years) and found no increase in urine deoxypyridinoline excretion (a marker of bone resorption). For all these reasons, it is doubtful whether phosphorus intakes, within the range currently thought to be experienced by the U.S. population and/or associated with serum Pi values in the normal range, adversely affect bone health.

Normal, healthy, term-born infants, like adults, can adjust to a relatively wide range of dietary Ca:P ratios as provided in contemporary infant formulas. However, as a result of developmental immaturity in renal handling of phosphorus by infants, ECF [Ca2+] and Pi concentrations are closer to saturation in infancy, and infants are, therefore, more at risk of developing hypocalcemia as a consequence of hyperphosphatemia (DeVizia and Mansi, 1992). However, in the first month of life, some infants exhibit unusual sensitivity to phosphorus intakes above those associated with human milk. In the past, the clinical syndrome of late neonatal hypocalcemic tetany was observed when infants were fed whole evaporated cow milk with a very high phosphorus content (DeVizia and Mansi, 1992). Surprisingly, even with the introduction of modified cow milk formulas with phosphorus content reduced to one-half or less than that of evaporated whole milk, the syndrome of hypocalcemia has still been observed in young infants (Specker et al., 1991b; Venkataraman et al., 1985). However, the phosphorus content of such formulas is still substantially higher than that of human milk (Specker et al., 1991b). If such hyperphosphatemia is allowed to persist during early infancy, parathyroid hyperplasia, ectopic calcifications, and low serum calcitriol may occur (Portale et al., 1986). In such cases, the compensatory mechanisms for handling phosphate loads, mainly renal excretion, must be overwhelmed, leading to excessive phosphorus retention and the other metabolic consequences.

It has also been suggested that a high content of phosphorus and calcium in an infant's diet may be a predisposing factor for the development of retention acidosis (Manz, 1992). It is not possible to identify, in advance, infants at risk for these syndromes unless they have renal dysfunction. Based on the data of Specker et al. (1991b), the risk of hypocalcemia (serum calcium less than 1.1 mmol/liter [4.4 mg/dl]) is 30 out of 10,000 neonates fed such formulas. Human milk with its low phosphorus content is both safer and better suited to the growth needs of the infant than cow milk (Manz, 1992). Finally, one report associates high intakes of phosphoric acid-containing cola beverages with slight reductions of serum calcium in Mexican children (Mazariegos-Ramos et al., 1995), but it is not clear to what extent the effect is due to the acid load of



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