Literature search and review related to specific preparatory work in the establishment of Dietary Reference Values for Phosphorus, Sodium and Chloride

phosphorus, sodium, chloride, comprehensive literature review, Dietary Reference Values (DRVs), dietary requirements, health outcomes
First published in EFSA Supporting Publications
30 octobre 2013
25 octobre 2013
External Scientific Report

The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively by the author(s) in the context of a contract between the European Food Safety Authority and the author(s), awarded following a tender procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be considered as an output adopted by the Authority. The European food Safety Authority reserves its rights, view and position as regards the issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.


The aim of this review was to identify the scientific data from 1990 onwards upon which Dietary Reference Values (DRVs) for phosphorus, sodium and chloride may potentially be based. Searches were performed in PubMed (all nutrients) and Cochrane Library (phosphorus). References were checked for relevance and study quality was appraised. For phosphorus, 21 articles were included in the review. Four articles described the association between phosphorus and intermediate health markers and seventeen articles described the association between phosphorus intake or blood concentrations and health outcomes (i.e. bone health, cancer, hypertension, muscle mass, cardiovascular diseases and kidney disease). For sodium and chloride, 23 articles were included. Eleven studies described the association between dietary intake of sodium in relation to urinary excretion or plasma/serum sodium concentration. Fourteen studies described the association between sodium and intermediate health markers (renin-aldosterone-angiotensin system, cholesterol concentrations) and four studies described the associations between sodium and insulin resistance. One article described the association between blood levels of chloride and mortality. Results indicate that phosphorus homeostasis is regulated by the hormones PTH, FGF-23 and 1,25(OH)2D that react on short term changes in phosphorus intake. Inconsistent evidence was found for the association of phosphorus intake and cancer types, but positive associations were found between serum inorganic phosphorus levels and mortality from cardiovascular causes, incident cardiovascular disease, heart failure and coronary artery calcification. Maternal intake of phosphorus may affect bone mineral status in the infant, but results are inconclusive. The review on sodium chloride showed that sodium restriction increases activity of the renin-aldosterone-angiotensin system, whereas HDL or triglyceride concentrations are not affected. Associations between intake and most health-related outcomes appear to be inconsistent. Prospective cohort data show that low sodium intakes may be associated with increased mortality. Effects of sodium restriction may be modified by race-ethnicity and salt-sensitivity status.

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