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ABSTRACT
For more than 50 years the exchange lists have been one method of meal planning for persons with diabetes as well as for those on weight-loss regimens. Little research has been conducted, however, concerning the methodologic basis of the system or its clinical effectiveness. Justification for specific food inclusions and general food groupings for the 1995 revision of the Exchange Lists for Meal Planning is provided by a database of foods and associated energy and macronutrient values. The mean energy and macronutrient values for each of the lists and sublists (starch, fruit, milk, and vegetables from the carbohydrate group; the meat and meat substitutes group, and the fat group) closely match the mean exchange values; however, the standard deviation and range are large. Interpretation of the database provides a rationale and guidance for decision making in clinical practice when using exchanges for meal planning, recipe, and food label calculations. J Am Diet Assoc. 1996; 96:1167-1171.
In 1950, ajoint effort by The American Dietetic Association, the American Diabetes Association, and the US Public Health Service to prepare a set of food values for estimating nutrients and energy for meal plans for persons with diabetes, a short method for calculating the diet, and several lists of foods of similar values resulted in the first edition of the Exchange Lists for Meal Planning (1). Now 45 years and three revisions (in 1976, 1986, and 1995) later, the general concepts for exchanges still apply. Foods are categorized by lists, and mean macronutrient and energy values for each list are similar to specific food values.
Even though this meal planning tool is commonly used in nutrition counseling, few research papers have been published concerning its effectiveness in producing desired outcomes (2-7). Fewer yet have challenged its methodologic basis, particularly how closely composition values for the specific foods in each exchange list match mean exchange values for energy, carbohydrate, protein, and fat used in meal planning. Sorenson et al (8) found that the 1950 exchange lists underestimated energy, which could result in weight maintenance for a person supposedly following an energy-reduced pattern. Wyse (9) compared the 1976 exchange lists with the revised 1972 nutrient database computer tapes of the US Department of Agriculture (USDA) Agricultural Handbook No. 8...