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Are There Fast-Food Choices for End-Stage Renal Disease Patients? A Look at Phosphorus and Potassium Content in Common Fast Foods

  • Christina Arquette
    Correspondence
    Address correspondence to Christina Arquette, MS, RD, LDN, George Washington University Southeast Davita Dialysis, 3857A Pennsylvania Ave, Southeast Washington, DC 20020.
    Affiliations
    Renal Nutrition, Davita Dialysis Center George Washington University - Southeast Washington, DC
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      Fast food is cheap, convenient, and common for the average American; adults consume an average of 11.3% of their daily calories from fast food.

      Centers 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.

      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.

      MedlinePLUs. Fast food tips. http://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000105.htm. Accessed January 24, 2014.

      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.
      • Byham-Gray L.
      • Stober J.
      • Wiesen K.
      A Clinical Guide to Nutrition Care in Kidney Disease.
      Mortality rates for ESRD exceed 20% per year.
      • Block G.A.
      • Klassen P.S.
      • Lazarus J.M.
      • et al.
      Mineral metabolism, mortality, and morbidity in maintenance hemodialysis.
      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.
      • McCann L.
      Pocket Guide to Nutrition Assessment of the Patient with Chronic Kidney Disease.
      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.
      • McCann L.
      Pocket Guide to Nutrition Assessment of the Patient with Chronic Kidney Disease.
      As of August 2013, 30% of dialysis patients have a phosphorus level greater than 5.5 mg/dL.

      US-DOPPS Practice Monitor, 2013; http://www.dopps.org/DPM. Accessed January 28, 2014.

      Potassium control is vital in ESRD, and elevated potassium leads to weakness, cardiac dysrhythmia, and cardiac arrest.
      • National Kidney Foundation
      KDOQI Clinical Practice Guidelines on Hypertension and Antihypertensive Agents in Chronic Kidney Disease.
      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.
      • McCann L.
      Pocket Guide to Nutrition Assessment of the Patient with Chronic Kidney Disease.
      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 Chart
      NameServings 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)29065022910492262
      KFC
       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 wing5214011450121106
      McDonalds
       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 egg16044021850274274
      Taco 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—beef463770261,3501,060477
      Wendy'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
      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 colleagues
      • Sarathy S.
      • Sullivan C.
      • Leon J.B.
      • et al.
      Fast food, phosphorus-containing additive, and the renal diet.
      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.
      • Sarathy S.
      • Sullivan C.
      • Leon J.B.
      • et al.
      Fast food, phosphorus-containing additive, and the renal diet.
      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.
      • Sarathy S.
      • Sullivan C.
      • Leon J.B.
      • et al.
      Fast food, phosphorus-containing additive, and the renal diet.
      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.

      Nutrient Information Sources

      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

      References

      1. Centers 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.

      2. MedlinePLUs. Fast food tips. http://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000105.htm. Accessed January 24, 2014.

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