Historical Background

In 1950, the following problems that had led to inconsistencies in food recommendations for persons with diabetes were identified: (1) methods used diet: the total daily food intake, or the to estimate the composition of a diet were prolonged and needlessly pre-

types of foods eaten cise; (2) there were many inconsistencies in the inclusion or restriction of foods; and (3) sizes of recommended portions were often stated in impractical amounts that were difficult to measure. Recognizing these facts, the food values given in table 1 were established. By combining foods of similar composition into food exchange lists, long and extensive lists of foods could be greatly abbreviated.

The first major revision of the exchange lists was published in 1976. The goals at that time were: to be more accurate in the caloric content of listed foods, to emphasize fat modification, and to provide for individualized meal plans to be used with the exchange lists.

The next revision of the exchange lists occurred in 1986. The goals of this revision were to ensure the exchange lists would reflect the principles of nutrition and to develop a database of the nutrient composition of the foods listed. Using the data from the database, revisions in the nutrient values assigned to some exchanges were made. For example, the Fruit list was changed from 10 grams of carbohydrate to 15 grams, with a subsequent increase in calories from 40 to 60 per exchange serving, to reflect the content of typical fruit portions.

The goals of the 1995 revision were: (1) to group carbohydrate food sources into one section to provide more flexibility in food choices; (2) to update the lists of foods and the database, primarily to add fat-modified foods, vegetarian food items, and fast foods; and (3) to allow for more accurate calculation of exchanges from nutrient information on labels, recipes, and prepared foods. The most significant revision in the 1995 revision was in the order and grouping of the lists. The Carbohydrate Group was listed

1950 FOOD VALUES FOR CALCULATING DIABETIC DIETS

Weight

Carbohydrate

Protein

Fat

Energy

Group

Amount

(grams)

(grams)

(grams)

(grams)

(calories)

Milk, whole

% pt

240

12

8

10

170

Vegetable, Group A

as desired

Vegetable, Group B

% cup

100

7

2

36

Fruit

varies

10

40

Bread exchanges

varies

15

2

68

Meat exchanges

1 oz

30

7

5

73

Fat exchanges

1 tsp

5

5

45

SOURCE: Caso, E. K., Journal of the American Dietetic Association.

NUTRIENT VALUES IN

ONE SERVING

FROM EACH

EXCHANGE

LIST

Carbohydrate

Protein

Fat

Groups/Lists

(grams)

(grams)

(grams) Calories

Carbohydrate Group

Starch

15

3

0-1

80

Fruit

15

60

Milk

Fat-Free

12

8

0-3

90

Reduced-Fat

12

8

5

129

Whole

12

8

8

150

Sweets, Desserts, and

15

varies

varies

varies

Other Carbohydrates

Vegetables

5

2

25

Meat and Meat Substitute Group

Very Lean

7

0-1

35

Lean

7

3

55

Medium-Fat

7

5

75

High-Fat

7

8

100

Fat Group

5

45

SOURCE: American Dietetic Association and American Diabetes Association, 2003.

first and included the Other Carbohydrates list, which lists foods containing carbohydrate and fat, such as sweets, pie, cake, and ice cream. Foods on the Other Carbohydrate list usually provide 1 to 2 carbohydrate choices and 1 to 2 fat exchanges, and they may be interchanged with items on the Starch, Fruit, or Milk lists and the Fat list, if appropriate.

The American Diabetes Association and the American Dietetic Association published the latest version of the Exchange Lists for Meal Planning in January 2003. Food lists were updated and the Other Carbohydrate list was renamed the Sweets, Desserts, and Other Carbohydrates list. Each list begins with generalized servings of exchange. The nutrient values from the 1995 and 2003 exchange lists are the same and are listed in table 2. Also included in the booklet are a listing of free foods (foods containing less than 20 calories and 5 grams of carbohydrate); combination foods (entrees, frozen entrees, soups), and fast foods. see also Diabetes.

Marion J. Franz

Bibliography

American Diabetes Association, and American Dietetic Association (2003). Exchange Lists for Meal Planning. Chicago and Alexandria, VA: American Dietetic Association and American Diabetes Association.

American Dietetic Association (2003). "Evidence-Based Nutrition Principles and Recommendations for the Treatment and Prevention of Diabetes and Related Complications." Diabetes Care 26(suppl. 1):S51-S61.

Caso, E. K. (1950). "Calculation of Diabetic Diets. Report of the Committee on Diabetic Diet Calculations, American Dietetic Association. Prepared Cooperatively with the Committee on Education, American Diabetes Association and Diabetes Branch, U.S. Public Health Service." Journal of the American Dietetic Association 26:575-582.

Franz, M. J.; Barr, P.; Holler, H.; Powers, M. A.; Wheeler, M. L.; Wylie-Rosett, J. (1987). "Exchange Lists, Revised 1985." Journal of the American Dietetic Association 87:28-34.

Wheeler, M. L.; Franz, M.; Barrier, P.; Holler, H.; Cronmiller, N.; Delahanty, L. (1996). "Macronutrient and Kilocalorie Database for the 1995 Exchange Lists for Meal Planning: A Rationale for Clinical Practice Decisions." Journal of the American Dietetic Association 96:1167-1171.

Diabetes 2

Diabetes 2

Diabetes is a disease that affects the way your body uses food. Normally, your body converts sugars, starches and other foods into a form of sugar called glucose. Your body uses glucose for fuel. The cells receive the glucose through the bloodstream. They then use insulin a hormone made by the pancreas to absorb the glucose, convert it into energy, and either use it or store it for later use. Learn more...

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