Noori Nazanin, Sims John J, Kopple Joel D, Shah Anuja, Colman Sara, Shinaberger Christian S, Bross Rachelle, Mehrotra Rajnish, Kovesdy Csaba P, Kalantar-Zadeh Kamyar
Harold Simmons Center for Chronic Disease Research and Epidemiology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center and Departments of Epidemiology or Community Health Sciences, UCLA School of Public Health, Los Angeles, USA.
Iran J Kidney Dis. 2010 Apr;4(2):89-100.
Dietary phosphorus control is often a main strategy in the management of patients with chronic kidney disease. Dietary protein is a major source of phosphorus intake. Recent data indicate that imposed dietary phosphorus restriction may compromise the need for adequate protein intake, leading to protein-energy wasting and possibly to increased mortality. The two main sources of dietary phosphorus are organic, including animal and vegetarian proteins, and inorganic, mostly food preservatives. Animal-based foods and plant are abundant in organic phosphorus. Usually 40% to 60% of animal-based phosphorus is absorbed; this varies by degree of gastrointestinal vitamin-D-receptor activation, whereas plant phosphorus, mostly associated with phytates, is less absorbable by human gastrointestinal tract. Up to 100% of inorganic phosphorus in processed foods may be absorbed; ie, phosphorus in processed cheese and some soda (cola) drinks. A recent study suggests that a higher dietary phosphorus-protein intake ratio is associated with incremental death risk in patients on long-term hemodialysis. Hence, for phosphorus management in chronic kidney disease, in addition to absolute dietary phosphorus content, the chemical structure (inorganic versus organic), type (animal versus plant), and phosphorus-protein ratio should be considered. We recommend foods and supplements with no or lowest quantity of inorganic phosphorus additives, more plant-based proteins, and a dietary phosphorus-protein ratio of less than 10 mg/g. Fresh (nonprocessed) egg white (phosphorus-protein ratio less than 2 mg/g) is a good example of desirable food, which contains a high proportion of essential amino acids with low amounts of fat, cholesterol, and phosphorus.
饮食磷控制通常是慢性肾脏病患者管理中的主要策略。饮食蛋白质是磷摄入的主要来源。近期数据表明，强制进行饮食磷限制可能会损害充足蛋白质摄入的需求，导致蛋白质能量消耗，并可能增加死亡率。饮食磷的两个主要来源是有机磷，包括动物蛋白和植物蛋白，以及无机磷，主要是食品防腐剂。动物性食物和植物性食物富含有机磷。通常动物性磷的40%至60%会被吸收；这因胃肠道维生素D受体激活程度而异，而植物磷大多与植酸盐结合，人体胃肠道对其吸收较少。加工食品中高达100%的无机磷可能会被吸收；例如，加工奶酪和一些汽水（可乐）饮料中的磷。最近一项研究表明，较高的饮食磷与蛋白质摄入比与长期血液透析患者的死亡风险增加有关。因此，对于慢性肾脏病的磷管理，除了饮食磷的绝对含量外，还应考虑化学结构（无机与有机）、类型（动物与植物）以及磷与蛋白质的比例。我们推荐无机磷添加剂含量为零或最低的食物和补充剂、更多的植物性蛋白质，以及饮食磷与蛋白质比小于10毫克/克的食物。新鲜（未加工）蛋清（磷与蛋白质比小于2毫克/克）就是理想食物的一个很好例子，它含有高比例的必需氨基酸，脂肪、胆固醇和磷含量低。
