Updating of the Philippine food exchange lists for meal planning

Abstract

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.