Dietary phosphate exposure–strategies to protect vulnerable population groups

Phosphorus is commonly part of the diets in developed countries, both as a natural component of protein-rich foods and as a food additive. Consumption of food containing high amounts of phosphate as a food additive has continued to rise over time, resulting in increasing dietary exposure to phosphate. In 2019, an evaluation of phosphoric acid and phosphates conducted by the European Food Safety Authority (EFSA) identified young populations as groups with exposures exceeding the Acceptable Daily Intake (ADI), and also raised concern that the current ADI may not be sufficiently protective for individuals with an impaired renal function, which may account for 10% of the general population. The Senate Commission on Food Safety (SKLM) of the German Research Foundation (DFG) critically reviewed the safety of dietary phosphate, with a particular focus on the kidney as the primary target organ, taking into account the occurrence and content of phosphate in food, the most recent exposure estimates, the bioavailability of phosphate from different sources, the evidence linking excessive phosphate intake to kidney damage in animal models and humans as well as the exceedance of the current ADI in children. Moreover, the SKLM identified data gaps and research needs that should be addressed to improve the risk assessment of phosphate, with a special focus on vulnerable population groups. Based on the presented evidence, the Commission concludes that excessive dietary phosphate intake warrants further attention regarding possible health effects in vulnerable population groups or at exposure levels exceeding the ADI. Finally, the SKLM suggests a battery of risk management measures to reduce dietary exposure to phosphate, particularly in infants, toddlers and children, and to protect patients with chronic renal diseases.