Effects of Dietary Phosphate and Calcium Intake on Fibroblast Growth Factor-23

Vervloet, Marc G.; Ittersum, Frans J. van; Büttler, Rahel M.; Heijboer, Annemieke C.; Blankenstein, Marinus A.; Wee, Piet M. ter

doi:10.2215/cjn.04730510

Cited by 198 publications

(156 citation statements)

References 32 publications

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“…Finally, we were unable to examine whether diurnal changes in FGF23 throughout the morning might have affected changes in FGF23 levels during the infusion period. However, given a recent study showing that FGF23 levels, if anything, increase during the morning and early afternoon in healthy volunteers (28), diurnal changes are unlikely to explain the decrease in FGF23 in this study.…”

Section: Discussioncontrasting

confidence: 55%

(1-34) Parathyroid Hormone Infusion Acutely Lowers Fibroblast Growth Factor 23 Concentrations in Adult Volunteers

Gutiérrez

Smith

Barchi-Chung

et al. 2012

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Fibroblast growth factor 23 (FGF23) regulates phosphorus and vitamin D metabolism. Parathyroid hormone (PTH) infusion for 24 hours stimulated FGF23 secretion in healthy volunteers. The extent to which this was due to a direct stimulatory effect of PTH versus an indirect effect of increasing 1,25-dihydroxyvitamin D [1,25(OH) 2 D] levels was unclear.Design, setting, participants, & measurements Changes in FGF23 in 26 adults undergoing 6-hour (1-34) PTH infusion were examined, focusing particularly on the effects of PTH on FGF23 in the early period of infusion before sustained increases in 1,25(OH) 2 D.Results FGF23 levels declined in parallel with serum phosphate during infusion (P,0.05 for both), with both analytes decreasing within the first hour and reaching their respective nadirs at 6 hours. These changes were observed despite no change in 1,25(OH) 2 D levels during the first hour and a significant increase in 1,25(OH) 2 D from baseline after 6 hours (P,0.001). There were no differences in these responses by race. However, modest racial differences in the phosphaturic response to (1-34) PTH were observed (P=0.04 for interaction), with a higher rate of increase in fractional phosphate excretion in blacks than in whites.Conclusions During short-term (1-34) PTH infusion, FGF23 levels decreased in parallel with serum phosphate levels and despite significant increases in 1,25(OH) 2 D. When coupled with the results of prior longer-term infusion studies, these findings suggest that acute increases in PTH initially act to suppress FGF23 secretion, perhaps to mitigate urinary phosphate losses, before the stimulatory effect of 1,25(OH) 2 D on FGF23 eventually begins to predominate.

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Section: Discussioncontrasting

confidence: 55%

(1-34) Parathyroid Hormone Infusion Acutely Lowers Fibroblast Growth Factor 23 Concentrations in Adult Volunteers

Gutiérrez

Smith

Barchi-Chung

et al. 2012

Clinical Journal of the American Society of Nephrology

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“…We previously reported no postprandial changes in FGF23 (6), which were confirmed here. In contrast, a single study of 10 healthy volunteers, in whom FGF23 levels were measured three times during the day, found that there was some circadian variability in FGF23 levels, with a rise in mean (6SE) cFGF23 levels from 45627 to 68645 reference units/ml at the end of the day (27). Taken together, the findings to date seem to indicate that, if circadian variability in FGF23 levels does exist, it is likely of very low amplitude.…”

Section: Discussionmentioning

confidence: 83%

Daily Variability in Mineral Metabolites in CKD and Effects of Dietary Calcium and Calcitriol

Isakova

Xie

Barchi-Chung

et al. 2012

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Primary prevention of disordered mineral metabolism in CKD necessitates knowledge of its early pathophysiology. This study evaluated daily fluctuations in mineral metabolites in patients with CKD stages 3 and 4 before and after short-term calcitriol treatment and tested the effects of dietary calcium and calcitriol supplementation on these parameters in the dynamic postprandial setting.Design, setting, participants, & measurements Twelve CKD patients received calcitriol (0.25 mg daily for 1 week) with hourly assessments of mineral metabolites made throughout the day and in the context of standardized meals before and after treatment. Calcium content (250 versus 500 mg) in the breakfasts constituted the dietary calcium intervention. Twelve healthy volunteers were used as controls.Results At baseline, compared with controls, fasting CKD subjects had higher parathyroid hormone and fibroblast growth factor 23 levels and greater fractional excretion of phosphate. After breakfast, urinary calcium excretion increased and parathyroid hormone levels dipped transiently in both groups, but they rose soon thereafter, reaching higher peaks in CKD. Calcitriol decreased fasting parathyroid hormone levels, and when combined with dietary calcium load, it normalized the postprandial parathyroid and calcemic responses. Daily variability in mineral metabolites was preserved in CKD before and after calcitriol. Fibroblast growth factor 23 levels increased after calcitriol, although the response was heterogeneous.Conclusions Short-term treatment with calcitriol and dietary calcium supplementation normalizes the parathyroid and calcemic postprandial responses in patients with CKD, in whom the diurnal rhythms of mineral metabolites are preserved. Future studies should investigate the variable fibroblast growth factor 23 response to calcitriol in CKD.

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“…Figure 4 illustrates how both serum phosphate and PTH fluctuate with an inherent biphasic pattern, peaking in the afternoon and late evening but readjusting to the morning fasting concentration of the previous day (indicated by the arrows). This phenomenon of readjusting to the morning fasting concentration of the previous day has been shown for serum phosphate (16,(42)(43)(44), PTH (16,43), and, although less convincingly, FGF-23 (41,45). The need for multiple serum sampling to monitor dietary phosphorus effects on calcium and phosphorus balance was first suggested by Smith and Nordin in 1964 (42), when they were unable to demonstrate a change in serum calcium or phosphate concentrations in response to phosphorus intake using a single daily blood sampling.…”

Section: Masking Of Diet-related Changes In Serum Phosphorus Pth Anmentioning

confidence: 79%

Assessing the Health Impact of Phosphorus in the Food Supply: Issues and Considerations

Calvo

Moshfegh

Tucker

2014

Advances in Nutrition

148

106

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The Western dietary pattern of intake common to many Americans is high in fat, refined carbohydrates, sodium, and phosphorus, all of which are associated with processed food consumption and higher risk of life-threatening chronic diseases. In this review, we focus on the available information on current phosphorus intake with this Western dietary pattern, and new knowledge of how the disruption of phosphorus homeostasis can occur when intake of phosphorus far exceeds nutrient needs and calcium intake is limited. Elevation of extracellular phosphorus, even when phosphorus intake is seemingly modest, but excessive relative to need and calcium intake, may disrupt the endocrine regulation of phosphorus balance in healthy individuals, as it is known to do in renal disease. This elevation in serum phosphate, whether episodic or chronically sustained, may trigger the secretion of regulatory hormones, whose actions can damage tissue, leading to the development of cardiovascular disease, renal impairment, and bone loss. Therefore, we assessed the health impact of excess phosphorus intake in the context of specific issues that reflect changes over time in the U.S. food supply and patterns of intake. Important issues include food processing and food preferences, the need to evaluate phosphorus intake in relation to calcium intake and phosphorus bioavailability, the accuracy of various approaches used to assess phosphorus intake, and the difficulties encountered in evaluating the relations of phosphorus intake to chronic disease markers or incident disease. Adv. Nutr. 5: 104-113, 2014.

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Effects of Dietary Phosphate and Calcium Intake on Fibroblast Growth Factor-23

Cited by 198 publications

References 32 publications

(1-34) Parathyroid Hormone Infusion Acutely Lowers Fibroblast Growth Factor 23 Concentrations in Adult Volunteers

(1-34) Parathyroid Hormone Infusion Acutely Lowers Fibroblast Growth Factor 23 Concentrations in Adult Volunteers

Daily Variability in Mineral Metabolites in CKD and Effects of Dietary Calcium and Calcitriol

Assessing the Health Impact of Phosphorus in the Food Supply: Issues and Considerations

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