(P03-053-24) Phosphate Additives in US Foods and Beverages: A Hidden, Real Danger to Kidney Patients’ Health

Objectives: Restricting dietary phosphate intake is critical to the management of chronic kidney disease (CKD) patients in order to slow the progression to kidney failure (dialysis), bone disease and cardiovascular disease. Limiting phosphate intake requires knowledge of the quantity and forms present in foods, information that is not often available on Nutrition Facts Labels or available in nutrient content databases. Compared to natural dietary sources of phosphate in food, phosphate additives have a significantly greater efficiency and rate of absorption (bioavailability) and therefore higher potential to disrupt hormonal regulation in CKD. Current food labels offer limited information about total phosphate content from all sources (natural and added) or the use of additives containing phosphate in processing. Our study objective was to estimate phosphate additive exposure in the US population by examining food and beverage products sold by the top 25 US manufacturers.

Methods: In the absence of data linking phosphate additives in foods to dietary intake surveys, we used a proxy method by examining the ingredients lists on food and beverage products sold by the top 25 food and beverage manufacturers (n=39,937) in 2020.

Results: We found that more than 50% of foods and beverage products sold by the top 25 manufacturers contained phosphate additives. More than 30% of foods and beverages contained inorganic phosphate additives with 41% containing added organic phosphates, largely as lecithin, and 28% of the total foods contained both organic and inorganic phosphate additives.

Conclusions: These are the first exposure estimates documenting the presence of phosphate additives in top selling food and beverage products, illustrating their widespread use which limits healthy food choices for people with CKD. Our findings call for common sense and feasible approaches to identify phosphate additives in foods and to quantify their natural phosphate content to better enable dietary management of CKD, a condition that affects 37 million US adults mostly in CKD stages 1-3 when dietary phosphate restriction can have valuable salutary effects.

Funding Sources: None