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PubMed1991

Calcium acetate control of serum phosphorus in hemodialysis patients.

Calcium acetate has many characteristics of an ideal phosphorus binder. It is a readily soluble salt that avidly binds phosphorus in vitro at pH 5 and above. One-dose/one-meal balance studies show it to be more potent than calcium carbonate or calcium citrate. We studied chronic (3-month) phosphorus binding with calcium acetate in 91 hyperphosphatemic dialysis patients at four different centers. All phosphorus binders were stopped for 2 weeks. Calcium acetate at an initial dose of 8.11 mmol (325 mg Ca2+) per meal was then used as the only phosphorus binder. Dose was adjusted to attempt control of predialysis phosphorus level less than 1.78 mmol/L (5.5 mg/100 mL). Final calcium acetate dose was 14.6 mmol (586 mg) Ca2+ per meal. Sixteen patients developed mild transient hypercalcemia (mean, 2.84 mmol/L [11.4 mg/dL]. Initial phosphorus values in mmol/L (mg/dL) were 2.39 (7.4); at 1 month, 1.91 (5.9); and at 3 months, 1.68 (5.2). Initial calcium values in mmol/L (mg/dL) were 2.22 (8.9); at 1 month, 2.37 (9.5); and at 3 months, 2.42 (9.7). Initial aluminum values in mumol/L (micrograms/L) were 2.99 (80.7); and at 3 months were 2.54 (68.4). Initial C-terminal parathyroid hormone (C-PTH) values in ng/mL were 14.6; at 1 month, 11.9; and at 3 months, 13.2. Sixty-nine patients then entered a double-blind study. Phosphorus binders were stopped for 1 week. Calcium acetate (at a dose established in a prior study) or placebo was then administered for 2 weeks. Next, patients were crossed to the opposite regimen for 2 weeks. Initial phosphorus was 2.36 mmol/L (7.3 mg/100 mL) and calcium 2.22 mmol/L (8.9 mg/100 mL).(ABSTRACT TRUNCATED AT 250 WORDS)

Acetates↗
PubMed1977

Renal response to phosphorus deprivation: effect of the parathyroids and bicarbonate.

Plasma inorganic phosphate (Pi) and Pi reabsorption were compared in intact and chronically thyroparathyroidectomized (TPTX) rats stabilized on a high or low-phosphorus diet after volume expansion with equivalent sodium bicarbonate or sodium chloride. Phosphate infusion after sodium chloride-loading resulted in greater hyperphosphatemia and diminished phosphaturia in TPTX rats than intact high-phosphorus rats. After sodium bicarbonate-loading, however, there was no difference between intact and TPTX high-phosphorus animals because bicarbonate inhibited Pi reabsorption extensively in both. In contrast, phosphate infusion after sodium chloride-loading in phosphorus-deprived rats elicited greater degrees of hyperphosphatemia and increased Pi reabsorption, irrespective of the presence or absence of the parathyroids. Sodium bicarbonate-loading inhibited Pi reabsorption significantly less in phosphorus-deprived rats than in high-phosphorus animals. Paradoxically, this inhibitory effect of bicarbonate in phosphorus depletion was greater in TPTX rats than in intact animals. Therefore, the presence of the parathyroids did not interfere with Pi reabsorption during phosphate infusion in sodium bicarbonate-loaded phosphorus-deprived rats. Sodium bicarbonate-loading interfered with Pi reabsorption most prominently in phosphorus-deprived rats when the parathyroids were absent.

Animals↗
PubMedDate not supplied

Hidden sources of phosphorus in the typical American diet: does it matter in nephrology?

Elevated serum phosphorus is a major, preventable etiologic factor associated with the increased cardiovascular morbidity and mortality of dialysis patients. An important determinant of serum phosphorus is the dietary intake of this mineral; this makes dietary restriction of phosphorus a cornerstone for the prevention and treatment of hyperphosphatemia. The average daily dietary intake of phosphorus is about 1550 mg for males and 1000 mg for females. In general, foods high in protein are also high in phosphorus. These figures, however, are changing as phosphates are currently being added to a large number of processed foods including meats, cheeses, dressings, beverages, and bakery products. As a result, and depending on the food choices, such additives may increase the phosphorus intake by as a much as 1 g/day. Moreover, nutrient composition tables usually do not include the phosphorus from these additives, resulting in an underestimate of the dietary intake of phosphorus in our patients. Our goal is to convey an understanding of the phosphorus content of the current American diet to better equip nephrologists in their attempt to control hyperphosphatemia.

Food↗
PubMed2004

Effect of phytase supplementation on phosphorus digestibility in low-phytate barley fed to finishing pigs.

Forty crossbred barrows (Camborough 15 Line female x Canabred sire) weighing an average of 79.6 +/- 8.0 kg were used in a factorial design experiment (5 barleys x 2 enzyme levels) conducted to determine the effects of phytase supplementation on nutrient digestibility in low-phytate barleys fed to finishing pigs. The pigs were assigned to one of 10 dietary treatments comprised of a normal 2-rowed, hulled variety of barley (CDC Fleet, 0.26% phytate) or 2 low-phytate hulled genotypes designated as LP422 (0.14% phytate) and LP635 (0.09% phytate). A normal, hulless barley (CDC Dawn, 0.26% phytate) and a hulless genotype designated as LP422H (0.14% phytate) were also included. All barleys were fed with and without phytase (Natuphos 5000 FTU/kg). The diets fed contained 98% barley, 0.5% vitamin premix, 0.5% trace mineral premix, 0.5% NaCl and 0.5% chromic oxide but no supplemental phosphorus. The marked feed was provided for a 7-day acclimatization period, followed by a 3-day faecal collection. In the absence of phytase, phosphorus digestibility increased substantially (P < 0.05) as the level of phytate in the barley declined. For the hulled varieties, phosphorus digestibility increased from 12.9% for the normal barley (0.26% phytate) to 35.3 and 39.8% for the two low-phytate genotypes (0.14 and 0.09% phytate respectively). For the hulless varieties, phosphorus digestibility increased from 9.2% for the normal barley (0.26% phytate) to 34.7% for the hulless variety with 54% of the normal level of phytate (0.14% phytate). In contrast, when phytase was added to the diet, there was little difference in phosphorus digestibility between pigs fed normal barley and those fed the low-phytate genotypes (significant barley x enzyme interaction, P = 0.01). For the hulled varieties, phosphorus digestibility was 50.1% for the barley with the normal level of phytate (0.26% phytate) compared with 51.1 and 52.4% for the varieties with 54 and 35% of the normal level of phytate (0.14 and 0.09% phytate respectively). For the hulless varieties, phosphorus digestibility increased from 47.1% for the normal barley (0.26% phytate) to 54.4% for the hulless variety with 54% of the normal level of phytate (0.14% phytate). In conclusion, both supplementation with phytase and selection for low-phytate genotypes of barley were successful in increasing the digestibility of phosphorus for pigs. Unfortunately, the effects did not appear to be additive. Whether or not swine producers will choose low-phytate barley or supplementation with phytase as a means to improve phosphorus utilization, will likely depend on the yield potential of low-phytate barley and the additional costs associated with supplementation with phytase.

6-Phytase↗
PubMed1995

Potential role of ammoniagenesis in the hypocalciuric effect of phosphorus in rats.

OBJECTIVE: Hypocalciuria associated with a high phosphorus intake is known to be both a parathyroid hormone and non-parathyroid hormone dependent event. The present study was designed to define the role that ammoniagenesis may play in the non-parathyroid hormone dependent pathway. DESIGN: Male rats, initially weighing 160 g, were fed a purified diet containing, in g/kg diet, a single level of protein (200) and variable inorganic phosphorus (1.8, 4.5, 9.0) for 20 days. RESULTS: Food intake and body weight were similar for the three groups. Significant inverse correlations were found for both urinary calcium and phosphorus and for urinary ammonia nitrogen and calcium excretion (r = -0.62, p < 0.01). Urinary ammonia nitrogen excretion was highly correlated with both phosphorus intake (r = 0.89, p < 0.001) and urinary phosphorus (r = 0.88, p < 0.001). Urinary urea nitrogen tended to vary inversely with phosphorus intake. High dietary phosphorus decreased the activity of glutamine synthetase and increased the activity of glutaminase I in kidney. CONCLUSION: Tying-up some of the hydrogen ions destined for excretion by phosphorus-stimulated ammoniagenesis could reduce the interfering effect of hydrogen ion on kidney calcium reabsorption and provide a mechanism to explain why phosphorus can have a direct positive impact upon tubular calcium reabsorption.

Ammonia↗
PubMed1979

Blood phosphorus levels of laying hens at various time intervals after dosing with phosphoric acid.

Two experiments were conducted to study the pattern of change in serum inorganic phosphorus level in laying hens fed a diet containing 0.30% total phosphorus after dosing with a known amount of phosphorus. Serum phosphorus level of undosed hens was 2.5 mg/100 ml at oviposition in both experiments. After dosing with 100 mg of phosphorus in 10 ml of a phosphoric acid solution, serum phosphorus level increased sharply and reached a peak of about 7.0 mg/100 ml between 30 and 60 minutes in experiment 2. After the peak the elevated level of serum phosphorus decreased logarithmically until 5 to 6 hours after dosing and eventually decreased to 2.5 mg/100 ml which was the serum phosphorus level of undosed hens in experiment 1. The half-life of the elevated portion of serum phosphorus due to the dosing was about 100 minutes.

Animals↗
PubMed1992

Inbred strains of rats have differential sensitivity to dietary phosphorus-induced nephrocalcinosis.

The degree of nephrocalcinosis after increasing the dietary phosphorus concentration from 0.2 to 0.5 g/100 g was measured in weanling female rats of 10 inbred strains. Based on kidney calcium concentrations and histological kidney calcification scores, there were considerable strain differences in nephrocalcinogenesis; 86% of the strain variability in nephrocalcinosis was attributable to genetic factors. Two strains with the most extreme nephrocalcinogenic responses were retested and the strain difference was found to be reproducible. Mean plasma phosphorus concentrations after phosphorus feeding were lower in the sensitive strain than in the insensitive strain. The high phosphorus diet produced greater urinary phosphorus concentrations, with the increase being greater in the sensitive strain. The strain difference in the response of urinary phosphorus concentrations after raising dietary phosphorus level may determine the strain difference in phosphorus-induced nephrocalcinosis. After consuming the high phosphorus diet, RP rats housed in groups in solid-floored cages had significantly higher degrees of nephrocalcinosis than their counterparts housed individually in metabolism cages with wire-mesh bases.

Animals↗
PubMed1993

Long-term phosphorus restriction prevents corticomedullary nephrocalcinosis and sustains reproductive performance but delays bone mineralization in rats.

In a long-term experiment with three successive generations of rats, the influence of dietary phosphorus restriction (2 instead of 4 g phosphorus/kg diet) on nephrocalcinosis, reproduction and bone mineralization was studied. Nephrocalcinosis in female rats, as based on kidney calcium concentration and histological examination, was prevented by phosphorus restriction. The low phosphorus diet caused reduced femur concentrations of magnesium, calcium and phosphorus in rats of the first and second generation aged 4 to 12 wk. The low phosphorus diet resulted in lower plasma phosphorus concentrations. In the kidneys of female rats, immediately after lactation, a higher degree of tubular hyperplasia was seen after the low phosphorus diet was fed. Reproductive performance was not affected by phosphorus restriction. We conclude that 0.2% phosphorus in the diet prevents nephrocalcinosis in female rats while it sustains reproduction but delays bone mineralization.

Administration, Oral↗
PubMed1999

The role of phosphorus in the development of secondary hyperparathyroidism and parathyroid cell proliferation in chronic renal failure.

Hyperplasia of the parathyroid glands and high levels of parathyroid hormone (PTH) are among the most consistent findings in patients with chronic renal failure. In early renal failure, alterations in vitamin D metabolism play a key role in the development of secondary hyperparathyroidism. Low levels of calcitriol and decreased expression of the vitamin D responsive element may allow greater synthesis and secretion of PTH. Phosphorus independent of serum calcium and calcitriol increases PTH synthesis and secretion by a post-transcriptional mechanism. Studies in vivo in uremic rats demonstrated that an increase in dietary phosphorus induces parathyroid gland hyperplasia. If the rats are then fed a low-phosphorus diet, the levels of serum PTH return to normal; however, the size of the parathyroid glands remains enlarged. No apoptosis was observed in the glands. To further characterize the effects of phosphorus on PTH synthesis and secretion, intact rat parathyroid glands were metabolically labeled during a 4-hour incubation in methionine-free medium containing 1.25 mM Ca2+, [35S]methionine, and either 2.8 mM or 0.2 mM phosphorus. Total PTH secretion, as measured in the medium, was increased more than 6-fold in glands incubated in high-phosphorus medium compared with glands incubated in the low-phosphorus medium. Thus, in the past 20 years, numerous investigators have provided strong evidence for the action of phosphorus on PTH secretion. Unfortunately, the absence of a parathyroid cell line is slowing the progress in understanding the molecular mechanism(s) involved in phosphorus regulation of PTH.

Animals↗
PubMed2006

Role of phosphorus and vitamin D analogs in the pathogenesis of vascular calcification.

Vascular calcification is a mortality risk factor for stage 5 chronic kidney disease patients. We investigated the role of phosphorus and vitamin D analogs in the pathogenesis of vascular calcification using in vivo, ex vivo, and in vitro models. Our results demonstrate that uremic rats receiving a hyperphosphatemia-inducing diet did not exhibit aortic calcification despite elevated levels of serum phosphorus and calcium-phosphorus (CaxP) product. The vitamin D analog 1alpha-hydroxyvitamin-D2 [1alpha(OH)D2] at 0.17 microg/kg raised serum calcium, phosphorus, CaxP product, and aortic calcification in the uremic rats, but 19-nor-1alpha,25(OH)2D2 (19-nor) at the same dose had no significant effect. At 0.67 microg/kg, both 1alpha(OH)D2 and 19-nor had similar effects on serum calcium, phosphorus, and CaxP product, but only 1alpha(OH)D2 induced significant aortic calcification. Only aortic rings from 1alpha(OH)D2-treated uremic rats exhibited a significant increase in 45Ca uptake ex vivo. When aortic rings from normal rats or a primary culture of human coronary artery smooth muscle cells were treated with phosphorus or vitamin D analogs in vitro, high phosphorus induced calcium accumulation and/or 45Ca uptake in a dose- or time-dependent manner, whereas vitamin D analogs including 1alpha(OH)D2 up to 100 nM had no significant effect despite the presence of a functional vitamin D receptor. However, serum from 1alpha(OH)D2-treated uremic rats induced 45Ca uptake into smooth muscle cells cultured in high phosphorus. These results suggest that the regulation of vascular calcification in vivo cannot be easily replicated in the ex vivo or in vitro models, and high phosphorus and some vitamin D analogs such as 1alpha(OH)D2 exert interactive effects on modulating vascular calcification.

Animals↗
PubMed1986

Effects of serum calcium and phosphorus on skeletal mineralization in vitamin D-deficient rats.

In the present study, we have evaluated the role of calcium and phosphorus concentrations in serum on the mineralization of bone in the absence of vitamin D. This was accomplished by feeding mother rats and subsequently their pups vitamin D-deficient diets varying in calcium, phosphorus, and lactose content. After 5-7 wk on these diets, serum concentrations of 25-hydroxyvitamin D [25(OH)D] and 1,25-hydroxyvitamin D [1,25(OH)2D] were undetectable. Rats fed a vitamin D-deficient diet containing 0.44% calcium and 0.3% phosphorus showed a serum calcium of 4.9-5.9 mg/dl and a serum phosphorus of 7.3-8.2 mg/dl; rickets (wide epiphysial plates) had developed as well as osteomalacia (wide osteoid seams). Rats maintained on a vitamin D-deficient diet containing 3% calcium and 0.65% phosphorus had normal serum calcium, low serum phosphorus, and severe rickets, but osteomalacia was not seen. Rats fed a diet containing 20% lactose, 4% calcium, and 1% phosphorus showed normal serum calcium, somewhat low serum phosphorus, normal serum PTH, normal width of the epiphysial plate, normal volume density of trabecular bone, and normal volume density of osteoid seams. These data confirm the findings of others, using a different experimental model, that serum calcium and phosphorus concentrations are the determining factors in mineralization defects and not the absence of 25(OH)D or 1,25(OH)2D. In these rats thyroparathyroidectomy is well tolerated, which makes for an ideal model for the study of the effects of calcium-regulating hormones on bone histology, cytology, and biochemistry.

Animals↗
PubMed1990

1,25(OH)2D response to combined zinc and phosphorus depletion in rats.

To investigate the role of zinc depletion in the response of calcitriol to a single provocative stimulus, we studied vitamin D metabolites, parathyroid hormone (PTH), and mineral balance during phosphorus depletion in animals with different zinc nutritional status. Male Lewis rats (66) were pair fed normal phosphorus (NP), zinc-replete (+) or -deplete (-) diets for 2 wk. Thereafter, one-half of each paired group underwent 1 wk of phosphorus depletion (LP). Zinc-deplete animals had lower plasma zinc, and phosphorus-deplete animals had lower plasma phosphorus concentrations than respective nutritionally replete controls. Plasma calcium, PTH, and 25-hydroxycholecalciferol concentrations were similar in all four groups at end of experiment. Mean plasma 1,25(OH)2D concentration increased 80% from 35 +/- 3 to 63 +/- 9 pg/ml (P less than 0.007) when values were compared before and after phosphorus restriction in zinc-replete animals (LP + group). The 7.9% increase from 35 +/- 4 to 38 +/- 4 pg/ml in 1,25(OH)2D concentration in animals with combined zinc and phosphorus depletion (LP-) was not significant. External calcium balance, however, was maintained in the combined zinc and phosphorus-deplete group. We conclude that zinc depletion limits the increase in plasma 1,25(OH)2D concentration associated with phosphorus depletion. The mechanism is unknown but may involve an effect of zinc on renal 25(OH)D 1-alpha-hydroxylase synthetic activity.

Animals↗
PubMed1976

Influence of dietary phosphorus on renal phosphate reabsorption in the parathyroidectomized rat.

Inorganic phosphate (Pi) reabsorption was studied during Pi infusion, after acute or chronic thyroparathyroidectomy (TPTX), in rats stabilized on a high-phosphorus (1% P) or a low-phosphorus (0.02% P) diet. After acute TPTX, there were no consistent differences in Pi reabsorption between the high- and low-phosphorus dietary groups. After chronic TPTX, the rats stabilized on the low-phosphorus diet exhibited nearly complete Pi reabsorption at every plasma Pi level, while the animals receiving the high-phosphorus diet manifested a marked phosphaturic response to Pi infusion. In addition, Pi reabsorption was significantly increased in the chronic TPTX low-phosphorus rats which achieved the highest filtered Pi loads, while their urine remained essentially phosphate-free. Dietary phosphorus-dependent alterations in Pi reabsorption may play a significant role in establishing the rate of Pi excretion per nephron under certain circumstances and should be considered in the interpretation of studies investigating renal Pi handling. The ability of phosphorus-depleted animals to maintain a phosphate-free urine during Pi loading would favor the rapid repletion of body phosphorus stores.

Absorption↗
PubMed1976

Renal resistance to parathyroid hormone during phosphorus deprivation.

Because previous studies have demonstrated that renal inorganic phosphate reabsorption is enhanced in rats after dietary phosphorus deprivation, we studied the effects of parathyroid hormone (PTH) upon inorganic phosphate reabsorption in acutely thyroparathyroidectomized rats stabilized on a low phosphorus diet to determine if the phosphaturic response to PTH is impaired during phosphorous depletion. Acutely thyroparathyroidectomized phosphorus-deprived rats responded only minimally to PTH, whereas similarly prepared animals stabilized on a high phosphorus diet exhibited a large phosphaturic response. Base-line urinary cyclic AMP values and PTH-induced increases in cyclic AMP excretion were similar in both groups. In other experiments, dibutyryl cyclic AMP elicited a greatly diminished phosphaturic response in phosphorus-deprived rats, as compared to their high phosphorus counterparts. These results indicate that the renal phosphaturic responses to PTH and cyclic AMP are impaired during dietary phosphorus deprivation. The impaired phosphaturia would contribute to phosphorus conservation and to the replenishment of inorganic phosphate stores after phosphorus depletion.

Animals↗
PubMed1985

Healing of bone disease in X-linked hypophosphatemic rickets/osteomalacia. Induction and maintenance with phosphorus and calcitriol.

Although conventional therapy (pharmacologic doses of vitamin D and phosphorus supplementation) is usually successful in healing the rachitic bone lesion in patients with X-linked hypophosphatemic rickets, it does not heal the coexistent osteomalacia. Because serum 1,25-dihydroxyvitamin D levels are inappropriately low in these patients and high calcitriol concentrations may be required to heal the osteomalacia, we chose to treat five affected subjects with high doses of calcitriol (68.2 +/- 10.0 ng/kg total body weight/d) and supplemental phosphorus (1-2 g/d) performing metabolic studies and bone biopsies before and after 5-8 mo of this therapy in each individual. Of these five patients, three (aged 13, 13, and 19 yr) were receiving conventional treatment at the inception of the study and therefore showed base-line serum phosphorus concentrations within the normal range. The remaining two untreated patients (aged 2 and 37 yr) displayed characteristic hypophosphatemia before calcitriol therapy. All five patients demonstrated serum calcitriol levels in the low normal range (22.5 +/- 3.2 pg/ml), impaired renal phosphorus conservation (tubular maximum for the reabsorption of phosphate per deciliter of glomerular filtrate, 2.13 +/- 0.20 mg/dl), and osteomalacia on bone biopsy (relative osteoid volume, 14.4 +/- 1.7%; mean osteoid seam width, 27.7 +/- 3.7 micron; mineral apposition rate, 0.46 +/- 0.12 micron/d). On high doses of calcitriol, serum 1,25-dihydroxyvitamin D levels rose into the supraphysiologic range (74.1 +/- 3.8 pg/ml) with an associated increment in the serum phosphorus concentration (2.82 +/- 0.19 to 3.78 +/- 0.32 mg/dl) and improvement of the renal tubular maximum for phosphate reabsorption (3.17 +/- 0.22 mg/dl). The serum calcium rose in each patient while the immunoactive parathyroid hormone concentration measured by three different assays remained within the normal range. Most importantly, repeat bone biopsies showed that high doses of calcitriol and phosphorus supplements had reversed the mineralization defect in all patients (mineral apposition rate, 0.88 +/- 0.04 micron/d) and consequently reduced parameters of bone osteoid content to normal (relative osteoid volume, 4.1 +/- 0.7%; mean osteoid seam width, 11.0 +/- 1.0 micron). Complications (hypercalcemia and hypercalciuria) ensued in four of these five patients within 1-17 mo of documented bone healing, necessitating reduction of calcitriol doses to a mean of 1.6 +/- 0.2 micrograms/d (28 +/- 4 ng/kg ideal body weight per day). At follow-up bone biopsy, these four subjects continued to manifest normal bone mineralization dynamics (mineral apposition rate, 0.88 +/-0.10 micrometer/d) on reduced doses of 1.25-dihydroxyvitamin D with phosphorus supplements (2 g/d) for a mean of 21.3 +/- 1.3 mo after bone healing was first documented. Static histomorphometric parameters also remained normal (relative osteoid volume, 1.5 +/- 0.4%; mean osteoid seam width, 13.5 +/- 0.8 micrometer). These data indicate that administration of supraphysiologic amounts of calcitriol, in conjunction with oral phosphorus, results in complete healing of vitamin D resistant osteomalacia in patients with X-linked hypophosphatemic rickets. Although complications predictably require calcitriol dose reductions once healing is achieved, continued bone healing can be maintained for up to 1 yr with lower doses of 1,25-dihydroxyvitamin D and continued phosphorus supplementation.

Adolescent↗
PubMed1986

Oral intake of phosphorus can determine the serum concentration of 1,25-dihydroxyvitamin D by determining its production rate in humans.

Changes in the oral intake of phosphorus could induce the reported changes in the serum concentration of 1,25-dihydroxyvitamin D (1,25-(OH)2D) by inducing changes in its production rate (PR) or metabolic clearance rate (MCR), or both. To investigate these possibilities, we employed the constant infusion equilibrium technique to measure the PR and MCR of 1,25-(OH)2D in six healthy men in whom the oral intake of phosphorus was initially maintained at 1,500 mg/70 kg body weight per d for 9 d, then restricted to 500 mg/d (coupled with oral administration of aluminum hydroxide) for 10 d, and then supplemented to 3,000 mg/d for 10 d. With phosphorus restriction, the serum concentration of 1,25-(OH)2D increased by 80% from a mean of 38 +/- 3 to 68 +/- 6 pg/ml, P less than 0.001; the PR increased from 1.8 +/- 0.2 to 3.8 +/- 0.6 micrograms/d, P less than 0.005; the MCR did not change significantly. The fasting serum concentration of phosphorus decreased from 3.5 +/- 0.2 to 2.6 +/- 0.2 mg/dl, P less than 0.01. With phosphorus supplementation, the serum concentration of 1,25-(OH)2D decreased abruptly, reaching a nadir within 2 to 4 d; after 10 d of supplementation, the mean concentration of 27 +/- 4 pg/ml was lower by 29%, P less than 0.01, than the value measured when phosphorus intake was normal. The PR decreased to 1.3 +/- 0.2 micrograms/d, P less than 0.05; the MCR did not change significantly. The fasting serum concentration of phosphorus increased significantly, but only initially. These data demonstrate that in healthy men, reductions and increases in the oral intake of phosphorus can induce rapidly occurring, large, inverse, and persisting changes in the serum concentration of 1,25-(OH)2D. Changes in the PR of 1,25-(OH)2D account entirely for the phosphorus-induced changes in serum concentration of this hormone.

Administration, Oral↗
PubMed1988

Dietary phosphorus and 1,25-dihydroxyvitamin D metabolism: influence of insulin-like growth factor I.

Hypophysectomy abolishes the increase in serum 1,25-dihydroxyvitamin D [1,25-(OH)2D] induced by restriction of dietary phosphorus. Administration of GH increases circulating insulin-like growth factor I levels (IGF-I) and restores, in part, the responsiveness of serum 1,25-(OH)2D to restriction of dietary phosphorus. To determine whether the GH-dependent increase in serum 1,25-(OH)2D induced by restriction of dietary phosphorus is mediated by IGF-I, we measured the serum concentration of 1,25-(OH)2D in hypophysectomized rats treated with either GH (100 micrograms/day) or recombinant human IGF-I (150 micrograms/day) and fed either a normal or low phosphorus diet for 6 days. Restriction of dietary phosphorus in sham-hypophysectomized rats increased serum 1,25-(OH)2D from 97 +/- 13 to 251 +/- 36 pg/ml, or 159%, but had no effect on serum 1,25-(OH)2D in hypophysectomized rats. Restriction of dietary phosphorus in rats receiving GH increased, (P less than 0.001) serum 1,25-(OH)2D from 52 +/- 8 to 133 +/- 18 pg/ml, or 156%. Restriction of dietary phosphorus in rats receiving IGF-I increased (P less than 0.001) serum 1,25-(OH)2D from 33 +/- 5 to 94 +/- 11 pg/ml, or 185%, an increase equivalent to that observed in animals receiving GH. For a given diet, no significant differences were seen between the serum concentrations of 1,25-(OH)2D in animals receiving GH or IGF-I. These data indicate that IGF-I can restore the increase in serum 1,25-(OH)2D induced by restriction of dietary phosphorus to the same degree as GH. This strongly suggests that the GH-dependent increase in serum 1,25-(OH)2D induced by restriction of dietary phosphorus is mediated by IGF-I.

Animals↗
PubMed1984

Role of change in vitamin D metabolism with age in calcium and phosphorus metabolism in normal human subjects.

This study describes the age-related changes of vitamin D metabolism and its related hormones, immunoreactive PTH (iPTH) and calcitonin (CT) in normal human subjects. The objective was to assess their roles in the changes in metabolism of calcium and phosphorus with age. Serum calcium and phosphorus levels declined linearly with age from newborn infants to older adults (r = -0.385, P less than 0.01; r = -0.568, P less than 0.01). The serum calcium and phosphorus levels in adults of 51 yr of age or more were significantly lower than those in children and younger adults of 50 yr of age or less (P less than 0.025, P less than 0.01), whereas the calcium and phosphorus levels in cord blood were significantly higher than those in children and younger adults (P less than 0.025, P less than 0.01). The serum concentration of 1 alpha,25-dihydroxyvitamin D (1 alpha,25-(OH)2-Vit D) did not change in children and younger adults, being 42.0 +/- 1.4 (SE) pg/ml, but it significantly decreased to 31.4 +/- 1.9 pg/ml in older adults (P less than 0.01). There were no significant age-related changes in the serum concentrations of 25-hydroxyvitamin D, 24,25-dihydroxyvitamin D, or vitamin D-binding protein (DBP) among children, younger adults and older adults. The concentrations of all vitamin D metabolites and DBP in cord serum were significantly lower than those in children and younger adults (P less than 0.01). Serum iPTH levels were higher in older adults (P less than 0.05) and lower in cord blood (P less than 0.1), compared with those in children and younger adults, whereas the serum CT level was higher in cord serum (P less than 0.01). No sex differences were found in the serum concentrations of calcium, phosphorus, vitamin D metabolites, DBP, iPTH, and CT. The serum concentration of calcium or phosphorus did not correlate significantly with that of 1 alpha 25-(OH)2-Vit D by simple correlation analysis. Multivariate analysis, however, showed that the change in the serum concentration of 1 alpha,25-(OH)2-Vit D, as well as iPTH and CT, contributed to their correlation with the change in the serum concentrations of calcium and phosphorus. These data indicate that change in vitamin D metabolism might play some role in the age-related change of serum calcium and phosphorus levels in children and adults, but that calcium and phosphorus metabolism in the fetus might be regulated by some mechanisms other than vitamin D metabolism.

Adolescent↗