Fibroblast Growth Factor 23, Cardiovascular Disease Risk Factors, and Phosphorus Intake in the Health Professionals Follow-up Study

Gutiérrez, Orlando M.; Wolf, Myles; Taylor, Eric N.

doi:10.2215/cjn.02740311

Cited by 142 publications

(114 citation statements)

References 32 publications

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“…Our results agree with the recent work by Gutierrez et al (43) that evaluated 1261 participants of the Health Professionals Follow-Up Study. They showed that, in subjects with largely preserved kidney function, a higher phosphorus intake was associated with higher FGF23 values (43).…”

Section: Discussionsupporting

confidence: 93%

Acute Effects of Very-Low-Protein Diet on FGF23 Levels

Iorio¹,

Micco²,

Torraca³

et al. 2012

Clinical Journal of the American Society of Nephrology

103

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SummaryBackground and objectives High levels of fibroblast growth factor 23 are associated with mortality, CKD progression, and calcification in CKD patients. The aim of this pilot study is to assess whether a very-low-protein diet (0.3 g/kg per day) with a consequent low intake of phosphorus would reduce fibroblast growth factor 23 compared with a low-protein diet (0.6 g/kg per day) in CKD patients not yet on dialysis.Design, setting, participants, & measurements A prospective, randomized, controlled crossover study was performed in which 32 patients were randomized into two groups. Group A (16 patients) received a very-lowprotein diet (0.3 g/kg body wt per day) supplemented with ketoanalogues during the first week and a lowprotein diet during the second week, and group B (16 patients) received a low-protein diet during the first week and a very-low-protein diet during the second week. Fibroblast growth factor 23, seric, and urinary phosphate levels were measured at baseline and the end of each study period.Results After only 1 week of the very-low-protein diet, reductions in fibroblast growth factor 23 levels (33.5%), serum phosphate (12%), and urinary phosphate (34%) with the very-low-protein diet compared with the lowprotein diet were observed. Serum and urinary phosphate levels and protein intake were significant determinants of fibroblast growth factor 23 (95% confidence interval=1.04-1.19, 1.12-1.37, and 1.51-2.23, respectively).Conclusions A very-low-protein diet supplemented with ketoanalogues reduced fibroblast growth factor 23 levels in CKD patients not yet on dialysis.

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Section: Discussionsupporting

confidence: 93%

Acute Effects of Very-Low-Protein Diet on FGF23 Levels

Iorio¹,

Micco²,

Torraca³

et al. 2012

Clinical Journal of the American Society of Nephrology

103

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“…On the other hand, from the results of this latter study, additional mechanisms beyond mere suppression of 1-α Hydroxylase by uric acid seem to play a role here. The findings of the latter study were confirmed in another study by Gutierrez et al (15). The authors evaluated the data of Health Professionals Follow-up Study and showed that serum uric acid and PTH but not 25(OH) vitamin D levels were significantly higher in patients in the highest quartile of FGF23 compared with patients in the lowest FGF23 quartile.…”

Section: Discussionsupporting

confidence: 58%

Association Between Elevated Serum Uric Acid and Vitamin D Insufficiency Among the Middle-Aged and Elderly Population

Takır¹,

Solak²,

Erek³

et al. 2016

Turk Neph Dial Transpl

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OBJECTIVE: Vitamin D insufficiency might have a role in numerous diseases including autoimmune disease, cancer, diabetes mellitus, hypertension and heart diseases. The relationship between vitamin D insufficiency and hyperuricemia has been shown previously but there are conflicting results in studies. MATErIAl and METhODS:A total of 1562 patients who had serum uric acid and vitamin D levels measured at the same time were enrolled. Patients who were on vitamin D replacement therapy, receiving calcium and/or allopurinol, or had gout and chronic kidney disease were excluded. rESulTS: Hyperuricemic patients had significantly lower levels of serum vitamin D level compared with normouricemic patients (p<0.001) whereas there was no difference between the groups in terms of serum calcium, phosphorus, parathormone and alkaline phosphatase. Severe deficiency (25(OH) vitamin D <10) was significantly more common among patients with hyperuricemia (p<0.001). When vitamin D levels were analyzed according to age, a significant inverse correlation between vitamin D and serum uric acid level was found in decades 7 and 8. Age, eGFR and vitamin D level below 20 appeared as independent associates of serum uric acid levels.COnCluSIOn: These data suggest that hyperuricemia associates with vitamin D deficiency. Further studies are needed to understand the mechanism underlying this association and its potential clinical implications. BulGulAr: Hiperürisemik hastaların serum vitamin D düzeyleri normoürisemik hastalara göre daha düşük olduğu görülmesine (p<0.001) karşın, gruplar serum kalsiyum, fosfor, parathormon ve alkalen fosfataz düzeyleri bakımından benzerdi. D vitamini düzeylerine göre değerlendirildiğinde ağır (vitamin D <10) düzeyde eksikliği olan hastaların daha çok hiperürisemik (p<0.001) grupta olduğu görüldü. Yaşa göre serum D vitamini ve ürik asit düzeyleri arasında anlamlı derecede negatif korelasyonun 7. ve 8. dekatlarda olduğu görüldü. Yaş, serum D vitamini düzeyinin <20 olması ve eGFR düzeyleri, serum ürik asit düzeyi ile anlamlı korelasyon gösterdiği görüldü.SOnuç: Çalışmamızda, hiperüriseminin D vitamini eksikliği ile ilişkili olduğu saptanmıştır. Bu ilişkiyi açıklayabilecek mekanizma ve bunun klinik açıdan etkilerine yönelik daha ileri çalışmalara ihtiyaç vardır.

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“…A recent study (40) showed a significant increase in FGF23 concentrations with increased dietary phosphorus intake in community-dwelling adults with preserved renal function. This is in contrast to another recent study in nearly 4000 participants in the Chronic Renal Insufficiency Cohort (CRIC) Study (41), in which there was no association between dietary phosphorus intake and FGF23 concentrations.…”

Section: Association Between Serum Phosphorus and Progression Of Kidnmentioning

confidence: 98%

Phosphorus and the Kidney: What Is Known and What Is Needed

Nadkarni

Uribarri

2014

Advances in Nutrition

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A major role of the kidneys is to maintain phosphorus homeostasis. High serum phosphorus has been linked to all-cause and cardiovascular mortality in chronic kidney disease (CKD) both before and after initiation of renal replacement therapy. Considering the clinical implications of uncontrolled hyperphosphatemia, maintenance of phosphorus concentrations within an optimum range is standard of care in this patient population. Recently, the epidemiologic associations between serum phosphorus and worse outcome have been extended to the general population. This becomes even more important in view of the increasing dietary phosphorus intake in the American diet due in large part to the greater consumption of foods processed with phosphate additives. A greater understanding of mechanisms and epidemiology of altered phosphorus metabolism and disease in CKD may help clarify the possible role of excess dietary phosphorus as a health risk factor in the general population. Adv. Nutr. 5: 98-103, 2014.

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Fibroblast Growth Factor 23, Cardiovascular Disease Risk Factors, and Phosphorus Intake in the Health Professionals Follow-up Study

Cited by 142 publications

References 32 publications

Acute Effects of Very-Low-Protein Diet on FGF23 Levels

Acute Effects of Very-Low-Protein Diet on FGF23 Levels

Association Between Elevated Serum Uric Acid and Vitamin D Insufficiency Among the Middle-Aged and Elderly Population

Phosphorus and the Kidney: What Is Known and What Is Needed

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