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Assessment of one published review on health risks associated with phosphate additives in food

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The European Food Safety Authority (EFSA) was asked by the European Commission to undertake a scientific assessment of the concerns raised in a scientific article that suggested an association between high intake of phosphates as food additives and increased cardiovascular risk in the general population. The publication assessed is a narrative review summarising the latest evidence from observational studies on a possible association between elevated serum phosphate levels and an increased risk of cardiovascular disease and overall mortality in the general population. In their review, the authors also present some considerations on the metabolism of inorganic phosphate, the latest insights into the hormonal mechanisms that are involved in its homeostasis and possible explanations for its role in vascular calcification. The authors reported that intake of phosphate as a food additive, especially through consumption of processed and ready-to-eat food, is of particular concern. EFSA assessed this published review and concluded that, owing to the intrinsic limitations of the non-interventional design of the studies included, it is not possible to make causal inferences for serum phosphate levels and the observed adverse effects. In addition, from the evidence reviewed it is not clear whether the increased cardiovascular risk observed in these observational studies is attributable to differences in the dietary intake of phosphorus in general or in the form of phosphate additives and serum phosphate levels. As set out by Regulation (EU) No 257/2010, phosphates for use as food additives will be re-evaluated by EFSA with high priority by 31 December 2018. In the context of this re-evaluation all relevant toxicological information will be collated and evaluated. A dedicated call for data aimed at gathering information on usage levels of phosphates in food will be launched in preparation for the re-evaluation.