FP306PRIOR DIETARY PHOSPHATE EXPOSURE ALTERS THE HORMONAL AND URINARY REPONSE TO AN ORAL PHOSPHATE LOAD IN HEALTHY YOUNG ADULTS
Notice bibliographique
Résumé
INTRODUCTION AND AIMS: Dysregulated phosphate metabolism is a risk factor for CVD-related events and mortality in the general population, and becomes particularly evident as kidney function declines. However, circulating phosphate rarely increases above the normal range until GFR is <30mL/min. The excretion profile of phosphate following an oral load and the hormonal response to the challenge reveals impaired excretion in the absence of elevated serum phosphate. Several long-term (vitamin D, fibroblast growth factor 23 (FGF-23)) and short term (parathyroid hormone (PTH)) factors regulate phosphate absorption and urinary excretion. The objective of this study was to determine the impact of dietary phosphate modification on the acute hormonal response and urinary excretion profile of an oral phosphate challenge in healthy individuals. METHODS: In each cycle of this randomized cross-over study, participants (N=15) either consumed a dietician-designed low-phosphorus (LP) diet (750 mg) containing 1500 mg calcium, or the diet plus a 1250 mg phosphorus supplement (HP) for five days. On the sixth morning, fasted participants consumed a 500 mg oral phosphorus challenge. Levels of phosphate, calcium, magnesium, PTH, vitamin D metabolites and FGF-23 were measured in blood samples at baseline and hourly for 3 hours. Phosphate, calcium, magnesium and the fractional excretion of each mineral was assessed in the urine at baseline and for 3 hours following the oral challenge. RESULTS: The mean age of the participants was 23.3±2.5 years, 64% (N=9) were female, and the mean creatinine was 76.5±12.1. During the HP cycle, the 24-hour urine excretion of phosphate increased from 21.5±10.8 to 49.9±14.2 mmol/day (p<0.0001). At baseline, paired analysis revealed FGF-23 (55.2±41.3 vs 63.7±38.8 pg/mL, p<0.01) and PTH (3.8±1.2 vs 4.6±1.5 pmol/L, p<0.05) to be significantly elevated with the HP diet whereas circulating calcium, phosphate and magnesium were similar. Fractional excretion (FE) of phosphate and urinary phosphate-to-creatinine ratio were significantly higher at baseline in response to HP, whereas the FE of calcium and urinary calcium to creatinine ratio did not change. Various vitamin D metabolites were not altered by the phosphate diet, however, the 25-OH-D3:24,25-D3 ratio was decreased significantly with the HP diet (16.9±4.9 vs 14.6±2.7 ng/mL, p<0.05).Following the oral challenge, serum phosphate increased similarly in both diet conditions at 1 hour (+0.15mM, p<0.001) and returned to baseline by 2 and 3 hours. Following the LP diet, there were no differences in PTH whilst fractional excretion of phosphate was significantly increased over baseline at 2 and 3 hours. In contrast, while on the HP diet, PTH decreased significantly from baseline at 1 and 2 hours following the phosphate challenge (-0.7 and 1.1 pmol/L, p<0.05) and FE of phosphate was significantly decreased from baseline at 1 hour. CONCLUSIONS: In healthy people, a chronic high dietary intake of phosphate, while increasing resting fractional excretion, appears to blunt the acute hormonal and functional response to an oral phosphate challenge. The dietary level of phosphate appears to be an important regulator of the hormonal response and urinary excretion of a defined phosphate load. Detection of early onset of phosphate intolerance in otherwise healthy individuals may be early indicator of CVD risk.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».