Beruflich Dokumente
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Fat-Free and Very Low-Fat Milk contain 90 calories per serving. One serving equals:
1C Milk, fat-free or 1% fat
¾C Yogurt, plain nonfat or low-fat
1C Yogurt, artificially sweetened
Very Lean Protein choices have 35 calories and 1 gram of fat per serving. One serving equals:
1 oz Turkey breast or chicken breast, skin removed
1 oz Fish fillet (flounder, sole, scrod, cod, etc.)
1 oz Canned tuna in water
1 oz Shellfish (clams, lobster, scallop, shrimp)
¾C Cottage cheese, nonfat or low-fat
2 Egg whites
¼C Egg substitute
1 oz Fat-free cheese
½C Beans, cooked (black beans, kidney, chick peas or lentils): count as 1
starch/bread and 1 very lean protein
Lean Protein choices have 55 calories and 2–3 grams of fat per serving. One serving equals:
1 oz Chicken—dark meat, skin removed
1 oz Turkey—dark meat, skin removed
1 oz Salmon, swordfish, herring
1 oz Lean beef (flank steak, London broil, tenderloin, roast beef)*
1 oz Veal, roast or lean chop*
1 oz Lamb, roast or lean chop*
1 oz Pork, tenderloin or fresh ham*
1 oz Low-fat cheese (with 3 g or less of fat per ounce)
1 oz Low-fat luncheon meats (with 3 g or less of fat per ounce)
¼C 4.5% cottage cheese
2 med. Sardines
* Limit to 1–2 times per week
Medium-Fat Proteins have 75 calories and 5 grams of fat per serving. One serving equals:
1 oz Beef (any prime cut), corned beef, ground beef**
1 oz Pork chop
1 Whole egg (medium)**
1 oz Mozzarella cheese
¼C Ricotta cheese
4 oz Tofu (note this is a heart healthy choice)
** Choose these very infrequently
Starches contain 15 grams of carbohydrate and 80 calories per serving. One serving equals:
1 slice Bread (white, pumpernickel, whole wheat, rye)
2 slices Reduced-calorie or "lite" bread
¼ (1 oz) Bagel (varies)
½ English muffin
½ Hamburger bun
¾C Cold cereal
1
⁄3 C Rice, brown or white, cooked
1
⁄3 C Barley or couscous, cooked
1
⁄3 C Legumes (dried beans, peas or lentils), cooked
½C Pasta, cooked
½C Bulgar, cooked
½C Corn, sweet potato, or green peas
3 oz Baked sweet or white potato
¾ oz Pretzels
3C Popcorn, hot air popped or microwave (80% light)
Fats contain 45 calories and 5 grams of fat per serving. One serving equals:
1 tsp Oil (vegetable, corn, canola, olive, etc.)
1 tsp Butter
1 tsp Stick margarine
1 tsp Mayonnaise
1 Tbsp Reduced-fat margarine or mayonnaise
1 Tbsp Salad dressing
1 Tbsp Cream cheese
2 Tbsp Lite cream cheese
1/8th Avocado
8 large Black olives
10 large Stuffed green olives
1 slice Bacon
Definition
The word exchange refers to the fact that each item on a particular list in the portion listed may
be interchanged with any other food item on the same list. An exchange can be explained as a
substitution, choice, or serving. Each list is a group of measured or weighed foods of
approximately the same nutritional value. Within each food list, one exchange is approximately
equal to another in calories, carbohydrate, protein, and fat. To use the exchange lists, an
individual needs an individualized meal plan that outlines the number of exchanges from each
list for each meal and for snacks. The American Diabetes Association recommends that because
of the complexity of nutrition issues, a registered dietitian, knowledgeable and skilled in
implementing nutrition therapy into diabetes management and education, be the team member
developing and implementing meal plans. The meal plan is developed in cooperation with the
person with diabetes and is based on an assessment of eating changes that would assist the
individual in achieving his or her target metabolic goals and of changes the individual is willing
and able to make. Because of the accuracy and convenience of the exchange system, the
exchange lists are used for weight management as well for diabetes management.
The exchange system categorizes foods into three main groups: Carbohydrates, Meat and Meat
Substitutes, and Fats. Foods are further subdivided in these three groups into specific exchange
lists. The Carbohydrate Group contains the Starch, Fruit, Milk, Sweets and desserts (other
carbohydrates), and Vegetable lists. Foods from the Starch, Fruit, Milk, and Sweets lists can be
interchanged in the meal plan, as they each contain foods with 60 to 90 calories and
approximately 15 grams of carbohydrate. The Meat and Meat Substitute Group contains food
sources of protein and fat. The group is divided into four lists: Very Lean Meats, Lean Meats,
Medium-Fat Meats, and High-Fat Meats, allowing the user to see at a glance which meats are
low-fat and which meats are high-fat. The lists have foods containing 35, 55, 75, and 100
calories, and 1, 3, 5, and 8 grams of fat, respectively. The Fat Group contains three lists:
Monounsaturated Fats, Polyunsaturated Fats, and Saturated Fats. Each food source contains an
average of 45 calories and 5 grams of fat. The exchange lists also identify foods that contribute
significant amounts of sodium. A sodium symbol is shown next to foods that contain 400 mg or
more of sodium per exchange serving.
Despite the many advantages the exchange lists offer, they may not be the most appropriate
meal-planning tool for many persons. For instance, they are not appropriate for those who cannot
understand the concept of "exchanging" foods. Because the exchange booklets are written at a
ninth- to tenth-grade reading level, individuals must be able to either read at this level or
understand the concept of exchanging foods. For an individual to use them effectively, several
educational sessions, and practice, may be required.
Historical Background
In 1950, the following problems that had led to inconsistencies in food recommendations for
persons with diabetes were identified: (1) methods used to estimate the composition of a diet
were prolonged and needlessly precise; (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
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.
Marion J. Franz