Phosphorus Content in Commonly Consumed Beverages
2013; Elsevier BV; Volume: 24; Issue: 1 Linguagem: Inglês
10.1053/j.jrn.2013.10.002
ISSN1532-8503
Autores Tópico(s)Genetic Syndromes and Imprinting
ResumoResearchers agree that consuming soda leads to a myriad of health concerns, including the increased risk of diabetes, obesity, poor dental health, and cardiovascular disease, which can lead to stroke, myocardial infarction, and premature death.1Levine, MI. Kidney Disease Education. Nutrition: Phosphorus and the Kidney Diet. http://www.kidneyeducationmilevinemd.com/nutrition-rm3.php. Accessed September 3, 2013.Google Scholar Because certain sodas, especially dark colas, contain inorganic phosphates, or additives, in high amounts, soda consumption among patients with chronic kidney disease is even more dangerous.2Kalantar-Zadeh K. Gutekunst L. Mehrotra R. et al.Understanding sources of dietary phosphorus in the treatment of patients with chronic kidney disease.Clin J Am Soc Nephrol. 2010; 5: 519-530Crossref PubMed Scopus (346) Google Scholar Phosphorus is a mineral essential for the proper functioning of the body. It is found primarily in the bones and is necessary for all cellular processes.1Levine, MI. Kidney Disease Education. Nutrition: Phosphorus and the Kidney Diet. http://www.kidneyeducationmilevinemd.com/nutrition-rm3.php. Accessed September 3, 2013.Google Scholar, 3Fresenius Medical Care. Phosphorus. http://www.ultracare-dialysis.com/HealthyLifestyles/EatHealthy/Vitamins%20and%20Nutrients/Phosphorus.aspx. Accessed September 9, 2013.Google Scholar It plays an important role in controlling pH balance, energy production and storage, hormone secretion, utilization of B vitamins, oxygen delivery to tissues, and the growth of connective tissue. Most importantly, it works with calcium to build strong bones.2Kalantar-Zadeh K. Gutekunst L. Mehrotra R. et al.Understanding sources of dietary phosphorus in the treatment of patients with chronic kidney disease.Clin J Am Soc Nephrol. 2010; 5: 519-530Crossref PubMed Scopus (346) Google Scholar, 3Fresenius Medical Care. Phosphorus. http://www.ultracare-dialysis.com/HealthyLifestyles/EatHealthy/Vitamins%20and%20Nutrients/Phosphorus.aspx. Accessed September 9, 2013.Google Scholar In people with healthy, functioning kidneys, excess phosphorus is removed by the body. However, individuals with chronic kidney disease cannot adequately remove phosphorus and are at a higher risk of developing hyperphosphatemia.1Levine, MI. Kidney Disease Education. Nutrition: Phosphorus and the Kidney Diet. http://www.kidneyeducationmilevinemd.com/nutrition-rm3.php. Accessed September 3, 2013.Google Scholar This may ultimately result in elevated parathyroid hormone secretion, progressive deterioration of kidney function, renal bone disease, vascular calcification, increased risk of cardiovascular accidents, and higher mortality rates.2Kalantar-Zadeh K. Gutekunst L. Mehrotra R. et al.Understanding sources of dietary phosphorus in the treatment of patients with chronic kidney disease.Clin J Am Soc Nephrol. 2010; 5: 519-530Crossref PubMed Scopus (346) Google Scholar, 4Uribarri J. Phosphorus additives in food and their effect in dialysis patients.Clin J Am Soc Nephrol. 2009; 4: 1290-1292Crossref PubMed Scopus (63) Google Scholar Because elevated phosphorus affects bone and cardiovascular risk, the Kidney Disease Improving Global Outcomes guidelines refer to this condition as mineral bone disorder of chronic kidney disease.5Kidney Disease Improving Global OutcomesKDIGO clinical practice guidelines for the diagnosis, evaluation, prevention, and treatment of chronic kidney disease-mineral and bone disorder (CKD-MBD).Kidney Int. 2009; 76: S1-S130Crossref Google Scholar Patients with chronic kidney disease are likely to experience certain symptoms when their phosphorus gets too high. Individuals with diabetes may suffer from severe itching all over their body.1Levine, MI. Kidney Disease Education. Nutrition: Phosphorus and the Kidney Diet. http://www.kidneyeducationmilevinemd.com/nutrition-rm3.php. Accessed September 3, 2013.Google Scholar In the dialysis population, elevated serum phosphorus levels are a constant struggle for the clinical team and the patient alike. As a dietitian, there is a constant search for a solution to help renal patients control their serum phosphorus and in many cases to remember to take their phosphate binders. Americans have become accustomed to highly processed, packaged, convenience foods. This includes the increased consumption of soda and sugar-sweetened beverages. CNN reports that sweetened beverage intake should be limited to less than 12 oz per day, but nearly 1 in 20 Americans drink more than 48 oz of soda each day. This is not to mention that serving sizes have nearly tripled since the 1950s.6Park M. Half of Americans Sip Sugary Drinks Daily. CNN. August 2011. http://www.cnn.com/2011/08/31/health/soda-drinking-habits/index.html. Accessed September 12, 2013.Google Scholar In addition, processed foods in the early 1990s contributed approximately 470 mg per day to the American diet, but today this has more than doubled to provide 1,000 mg per day.6Park M. Half of Americans Sip Sugary Drinks Daily. CNN. August 2011. http://www.cnn.com/2011/08/31/health/soda-drinking-habits/index.html. Accessed September 12, 2013.Google Scholar These beverages pose a threat for patients with chronic kidney disease because of their high phosphorus content.2Kalantar-Zadeh K. Gutekunst L. Mehrotra R. et al.Understanding sources of dietary phosphorus in the treatment of patients with chronic kidney disease.Clin J Am Soc Nephrol. 2010; 5: 519-530Crossref PubMed Scopus (346) Google Scholar, 6Park M. Half of Americans Sip Sugary Drinks Daily. CNN. August 2011. http://www.cnn.com/2011/08/31/health/soda-drinking-habits/index.html. Accessed September 12, 2013.Google Scholar According to Kalantar-Zadeh and colleagues,2Kalantar-Zadeh K. Gutekunst L. Mehrotra R. et al.Understanding sources of dietary phosphorus in the treatment of patients with chronic kidney disease.Clin J Am Soc Nephrol. 2010; 5: 519-530Crossref PubMed Scopus (346) Google Scholar the amount of phosphorus absorbed from food additives is much higher (>90%) than that of natural sources, such as animal and plant proteins (40-60%).4Uribarri J. Phosphorus additives in food and their effect in dialysis patients.Clin J Am Soc Nephrol. 2009; 4: 1290-1292Crossref PubMed Scopus (63) Google Scholar Several preservative and additive salts containing phosphorus are found in processed, convenience foods. These additives are useful in prolonging shelf life, enhancing flavor, retaining moisture, and improving the color of the food item.4Uribarri J. Phosphorus additives in food and their effect in dialysis patients.Clin J Am Soc Nephrol. 2009; 4: 1290-1292Crossref PubMed Scopus (63) Google Scholar, 6Park M. Half of Americans Sip Sugary Drinks Daily. CNN. August 2011. http://www.cnn.com/2011/08/31/health/soda-drinking-habits/index.html. Accessed September 12, 2013.Google Scholar The form of phosphorus in additives is not bound to protein, but rather it is a salt that is readily absorbed in the intestinal tract. Table 1 illustrates the nutritional content, including the calorie, potassium, and phosphorus content found in commonly consumed beverages. It is of interest that most clear sodas are lower in phosphorus, but many still contain natural and added potassium (Gordon D, personal communication, July 12, 2013).7Pepsi Co. Nutrition Information. http://www.pepsicobeveragefacts.com/infobyproduct.php?prod_type=1026&prod_size=20&brand_fam_id=1051&brand_id=1000&product=Pepsi. Assessed July 12, 2013.Google ScholarTable 1Phosphorus and Potassium Content of Commonly Consumed BeveragesProductCaloriesPotassium (mg)Phosphorus (mg)Aquafina Flavor Splash Grape<1<185 Lemon<15767 Peach Mango<15782 Raspberry<1-62 Strawberry Kiwi<15782 Wild Berry<1<162A&W Root Beer174<1<1 Diet Root Beer<1<1<1 Cream Soda174<1<1 Diet Cream Soda<1<1<1Barq's Root Beer166<1<1 Barq's Diet Root Beer<112<1 Barq's Red Cream172<1<1 Barq's Diet Red Cream6<1<1 French Vanilla Cream168<1<1 Diet French Vanilla Cream2<1<1Canada Dry Ginger Ale140<1<1 Diet Ginger Ale<1<1<1 Cranberry Lime Seltzer<1<1<1 Mandarin Orange Seltzer<1<1<1 Raspberry Seltzer<1<1<1 Lemon Lime Seltzer<1<1<1 Tonic Water135<1<1 Club Soda<1<1<1Coca-Cola145<158 Coca-Cola with Lime1465156 Coke Zero24754 Diet Coke21827 Diet Coke with Lime32927 Cherry Coke156<156 Diet Cherry Coke22935 Cherry Coke Zero25056 Vanilla Coke200056 Vanilla Coke Zero24756Crush Orange162<1<1 Diet Orange<1<1<1 Grape16255 Cherry16255Dr. Pepper1502054 Dr. Pepper 1010<128 Diet Dr. Pepper<1<150 Dr. Pepper Cherry1502054 Cherry Vanilla1442860Fanta Apple182<1<1 Berry176262 Citrus1362<1 Grape183<1<1 Lemon168<1<1 Orange16753<1Fresca Original Citrus<1<1<1 Black Cherry<1<1<1 Peach Citrus<1<1<1Fruit Works Apple Raspberry15035100 Fruit Punch16560123 Guava Berry16556117 Passion Orange16560123 Peach Papaya16560123 Pink Lemonade1658063 Strawberry Melon165110120 Tangerine Citrus1653590 Tropical Berry16560140Hawaiian Punch17050175 Fruit Juicy17045173 Green Berry Rush17043173Lipton Iced Green Tea with Citrus701065 Iced Tea Sweetened701519 Iced Tea Unsweetened<11018Mello Yellow17010<1 Diet<1<1<1Mountain Dew110<1<1 Diet Mountain Dew<163<1 Mountain Dew Coe Red1701053 Mountain Dew Live Wire1705<1Mug Root Beer17015<1 Diet Mug Root Beer<110<1 Mug Cream Soda180<1<1 Diet Mug Cream Soda<1<1<1Nestea Lemon Sweet129<1<1 Honey Lemon Green12035<1 Raspberry135<1<1 Sweetened125<132 Unsweetened<1<132Orange Slice180<135 Cherry Slice165,<135 Dr. Slice180<135Pepsi1501053 Diet Pepsi<12533 Pepsi Max<12042 Pepsi Next351533 Wild Cherry1601053 Diet Pepsi Lime<14089 Diet Pepsi Vanilla<14589Pibb Xtra1452144 Pibb Zero23344Schweppes Ginger Ale180<1<1 Diet Ginger Ale<1<1<1 Tonic Water135<1<1 Club Soda<1<1<1Sierra Mist9035<1 Diet Sierra Mist<171<1 Sierra Mist Cranberry Splash16050<1 Diet Cranberry Splash<137<1 Sierra Mist Strawberry Kiwi14050<1 Diet Strawberry Kiwi5137<1Sprite144<1<1 Sprite Zero3.6110<1Tropicana Fruit Punch1309093 Lemonade1204038 Pink Lemonade1703937 Peach Papaya1204193 Strawberry Melon1507693Tropicana Twister Orange19553<1 Diet Orange053<1 Strawberry16530<1 Grape18053<1 Open table in a new tab Phosphorus additives on labels are often hard to decipher because of the use of complex names for the ingredients.2Kalantar-Zadeh K. Gutekunst L. Mehrotra R. et al.Understanding sources of dietary phosphorus in the treatment of patients with chronic kidney disease.Clin J Am Soc Nephrol. 2010; 5: 519-530Crossref PubMed Scopus (346) Google Scholar Phosphorus salts are typically included in a product's ingredient list by the manufacturer. However, in the United States, the U.S. Food and Drug Administration does not require manufacturers to list the quantity of phosphorus per serving on food labels.6Park M. Half of Americans Sip Sugary Drinks Daily. CNN. August 2011. http://www.cnn.com/2011/08/31/health/soda-drinking-habits/index.html. Accessed September 12, 2013.Google Scholar Therefore, it is extremely difficult to distinguish between natural phosphorus and phosphorus salts used as additives. Many renal patients mistakenly believe that if phosphorus is not listed on the Nutrition Facts label, then there is none in the food.2Kalantar-Zadeh K. Gutekunst L. Mehrotra R. et al.Understanding sources of dietary phosphorus in the treatment of patients with chronic kidney disease.Clin J Am Soc Nephrol. 2010; 5: 519-530Crossref PubMed Scopus (346) Google Scholar, 6Park M. Half of Americans Sip Sugary Drinks Daily. CNN. August 2011. http://www.cnn.com/2011/08/31/health/soda-drinking-habits/index.html. Accessed September 12, 2013.Google Scholar It is also important to consider that phosphorus is not the only mineral found in soft drinks. Sodium and potassium often accompany phosphorus.4Uribarri J. Phosphorus additives in food and their effect in dialysis patients.Clin J Am Soc Nephrol. 2009; 4: 1290-1292Crossref PubMed Scopus (63) Google Scholar Salts have the ability to preserve food and improve appearance. Therefore, phosphorus salts are used to enhance flavor and shelf life, meaning they are used most commonly in soft drinks. This research indicates that as a renal dietitian it is extremely important to advise patients to reduce their intake of processed foods such as soda and choose foods with natural occurring, protein-bound phosphorus such as meat.2Kalantar-Zadeh K. Gutekunst L. Mehrotra R. et al.Understanding sources of dietary phosphorus in the treatment of patients with chronic kidney disease.Clin J Am Soc Nephrol. 2010; 5: 519-530Crossref PubMed Scopus (346) Google Scholar, 4Uribarri J. Phosphorus additives in food and their effect in dialysis patients.Clin J Am Soc Nephrol. 2009; 4: 1290-1292Crossref PubMed Scopus (63) Google Scholar http://www.pepsico.com/ http://us.coca-cola.com/ http://www.fresca.com/flash_content/ http://www.rootbeer.com/ http://www.canadadry.com/ http://www.fanta.com/en_US/pages/landing/index.html http://www.aquafina.com/products.php http://www.tropicana.com/#/trop_home/home.swf
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