Philippine Journal of Science 150 (5): 955-968, October 2021 ISSN 0031 - 7683 Date Received: 06 Aug 2020 Updating of the Philippine Food Exchange Lists for Meal Planning Consuelo L. Orense, Marilou L. Madrid*, Noelle Lyn C. Santos, Hazel T. Lat, and David Kenneth C. Mendoza Department of Science and Technology Food and Nutrition Research Institute (DOST-FNRI) Bicutan, Taguig City 1631 Philippines 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. Keywords: food exchange lists, food exchanges, meal planning, nutrition, nutritionist-dietitians INTRODUCTION fat. It is made up of food groups, each being called an exchange list that contains food items with approximately The Philippine FEL is a tool used by RNDs in planning the same amounts of energy and macronutrients within meals for individuals who need a calculated intake of the list; thus, a substitute of food with another can be energy and macronutrients – carbohydrates, protein, and made (Caso 1950). The Philippine FEL was initially intended to provide carbohydrate information for use in *Corresponding Author: [email protected] the diet management of persons with diabetes. Today, 955 Philippine Journal of Science Orense et al.: Updating of the Philippine Food Vol. 150 No. 5, October 2021 Exchange Lists for Meal Planning the Philippine FEL is used as a guide in prescribing and METHODS planning meals for healthy and therapeutic diets, as well as an educational tool by nutrition professionals in clinics and The study protocol was approved and project hospitals, fitness centers, and other health care facilities implementation was cleared on 28 March 2017 by (Tanchoco et al. 1994). the Department of Science and Technology–Food and Nutrition Research Institute’s (DOST-FNRI) The first FEL was developed in the 1950s by the American Institutional Ethics and Review Committee (Protocol Diabetes Association, the American Dietetic Association Code FIERC-2017-006). Signed informed consent (ADA), and the United States (US) Public Health Service forms were obtained from the study participants prior for the management of patients with diabetes (Wheeler to data collection. Participants were informed of the et al. 1996). It has undergone several revisions from its confidentiality of all the information obtained from previous title “Exchange Lists for Diabetes” to “Choose them and that their participation in the study is voluntary Your Foods: Exchange Lists for Diabetes” in the sixth and they can withdraw from the study anytime without revision published in 2008 (Wheeler et al. 2008; Geil penalty. Data collection was conducted from April 2017– 2008). The Philippine FEL was adapted from the US March 2018. The authors declared no conflict of interest in 1953 by Corpus et al. and was revised in 1965 by on this project. Madlangsakay that included six food groups [as cited in Flores et al. (1984)]. The 1965 revision was updated The steps undertaken in coming up with the 2019 FEL by Flores et al. in 1984 wherein the sugars and sweets were: 1) collection of data on the needs of FEL users by from the rice group were removed to form the sugar means of survey and FGDs, 2) review and computations exchange as the seventh group. The third revision in 1994 of the macronutrient content of exchange portions of each by Tanchoco et al. had the subgroups of the vegetable food item, and 3) revision/updating of content and design and milk exchanges modified while retaining the seven of handbook. main groups. Some changes in this version included the following: adjustment of portion sizes, use of Filipino Survey language in the food listing, a separate grouping of The survey among FEL users was done using a pre- processed/selected foods, and identified fruits with high tested, semi-structured self-administered questionnaire. vitamin A and vitamin C content. Prior to this study, Survey questions evaluated the technical content, the the 1994 FEL was not updated because the local food physical attributes – comprehensibility, usefulness, layout, composition database was being modified. and design – that were used to improve the 1994 FEL handbook. Tools in nutrition have to be periodically reviewed to keep up with current trends in the management of nutrition- The target population was users of FEL in the Philippines. related conditions. As a guide in dietary planning, the FEL The RNDs were initially targeted as respondents, but the should maintain a list of foods currently available in the addition of student respondents was later on considered market and which are consumed by many people. Novel as users of FEL in school. The inclusion criteria for FEL foods that are now part of family meals have to be evaluated users were any of the following: 1) RND staff in hospitals on how these can fit into the diet plan of individuals with and wellness centers, 2) teachers of major nutrition courses different health concerns. Moreover, the popularity of the using FEL, or 3) students of nutrition in their senior years. FEL as a reference material deems it necessary to always Excluded from the study were non-users of FEL or persons provide timely and adequate information to its users who not belonging to the mentioned criteria. The number of are working in the different fields of nutrition. respondents was calculated based on a 50% proportion of FEL users, with 95% confidence and a 1.0 design effect. The need to innovate the FEL is important because Using the Open Epi software version 3.01, the number of the rising number of Filipino clients with lifestyle- of respondents needed to satisfy the sampling conditions related diseases who will avail of nutrition education and was approximately 400 individuals (Dean et al. 2013). counseling. In improving tools for clients, simplicity, ease of use, user-friendliness, and visual appearance are some A listing of RNDs from government and private hospitals features that have to be considered in addition to its main of the National Capital Region (NCR) and other areas was or technical content. secured from heads of dietary, food service, and nutrition clinics via phone inquiry or internet search. Letters were The FEL was updated for the purpose of reviewing the sent to these institutions to request their participation. calculations and grouping of foods based on current tools The survey questionnaires and consent forms for the and nutritional recommendations, improving the methods RNDs were sent either by courier, personal delivery and of assessing individuals using updated methods, and pick-up, or email. enhancing the design and appearance of the handbook. 956 Philippine Journal of Science Orense et al.: Updating of the Philippine Food Vol. 150 No. 5, October 2021 Exchange Lists for Meal Planning For respondents in the academe, a listing of schools A working database file was kept for each food group offering nutrition programs was obtained from the that contains information on the food item description, Professional Regulation Commission. Schools with nutrient contents, and a food code that matched an item high enrollment in nutrition programs were selected to in the 2017 Philippine FCTs. represent the students who use the FEL. Coordination with the school and the faculty handling major nutrition The macronutrient and energy contents of foods were subjects was made through letters of request or email, calculated from the new FCTs (DOST-FNRI 2017a) which were sent to school heads or the faculty concerned. and other food databases such as those from Australia, The distribution and retrieval of the forms from the ASEAN, Japan, Korea, and the US. Using Microsoft school to the researchers were also done by the faculty- Excel software, the edible portion (EP) weight of the contact person. Consent forms were also attached to the food was determined to provide one exchange portion. questionnaire to seek approval to participate in the study. Small adjustments were made on the weight of the food per exchange to avoid difficulty in translating it to household measure, e.g.