FOOD EXCHANGE LIST (FEL)

The Exchange List is one of the basic tools in applied nutrition and diet therapy. It is used in meal
planning, diet instruction an in estimating the energy and macronutrient content of normal and
therapeutic diets. It is a valuable tool for teaching patients the principles of basic nutrition, nutrient
composition and caloric density. It is used as reference material by nutrition and dietetics, medical
and nursing students.

The exchange list method of meal planning was originally developed to facilitate the computation
and planning of diabetic diets. Since its introduction in the Philippines in the 1950’s, the method
has come to be used in planning normal diets as well as therapeutic diets other than for diabetics.

In the Food Exchange List, commonly used foods are divided into seven groups or ‘list”. Each
list or sub-groups under a list includes foods that contain approximately the same amount of
carbohydrate, protein, fat and therefore, calories per exchange. A food in any group can thus be
substituted for or “exchanged” with another food in the same list or sub-group. For example, one
medium size fish may be exchange foe 1 matchbox size of any lean meat included in the sub-
groups.

To illustrate further, a patient who is allowed 4 exchanges of low fat meat and fish per day might
select the following: 1 medium-sized fish, ¾ cup chicken liver, 3 tablespoons corned beef and 1
slice of well-trimmed tenderloin.

Or, 6 exchanges of rice might be distributed as 2 slice American bread for breakfast, 1 cup rice
each for lunch and supper and 1 small ensaymada for snacks.

Uses of the Food exchange List

The use if the Food exchange List facilitates the planning of meals with a prescribed amount of
carbohydrate, protein, fat and energy. It must be noted however, that serving portions and the
exchange portions are not identical. Serving portions indicate amount of food that can be normally
consumed by one person at one time or in one meal. For example, 1 medium piece of star apple
would generally be considered 1 serving of fruit but it is equal to 2 exchanges of fruit. Or a serving
of meat and fish may consist of two to three pieces each the size of a matchbox and would therefore
be equivalent to two to three meat and fish exchange.

It should also be noted that the nutrient values per exchange are average values and will thus be
most applicable only if the day to day meals are sufficiently varied.

The exchange list may also be used in estimating the carbohydrate, protein, fat and energy values
of a meal. However, since the nutrient values are average values, they may not be used for diets
or diets for research (e.g. metabolic studies) purposes. For these, the traditional long method of
dietary calculations or chemical analysis of duplicate meals should be used depending on the
degree of precision required.
 Composition of Food Exchanges

List Food Measure CHO PRO FAT Energy

I.A Veg. A 1 cup raw - - - -

½ cup, cooked

I.B Veg. A 2 cups raw -

1 cup, cooked 3 1 16

I.B Veg. B ½ cup, raw -

½ cup, cooked 3 1 16

II. Fruit Varies 10 - - 40

III Milk

Whole Varies 12 8 10 170

Low fat 4 tablespoons 12 8 5 125

Skimmed Varies 12 8 Traces 80

IV. Rice ½ cup, well packed 23 2 - 100

1 cup cooked

V. Meat

Low fat Varies - 8 1 41

Med fat Varies - 8 6 86

High fat Varies - 8 10 122

VI. Fat 1 teaspoon - - 5 45

VII. Sugar 1 teaspoon 5 - - 20

FEL, DOST, FNRI, 3rd Revision 2005

FOOD LABELING
Food labels give information about the products contents, ingredients and nut value, to name a
few. They provide the consumers info so that they can meek a healthier food choices. Information
in the food label helps the consumer see how a food fits into their overall daily diet. The Bureau
of Food and Drugs (BFA) of the DOH is the government’s major implementer of nutrition labelling
in the Philippines. Its US counterpart is the Food and Drug Administration.

Information on Food label

Mandatory information on Food Labels (USFDA): every food label must prominently display
and express in ordinary words of the following:

• Name of product: this tells the consumer what they are buying and must not give false
impressions.

• Name and address of the manufactures, packer or distributors. This is shown for
comment/ complains or questions the consumer may wish to ask.
• Place of origin: some products may appear misleading if their place of origin is not
stated.
• Preparation instructions. This should be shown especially on high risk foods as all
bacteria are killed during cooking.
• Weight and quantity. This data will help consumer compare products fairly.
• Storage instructions. The storage instruction should be given so that the date mark is
valid

Open – date Marking. All foods should be date marked apart from very long life products.

• Consume before or use before or expiration date signifies the end of the estimate shelf
life of a product beyond which certain quality attributes become significantly
impaired.

• Best use by indicated the end of a period after which certain qualities of a product
must be expected to deteriorate. After such date the product may still be satisfactory
for human consumption and may remain marketable but the, makers presumably no
longer guarantee its best quality.
 DIETARY COMPUTATIONS

1. Body mass Index (BMI)

2. Desirable Body Weight (DBW) Determination

3. Total Energy requirement and distribution of TER

4. Application of Food Exchange list (FEL) and Sample Menu

 DIETARY COMPUTATIONS

1. ESTIMATING DBW OF ADULTS

SAMPLE

Tannhauser’s Method

5’ 2 to inches is 62 inches (5x12+2)

= 62 inches to cm is 157.48 (62x2.54)
= 157.48 – 100 = 57.48 kg
= 10% of 57.48 kg is 5.748
= 57.48 – 5.748 = 52 kg (DBW)

Adopted Method

For 5 feet use 105 lbs; for every inch above 5 feet add 5 lbs
5 feet 2 inches
5 ft = 105 lbs
2 in x 5 lbs = 10 lbs
105 + 10 lbs = 115 lbs or 52 kgs (DBW)

2. TOTAL ENERGY REQUIREMENT AND DISTRIBUTION OF TER

STEPS IN CALCULATING THE DIETS

1. Estimate the desirable body weight (DBW), sometimes referred to as reference, ideal or
standard body weight.

A. Use Standard Tables – FNRI Standard Weight for Filipinos.

Note:+ 10% of the value obtained will be within the range of the DBW.

B. In the absence of the FNRI Standard Table, use the Tannhauser’s (Broca)
Method. Measure height in centimeter (cm), deduct from the measurement the
factor 100 and the difference is the DBW in kilograms (kg). To apply this
DBW in Filipino stature, deduct 10%.
 For example: an adult sedentary female who stands 5 feet I inc
Ht = 5 feet 1 inch = 61.0 inches
= 61.0 inches x 2.54
= 154.94 cm
DBW = 154.94 –100 = 54.94 kg
= 54.94 – 5.94 (10% of 54.94)
= 49.95 kg or
= 50 kg

C. Use the NDAP Formula which gives the closest approximation of the desirable
BMI as well as the midpoint of FNRI’s range of reference weights.

DBW for men 5 feet tall is 112 lbs. Add (subtract) 4 lbs. for every inch above
(below) 5 feet.

DBW for women 5 feet tall is 106 lbs. Add (subtract) 4 lbs. for every inch above
(below) 5 feet.

D. Determine the reasonable energy allowance of the individual by multiplying

his DBW with the following values, according to:

ACTIVITY Kcal/kg DBW/day

Bed rest but mobile (hospital patient) 27.5

Sedentary (mostly sitting) 30.0

Light ( tailor, nurse, physician, jeepney driver) 35.0

Moderate (carpenter, painter, heavy housework) 40.0

Very Active (swimming, lumberman) 45.00

For example: Total energy allowance (TEA) of a sedentary person weighing 50 kg

= 50 kg x 30 = 1500 kcal.

2. Determine the Carbohydrate (CHO), protein (CHON) and fat by:

 A. Percentage distribution :
Carbohydrates = 55-70% of TEA
Protein = 10-15% of TEA
Fats = 20-30% of TEA

Note: Percentage of levels used will depend upon the diet prescription or usual food habits
of the patient.

For example:

For a normal diet, allot 65% of the TEA for CHO, 15% of CHON, 20% of fat. The
corresponding energy contributions of the 3 nutrients are:

CHO = 1500 x0.65 = 975 kcal

CHON = 1500 x0.15 = 225 kcal
FAT = 1500 x0.20 = 300 kcal

B. Calculate the number of grams of CHO, CHON, and FAT by dividing the calories
for each nutrient by the corresponding physiological fuel value (4 Kcal for CHO
and PRO and 9 kcal for fat per gram).

For example:
CHO: 975/ 4 = 245 g
CHON 225/4 = 56.2g
FAT 300/9 = 35g

For simplicity and practicality of the diet prescription (Rx), round off calories to the
nearest 50, and carbohydrates, proteins and fats to the nearest 5 grams. Thus:

Diet Rx: kcal 1500; CHO 245 g; CHON 55 g; FAT 35 g

Design a practical meal pattern by consulting the patient, taking into consideration
patient’s food habits, food behavior and preferences, etc..

HOW TO USE THE FOOD EXCHANGE LISTS IN MEAL PLANNING

Using the example in the preceding section of a prescription of 1500 kcalories: 245 g CHO, 55 g
PRO, 35 g FAT. To translate the prescription into food exchange list, the procedure is as
follows:
 List all foods furnishing, carbohydrates with the exception of rice, i.e., vegetables, fruit, milk
and sugar.

a. It is desirable to allow 2-3 exchanges of List 1 A&B vegetables per day

b. Unless there is a need for drastic restriction of simple carbohydrates, 3-4 exchanges of
fruits per day are reasonable allowances.
c. The amount and type of milk depends upon the patient’s need, food habits and other
economic considerations.
d. Allow 5-9 teaspoons of sugar per day unless contra-indicated.

a. To determine how many rice exchanges:

a. Add CHO from vegetables, fruit, milk and sugar.
b. Subtract this sum from the prescribed CHO.
c. Divide the difference by 23 (g CHO furnished by 1 rice exchange).
d. The nearest whole quotient is the number of rice exchange allowed.

b. To determine how many meat and fish exchanges are allowed.

a. Add the protein furnished by the food groups already listed.
b. Subtract the sum from the prescribed protein.
c. Divide the difference by 8 (g per PRO per meat and fish exchange).
d. The nearest whole quotient is the number of meat and fish exchange allowed.
e. When calculating grams of fat per meat and fish exchange, use the fat value that best
represents the patient’s usual intake. There is no need to add or subtract fat exchanges if
the appropriate meat and fish category is used in the computation of food allowance.

Normally, for individuals consuming a sufficiently varied diet from day to day, the fat
value for medium fat meat and fish exchange may be used as it can be assumed that the
low fat and high fat meat and fish exchanges that the patient uses will balance out to the
value of the medium fat meat and fish exchange. On the other hand, if the patient is on fat
restricted diet, use the low fat meat and fish exchange and instruct patient to limit the
choices to those foods in the list.

f. Follow the same procedure for fat, using 5 as the divisor since one fat exchange contains 5
g of fat.
An allowance of + 5 grams the prescribed amount for protein, carbohydrate and fat and +
50 kilocalories for energy for energy are given so the fraction of servings are avoided.

Distribute the food allowance into breakfast, lunch, supper and snacks, depending on the
patient’s eating habits.
 SAMPLE CALCULATIONS

Diet Rx: kcal 1500; CHO 245 g; CHON 55 g; FAT 35 g

List Food No. of Exchanges CHO PRO FAT Energy

I.A Veg A 2 3 1 - 16

I.B Veg. B 1 3 1 - 16

II. Fruit 4 40 - - 160

III Milk 1 12 8 10 170

Whole

VII. Sugar 5 25 - - 100

Partial sum = 83

245 (prescribed CHO)

-83 (partial sum of CHO)
162 / 23 = 7 no. of rice exchange

List Food No. of Exchanges CHO PRO FAT Energy

IV. Rice 7 161 14 - 700

Partial sum = 24

55 (prescribed PRO)
-24 (partial sum of PRO)
31 / 8 = 4 no. of meat exchange

List Food No. of Exchanges CHO PRO FAT Energy

V. Meat
 Low fat 3 - 24 3 123

Med fat 1 - 8 6 86

Partial sum = 24
35 (prescribed FAT)
-19 (partial sum of PRO)
16 / 5 = 3 no. of fat exchange

List Food No. of Exchanges CHO PRO FAT Energy

VI. Fat 3 - - 15 135

TOTAL 56 56 34 1506

SAMPLE MEAL PLAN AND MENU FOR ONE DAY

Total Food for the Day:

Vegetable A - 2 exchanges Sugar - 5 exchanges
Vegetable B - 1 exchange Rice - 7 exchanges
Fruit - 4 exchanges Meat & Fish - 4 exchanges
Milk - 1 exchange Fat - 3 exchanges

Food Exchanges No. of Exchanges Sample Menu Approximate Size Per Serving
Breakfast
Fruit 1 Ripe Papaya 1 slice (10x6x2cm)
Meat, and Fish or 1 Baked Ham or ¾ cup
substitute Sausage 3 (9cm diax.3cm thick)
Rice or substitute 1 Pan Amerikano 2 slices (9x8x1cm each)
Milk for Coffee ¼ Evaporated Milk 2 tablespoons
Sugar 2 White Sugar 2 teaspoons
______________________________________________________________________________
Mid-A.M. Snack
Rice or substitute 1 Pan de Limon 1 piece (6x5x4)
Meat 1 Cottage Cheese 1/3 cup
______________________________________________________________________________
Lunch
Soup Clear Broth from
Chicken Tinola
Meat and Fish or 1 Chicken Tinola 1 small leg-
Substitute 13-1/2 cm long x 3cm diameter
 Vegetable A 2 Green Papaya 1 cup
& Sili Leaves
Rice 1-1/2 Boiled Rice ¾ cup
Fruit 1 watermelon 1 slice (12x6x3cm) or 1 cup
Fat 1 Cooking oil for 1 teaspoon
Mid-Pm Snack
Rice or substitute 1 Pan de Monay 1 piece (10x9x4cm)
Fat 1 Cream cheese 1 tablespoons
Fruit 1 Pineapple Juice 1/3 cup (undiluted)
Sugar 1 White Sugar 1 teaspoon
Supper
Soup 1 Parsleyed Beef Broth
Meat and Fish or substitute 1 Broiled Bangus w/ Kalamansi 1 slice (7x3x2cm)
Vegetables B 1 Sauteed Squash ½ cup
Rice 1½ Boiled Rice ¾ cup
Fruit 1 Lakatan 1 piece (9x3cm)
Fat 1 Cooking oil for squash 1 teaspoon
Bed-Time Snack
Rice or substitute 1 Galyetas de Patatas 10 pieces of (4x4x1/2 cm each)
Milk ¾ Evaporated Milk 1/3 cup (undiluted)
Sugar 2 White Sugar 2 teaspoons

Exercise 2

Tools in Nutrition

Objective:

1. To compute for your DBW and TER and distribute the TER
2. To apply FEL and make a sample menu

1. Compute your BMI

Height _____
Weight _____

2. Determine your desirable body weight using Tann Hauser method and compute for
you TER (show computation).

3. Plan a one day meal for yourself

 a. Indicate CHO,PRO and Fat allowances
b. Using FEL, translate your dietary prescription into food exchanges, distribution
CALORIES, CHO,PRO and FAT into breakfast, lunch, supper and snacks
accordingly depending on your eating habits.

c. Show your sample meal plan for one day.

DIETARY PRESCRIPTION
Energy : _____
CHO : ______
CHON : ______
FAT: ______

TABLE 1. FOOD EXCHANGE

NUMBER OF ENERGY
FOOD GROUP CHO (g) CHON (g) FAT (g)
SERVINGS (kCal)

I. Veg. A

Veg. B

II. Fruit

III. Milk

IV. Rice

V. Meat

VI. Fat

VII. Sugar

TOTAL