Are There Fast-Food Choices for End-Stage Renal Disease Patients? A Look at Phosphorus and Potassium Content in Common Fast Foods
2014; Elsevier BV; Volume: 24; Issue: 3 Linguagem: Inglês
10.1053/j.jrn.2014.02.004
ISSN1532-8503
Autores Tópico(s)Dialysis and Renal Disease Management
ResumoFast food is cheap, convenient, and common for the average American; adults consume an average of 11.3% of their daily calories from fast food.1Centers for Disease Control and Prevention. Caloric intake from fast food among adults: United States, 2007-2010. http://www.cdc.gov/nchs/data/databriefs/db114.htm. Accessed January 24, 2014.Google Scholar Fast food has become routine in most American's lifestyles, including people with end-stage renal disease (ESRD). It is known that most fast foods are high in calories, fat, sugar, and salt because fast-food companies must provide nutritional facts at their stores and online.2MedlinePLUs. Fast food tips. http://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000105.htm. Accessed January 24, 2014.Google Scholar The phosphorus and potassium concentrations in foods are unfortunately not readily available to most patients or practitioners. Controlled serum phosphorus and potassium can be extremely challenging in patients with ESRD. Remembering what foods to avoid, which foods to take a binder with, and why controlling a diet is important are continual hurdles in obtaining and maintaining phosphorus and potassium levels in patients. Elevated phosphorus has been implicated as a key risk factor in mortality rate, decreased quality of life, and extraskeletal calcification.3Byham-Gray L. Stober J. Wiesen K. A Clinical Guide to Nutrition Care in Kidney Disease.2nd ed. Academy of Nutrition and Dietetics, Chicago, IL2013Google Scholar Mortality rates for ESRD exceed 20% per year.4Block G.A. Klassen P.S. Lazarus J.M. et al.Mineral metabolism, mortality, and morbidity in maintenance hemodialysis.J Am Soc Nephrol. 2004; 15: 2208-2218Crossref PubMed Scopus (2208) Google Scholar The National Kidney Foundation Kidney Disease Outcomes Quality Initiative serum phosphorus recommendation for a person on hemodialysis is 3.5 to 5.5 mg/dL.5McCann L. Pocket Guide to Nutrition Assessment of the Patient with Chronic Kidney Disease.4th ed. National Kidney Foundation, Mountain View, CA2009: 2-15Google Scholar The daily recommendation of phosphorus intake is 800 to 1000 mg/day of phosphorus or 10 to 12 mg of phosphorous per gram of protein.5McCann L. Pocket Guide to Nutrition Assessment of the Patient with Chronic Kidney Disease.4th ed. National Kidney Foundation, Mountain View, CA2009: 2-15Google Scholar As of August 2013, 30% of dialysis patients have a phosphorus level greater than 5.5 mg/dL.6US-DOPPS Practice Monitor, 2013; http://www.dopps.org/DPM. Accessed January 28, 2014.Google Scholar Potassium control is vital in ESRD, and elevated potassium leads to weakness, cardiac dysrhythmia, and cardiac arrest.7National Kidney Foundation KDOQI Clinical Practice Guidelines on Hypertension and Antihypertensive Agents in Chronic Kidney Disease.Am J Kidney Dis. 2004; 43: S1-S290Abstract Full Text Full Text PDF PubMed Google Scholar The National Kidney Foundation Kidney Disease Outcomes Quality Initiative recommends a serum potassium level of 3.5 to 6.0 mEq/L, with a daily potassium intake of 2 to 3 g/day adjusted to serum levels.5McCann L. Pocket Guide to Nutrition Assessment of the Patient with Chronic Kidney Disease.4th ed. National Kidney Foundation, Mountain View, CA2009: 2-15Google Scholar Dietitians push fresh food and home cooking, but in reality patients are going to eat fast food. It is important for registered dietitians to help steer patients to "better" choices that will allow patients to feel less restricted in eating while keeping their phosphorus and potassium in control. Table 1 provides the phosphorus and potassium content of common entrees at 5 fast-food chains that had their nutritional content available through the U.S. Department of Agriculture (USDA) Nutrient Database. Unfortunately, many menu options are not available through the database and are not included in the data.Table 1Fast-Food Comparison ChartNameServings Size (g)Calories (kcal)Protein (g)Sodium (mg)Potassium (mg)Phosphorus (mg)Burger King Cheeseburger11127011630198159 Chicken nuggets (6pc)10528013452313204 Croissan'wich (egg, cheese)12133011620203301 Croissan'wich (sausage, egg, cheese)16550019930261228 Double Whopper (cheese)4211,070441,780796539 Double Whopper (no cheese)37590035980718415 Fish sandwich198530171,360408230 French fries (medium)1534104570715182 Hamburger1002309460217126 Original chicken sandwich21864021,140453255 Whopper (cheese)314730261,260534357 Whopper (no cheese)29065022910492262KFC Biscuit (1)54180453060305 Extra-crispy chicken—breast181490351,140467389 Extra-crispy chicken—drumstick5716013390135113 Extra-crispy chicken—thigh10837018760292246 Extra-crispy chicken—whole wing5821012490129111 Extra-crispy tenders (3)15538033940470420 Original Recipe chicken—breast178320361,130484406 Original Recipe chicken—drumstick5612011380156127 Original Recipe chicken—thigh11029018850255210 Original Recipe chicken—whole wing5214011450121106McDonalds Big Mac21555025970396262 Cheeseburger11430015680228160 Egg McMuffin13529015740218252 Filet-o-Fish14239015590312195 French fries (medium)1173804270697149 Hamburger10025012480192107 McChicken14336014800227182 McNuggets, 6 piece9828013540239258 Quarter Pounder (cheese)202520301,100442325 Quarter Pounder (no cheese)17141724730388212 Sausage McMuffin with egg16044021850274274Taco Bell Bean burrito19837013980483302 Burrito Supreme (beef)248420171,100492316 Burrito Supreme (chicken)248400211,060655404 Burrito Supreme (steak)248390171,100562325 Crunchy taco (beef, lettuce, cheese)781708290163139 Nacho Supreme19144012640569292 Nachos993304370358196 Soft taco (beef, lettuce, cheese)9620010510155160 Fiesta taco salad—beef463770261,3501,060477Wendy's Crispy chicken sandwich14238015680233229 Double stack with cheese170420271,060377229 French fries (medium)1424105440888179 Homestyle chicken filet sandwich247510291,200524370 Jr. cheeseburger11429016800203153 Jr. hamburger10225014600205125 Regular chicken nuggets9027014520204221 Ultimate chicken sandwich23137034880511388 Open table in a new tab The calorie, protein, and salt nutrient concentrations were collected from the fast-food company's website, and the phosphorus and potassium concentrations were obtained from the USDA's Nutrient Database. Sarathy and colleagues8Sarathy S. Sullivan C. Leon J.B. et al.Fast food, phosphorus-containing additive, and the renal diet.J Ren Nutr. 2008; 18: 466-470Abstract Full Text Full Text PDF PubMed Scopus (40) Google Scholar showed that few fast-food entrees and side dishes are appropriate for a renal diet because of the added phosphorus from phosphorus-containing additives. USDA uses the recipe provided by the restaurant to calculate the micronutrients; unfortunately, this does not contain preservatives or additives added to the food, meaning that the phosphorus content provided could be less than half of the actual phosphorus consumed for each item.8Sarathy S. Sullivan C. Leon J.B. et al.Fast food, phosphorus-containing additive, and the renal diet.J Ren Nutr. 2008; 18: 466-470Abstract Full Text Full Text PDF PubMed Scopus (40) Google Scholar It is unlikely that a McDonald's Big Mac has only 262 mg of phosphorus, and it could potentially have 2 to 3 times that amount.8Sarathy S. Sullivan C. Leon J.B. et al.Fast food, phosphorus-containing additive, and the renal diet.J Ren Nutr. 2008; 18: 466-470Abstract Full Text Full Text PDF PubMed Scopus (40) Google Scholar Understanding that the data provide the minimum amount of phosphorus, it is easy to see how a fast-food meal can quickly exceed the phosphorus and potassium recommendations for the day. Looking at Burger King, McDonald's, and Wendy's, the regular plain hamburger looks like the best choice with the lowest phosphorus and potassium. In general, Taco Bell has few ideal options, with their crunchy and soft tacos as the best options; however, it is rare for people to eat just 1 taco. KFC has a similar issue as Taco Bell, in which someone would almost never eat 1 drumstick or 1 wing so as to meet the recommended nutrient intake. These data show that there are options at fast-food restaurants that can fit into the recommended diet for ESRD patients. They also demonstrate that gathering accurate information can be challenging, and finding the true amount of phosphorus and potassium in the foods may not be readily available. Because fast food will be a part of the diets of many ESRD patients, it is vital for registered dietitians to help guide patients to better options. Further research into the phosphorus and potassium contents of served fast-food entrees is needed to have accurate nutrient concentrations on which to base food recommendations. Burger King: http://www.bk.com; 866-394-2493 McDonald's: http://www.mcdonalds.com; 800-244-6227; 2111 McDonald's Drive, Oak Brook, IL 60523 KFC: http://www.kfc.com; 1900 Colonel Sanders Ln., Louisville, KY 40213 Taco Bell: http://www.tacobell.com/nutrition/information; 800-8226-235; 1 Glen Bell Way, Irvine, CA 926185 Wendy's: http://www.wendys.com; 866-624-8140; One Dave Thomas Blvd., Dublin, OH 43017 USDA Nutrient Database: http://ndb.nal.usda.gov/ndb/search/list
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