High dietary phosphorus intake is associated with an increased risk of type 2 diabetes in the large prospective E3N cohort study

Francesca Romana Mancini, Aurélie Affret, Courtney Dow, Beverley Balkau, Françoise Clavel-Chapelon, Fabrice Bonnet, Marie Christine Boutron-Ruault, Guy Fagherazzi*

*Corresponding author for this work

Research output: Contribution to journalArticleResearchpeer-review

26 Citations (Scopus)


Phosphorus is an essential nutrient; the adult recommended daily intake ranges from 550 to 700 mg/day, with a tolerated upper limit of 4000 mg/day. Phosphorus intake has increased in the general population in recent years, and simultaneously an alarming rise of type 2 diabetes incidences has been observed. No study has investigated the relationship between phosphorus intake and the risk of type 2 diabetes. To evaluate the association between phosphorus intake and incidence of type 2 diabetes. Among 71,270 women from the French E3N-EPIC cohort, 1845 cases of incident type 2 diabetes were validated during follow-up (1993–2011). Adjusted Cox proportional hazards regression models were used to calculate hazard ratios and 95% confidence intervals (95% CI) for the associations between phosphorus intake and type 2 diabetes risk, adjusted on potential confounders. The overall mean (±SD) phosphorus intake was 1477 mg/day (±391 mg/day). High phosphorus intake was associated with risk of type 2 diabetes. In multivariate models, compared with women in the 1st quartile of phosphorus intake (<1203 mg/day), those included in the 2nd (1203–1434.0 mg/day), 3rd (1434–1700 mg/day), and 4th (>1700 mg/day) were at a higher risk of type 2 diabetes, with a hazards ratios (95% CI) of 1.18 (1.00–1.38), 1.41 (1.20–1.66) and 1.54 (1.25–1.90), respectively. Our results may have important public health implications for dietary recommendations in the prevention of type 2 diabetes. More studies are warranted to better understand the biological mechanisms underlying this positive association.

Original languageEnglish
Pages (from-to)1625-1630
Number of pages6
JournalClinical Nutrition
Issue number5
Publication statusPublished - Oct 2018
Externally publishedYes


  • Dietary intake
  • E3N cohort
  • Phosphorus
  • Risk
  • Type 2 diabetes


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