Following a request from the European Commission, the Panel on Dietetic Products, Nutrition and Allergies derived Dietary Reference Values (DRVs) for phosphorus. The Panel considered data from balance studies, losses of phosphorus from the body and intestinal absorption for possible use in a factorial approach, and studies on phosphorus intake and long-term health outcomes. The Panel concluded that these data were insufficient for setting DRVs for phosphorus. Data on the calcium to phosphorus

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... tio in bones of healthy adults, adjusted for the proportion of phosphorus found outside bone, and data on whole-body calcium and phosphorus contents in Caucasian adults indicate that the calcium to phosphorus molar ratio in the body ranges from 1.4:1 to 1.9:1. Although the fractional absorption of phosphorus is higher than that of calcium, the Panel considered that the actual amounts of calcium and phosphorus that are available for absorption from the diet cannot be determined; therefore, the whole-body calcium to phosphorus ratio was used to set DRVs. The data were considered insufficient to derive Average Requirements and Population Reference Intakes. Based on the DRVs for calcium and considering a molar calcium to phosphorus ratio of 1.4:1 to 1.9:1, amounts of phosphorus were calculated. The Panel chose the lower bound of this range (a ratio of 1.4:1, which results in a higher phosphorus intake value) for setting an Adequate Intake (AI), taking into account estimated phosphorus intakes in Western countries, which are considerably higher than the values calculated. The AI is 160 mg/day for infants (7-11 months) and between 250 and 640 mg/day for children. For adults, the AI is 550 mg/day. Taking into consideration adaptive changes in phosphorus metabolism that occur during pregnancy and lactation, it was considered that the AI for adults also applies to pregnant and lactating women. for the preparatory work on this scientific opinion and EFSA staff: Anja Brönstrup, Sofia Ioannidou and Liisa Valsta for the support provided to this scientific opinion. Dietary Reference Values for phosphorus EFSA Journal 2015;13(7):4185 2 SUMMARY Following a request from the European Commission, the EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA) was asked to deliver a Scientific Opinion on Dietary Reference Values (DRVs) for the European population, including phosphorus. Phosphorus is involved in many physiological processes, such as in the cell's energy cycle, in regulation of the body's acid-base balance, as a component of the cell structure, in cell regulation and signalling, and in the mineralisation of bones and teeth. About 85 % of the body's phosphorus is in bones and teeth, 14 % is in soft tissues, including muscle, liver, heart and kidney, and only 1 % is present in extracellular fluids. Phosphorus homeostasis is intricately linked to that of calcium because of the actions of calcium-regulating hormones, such as parathyroid hormone (PTH) and 1,25dihydroxy-vitamin D (1,25(OH) 2 D), at the level of the bone, the gut and the kidneys. Phosphorus absorption occurs through passive diffusion and sodium-dependent active transport and via paracellular and cellular pathways. In adults, limited data suggest that net phosphorus absorption ranges from 55 to 80 % of intake. Phosphorus absorption is affected by the total amount of phosphorus in the diet and also by the type of phosphorus (organic versus inorganic), the food origin (animalversus plant-derived) and the ratio of phosphorus to other dietary components. Absorption is regulated by 1,25(OH) 2 D and PTH. Hypophosphataemia, defined by a serum inorganic phosphorus concentration of < 0.80 mmol/L (2.48 mg/dL), only rarely occurs because of inadequate dietary phosphorus intake, and is generally due to metabolic disorders. The major dietary contributors to phosphorus intake are foods high in protein content, i.e. milk and milk products followed by meat, poultry and fish, grain products and legumes. Based on data from 13 dietary surveys in nine European Union countries, mean phosphorus intakes range from 265 to 531 mg/day in infants, from 641 to 973 mg/day in children aged 1 to < 3 years, from 750 to 1 202 mg/day in children aged 3 to < 10 years, from 990 to 1 601 mg/day in children aged 10 to < 18 years and from 1 000 to 1 767 mg/day in adults ( 18 years). Balance studies in adults were considered to be heterogeneous and to have many limitations. Overall, balance studies, including those in children and pregnant women, could not be used for setting DRVs for phosphorus. In addition, it was considered that estimations of phosphorus absorption from the diet, as well as losses of phosphorus via urine and faeces, vary over a wide range, so that the factorial approach cannot be used for deriving the requirement for phosphorus. Evidence from human studies on the relationship between phosphorus intake and various health outcomes was also reviewed. It was considered that data on measures of bone health, cancer-related outcomes and evidence related to all-cause mortality and cardiovascular outcomes could not be used to derive DRVs for phosphorus.