Nierenzentrum Heidelberg, 69120 Heidelberg, Germany.
Dtsch Arztebl Int. 2012 Jan;109(4):49-55. doi: 10.3238/arztebl.2012.0049. Epub 2012 Jan 27.
Hyperphosphatemia has been identified in the past decade as a strong predictor of mortality in advanced chronic kidney disease (CKD). For example, a study of patients in stage CKD 5 (with an annual mortality of about 20%) revealed that 12% of all deaths in this group were attributable to an elevated serum phosphate concentration. Recently, a high-normal serum phosphate concentration has also been found to be an independent predictor of cardiovascular events and mortality in the general population. Therefore, phosphate additives in food are a matter of concern, and their potential impact on health may well have been underappreciated.
We reviewed pertinent literature retrieved by a selective search of the PubMed and EU databases (www.zusatzstoffe-online.de, www.codexalimentarius.de), with the search terms "phosphate additives" and "hyperphosphatemia."
There is no need to lower the content of natural phosphate, i.e. organic esters, in food, because this type of phosphate is incompletely absorbed; restricting its intake might even lead to protein malnutrition. On the other hand, inorganic phosphate in food additives is effectively absorbed and can measurably elevate the serum phosphate concentration in patients with advanced CKD. Foods with added phosphate tend to be eaten by persons at the lower end of the socioeconomic scale, who consume more processed and "fast" food. The main pathophysiological effect of phosphate is vascular damage, e.g. endothelial dysfunction and vascular calcification. Aside from the quality of phosphate in the diet (which also requires attention), the quantity of phosphate consumed by patients with advanced renal failure should not exceed 1000 mg per day, according to the guidelines.
Prospective controlled trials are currently unavailable. In view of the high prevalence of CKD and the potential harm caused by phosphate additives to food, the public should be informed that added phosphate is damaging to health. Furthermore, calls for labeling the content of added phosphate in food are appropriate.
在过去十年中，高磷血症已被确定为晚期慢性肾脏病（CKD）患者死亡的强有力预测因子。例如，一项针对 CKD 5 期患者（年死亡率约为 20%）的研究表明，该组患者中有 12%的死亡归因于血清磷酸盐浓度升高。最近，高正常血清磷酸盐浓度也被发现是普通人群心血管事件和死亡率的独立预测因子。因此，食品中的磷酸盐添加剂是一个值得关注的问题，其对健康的潜在影响很可能被低估了。
我们通过对 PubMed 和 EU 数据库（www.zusatzstoffe-online.de，www.codexalimentarius.de）进行选择性搜索，检索到相关文献，并使用了“磷酸盐添加剂”和“高磷血症”等搜索词。
没有必要降低食品中天然磷酸盐（即有机酯）的含量，因为这种类型的磷酸盐不易被吸收；限制其摄入甚至可能导致蛋白质营养不良。另一方面，食品添加剂中的无机磷酸盐可被有效吸收，并可使晚期 CKD 患者的血清磷酸盐浓度显著升高。添加磷酸盐的食物往往被社会经济地位较低的人食用，他们食用更多的加工食品和“快餐”。磷酸盐的主要病理生理作用是血管损伤，如内皮功能障碍和血管钙化。除了饮食中磷酸盐的质量（也需要注意）之外，根据指南，晚期肾衰竭患者每天消耗的磷酸盐不应超过 1000 毫克。
目前尚无前瞻性对照试验。鉴于 CKD 的高患病率以及食物中磷酸盐添加剂可能对健康造成的危害，应告知公众添加的磷酸盐对健康有害。此外，呼吁在食品中添加磷酸盐的含量进行标注是恰当的。
