosphate derives.
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            Discrepancy between the Atwater factor predicted and empirically measured energy values of almonds in human diets1234

            Background: The energy content of foods is primarily determined by the Atwater factors, which may not be accurate for certain food groups. Nuts are a food group for which substantial evidence suggests that the Atwater factors may be poorly predictive. Objective: A study was conducted to determine the energy value of almonds in the human diet and to compare the measured energy value with the value calculated from the Atwater factors. Design: Eighteen healthy adults consumed a controlled diet or an almond-containing diet for 18 d. Three treatments were administered to subjects in a crossover design, and diets contained 1 of 3 almond doses: 0, 42, or 84 g/d. During the final 9 d of the treatment period, volunteers collected all urine and feces, and samples of diets, feces, and urine were analyzed for macronutrient and energy contents. The metabolizable energy content of the almonds was determined. Results: The energy content of almonds in the human diet was found to be 4.6 ± 0.8 kcal/g, which is equivalent to 129 kcal/28-g serving. This is significantly less than the energy density of 6.0–6.1 kcal/g as determined by the Atwater factors, which is equivalent to an energy content of 168–170 kcal/serving. The Atwater factors, when applied to almonds, resulted in a 32% overestimation of their measured energy content. Conclusion: This study provides evidence for the inaccuracies of the Atwater factors for certain applications and provides a rigorous method for determining empirically the energy value of individual foods within the context of a mixed diet. This trial was registered at clinicaltrials.gov as NCT01007188.
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              Dietary potassium intake and mortality in long-term hemodialysis patients.

              Hyperkalemia has been associated with higher mortality in long-term hemodialysis (HD) patients. There are few data concerning the relationship between dietary potassium intake and outcome.
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                Author and article information

                Journal
                The Journal of Nutrition
                Oxford University Press (OUP)
                0022-3166
                1541-6100
                May 2019
                May 01 2019
                April 29 2019
                May 2019
                May 01 2019
                April 29 2019
                : 149
                : 5
                : 816-823
                Affiliations
                [1 ]Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
                [2 ]Welch Center for Prevention, Epidemiology, and Clinical Research
                [3 ]Food Analysis Laboratory Control Center, Biochemistry Department, Virginia Tech, Blacksburg, VA
                [4 ]Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA
                [5 ]Division of General Internal Medicine, Johns Hopkins University, Baltimore, MD
                Article
                10.1093/jn/nxy318
                6499101
                31034014
                71e7307f-c7d9-44f1-8148-66deed97eb4d
                © 2019

                https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model

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