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Choose Your Foods: Exchange Lists for Diabetes, Sixth Edition, 2008: Description and Guidelines for Use

  • UW Neighborhood Clinics
  • Nutrition Concepts by Franz, Inc.

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Choose Your Foods: Exchange Lists for Diabetes (formerly Exchange Lists for Meal Planning), a booklet used to help people with diabetes plan meals, has been in existence for more than 50 years. Planning for the fifth revision was guided by survey responses from >3,000 registered dietitians and other health professionals, current diabetes management and nutrition recommendations, and the food marketplace. In addition to a name change, major changes were made in design and overall readability. Changes within food groupings and the addition of a number of foods (mainly ethnic/regional) were accomplished while maintaining the well-recognized and accepted mean macronutrient and energy values of the basic lists. As with previous editions, this publication is intended as a resource for use by individuals with diabetes, with the guidance of a registered dietitian. This booklet is also intended to be used as a basis for nutrition educational materials developed by the American Dietetic Association and American Diabetes Association (eg, carbohydrate counting, weight management) and as a method for students and others to learn about diabetes meal planning. Practical guidelines for use of this updated resource for meal planning (eg, sugar alcohols, dietary fiber, and alcohol) are also presented.
Content may be subject to copyright.
from the association
Choose Your Foods: Exchange Lists for Diabetes,
Sixth Edition, 2008: Description and Guidelines for Use
Madelyn L. Wheeler, MS, RD, FADA; Anne Daly, MS, RD; Alison Evert, MS, RD;
Marion J. Franz, MS, RD; Patti Geil, MS, RD, FADA; Lea Ann Holzmeister, RD;
Karmeen Kulkarni, MS, RD; Emily Loghmani, MS, RD; Tami A. Ross, RD; Pamela Woolf
Choose Your Foods: Exchange Lists for
Diabetes (formerly Exchange Lists for
Meal Planning), a booklet used to help
people with diabetes plan meals, has
been in existence for more than 50
years. Planning for the fifth revision
was guided by survey responses from
3,000 registered dietitians and other
health professionals, current diabetes
management and nutrition recommen-
dations, and the food marketplace. In
addition to a name change, major
changes were made in design and over-
all readability. Changes within food
groupings and the addition of a number
of foods (mainly ethnic/regional) were
accomplished while maintaining the
well-recognized and accepted mean
macronutrient and energy values of the
basic lists. As with previous editions,
this publication is intended as a re-
source for use by individuals with dia-
betes, with the guidance of a registered
dietitian. This booklet is also intended
to be used as a basis for nutrition edu-
cational materials developed by the
American Dietetic Association and
American Diabetes Association (eg,
carbohydrate counting, weight man-
agement) and as a method for students
and others to learn about diabetes meal
planning. Practical guidelines for use of
this updated resource for meal plan-
ning (eg, sugar alcohols, dietary fiber,
and alcohol) are also presented.
J Am Diet Assoc. 2008;108:883-888.
In 1950, the first edition of the Ex-
change Lists for Meal Planning
booklet (1) was developed by the
American Dietetic Association, the
American Diabetes Association, and
the United States Public Health Ser-
vice. The goal was to provide a set of
food values for estimating nutrients
and energy for meal plans for people
with diabetes, a short method for cal-
culating the diet, and several lists of
foods of similar values. Since that
time, the booklet has been updated
four times (2-4). Because of recent ad-
vancements in diabetes management,
the evolving evidence base for nutri-
tion recommendations for people with
diabetes, and changes in the food
marketplace and the eating patterns
of Americans, this booklet has been
revised again.
The American Diabetes Association
has recently updated its nutrition
recommendations (5) and the Amer-
ican Dietetic Association has up-
dated and expanded the Evidence
Analysis Library recommendations
for type 1 and type 2 diabetes (6).
Medical nutrition therapy is essen-
tial to help people with diabetes ac-
complish the goals of achieving and
maintaining (a) blood glucose close
to or at the normal range, (b) a lipid
and lipoprotein profile that reduces
risk for vascular disease, and (c)
blood pressure close to or at the nor-
mal range. A registered dietitian is
the health professional recommended
to provide medical nutrition therapy
(5,6). Studies employing a variety of
nutrition interventions using medical
nutrition therapy report a reduction
in hemoglobin A1c levels, improved
lipid profiles, improved weight man-
agement, decreased need for medica-
tions, and reduction in risk for onset
and progression of comorbidities (6).
Nutrition interventions include ad-
justing insulin doses to match carbo-
M. L. Wheeler is coordinator, Nutritional Computing Concepts, Zionsville,
IN. A. Daly is director of nutrition and diabetes education, Springfield Dia-
betes and Endocrine Center, Springfield, IL. A. Evert is a diabetes nutrition
educator, University of Washington Medical Center, Diabetes Care Center,
Seattle. M. Franz is a nutrition/health consultant, Nutrition Concepts by
Franz, Inc, Minneapolis, MN. P. Geil is a certified diabetes educator, Geil
Nutrition Communications, Lexington, KY. L. A. Holzmeister is a certified
diabetes educator, Holzmeister Nutrition Communications, LLC, Tempe, AZ.
K. Kulkarni is director of Scientific Affairs, Intensive Diabetes Management,
Abbott Diabetes Care, Salt Lake City, UT. E. Loghmani is a diabetes educa-
tor, Endocrinology and Diabetes Consultants, an Affiliate of Wentworth-
Douglass Hospital, Dover, NH. T. A. Ross is a diabetes nutrition educator,
Internal Medicine Associates, Lexington, KY. P. Woolf is with the American
Health Information Management Association; at the time of the study, she
was a development editor, American Dietetic Association, Chicago, IL. M. L.
Wheeler, A. Daly, A. Evert, M. Franz, P. Geil, L. A. Holzmeister, K. Kul-
karni, E. Loghmani, and T. A. Ross are also certified diabetes educators.
Address correspondence to: Madelyn L. Wheeler, MS, RD, FADA, Nutri-
tional Computing Concepts, 5014 Turkey Foot Rd, Zionsville, IN 46077.
Copyright © 2008 by the American Dietetic Association.
doi: 10.1016/j.jada.2008.02.002
©2008 by the American Dietetic Association Journal of the AMERICAN DIETETIC ASSOCIATION 883
hydrate intake, consistency in carbo-
hydrate intake, weight management,
increasing fiber to meet the Ade-
quate Intake (14 g/1,000 kcal) recom-
mended by the Dietary Reference In-
takes (7), limiting saturated fats to
7% of total calories, minimizing
trans fats, lowering cholesterol to
200 mg/day, and reducing sodium
intake to 2,300 mg/day. Monitoring
carbohydrate intake, either by carbo-
hydrate counting, exchanges, or expe-
rienced-based estimation, is a key
intervention in achieving glycemic
control. Specific food recommenda-
tions include increased use of fruits,
vegetables, whole grains, and le-
gumes, as well as low-fat dairy prod-
ucts and lean meats rather than full-
fat products, and unsaturated fats
rather than saturated fats.
The process for the fifth revision was
initiated by the American Dietetic As-
sociation with an online survey sent
to 14,000 members of the American
Dietetic Association (particularly the
Diabetes Care and Education and
Weight Management practice groups),
the American Diabetes Association,
and the American Association of Dia-
betes Educators. The survey was of
the exempt type and did not require
institutional review board approval
or informed consent. Questions were
both closed (yes or no) and open-
ended. Three-thousand and eighty-
eight (22%) usable responses were re-
ceived. Because the philosophy of food
grouping for healthful meal planning
is basic to diabetes education, and is
used for other meal planning meth-
ods, such as carbohydrate counting as
well as weight management, the sur-
vey indicated that the booklet should
be retained and updated. The recom-
mendations were summarized into
five categories: title, food list group-
ings and foods within the lists
(eg, more cultural diversity), sidebar
ideas, design (eg, color coding), and
other considerations (eg, more gener-
alized diabetes health care informa-
tion, more emphasis on readability).
This revision is based on the survey
results, nutrition recommendations
(5,6), and an update of foods available
in the marketplace.
Title of Booklet
The survey indicated that use of the
word exchanges was outdated and
confusing to many; on the other hand,
the word has recognition for both or-
ganizations. Therefore, the title was
changed to “Choose Your Foods,” but
includes a subtitle (Exchange Lists for
Diabetes) so that health professionals
and the public would know this is a
revision rather than a completely new
concept (Figure 1).
Food List Groupings, and Foods
within the Lists
The basic philosophy of this publica-
tion has always been the grouping of
foods into general categories (or lists)
that, per serving size, are similar in
macronutrients and calories. While
the lists generally remain the same as
in previous editions, changes have
been made so they are easier to use.
For example:
The “starchfat” category has been
deleted from the Starch List.
A “dairy-like products” category
(eg, soy and rice milks, smoothies)
has been added to the Milk List.
Leafy greens have moved from the
Figure 1. Choose Your Foods: Exchange Lists for Diabetes cover page. © 2008 American
Diabetes Association and American Dietetic Association. Reprinted with permission.
884 May 2008 Volume 108 Number 5
Nonstarchy Vegetable List to the
Free Foods List.
Very lean meats have been inte-
grated into the Lean Meat List, and a
new category has been added to the
Meats and Meats Substitute Group,
the Plant-Based Protein List.
Several lists (Sweets, Desserts and
Other Carbohydrates, Combination
Foods, and Fast Foods) have been
subdivided for ease of use.
An Alcohol List has been added
to provide adults who choose to
drink with information (in alcohol
equivalents) about calories and
Foods within the lists have been
updated. While a few foods were de-
leted, a number were added, with the
total being represented by 700 foods
in the updated data set accompanying
this revision. Foods were selected
based on current common use and
wide availability (8,9).
To verify the average energy and ma-
cronutrient values used in the latest
set of food lists and to determine the
most appropriate serving sizes for
matching the list average values, the
previous Exchange Lists for Meal Plan-
ning data set (10) was the initial start-
ing point. The United States De-
partment of Agriculture’s Nutrient
Database for Standard Reference (11)
was used to obtain or update nutri-
ent values for each individual food.
Where this database was inadequate,
information from nutrition labels of
several brands of the food item were
averaged. Nutrient information for a
few foods was obtained from the United
States Department of Agriculture’s
Food and Nutrient Database for Di-
etary Studies (12). The Table provides
the average group macronutrient and
energy values and the means per serv-
ing of all foods in each of the food lists
for Choose Your Foods. This should re-
assure users that each food in a list, in
the serving size given, is reflective of
the rounded averages; however, it is
also a reminder that while the means
are close to the average values, the
standard deviation indicates a range
for each group.*
Many sidebars and boxes provide sug-
gestions to help people with diabetes
better manage the food selection com-
ponent for controlling their diabetes:
concepts such as energy balance and
helpful suggestions for portion sizes,
smart supermarket shopping, eating
more vegetables, ground beef label-
ing, and reducing trans fats. Increas-
ing physical activity is also covered,
in a “Get Moving” section. In addition,
the nutrition and food selection tips
for each list have been updated to re-
flect current food choices of the popu-
lation and increased availability of a
variety of foods and food products.
Overall the booklet was designed to
be more user-friendly. For example:
A“table” design is used to help
readers follow a food across the
page to the amount.
Color-coding separates the food
groups: brown for starches; orange
for fruits; blue for milk; green for
vegetables; red for meats and sub-
stitutes; and yellow for fats.
Flagging is used to alert readers
to foods high in sodium and good
sources of fiber. Following guidelines
*The complete nutrient data set
may be accessed by going to the
American Dietetic Association’s Web
site, Food and Information section
then choose the Food Nutrient Data-
set under “Consumer Resources.” Ac-
cessed April 4, 2008.).
Table. Macronutrient and energy values assigned to each food list compared to a mean of all foods within each list
Food list n Carbohydrate (g) Protein (g) Fat (g) Calories
4™™™™™™™™™™™™™™ Average (meanstandard deviation) ™™™™™™™™™™™™™™3
Starch: breads, cereals and grains, starchy
vegetables, crackers and snacks, and
beans, peas and lentils 112 15 (16.03.2) 0-3 (2.81.9) 0-1 (1.31.6) 80 (8420)
Fruit 50 15 (15.22.0) — (0.80.4) — (0.20.2) 60 (617)
Fat-free, low-fat, 1% 8 12 (12.51.1) 8 (8.50.8) 0-3 (1.11.1) 100 (9511)
Reduced-fat, 2% 5 12 (10.83.4) 8 (7.61.5) 5 (4.50.8) 120 (12017)
Whole 4 12 (11.90.7) 8 (8.60.4) 8 (8.91.1) 160 (1629)
Sweets, desserts, and other carbohydrates
68 15 Varies Varies Varies
Nonstarchy vegetables 67 5 (4.82.5) 2 (1.30.7) — (0.20.3) 25 (2311)
Meat and meat substitutes
Lean 78 — (0.61.1) 7 (7.11.5) 0-3 (1.61.1) 45 (4612)
Medium-fat 32 — (0.50.8) 7 (6.91.5) 4-7 (4.61.1) 75 (729)
High-fat 26 — (0.70.6) 7 (5.71.6) 8(8.21.3) 100 (10014)
Plant-based proteins
17 Varies 7 Varies Varies
Fat 72 — (1.11.4) — (0.71.0) 5 (4.40.9) 45 (4610)
Free foods 91 — (2.01.6) — (0.61.0) — (0.30.6) — (138)
Combination foods
30 15 Varies Varies Varies
Fast foods
30 15 Varies Varies Varies
7 Varies — — 100
Five lists do not contain meanstandard deviation because of wide macronutrient or caloric variability.
from the Code of Federal Regulations
for use of the term healthy in food
labeling, a food is flagged as high in
sodium if a serving contains 480
mg sodium, and a main dish/meal is
flagged if a serving contains 600
mg sodium (13). The Code of Federal
Regulations indicates that to define a
food as a “good source” of fiber, it
should contain 10% to 19% of the Di-
etary Reference Intake for fiber (14).
Thus, those foods containing 3g
fiber/serving have been flagged. A
third flag is the symbol to alert peo-
ple when to “add a fat” (eg, a starch
with an added fat).
Other Considerations
The booklet is written for a reading
level of 6th grade or less and contains
a number of small colorful food pic-
tures to provide visual emphasis.
While keeping essential content, the
introduction was reduced. The glos-
sary has been extensively revised and
now includes basic diabetes informa-
tion as well as food/nutrient informa-
tion. In addition, an extensive index
has been included to assist in finding
specific foods easily.
Guidelines for Food and Meal Planning
Using the Choose Your Foods Booklet
The booklet contains a “Your Meal
Plan” page for use in individualized
meal planning or for assessing food
intake. There is a small area for
personalization of nutritional goals
(calories, percent of calories as carbo-
hydrate, grams or choices of carbohy-
drate, grams of fat and protein) and a
simple meal-planning template table.
The template lists the main food
groups in a set of vertical columns,
with six rows for main meals and
snacks. A final column is available for
meal suggestions. An amount (eg,
number of choices or grams of carbo-
hydrate) can be inserted into each
block. Or, this template, along with
the carbohydrate, fat, protein, and
calorie values assigned to each food
group (Table) can be used for evalu-
ating food intake for the nutrition as-
sessment. Guidelines for using Choose
Your Foods in helping people with di-
abetes accomplish healthy meal plan-
ning follow:
1. Each list general macronutrient
and energy values are based on a
range of individual food values.
Calculations of food intake based
on the Choose Your Foods booklet
are not accurate enough for single-
digit precision. Estimates of en-
ergy in calculated meal plans
should be rounded off, for example
to the nearest 50 to 100 kcal.
2. Recommending a wide variety of
foods is important when planning
meals. A food pattern that includes
carbohydrate from fruits, vegeta-
bles, whole grains, legumes, and
low-fat dairy products should be
encouraged for good health. In ad-
dition, individuals should be en-
couraged to choose foods from the
Lean Meat/Plant-Based Protein
Lists of the Meats and Meat Sub-
stitutes Group, and the Mono- and
Polyunsaturated Fat Lists from
the Fat Group.
3. Percentages of macronutrients in
the meal plan should be based on
metabolic goals and the ability,
need, and willingness of the person
with diabetes to make lifestyle
changes (5,6). While there is no
carbohydrate percentage of energy
recommended specifically for people
with diabetes, it is not unreason-
able to use the Dietary Reference
Intakes’ Acceptable Macronutrient
Distribution Range of 45% to 65%
of total daily energy for both adults
and children (15).
4. Carbohydrate choices is a concept
used in this booklet and is based
on the fact that foods in the Starch,
Fruit, and Milk Lists of the Carbo-
hydrate Group each contain simi-
lar carbohydrate (15 g) and en-
ergy (80 kcal) content per serving
and thus they can be interchanged:
One serving of starch, fruit
or milk1 carbohydrate choice
(about 15 g carbohydrate). Pos-
sible problems need to be an-
ticipated and, in some cases,
individualized guidelines for in-
terchanging foods need to be pro-
vided. For example, if regular
substitution of fruits or starches
for milk is made, calcium intake
may be decreased and protein
(eg, for children) may be reduced
The sample meal plan page does
not include several of the lists
within this booklet. The Sweets,
Desserts and Other Carbohy-
drates, the Combination Foods,
and the Fast Foods have their
foods listed in a “count as” col-
umn, as xamount of carbohy-
drate, or xamount of carbohy-
drate yamount of fat. In the
case of dairy-like products in-
cluded within the milk list (eg,
soy milk), foods are listed as x
amount of carbohydrate and per-
haps yamount of fat and z
amount of milk choices.
In a situation analogous to
the carbohydrate choices, plant-
based proteins have been added
to the Meats and Meat Substi-
tutes Group. While they are sim-
ilar to meats in that, per serving,
they have 7 g protein, they
have carbohydrate as well. For
oz soy nuts is
“counted as”
medium-fat meat.
5. If foods in the Free Foods List are
consumed often in 1 day (particu-
larly those with amounts listed),
the calories and carbohydrates
consumed could affect expected
clinical outcomes.
6. Because many adults with diabe-
tes do consume alcohol, an alcohol
equivalents list has been included,
with each equivalent representing
100 calories of absolute alcohol. If
adults choose to drink alcohol,
they should be cautioned to con-
sume one drink or less/day for
women, two drinks or less per day
for men. A “drink” is defined as 12
oz beer, 5 oz wine, or 1
oz of
distilled spirits (5). Because alco-
hol does not readily interchange
with other food groups, the follow-
ing guidelines can be used:
Because alcohol does not require
insulin to be metabolized, it
should not be counted in the
meal plan if used occasionally.
If used daily, the meal plan cal-
orie level should be adjusted ac-
Any carbohydrate taken with
the alcohol (mixed drinks) needs
to be counted.
Determining Food List Choices for Food
Label Nutrition Facts or Recipes
Using information from food labels
helps individuals to include favorite
foods in their meal plans, and every-
one uses favorite recipes at one time
or another for meal planning. While
the Choose Your Foods booklet con-
tains a simple method that people can
886 May 2008 Volume 108 Number 5
use to convert recipes/nutrition facts
to food list choices, the information in
Figure 2 can be used as a guide to
increase the accuracy of the analysis.
The booklet also includes a sample
food label. Of particular interest is
the guidance for how to handle di-
etary fiber and sugar alcohols, as they
are incompletely digested, absorbed
and metabolized (16). Grams of sugar
alcohol (polyols) and dietary fiber are
included on the Nutrition Facts panel
of a food label; however, in deriving
energy value for food labeling, they
are calculated as having about half
the energy (2 kcal/g) of most other
carbohydrates (4 kcal/g). The Insti-
tute of Medicine indicates that less
energy is recovered from fiber than
the 4 kcal/g that is recovered from
carbohydrate, with the range being
1.5 to 2.5 kcal/g (17). The energy yield
of sugar alcohols ranges from 0.2
kcal/g (erythritol) to 3.0 g (hydroge-
nated starch hydrolysates) (18), and
averages about 2 kcal/g. Adjustment
is practical only if the amount per
serving of either dietary fiber or sugar
alcohols is 5 g. In that case, count-
ing only half of the carbohydrate
grams from these food ingredients/
components would be useful when
calculating exchanges/food choices for
food labels or recipes and for individ-
uals who are using insulin-to-carbo-
hydrate ratios for managing their di-
The fifth revision of this booklet contin-
ues to provide a structure for choosing
foods for diabetes and weight-manage-
ment meal planning. Based on a survey
of registered dietitians and other
health professionals, current diabetes/
nutrition recommendations, and cur-
rent marketplace foods, many changes
Steps Suggestions
1. Determine what list(s) to use
as choices/servings
Use starch, fruit, milk, and nonstarchy vegetables lists when possible rather than the generic
“carbohydrate.” This helps in planning healthy meals.
If there are substantial amounts of carbohydrate from three or all four of the
abovementioned lists, if the serving has 1/3 of the carbohydrate as added sugars, or if
the food is a dessert-type food, simply call the choice “carbohydrate.”
Occasionally a solution will include both a specific carbohydrate list and a general
carbohydrate serving (eg, one starch
2. Adjust carbohydrate grams if
If a food contains 5 g sugar alcohols or dietary fiber, subtract half the grams of sugar
alcohols or fiber from the carbohydrate grams to get the total adjusted carbohydrate
grams (16).
3. Use rounding to determine
the approximate number of
For carbohydrate, use 15 g per choice for starch, fruit, sweets; 12 g per choice for milk; 5 g
per choice for nonstarchy vegetables. Actual carbohydrate per serving should be within
5 g of choice determination. Range and rounding guidelines:
5 g: do not count
5to10 g:
10 to 20: 1 choice/serving
For protein, use 7 g per choice for meats/meat substitutes. Actual protein per serving should
be within 3 g of choice determination. Range and rounding guidelines:
4 g: do not count
4to10 g: 1 choice/serving
For fat, use 5 g/choice. Actual fat per serving should be within 2 g of the choice
determination. Range and rounding guidelines:
2: do not count
4to7 g: 1 choice/serving
The actual energy value per serving should be within 20 calories of the total choice
determination value.
Do not use
or 1/3 choices, and do not use
vegetable or
meat exchanges. Half
choices for starches, fruits, milk, or carbohydrate can be more easily used in meal
4. Prioritize Give carbohydrate grams first priority, protein second, and fat third. The calories will usually
fall into the acceptable level if the other figures are correct.
Milk and vegetables are sometimes hard to include in adequate amounts in a meal plan.
Make an effort to include even half amounts of milk. Designating a recipe or Nutrition
Facts label as having three or four nonstarchy vegetable choices (5 g carbohydrate each),
given that the vegetables are truly available in the food, would be appropriate.
5. Make adjustments if needed,
particularly for main dishes
or meals
No food group is represented completely by one nutrient (eg, the carbohydrate group foods
contain small amounts of fat and protein, see the Table). For example, three starches
could have up to9gofprotein, which will reduce the number of meat choices by one;
two lean meat choices may have up to 5-6 g fat, which will reduce the number of fat
choices by one.
Figure 2. Suggestions for converting label Nutrition Facts or recipe servings into food list choices/servings.
were made, including title change and
design; however, it retains the vali-
dated system of dividing foods into
groups (starches, fruits, milks, non-
starchy vegetables, meats and fats).
Thus, this booklet can be used as a
resource for people with diabetes, a
method for assessing food intake, a
base for developing/revising other meal
planning publications (eg, carbohy-
drate counting, weight management),
and a method for college students, die-
tetic interns, diabetes health profes-
sionals, and others to learn about dia-
betes meal planning. Choose Your
Foods: Exchange Lists for Diabetes,as
well as companion publications (Span-
ish version, Choose Your Foods: Ex-
change Lists for Weight Management)
may be purchased from the online
stores of the American Dietetic Associ-
ation (,ac-
cessed April 4, 2008) or the American
Diabetes Association (http://www., accessed April 4, 2008).
Development of this edition of the
booklet, as with almost all previous
editions, has been supported by the
American Dietetic Association and
the American Diabetes Associations
(survey and analysis, staff support,
conference calls, editing, and publica-
tion). The writing group received no
financial support for revising this
The authors thank Abe Ogden, As-
sociate Director, Book Publishing,
American Diabetes Association, for
his skill as an editor and his assis-
tance in coordinating “all the pieces,”
and Diana Faulhaber, Publisher,
American Dietetic Association, and
Victor van Beuren, Professional Book
Acquisitions, American Diabetes As-
sociation, for their support through-
out this project. The authors also ac-
knowledge Lawrence A. Wheeler,
MD, PhD, Nutritional Computing
Concepts, for his expertise in extract-
ing the database and providing statis-
tical assistance.
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888 May 2008 Volume 108 Number 5
... Since almost all the FBDG are expressed in a number of servings, it is more important to identify the size of the food serving that should be included in one serving to ensure a dramatic decrease in risk factors and plunging rates of nutrition-related NCDs as a consequent outcome. Especially in the treatment of diabetes mellitus, with the help of carbohydrate exchange tables, the patients have been emphasized on the total amount of carbohydrate consumed, rather than on the source or type of carbohydrate consumed (Wheeler et al., 2008). Here, serving size is a key measure to decide the size of carbohydrate food that can be replaced by the same or another size of a different type of carbohydrate food (Kulkarni, 2005). ...
... A number of photographic food atlases and food exchange lists of several countries were studied with reference to the classification of major food groups, the definition of serving sizes, and the foods that can be exchanged within a particular food group (Jayawardena, 2019;Nelson et al., 1997;Suzana et al., 2015;The Japan Diabetes Society., 2002;Wheeler et al., 2008). ...
... Their exchange list is shown in Table 6. Since milk and equivalents include all three major macronutrients, the amount of nutrient content in the regular milk glass (250 mL) is considered as one serving, which contains 12 g of carbohydrate, 8 g of protein, and 0-8 g of fat (Wheeler et al., 2008). The exchange list of milk and equivalents is shown in Table 7. ...
... As part of the nutrition care process, dietitians make personalized nutrition plans, considering dietary needs, preferences and health issues. Useful tools for menu planning are food exchange lists commonly used by dietitians [18]. These lists were initially developed by dietitians and diabetes health professionals in 1950 [19]. ...
... Foods belonging to the same group are "interchangeable" since they can replace each other in dietary schemes. Several updates have been made to the exchange lists since their conception [18,20,21]. Moreover, additional versions of food exchanges lists have been developed for renal diseases [22] or to incorporate baby foods [23,24], ethnic foods [25][26][27], Mediterranean foods [28,29], vegetarian foods [30,31] or sports foods [31] in order to cover specific needs and facilitate meal planning. ...
... To our knowledge there are no existing food exchanges lists for ONSs, and the existing algorithms may be time-consuming if performed on a per patient/client basis [18]. In addition, there is no large at-one-glance open-access ONS database available in the literature. ...
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Malnutrition is a prevalent issue in hospitals, nursing homes and the community setting. Nutritional products can be used by dietitians to supplement people’s diet by adding energy, macronutrients and other constituents. The aim of the present work was (i) to create a database of nutritional products with information on their energy and macronutrient content, (ii) to estimate the food exchanges of each product and assist in diet plan development for malnourished persons and (iii) to provide a tool for calculation of food exchanges of newly developed products not included in the database. We searched the web for nutritional supplements, and an electronic database with 461 products was generated with data regarding the contained energy and macronutrients of each entry. The following companies were included: Abbott Nutrition, Nestle Nutrition, Nutricia North America, Nutricia Global, Nutricia Europe & Middle East, Axcan Pharma Inc., Kate Farms, Global Health, High Protein, NutriMedical BV, Hormel Health Labs, Hormel Health Labs/Diamond Crystal Brands, Lyons Magnus, Mead Johnson, Medical Nutrition USA Inc., Medtrition, Nutritional Designs Inc., Nutrisens, Humana (Germany), and Vitaflo USA. The created database facilitates product comparisons and categorization into several groups according to energy and protein content. In addition, a tool was created to determine food exchanges for each supplement per serving and/or food exchanges for newly developed products by simply inserting their macronutrient content. The developed tool can facilitate dietitians in comparing products and incorporating them into diet plans, if needed. Such tools may thus serve clinical practice, may be used in dietary or other smart applications and can familiarize dietitians with the digital epoch.
... Participants (N = 120) who met the inclusion criteria were randomly allocated into one of two groups; a high protein snack (HP; n = 60) or an isocaloric low protein snack (LP; n = 60) that was incorporated into their daily meals using a convenience allocation. The HP group received high protein content snacks {50 g of soybeans (protein: 18.2 g, carbohydrate: 15 g, fat: 10 g, energy: 210 kcal)} while the LP group received low protein content snacks (≈3.5 servings of fruit), as desired, from the exchange list of foods based on American Diabetes Association and American Dietetic Association guidelines [24,25] ( Table 1). On a daily basis, participants in the HP group were instructed to weigh 50 g of soybeans on a digital scale whereas the LP group chose 3.5 servings of fruit based on the aforementioned guidelines. ...
... On a daily basis, participants in the HP group were instructed to weigh 50 g of soybeans on a digital scale whereas the LP group chose 3.5 servings of fruit based on the aforementioned guidelines. The snacks for both groups contained similar calories (≈210 kcal) [24,25] and all participants were instructed to consume their snacks daily at 10 a.m (~3 h before lunch). The exchange list of foods has been frequently utilized and validated in the Iranian population [26]. ...
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(1) Background: The favorable effects of high protein snacks on body composition and appetite status in lean and athletic populations have been illustrated previously. However, the effects of soy-enriched high protein snacks have not been investigated in women with normal-weight obesity (NWO). Consequently, we aimed at comparing the effects of six months of soy-enriched high protein snack replacement on appetite, body composition, and dietary intake in women with NWO. (2) Methods: One hundred seven (107) women with NWO [(age: 24 ± 3 yrs, BMI: 22.7 ± 2.3 kg/m2, body fat percentage (BFP): 38 ± 3.2%)] who were assigned to one of two groups; high protein snack (HP, n = 52) containing 50 g soybean or isocaloric low-protein snack (protein: 18.2 g, carbohydrate: 15 g, fat: 10 g, energy: 210 kcal) or isocaloric low protein snack (LP, n = 55) containing 3.5 servings of fruit (protein:
... Los cambios de los años 2003 y 2008 son más de forma que de fondo, detallando y separando los tipos de alimentos fuentes de carbohidratos en la primera, y categorizando los grupos de alimentos, en la segunda. Es así como el uso de esta herramienta se popularizó en la práctica clínica desde los años 70 en Estados Unidos, debido principalmente a su facilidad de uso y flexibilidad en la planificación de alimentos 14,17 . ...
... Estas listas están basadas en las primeras listas realizadas en los años 40-50. Sin embargo, mientras estas listas americanas fueron evolucionando, en algunos países se siguieron creando listas unificadas solamente a uno o dos macronutrientes, existiendo así listas de equivalencias por aporte calórico 32 , de hidratos de carbono 17 , de proteínas 29,30,31 , o de lípidos 34,35 . Finalmente, están las listas de intercambio definidas anteriormente 20,24,36 , las cuales cabe destacar, que según la Academia Americana de Nutrición y Dietética, son las únicas validadas para confeccionar dietas para abordar enfermedades, incluyendo la obesidad 19 . ...
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The food portion exchange list is a simple and fast methodology that is used to give dietary indications to healthy and sick users. A review was carried out to update concepts and evaluate the current state of the exchange list used and their application. The system is widely used in different countries, including Chile, there are different types of foods or preparations exchange lists that use different methodologies for the definition of portions, according to the diversity and number of foods present. Its use is mainly for healthcare purposes, being also useful in community education and college teaching. In Chile, the food portion exchange lists were published in 1999 and have not been updated since. Reasons such as the change in the epidemiological profile, greater access to information and the diversification of foods in the diet, make necessary an in-depth review of the national lists, in order to incorporate a greater diversity of foods and typical preparations. Exchange lists are a necessary technical tool fundamental for nutrition professionals and contribute to the health and culture of countries.
... Decrement of BP in all the participants may stem from following healthy diet principles including those related to combating hypertension. For example, following a diet rich in calcium results in improvement of vasoconstriction and decline in BP [59], and as all of our subjects were recommended to consume regular two servings of dairy products including milk [60] and not receiving other kinds of dairy products such as yogurt, yogurt drink, and kefir, this may had a slight reducing effect on BP in the two groups. Moreover, prebiotics enhance dietary calcium absorption through binding to calcium and transferring together to colon; then, calcium detaches from prebiotics and, by being located in an acidic environment made by SCFAs in distal colon, eventuates in more calcium concentration in colon and more absorption by colonocytes which assist blood pressure to be decreased [61]. ...
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Background: Metabolic syndrome is overwhelmingly increasing and is a significant risk factor for cardiovascular disorder, so effective treatment strategies are considered high priority. This study aimed to determine the effects of synbiotic supplementation on metabolic factors in patients with metabolic syndrome. Methods: In this triple-blind, randomized, placebo-controlled, clinical trial, 108 participants were divided into two groups to receive synbiotic supplementation or placebo for 12 weeks. All participants were also educated about maintaining a healthy lifestyle and consuming low-calorie nutritious meals, along with dietary intake and physical activity monitoring. Anthropometric measures, blood pressure, glycemic indices, lipid profile, hepatic enzymes, and hs-CRP were evaluated at the baseline and end of the trial. Results: Synbiotic supplementation significantly reduces fasting blood glucose (FBG) levels in the intervention group versus placebo group [-14.69 ± 15.11 mg/dl vs. -8.23 ± 7.90 mg/dl; p=0.007], but there was no difference between groups in other metabolic factors. Conclusions: These findings suggest that synbiotic supplementation while following a healthy lifestyle and nutrition improved FBG in patients with metabolic syndrome.
... At Weeks 2 and 9, the researcher provided a 3-h educational session for patients on problem-solving and complications, the plate method, 19 food exchange techniques, 20 and meal planning practice led by a nutritionist. An expert in successful glycemic control conducted a discussion session to address how to eat fewer carbohydrates, sweetened fruits, and soft drinks, while adding vegetable selections. ...
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Background Diabetes mellitus is increasing and a shortage exists of nurses to care for patients. Community health volunteers (CHVs) pose potential supportive networks in assisting patients to perform healthy behaviors. Aim The study aimed to develop and investigate the effects of a CHV involvement program on reducing glycated hemoglobin (HbA 1c ) levels among Thai patients with uncontrolled type 2 diabetes. Methods This sequential mixed-method study was conducted from January to June 2019. Sixty patients with HbA 1c exceeding 7% were recruited from 2 communities assigned as the intervention and comparison groups. Using King’s General Systems Framework as a basis to develop the program, the study initially explored the perceptions of diabetes and its management among patients, family members, and CHVs. Then, a quasi-experimental study with 2 groups pretest-posttest design was conducted and compared with usual care. The intervention included educational sessions, home visits, and activities created by CHVs including a campaign, broadcasting, and health food shops. Quantitative data were collected at baseline and 20-week follow-up and analyzed by descriptive statistics, Independent t-test, and paired t-test. Results The intervention group exhibited a lower mean HbA 1c ( p < .001) and reported significant, improvement concerning diabetes knowledge, self-efficacy, perceived support, and behavior compared with the comparison group at the end of the study (Cohen’s d > 1.0, effect size large). Conclusion Applying this framework to develop the program could benefit glycemic control among patients with uncontrolled diabetes residing in communities. Further studies should be conducted on a large sample to demonstrate the efficacy of the program.
... Involving users with the selection of their own food allows them to plan for healthy meals that meet their budget, as well as personal and cultural preferences [7][8][9]. A basic understanding of nutrition and basic reading, writing, and math skills at the high-school level at the least are essential for using this list [10]. ...
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(1) Background: The food exchange system was developed to serve as an educational tool in helping individuals plan their own meals. This study aimed to develop a friendly-user food exchange list for individuals with a low literacy level; (2) Methods: A two-group, pre-test/post-test research study aimed to develop a friendly-user food exchange list for individuals with a low literacy level. Thirty female workers of low literacy were recruited. Participants were divided into two groups. Group one was taught how to use the standard exchange system, while group two was taught how to use the modified exchange system. Each participant was assigned a task of prepare a meal with a specified caloric content and macronutrient distribution. The task was assigned before and after the exchange list education session. Groups’ differences were tested using the chi-square test, and the analysis of variance (ANOVA); (3) Results: A higher percentage of participants in group two were able to plan daily diets that achieved the recommendations of fruits (p = 0.02), protein (p = 0.03), dairy (p < 0.001), carbohydrates (p < 0.001), and calories (p < 0.001). Moreover, diet plans prepared by group two had a higher healthy eating index (p < 0.001) when compared to diet plans prepared by group one. The modified exchange lists are a friendly-user tool that can be implemented for individuals with low literacy, since it relies on visual techniques.
... The first FEL was developed in the 1950s by the American Diabetes Association, the American Dietetic Association (ADA), and the United States (US) Public Health Service for the management of patients with diabetes (Wheeler et al. 1996). It has undergone several revisions from its previous title "Exchange Lists for Diabetes" to "Choose Your Foods: Exchange Lists for Diabetes" in the sixth revision published in 2008(Wheeler et al. 2008Geil 2008). The Philippine FEL was adapted from the US in 1953 by Corpus et al. and was revised in 1965 by Madlangsakay that included six food groups [as cited in Flores et al. (1984)]. ...
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The food exchange list (FEL) is a tool for planning meals using a list of foods grouped with approximately the same amount of energy and macronutrients. The Philippine FEL underwent three revisions from its publication in 1953 until 1994. This most recent revision of the FEL aimed to review calculations of macronutrient and energy content per exchange and by food group, review the methods of dietary calculation, and enhance the design and appearance of the handbook. Revision of the handbook started with needs assessment using a survey as study design among 529 registered nutritionist-dietitians (RNDs) and nutrition students, and focus group discussion (FGD) among 36 selected hospital nutrition supervisors, nutrition faculty, and health workers in three cities of the Philippines-namely, Manila, Cebu, and Davao. The seven food groups in the previous FEL editions were adopted as the main components of foods for substitution. Macronutrient content per exchange was computed from the 2017 Philippine food composition tables (FCTs) and foreign food databases. Results of the survey revealed that most RNDs used the FEL in a clinical or hospital setting (98.1%), while students used the FEL for themselves (93.8%). The FEL was mainly used for meal planning (87.5%), as reference (62.8%), and for counseling (48.4%). Almost all respondents described the FEL as very useful. The addition of more foods available in the market was the most common suggestion of respondents. Based on the suggestions from the survey and FGD the following changes were made: recomputed and reclassified 525 food items within the seven food groups and subgroups; reclassified rice group into low-, medium-, and high-protein subgroups; the alphabetical arrangement of foods with Filipino common names and English names; additional equations for deriving desirable body weight (DBW) and total energy requirement (TER); and included photos of selected foods per exchange. Improvement of the design and appearance of the handbook was accomplished through the use of color-coding, food photos, and a tabulated food listing.
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Objetivo: La finalidad del estudio fue diseñar y validar una lista de intercambio de alimentos peruanos (LIA) para la confección de dietas y planificación de menús. Material y métodos: Se tomó como base la metodología para diseñar listas de intercambio descrita en trabajos previos, desarrollándose en seis fases realizadas en múltiples intervenciones en laboratorio, en donde se evaluaron 273 alimentos, que fueron estudiados a través de un análisis descriptivo cualitativo. Se realizó una validación con 12 nutricionistas que elaboraron un plan nutricional y luego se comparó la composición nutricional obtenida usando la tabla peruana de composición de alimentos 2017 (TPCA) con la composición nutricional aplicando LIA. Para la comparación de métodos se aplicó la prueba de Wilcoxon. Resultados: Se elaboró una lista de intercambio de alimentos peruanos (LIA) que incluyó 273 alimentos categorizados en siete grupos de intercambio. Se estimó la media del aporte de energía y macronutrientes por cada grupo de intercambio y se compiló un álbum fotográfico con las porciones de intercambio. Respecto a la validación de la LIA, en la comparación de la cantidad de energía, carbohidratos, proteínas y grasas de los planes alimentarios usando TPCA versus LIA no se encontraron diferencias significativas. Conclusión: Se obtuvo una LIA válida que permite la confección y planificación de dietas de forma eficiente, dentro de un margen de error adecuado, se recomiendan nuevos estudios que incorporen otras poblaciones más específicas y nuevos alimentos
Objective: The role of perioperative protein-enriched enteral nutrition for patients with primary liver cancer is unclear. We investigated the efficacy of perioperative protein-enriched enteral nutrition for patients with primary liver cancer followed hepatectomy. Methods: Patients with primary liver cancer that underwent hepatectomy between January 2016 and 2018 were enrolled. Patients in the treatment group was given enteral nutrition (TP-MCT) in addition to the regular diet. The primary outcome measures were duration of hospital stay and length of postoperative hospital stay. Secondary outcome measures included time to first flatus and time to first defecation. Results: There was a significant reduction of time to first flatus and time to first defecation in the treatment group, when compared with the control group (time to first flatus: P = 0.001, time to first defecation: P < 0.001). Conclusions: It is found that addition of protein-enriched enteral nutrition (TP-MCT) improved postoperative recovery for patients with primary liver cancer following hepatectomy, with a significant reduction in time to first flatus and time to first defecation.
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It continues to be essential that individual outcomes from MNT be monitored so that appropriate changes in the overall management plan for diabetes can be implemented. There are many aspects of MNT for diabetes that require additional research.
Responding to the expansion of scientific knowledge about the roles of nutrients in human health, the Institute of Medicine has developed a new approach to establish Recommended Dietary Allowances (RDAs) and other nutrient reference values. The new title for these values Dietary Reference Intakes (DRIs), is the inclusive name being given to this new approach. These are quantitative estimates of nutrient intakes applicable to healthy individuals in the United States and Canada. This new book is part of a series of books presenting dietary reference values for the intakes of nutrients. It establishes recommendations for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein, and amino acids. This book presents new approaches and findings which include the following: The establishment of Estimated Energy Requirements at four levels of energy expenditure Recommendations for levels of physical activity to decrease risk of chronic disease The establishment of RDAs for dietary carbohydrate and protein The development of the definitions of Dietary Fiber, Functional Fiber, and Total Fiber The establishment of Adequate Intakes (AI) for Total Fiber The establishment of AIs for linolenic and a-linolenic acids Acceptable Macronutrient Distribution Ranges as a percent of energy intake for fat, carbohydrate, linolenic and a-linolenic acids, and protein Research recommendations for information needed to advance understanding of macronutrient requirements and the adverse effects associated with intake of higher amounts Also detailed are recommendations for both physical activity and energy expenditure to maintain health and decrease the risk of disease. © 2002/2005 by the National Academy of Sciences. All rights reserved.
A committee composed of members of The American Dietetic Association and the American Diabetes Association has revised Exchange List for Meal Planning. Changes were made, as deemed necessary, on the basis of nutritional recommendations for persons with diabetes as understood in 1986. Major changes include rewriting the text to make it more useful in the education of persons with diabetes; changing the order of the exchange lists to emphasize a high-carbohydrate, high-fiber diet, as well as to better reflect the order of foods in menu planning; adding symbols to foods high in fiber and sodium; changing nutritive values for the starch/bread and fruit lists; adding lists of combination foods, free foods, and foods recommended only for occasional use; developing a data base; and initiating a plan for field testing and evaluation. The committee also developed a simplified meal planning tool, Healthy Food Choices, to be used for initial or "survival" level education. In poster format, foods are grouped by calories into six food groups. Approximate portion sizes of commonly used foods are listed. Blank lines are provided for the nutrition counselor to write in a suggested menu or meal plan for the client. Because the booklet does not use the word "diabetes" specifically, it is appropriate as a general teaching tool.
For more than 50 years the exchange lists have been one method of meal planning for persons with diabetes as well as for those on weight-loss regimens. Little research has been conducted, however, concerning the methodologic basis of the system or its clinical effectiveness. Justification for specific food inclusions and general food groupings for the 1995 revision of the Exchange Lists for Meal Planning is provided by a database of foods and associated energy and macronutrient values. The mean energy and macronutrient values for each of the lists and sublists (starch, fruit, milk, and vegetables from the carbohydrate group; the meat and meal substitutes group, and the fat group) closely match the mean exchange values; however, the standard deviation and range are large. Interpretation of the database provides a rationale and guidance for decision making in clinical practice when using exchanges for meal planning, recipe, and food label calculations.
Both the type and amount of carbohydrate found in foods influence postprandial glucose levels and can also affect overall glycemic control in individuals with diabetes. This review, based on the American Diabetes Association's Nutrition Recommendations and Interventions for Diabetes, and the American Dietetic Association's Evidence Analysis Library (Diabetes 1 and 2), provides a description and interpretation of the clinical studies involving diabetes and type and amount of carbohydrate. Although the relationship between blood glucose and insulin is linear, not all types of carbohydrate are fully metabolized to blood glucose. Added sugars such as sucrose and high fructose corn syrup are digested, absorbed, and fully metabolized in a similar fashion to naturally occurring mono- and disaccharides. Only about half of the carbohydrate grams from sugar alcohols and half or less from dietary fiber are metabolized to glucose whereas almost all "other carbohydrate" (mainly starch such as amylose and amylopectin) becomes blood glucose. The percent of energy as carbohydrate indicated for people with diabetes depends on individual preference, diabetes medication, and weight management goals. Glycemic index/glycemic load concepts are attempts to use these carbohydrate availability and amount issues for controlling postprandial glycemia.