Phosphate-based additives in processed foods: is excess exposure a cause for concern? A cross-sectional examination of the United States packaged food supply

Background: Limiting dietary phosphate intake to slow the progression of chronic kidney disease (CKD) to dialysis and death requires knowledge of the total quantity and forms of phosphate in food, information not currently required on United States food labels. Phosphate additives (P-additives) have more rapid/efficient absorption than naturally occurring dietary phosphate and are not accounted for in nutrient databases despite their greater contribution to total phosphorus intake. Objectives: This study aims to examine the presence of P-additives in United States foods and beverages sold by the top 25 United States manufacturers in 2020. Methods: Cross-sectional ingredient data for all products from the top 25 manufacturers were sourced from Label Insight (a NielsenIQ company) in May 2021. The presence of inorganic or organic P-additives in each product was determined by reviewing ingredient lists. The number and proportion of products containing P-additives overall and for each phosphate class (inorganic or organic) and individual P-additives were calculated, as well as the revenue derived for each component examined. Sales-weighted proportions were also examined. Results: P-additives were present in 56% of 39,937 products from the top 25 United States food and beverage manufacturers representing >$120 billion in consumer purchases in 2020. Top P-additives in products included lecithin (32%), sodium phosphate (13%), calcium phosphate (11%), modified starches (10%), and sodium acid pyrophosphate (6%), whereas P-additive numbers per product ranged from 0 to 8 with 21% of foods containing >1 Padditive. Conclusions: This study illustrates widespread exposure to P-additives in all packaged food and beverage categories in the United States, with sales-weighted data showing a high volume of purchases even in categories containing a lower percentage of products with P-additives. Research exploring the safety of excessive P-additive exposure in CKD and healthy populations requires the Food and Drug Administration to make labeling of the total phosphorus content on nutrition facts labels mandatory.