ABSTRACT
Total body phosphorus balance is tightly regulated through an intricate system of endocrine feedback loops that coordinate phosphorus trafficking between dietary sources, bone and soft tissue stores, and the kidney. Under normal conditions, excess dietary phosphorus intake is the primary factor leading to disturbances in total body phosphorus balance in free-living adults. Epidemiologic data showing that these disturbances are associated with cardiovascular disease events and death have fueled interest in dietary phosphorus restriction as a potential strategy for improving cardiovascular outcomes, particularly in chronic kidney disease. However, successfully restricting dietary phosphorus intake in free-living adults is challenging because of the wide variety of personal, cultural, and environmental barriers to limiting dietary phosphorus consumption in individuals consuming typical Westernized diets. Among these, low socioeconomic status plays a particularly important role in disturbing systemic phosphorus homeostasis by promoting excess intake of phosphorus with high bioavailability. This occurs not only because of difficulty in affording lower-phosphorus foods, but also because of specific elements of the built environment that can promote excess phosphorus intake via reduced access to low-phosphorus food options. Accordingly, any serious effort to reduce phosphorus intake requires an understanding of both individual and contextual socioeconomic factors that serve as obstacles to reducing total phosphorus intake per day. This chapter focuses on discussing the major socioeconomic factors that affect dietary phosphorus consumption in the interest of increasing the understanding of the most important barriers to maintaining normal phosphorus balance in individuals consuming typical Westernized diets.
