PRODUCT UPDATE Cereal Choices to Start the Day Right Kristin Sheridan, RD, LD Breakfast is the most important meal of the day. How often have we heard this and how often have we educated our patients on the importance of breakfast? Ready-to-eat cereals are popular, quick, and easy breakfast foods for patients of all ages. It is our job to help patients choose a cereal that fits well into their renal diet while helping them wade through claims regarding fiber, whole grains, vitamins, and minerals. With respect to cereals geared toward children, there may be concerns that some of them are high sugar containing, presweetened foods. However, other cereals might provide a way to increase the uptake of fiber and vitamins as well as provide increased choices in an already limited diet. Armed with the proper information, we can help patients choose the right cereal. To help the renal dietitian sift through information, a review of several cereal companies websites revealed the following: General Mills Big G cereals contain at least 8 g whole grain per serving. 1 They fortify their entire line of children s cereals with calcium and vitamin D. 1 A nutrition highlights panel is displayed on the front of the Big G cereal boxes to provide information related to calories, sugar, saturated fat, and sodium content, in addition to other nutrients that the company deems to be key. 1 Kellogg s has added fiber to many of their cereals for children. They have also displayed some nutrition information on the front of their boxes as a way to make it easier for consumers to see the information quickly without looking at the nutrition panel. These are referred to by the company as GDAs, Guideline Daily Amounts. (Note that the GDAs are based on % daily values University Hospitals Case Medical Center, Cleveland, Ohio. Address reprints requests to Kristin Sheridan, RD, LD, University Hospitals Medical Center, 11100 Euclid Ave, 2100 Lakeside Building, Dialysis Unit, Cleveland, OH 44106. E-mail: Kristin.sheridan@uhhospitals.org Ó 2010 by the National Kidney Foundation, Inc. All rights reserved. 1051-2276/$36.00 doi:10.1053/j.jrn.2010.06.017 and are not related to the GDAs of the United Kingdom s governmental standards overseen by their Food and Drink Federation. This was confirmed through a telephonic conversation with a Kellogg s representative.) All cereal boxes display calories, total fat, sodium, and sugar content. They also display information for a maximum of any 2 of the following nutritional factors: calcium, fiber, magnesium, potassium, vitamins A, C, and E. 2 As renal dietitians, we must rise to the additional challenge of assessing appropriate intake of minerals such as potassium, calcium, and phosphorus that are present in foods. This challenge is further complicated for the pediatric renal dietitian who is also involved in helping patients select ageappropriate foods. Table 1 presents the nutrition information for major cereals consumed by the pediatric population, and most likely by many adult patients as well. Such information can be used to determine whether any particular cereals could be safely incorporated into a patient s diet and helps give more choices to our patients. General Mills, Inc, P.O. Box 9452, Minneapolis, MN 55440, Phone: 1-800-248-7310 (7:30 AM to 5:30 PM weekdays, CT). Kellogg s Consumer Affair, Kellogg Company, P. O. Box CAMB, Battle Creek, MI 49016, Phone: 269-961-2000 and 1-800-962-1413. Post Foods, LLC, Attn: Consumer Services Post Foods, LLC, 800 Market Street, St. Louis, MO 63101, Phone: 1-800-431-POST (9 AM to 5 PM, Monday to Friday, Eastern Time). The Quaker Oats Company, P.O. Box 049003, Chicago, IL 60604-9003, Phone: 1-800-367-6287, Cap n (Phone: 1-800-234-6281). References 1. Benefits of Cereal. General Mills: Big G Nutrition. 2009 General Mills. Available at: http://www.generalmills.com/ corporate/health_wellness/pdfs/benefits_of_cereal.pdf. Accessed June 13, 2010. 2. Kellogg Cereal GDAs. Kellogg Nutrition. 2010 Kellogg NA Co. Available at: http://www.kelloggsnutrition.com/learnabout-labels/kellogg-gdas.html. Accessed June 13, 2010. Journal of Renal Nutrition, Vol 20, No 5 (September), 2010: pp e23ee28 e23
e24 Table 1. Cereals Nutrition Information Calcium Phosphorus Vitamin A Vitamin D Vitamin C Cereal* Serving Size Kcal PRO Total Fat Saturated Fat Trans Fat Cholesterol CHO Fiber Sugars K1 Na1 % DV % DV Phosphate Additives % DV %DV % DV General Mills Apple Banana Nut Berry Burst d Triple Berry Oat Cluster 3 / 4 cup 120 2 1.5 24 2 11 65 65 10 6 Trisodium 3 / 4 cup 100 1 1 23 1 9 70 160 10 6 Trisodium 3 / 4 cup 100 2 1 22 2 8 70 170 10 8 Trisodium 3 / 4 cup 100 2 1 22 2 8 60 135 8 NA Trisodium 1 cup 100 3 2 20 3 1 170 160 10 10 Tripotassium 3 / 4 cup for 80 2 1.5 15 2 1 130 120 8 8 Tripotassium children under 4 3 / 4 cup 100 1 1 23 1 9 60 170 10 4 Trisodium 3 / 4 cup 110 2 1 23 2 10 55 170 10 6 Trisodium Fruity 3 / 4 cup 100 1 1.5 23 2 9 60 135 10 6 Trisodium MultiGrain 1 cup 110 2 1 23 3 6 85 160 10 8 Trisodium Yogurt Burst d Strawberry Honey Nut 3 / 4 cup 120 2 2 0.5 0 0 24 2 9 65 180 10 8 Trisodium 3 / 4 cup 110 2 1.5 22 2 9 115 190 10 10 Tripotassium Boo Berry 1 cup 130 1 1 28 1 12 35 190 10 6 Tricalcium & Chex 3 / 4 cup 130 1 2.5 26,1 8 55 240 10 4 None listed at Chex 3 / 4 cup 120 1 2 25,1 8 40 180 10 2 None listed at Chex Corn 1 cup 120 2 0.5 26 1 3 50 290 10 NA None listed at 10 6 10 15 10 10 SHERIDAN
Chex Honey Nut 3 / 4 cup 120 2 0.5 28 1 9 45 200 10 2 None listed at Chex Multi 3 / 4 cup 160 3 1.5 39 6 10 190 310 10 15 None listed at Bran Chex Rice 1 cup 100 2 0 23 0 2 45 250 10 NA None listed at Chex Wheat 3 / 4 cup 160 5 1 38 5 5 170 340 10 15 Trisodium 3 / 4 cup 130 1 3 0.5 0 0 25 1 10 45 220 10 4 Trisodium Toast Cocoa Puffs 3 / 4 cup 100 1 1.5 23 2 11 70 150 10 6 Tricalcium Cocoa Puffs 3 / 4 cup 110 1 1.5 23 1 11 40 160 10 4 Tricalcium Combos, & Vanilla Cookie Crisp 3 / 4 cup 100 1 1 22 1 10 40 150 10 4 Tricalcium Sprinkles Cookie Crisp Count Chocula Dora the Explorer Franken Berry 3 / 4 cup 100 1 1 23 1 10 40 150 10 4 Tricalcium & 3 / 4 cup 110 1 1 23 1 12 55 160 10 4 Tricalcium 3 / 4 cup 100 1 1.5 23 3 6 45 180 10 4 Dicalcium & 1 cup 130 1 1 29 1 12 40 200 10 6 Tricalcium & 3 / 4 cup 120 2 1 26 1 11 60 270 10 4 Trisodium Golden Grahams Kix 1¼ cups 110 2 1 25 3 3 60 190 15 NA Trisodium Honey Kix 1¼ cups 120 2 1 28 3 6 75 190 15 NA Trisodium Lucky Charms 3 / 4 cup 110 2 1 22 1 11 45 190 10 4 Trisodium Reese s Puffs 3 / 4 cup 120 2 3 0.5 0 0 22 1 11 60 180 10 6 Tricalcium Trix 1 cup 120 1 1.5 28 1 11 50 190 10 6 Tricalcium & (Continued) CEREAL CHOICES TO START THE DAY RIGHT e25
Table 1. Cereals Nutrition Information (Continued) Cereal* Serving Size Kcal PRO Total Fat Saturated Fat Trans Fat Cholesterol CHO Fiber Sugars K1 Calcium Phosphorus Vitamin A Vitamin D Vitamin C Na1 % DV % DV Kellogg s mg or %DV Apple Jacks 1 cup 100 1 0.5 25 3 12 35 130 0 11 mg Calcium Cocoa Krispies 3 / 4 cup 120 1 1 0.5 0 0 27,1 12 60 150 4 29 mg None listed at Corn Flakes 1 cup 10 24 1 2 25 200 0 14 mg None listed at Corn Pops 1 cup 120 1 0 29 3 10 45 125 0 15 mg None listed at Crispix 1 cup 110 2 0 25,1 4 40 220 0 26 mg None listed at Froot Loops 1 cup 110 1 1 0.5 0 0 25 3 12 35 135 0 19 mg None listed at Flakes 3 / 4 cup 110 1 0 27 1 11 20 140 0 10 mg None listed at Flakes, 1 cup 120 2 0 28,1 8 45 180 0 24 mg None listed at Reduced Sugar Honey 3 / 4 cup 100 2 0.5 24 1 15 40 50 0 46 mg None listed at Smacks Keebler Cookie Cereal Mini Wheats, Big Bite Mini Wheat, Bite Size Blueberry Muffin Streusel Little Bites 1 cup 110 2 1 26 1 12 40 170 0 NA None listed at 5 biscuits 180 5 1 41 5 10 170 5 0 153 mg None listed at 24 biscuits 200 6 1 48 6 12 200 5 0 173 mg None listed at 24 biscuits 180 4 1 43 5 12 17 165 mg None listed at 24 biscuits 180 4 1 44 5 12 18 101 mg None listed at 52 biscuits 200 5 2 1 0 0 45 6 12 270 200 0 200 mg None listed at Phosphate Additives % DV %DV % DV 25 10 25 e26 SHERIDAN
Little Bites, Honey Nut Mini Wheats, Little Bites, Original Maple & Brown Sugar Strawberry Delight Unfrosted, Bite Size 46 biscuits 190 5 1 47 6 12 200 120 0 200 mg None listed at 51 biscuits 190 5 1 46 6 12 20 15% None listed at 24 biscuits 190 4 1 44 5 13 18 148mg None listed at 24 biscuits 180 4 1 43 5 12 17 15% None listed at 30 biscuits 200 6 1.5 46 6 1 260 10 0 15% None listed at Rice Krispies 1¼ cups 130 2 0 29,1 4 30 220 0 36 mg None listed at 3 / 4 cup 110 1 0 27 0 12 20 130 0 24 mg None listed at Krispies Rice Krispies 3 / 4 cup 120 1 1.5 0 0 9 25 170 0 24 mg None listed at Treats Cereal Smorz 1 cup 120 1 2 0.5 0 0 25,1 13 30 140 0 20 mg Sodium hexameta Post Alpha Bits 1 cup 110 2 1 23 2 10 60 160 0 8 None listed at 3 / 4 cup for 80 2 1 18 1 7 45 120 0 6 None listed at children under 4 Golden Crisp 3 / 4 cup 110 2 0 24,1 14 45 25 0 4 None listed at Honeycomb 1½ cups 130 2 1 28 1 10 50 180 0 4 None listed at Honeycomb with Flavoring Fruity Pebbles Cocoa Pebbles 3 / 4 cup 130 2 1.5 0.5 0 0 27 2 10 60 190 0 6 None listed at 3 / 4 cup 120 1 1 26 0 11 20 19 None listed at 3 / 4 cup 120 1 1 26 0 11 50 190 0 2 None listed at 25 10 25 25 10 25 15 10 10 25 8 10 15 10 0 15 25 0 15 10 0 15 25 10 15 25 0 (Continued) CEREAL CHOICES TO START THE DAY RIGHT e27
Table 1. Cereals Nutrition Information (Continued) Cereal* Serving Size Kcal PRO Total Fat Saturated Fat Trans Fat Cholesterol CHO Fiber Sugars K1 Calcium Phosphorus Vitamin A Vitamin D Vitamin C Na1 % DV % DV Cupcake Pebbles 3 / 4 cup 120 1 1 1 0 0 26 0 11 20 200 0 NA None listed at Waffle Crisp 1 cup 120 2 2.5 25,1 12 40 110 0 4 None listed at Quaker mg for Cap n products Cap n 3 / 4 cup 110 1 1.5 1 0 0 23 1 12 50 200 0 45 None listed at Berries 3 / 4 cup 100 1 1.5 1 0 0 22 1 11 50 190 0 43 None listed at Oops! 1 cup 130 2 1.5 0.5 1 15 60 210 0 56 None listed at All Berries Cap n 3 / 4 cup 110 2 2.5 1 0 0 21 1 9 65 200 0 53 None listed at Peanut Butter % DV for cereals below Life 3 / 4 cup 120 3 1.5 25 2 6 90 160 10 10 Disodium Life Maple and Brown Sugar Life Oh s ½ cup for children under 4 80 1 1 16 1 4 60 110 10 15 Disodium 3 / 4 cup 120 3 1.5 25 2 8 85 150 10 10 Disodium 3 / 4 cup 120 3 1.5 25 2 8 85 150 10 10 Disodium 3 / 4 cup 110 1 2 1.5 0 0 23 1 12 44.1 17 None listed at PRO, protein; CHO, carbohydrate; % DV, percent daily value; NA, not applicable. *Information for cereal only, does not include milk. Phosphate Additives % DV %DV % DV 15 25 0 15 10 0 10 30 10 e28 SHERIDAN