NCM 105: NUTRITION AND DIET THERAPY

UNIT TWO. BASIC TOOLS IN NUTRITION

Food Groups – Food guides translate quantitative nutritional requirements into simple, practical and
non- technical language using available and common foods of the country.

The 3 Main Food Groups:

1. Body-building foods - foods that supply good quality proteins, some vitamins and minerals.
2. Energy foods - mostly of rice and other cereals, starches, sugars and fats contribute the bulk of
Calories.
3. Regulating foods - composed of fruits and vegetables that provide vitamins and minerals,
particularly ascorbic acid and pro vitamin A.

Dietary Guidelines strategies to promote appropriate diets and related health practices to achieve
the goal of improving the nutritional condition.

CHAPTER 1: FNRI AND USDA FOOD GUIDE PYRAMID, PINGGANG PINOY AND MYPLATE
The Food Pyramid is designed to make healthy eating easier. Healthy eating is about getting the
correct amount of nutrients – protein, fat, carbohydrates, vitamins and minerals you need to
maintain good health.

Foods that contain the same type of nutrients are grouped together on each of the shelves of the
Food Pyramid. This gives you a choice of different foods from which to choose a healthy diet.
The food pyramid is the basic tool in identifying the right amount of food to be taken per food
category. However, most people do not follow the dietary guidelines in the food pyramid and just
rely on what they want and what is appealing for them. The food pyramid helps people in preparing
the most balanced meal in order to consume only what are right for the body and prevent
deficiencies and excess. The following discusses the food groups under the food pyramid and their
general uses and benefits to the body.

In a nutshell, healthy eating involves:

plenty of vegetables, salad and fruit
a serving of whole meal cereals and breads, potatoes, pasta and rice at every meal - go for
wholegrain varieties wherever possible
some milk, yoghurt and cheese
some meat, poultry, fish, eggs, beans and nuts
a very small amount of fats, spreads and oils
and a very small amount or no foods and drinks high in fat, sugar and salt

FNRI (Foods & Nutrition Research Institute)

The Food and Nutrition Research Institute (FNRI), the principal research arm of the government
in food and nutrition, is one of the research and development institutes of the Department of
Science and Technology (DOST). It was created under Executive Order No. 128 signed on January
30, 1987. As such, the Institute is committed to pursue the goals and objectives of the National
Science and Technology Plan (NSTP) and the Philippine Plan of Action for Nutrition (PPAN).
The Institute continues to provide relevant technologies and scientific information on food
and nutrition. Some of its major accomplishments include the development and commercialization
of nutritional food products; conduct of periodic nationwide nutrition surveys; development of
analytical food quality and safety assurance system; strategies and programs to address the
malnutrition problem and tools, guidelines and standards to serve the needs of nutrition and
nutrition-related workers. All these technologies are transferred to health and nutrition program
implementors as well as the households and communities with the end view of improving the quality
of life of Filipinos.

The Food and Nutrition Research Institute is one of the research and development institutes
(RDIs) of the Department of Science and Technology (DOST).

The chronology of the events to its present status follows:

1947 - Creation of the Institute of Nutrition (IN) under the Office of the President as the clearing-
house of data and information concerning nutrition (Exec. Order 94)
1948 - Creation of the IN Board for an integrated and multisectoral approach to malnutrition
1949 -Inclusion in the mandate of the IN to undertake research in the applied science of food and

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 NCM 105: NUTRITION AND DIET THERAPY
nutrition (Administrative Order No. 81)
1950 - Transfer of the IN to the Department of Health (Executive Order 392)
1958 - Transfer of the newly created National Science Development Board (NSDB) as the Food
and Nutrition Research Center (FNRC) under the National Institute of Science and
technology(NIST) (RA 2058)
1973 - Attainment of full agency status directly under the NSDB as a research and development
institute
1975 - Renaming of the FNRC into Food and Nutrition Research Institute (FNRI) upon conversion of
NSDB to the National Science and Technology Authority (NSTA) under PD. 733.
1987 - Redefinition of the functions of FNRI upon reorganization of NSTA to DOST (Executive Order
No. 128)
1993 - Transfer of the FNRI to its newly constructed building at the DOST Compound, Bicutan,
Taguig, Metro Manila
1994 - Designation of FNRI as an Associated Institution of the United Nations University
1996 - Designation of the FNRI's national nutrition surveys and regional updating of the nutritional
status of Filipino children among the statistical activities that will generate critical data for
decision-making of the government and private sector
(E.O. 351)
2001 - Accreditation to ISO 17025 of the FNRI's Food Analytical Service Laboratory (FASL) under
the Department of Trade and Industry's Bureau of Product Standards Laboratory Accreditation
Scheme

MANDATE
Under Executive Order No. 128 signed on January 30, 1987, the Food and Nutrition Research
Institute, consonant to the promotion of efficiency and effectiveness in the delivery of public
services, is mandated to perform these functions:
• Undertake researches that define the citizenry’s nutritional status, with reference to the
malnutrition problem, its causes and effects
• Develop and recommend policy options, strategies, programs and projects for implementation
by appropriate agencies.
• Diffuse knowledge and technologies in food and nutrition and provide S&T services to relevant
stakeholders (as per E.O. 366, November 13, 2009)

VISION
OPTIMUM NUTRITION for all Filipinos, socially and economically empowered through scientifically
sound, environment- friendly and globally competitive technologies.

MISSION
As the lead agency in food and nutrition research and development in the country, the FNRI’s
mission is the:
• Provision of accurate data, correct information, and innovative technologies to fight malnutrition.

MAJOR THRUST
• Development of nutritional food products for domestic and export markets
• Consumer protection through food quality and safety assurance
• Nutrition condition update and analyses of factors affecting malnutrition
• Nutrition intervention modelling for prevention and control of protein-energy and
• Micronutrient malnutrition
• Promotion and transfer of food and nutrition technologies
• Human resource development

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Daily Nutritional Guide Pyramid for Filipino Lactating Women

Daily Nutritional Guide Pyramid for Filipino Pregnant Women

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Daily Nutritional Guide Pyramid for Older Persons (60-69 years old)

Daily Nutritional Guide Pyramid for Filipino Adults (20-39 years old)

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Daily Nutritional Guide Pyramid for Filipino Teens (13-19 years old)

Daily Nutritional Guide Pyramid for Filipino Children (7-12 years old)

Daily Nutritional Guide Pyramid for Filipino Children (1-6 years old)

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Pinggang Pinoy: Healthy Food Plate for Filipino Adults

• easy-to-understand
• uses a familiar food plate model to convey right food group proportions
• per-meal basis to meet energy and nutrient needs of Filipino adults

Pinggang Pinoy is a new, easy to understand food guide that uses a familiar food plate model to
convey the right food group proportions on a per-meal basis, to meet the body’s energy and
nutrient needs of Filipino adults. Pinggang Pinoy serves as visual tool to help Filipinos adopt healthy
eating habits at meal times by delivering effective dietary and healthy lifestyle messages.

Will Pinggang Pinoy replace the FNRI Daily Nutritional Guide (DNG) Pyramid?

The “Pinggang Pinoy” can be used side by side with the existing DNG Pyramid for Filipinos but it will
not replace it. According to FNRI, Pinggang Pinoy is a quick and easy guide on how much to eat
per mealtime, while the DNG Pyramid shows at a glance the whole day food intake
recommendation.

Both the “Pinggang Pinoy” and the DNG Pyramid for Filipinos are based on the latest science about
how our food, drink, and activity choices affect our health.

The DNG Pyramid is a simple, trustworthy guide in choosing a healthy diet. It builds from the base,
showing that we should eat more foods from the bottom part of the pyramid like vegetables, whole
grains and less from the top such as red meat, sugar, fats and oils. When it’s time to eat, most of us
use a plate. So it is just appropriate to use the “Pinggang Pinoy” as a guide for a typical balanced
meal.

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▪ To establish a diet to help Filipinos maintain and even improve overall health and reduce risk
of diet-related diseases
▪ Directed to healthy Filipino adults 19-64 years old with moderate physical activity
▪ Not directed for treatment of disease or individuals with medical problems
▪ Developed by the Food and Nutrition Research Institute in coordination with the NNC and
DOH with support from WHO Philippines

Development entailed:
Review of existing food guide and nutritional status and evidence
Develop preliminary concepts and pre-testing
Experts consultation
Finalization and presentation to NNC Techcom

USDA (United States Department of Agriculture)

USDA is responsible for providing a safety net for millions of Americans who are food-insecure and
for developing and promoting dietary guidance based on scientific evidence. USDA works to
increase food security and reduce hunger by providing children and low-income people access
to food, a healthful diet and nutrition education in a way that supports American agriculture and
inspires public confidence. USDA provides critical nutrition assistance through Food and Nutrition
Service (FNS) programs that include child nutrition programs, the Supplemental Nutrition Assistance
Program (SNAP) and emergency food assistance among many other programs. The Center for
Nutrition Policy and Promotion (CNPP) is responsible for developing and promoting dietary
guidance that links the best evidence-based scientific research to the nutrition needs of Americans.

A Brief History of USDA Food Guides

Many individuals remember the Pyramids – the Food Guide Pyramid and MyPyramid – USDA’s food
guidance symbols before MyPlate, but not many people realize just how long USDA’s history of
providing science-based dietary guidance to the American public actually is. Starting over a
century ago, USDA has empowered Americans to make healthy food choices by providing a
number of publications, food guidance symbols, and, more recently, a suite of interactive online
tools. Explore the history of USDA’s food guidance on the timeline below.

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1916 to 1930s: "Food for Young Children" and "How to Select Food"
• Established guidance based on food groups and household measures
• Focus was on “protective foods”

1940s: A Guide to Good Eating (Basic Seven)

• Foundation diet for nutrient adequacy
• Included daily number of servings needed from each of seven food groups
• Lacked specific serving sizes
• Considered complex

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1956 to 1970s: Food for Fitness, A Daily Food Guide (Basic Four)
• Foundation diet approach—goals for nutrient adequacy
• Specified amounts from four food groups
• Did not include guidance on appropriate fats, sugars, and calorie intake

1979: Hassle-Free Daily Food Guide

• Developed after the 1977 Dietary Goals for the United States were released
• Based on the Basic Four, but also included a fifth group to highlight the need to moderate intake
of fats, sweets, and alcohol

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1984: Food Wheel: A Pattern for Daily Food Choices

• Total diet approach - Included goals for both nutrient adequacy and moderation
• Five food groups and amounts formed the basis for the Food Guide Pyramid
• Daily amounts of food provided at three calorie levels
• First illustrated for a Red Cross nutrition course as a food wheel

1992: Food Guide Pyramid

• Total diet approach—goals for both nutrient adequacy and moderation
• Developed using consumer research, to bring awareness to the new food patterns
• Illustration focused on concepts of variety, moderation, and proportion
• Included visualization of added fats and sugars throughout five food groups and in the tip
• Included range for daily amounts of food across three calorie levels

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2005: MyPyramid Food Guidance System

• Introduced along with updating of Food Guide Pyramid food patterns for the 2005 Dietary
Guidelines for Americans, including daily amounts of food at 12 calorie levels
• Continued “pyramid” concept, based on consumer research, but simplified illustration. Detailed
information provided on website “MyPyramid.gov”
• Added a band for oils and the concept of physical activity
• Illustration could be used to describe concepts of variety, moderation, and proportion

2011: MyPlate
• Introduced along with updating of USDA food patterns for the 2010 Dietary Guidelines for
Americans
• Different shape to help grab consumers’ attention with a new visual cue
• Icon that serves as a reminder for healthy eating, not intended to provide specific messages
• Visual is linked to food and is a familiar mealtime symbol in consumers’ minds, as identified
through testing
• “My” continues the personalization approach from MyPyramid

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MyPlate is a reminder to find your healthy eating style and build it throughout your lifetime.
Everything you eat and drink matters. The right mix can help you be healthier now and in the future.
This means:
• Focus on variety, amount, and nutrition.
• Choose foods and beverages with less saturated fat, sodium, and added sugars.
• Start with small changes to build healthier eating styles.
• Support healthy eating for everyone.

CHAPTER 2: 10 NGF (Nutritional Guide for Filipinos)

10 Nutritional Guidelines for Filipinos

1. Eat a variety of foods every day.

• The human body needs more than 40 different nutrients for good health. No single food can
provide all the nutrients in the amounts needed. Eat a variety of foods, to provide all the nutrients
required in the proper amount and balance.

2. Breast-feed infants exclusively from birth to 4-6 months and then, give appropriate foods while
continuing breast-feeding.

• Infants and children up to 2 years of age are most vulnerable to malnutrition. Breast-feeding is
one of the most effective strategies to improve child survival. Nutritional requirements of an infant
can be obtained solely from breast milk for the first 6 months of life. After that time, breast milk must
be complemented with appropriate foods, but breast-feeding should be continued for up to 2
years of age or longer.

• The decision to breast-feed is made by the mother. Nonetheless, the husband and other family
members, health workers, neighbors, community organizations, officemates and employers must
encourage her to breast-feed her infant.

3. Maintain children's normal growth through proper diet and monitor their growth regularly.

• An adequate diet for an active child is one that promotes good health and normal growth.
• A well-nourished child is healthy, strong, and alert, has good disposition, and grows at a normal
rate.
• A poorly nourished child exhibits sluggish if not permanently delayed physical and mental
development. In addition, he is lethargic and frequently ill because of low resistance to infection.
• Over nutrition on the other hand, may lead to obesity that may cause physical and emotional
problems in childhood and later in life.

4. Consume fish, lean meat, poultry or dried beans.

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• To improve the Filipino diet, not only should the total quantity of food be increased but the quality
of the diet should also be improved by including animal products of substitutes.
• Including fish, lean meat, poultry, or dried beans in the daily meals will not only enhance the
protein quality if the diet but also supply highly absorbable iron, preformed vitamin A and zinc.
• Fish, lean meat, poultry without skin, and dried beans, in contrast to fatty meats, are low in
saturated fats, which are linked to heart disease.

5. Eat more vegetables, fruits and root crops.

• In general, most people do not eat enough vegetables, fruits and root crops. Results of food
consumption surveys conducted by the FNRI show that the average consumption of green leafy
vegetables, vitamin C-rich fruits and root crops are low in the Filipino diet.
• The consumption of more vegetables, fruits and root crops is encouraged to help correct the
micronutrient deficiencies consistently noted in national nutrition surveys. Eating root crops will add
dietary energy to the meal.

6. Eat foods cooked in edible/cooking oil daily.

• In general, Filipinos use very little oil in their cooking. Boiling is the most common method of food
preparation. Hence, the total fat and oil consumption in a Filipino diet is low.
• Fats and oils are concentrated sources of energy. A low fat and oil consumption results in a diet
low in energy value, contributing to chronic energy deficiency. Fats and oils are also essential for
absorption and utilization of fat-soluble vitamins, such as vitamin A. A low fat intake may be one of
the causes of vitamin A deficiency among Filipinos.
• To ensure adequate fat intake, Filipinos should be encouraged to stir-fry foods in vegetable oil or
to add fats and oils whenever possible in food preparation. This will guard against chronic energy
deficiency and help to lower the risk of vitamin A deficiency.

7. Consume milk, milk products and other calcium-rich foods such as small fish and dark green
leafy vegetables every day.

• Nutrition surveys indicate a consistent failure of Filipinos to meet dietary recommendations for
calcium. An adequate amount of calcium in the diet starting from childhood all through adulthood
will help prevent osteoporosis in later life.
• Milk and milk products provide highly absorbable calcium besides being good sources of protein,
vitamin A and other nutrients.
• Milk and other calcium-rich foods are valuable additions to our rice/plant-based diets, which are
not only poor sources of calcium but also contain calcium-inhibiting substances.

8. Use iodized salt, but avoid excessive intake of salty foods.

• Goiter and Iodine Deficiency Disorders are rampant in many areas of the Philippines, causing
physical and mental retardation in children. The regular use of iodized salt in the table and in
cooking in addition to taking iodine-rich foods, will greatly help in eradicating this preventable
disease.
• On the other hand, excessive intake of salt and salty foods particularly in susceptible individuals
increases the risk of hypertension and hence of heart disease. Avoiding too much table salt and
overly salty foods may help in the prevention and control of these conditions.

9. Eat clean and safe food.

• Food and water are essential to life but they may also carry disease-causing organisms like
bacteria, viruses, fungi and parasites, or harmful chemical substances.
• It is important to buy foods that are safe. Purchase food only from reliable sources. In addition,
care must be taken when preparing and serving meals to prevent food-borne diseases.

• Sharing in the efforts to improve environmental hygiene and sanitation in the community will
greatly contribute to food safety in the home.

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10. For a healthy lifestyle and good nutrition, exercise regularly, do not smoke and avoid drinking
alcoholic beverages.

• With the changing lifestyle of Filipinos, chronic degenerative diseases are becoming significant
public health problems. Healthy diets, regular exercise, abstinence from smoking and moderate
alcohol intake are key components of a healthy lifestyle

The 10 Kumainments is the popular version of the revised Nutritional Guidelines for Filipinos (NGF).
The 10 Kumainments consists of shorter and simpler messages for better recall and understanding.

CHAPTER 3: RDA or RENI

RDA & RENI
Recommended Dietary Allowance (RDA) - is the information of nutrient allowance for the
maintenance of good health. A tool for assessing a dietary intake of the population group. This
emphasize the amount of foods or diet.

RENI – Recommended Energy Nutrient Intake

- A new standard replacing RDA, emphasizing on recommending on the nutrients rather than
food or diet.
- This tool serve as a guide for designing nutrition and health intervention towards an
improvement of the health of the Filipinos.

RENI for Filipinos

RENI for Filipinos is a nutrient-based dietary standard in the Philippines. It is based on the new
World Health Organization (WHO)/Food and Agriculture Organization (FAO) and IOM guidelines
on energy and nutrient intakes, WHO Child Growth Standards 2006, NNS 2003, 2008, and 2013
(as new reference weights, deficiencies in dietary intakes of energy and nutrients, persisting
problems of micronutrients deficiencies), and increase in the prevalence of NCDs.

The Philippines, like many countries, relies on WHO and FAO to establish and disseminate this
information and adopt as part of their national dietary allowances. The common foundation for
all countries to develop food-based dietary guidelines for their populations is the establishment
of human nutrient requirements.

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Establishing requirements means that the public health and clinical significance of intake levels
– both deficiency and excess – and associated disease patterns for each nutrient need to be
thoroughly reviewed for all age groups.

Every 10 to 15 years, enough research is completed and new evidence accumulated to warrant
WHO and FAO undertaking a revision of at least the major nutrient requirements and
recommended intakes.

PDRI 2015

The Philippine Dietary Reference Intake (PDRI) is a comprehensive set of energy and nutrient
reference values for the healthy Filipino population. It consists of four reference values:

1) EAR (Estimate Average Requirement) is the average daily nutrient level estimated to meet
the requirements of half the healthy individuals in a particular life stage and sex group,
corrected for incomplete utilization or dietary nutrient bioavailability. It is the best estimate of
the requirement because it is the median requirement and it is directly based on primary
research data.

2) REI/RNI (Recommended Energy Intake/Recommended Nutrient Intake) is the level of intake

of energy or nutrient which is considered adequate for maintenance of health and well-being
of healthy persons in the population.

It is obtained by adding twice standard deviation of the requirement to the DAR. If there’s no
standard deviation, an assumed CV or coefficient of variation is used. However, the process of
adding 2SD or 2CV is not applicable to energy. Therefore, the median average requirement for
energy of the population is the recommended energy intake.

3) AI (Adequate Intake) is the daily nutrient intake level based on observed or experimentally-
determined approximations of the average nutrient intake by a group (or groups) of apparently
healthy people that is assumed to be adequate.

When there is no sufficient data that establish the AER, and therefore the REI/RNI, the AI can be
used. But as compared to the RNI, the AI has less certainty. It has no relationship with the AER or
RNI.

4) UL (Tolerable Upper Intake Level or Upper Limit) is the highest average daily nutrient intake
level likely to pose no adverse health effects to almost all individuals in the general population.
As intake increases above the UL, the potential risk of adverse effect increases.

Apart from the four reference values, the AMDR (Acceptable Macronutrient Distribution Range)
is the range of intakes for a particular energy source (carbohydrates, protein or fat) that is
associated with reduced risk of chronic diseases while providing adequate intakes of essential
nutrients. It is expressed as percentage of total energy intake.

According to Carl Vincent D. Cabanilla of DOST-FNRI who discussed the PDRI 2015’s key
concepts and recommendations, for most nutrients, the chosen criterion for the recommended
intake was the prevention of nutrient deficiency in the group, while for some (e.g. fluoride) the
application of chronic disease endpoints was used.

Because of unavailability/insufficient data on average requirements for some specific age

groups (i.e. children and older adults), extrapolation methods were applied.

Life stage and age groupings

Age groups were defined to reflect the established biological patterns as well as the application
of guidelines for breastfeeding duration and complimentary feeding.

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Reference weights were revised based on the NNS 2013. It adopted the new WHO-CGS (Child
Growth Standard) median weight for age at the midpoint of each target age range or
groupings, to reflect the objective of achieving the children’s growth potential.

Age groups five to nine and 10 to 18 years old – reference weights were based on WHO Growth
Reference, median weight for height and median of height-based BMI, respectively using the
2013 NNS median height of Filipino children with normal nutritional status.

Nutrients reviewed

In the PDRI 2015, 27 out of 28 nutrients in RENI 2002 were retained. Manganese was removed,
while polyunsaturated fatty acids were added.

The recommended energy intakes in the PDRI 2015 are higher compared to the RENI 2002. For
adults, 19-29-year-old males, they need 2,530 kcal as compared to the 2,400 kcal of RENI 2002.

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For the AMDRs this is new, for adults, they adopted the WHO population intake goals for different
macronutrients. For protein, it has 10-15 percent of the total energy; 15-30 percent should come
from total fat; and 55-75 percent should come from total carbohydrates.

For protein, it is slightly lower than the RENI 2002. For fatty acids (an addition to the PDRI 2015 as
there’s no recommendation in RENI 2002) for adults, 0.5 percent of the total energy
recommendations for alpha-Linolenic acid and two percent the total energy recommendations
for omega 6.

For dietary fiber, a daily intake of 25 grams is recommended for adults. For water, it is based on
the energy requirements. For electrolytes, the recommendations from RENI 2002 were retained.

For Vitamin D, the recommendations were retained. No increase despite new findings on the
effects of vitamin D. For iodine, the recommendations were retained of 150 micrograms per day
for adults.

Additional recommendations

For free sugars, the recommendation is to limit intake to <10 percent of total energy in children
and adults; Sodium intake should be limited to <2 g in adults and potassium should have
increased intake to 3,510 mg in adults (the recommendation for children on sodium and
potassium is extrapolated from adults based on energy requirements).

For dietary assessment, EAR/REI is both used for individuals and group. But for dietary planning,
RNI/REI is used for individual and EAR/REI for group. Use AI if no EAR/RNI available.

Examples of dietary assessment are the food consumption survey, evaluation of food assistance
programs, and monitoring of adequacy of food supply. For dietary planning, they are the meal
planning, food fortification, product development, food labeling and nutritional marketing.

Recommended Dietary Allowance (RDA) the amounts of selected nutrients considered

adequate to meet the known nutrient needs of healthy people. The RDA are based on scientific
knowledge and have been presented by a committee of the Food and Nutrition Board (FNB)
of the National Academy of Sciences (NAS). The Canadian equivalent is the Recommended
Nutrient Intakes. RDA is generally accepted throughout the world as a valid source of
information. At least 40 different nations have as well as organizations have published standards
similar to the RDA.
The table below serves as an example as to what is recommended as normal intake.
• How to calculate the Energy available from foods
vitamins explored

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Recommended Dietary Allowance - RDA

Following will be a discussion of the specific aspects of RDA:
Energy RDA Each individuals food energy intake must equal the energy expended, in order for
the person to maintain their body weight. The average energy consumption is aimed at setting
a standard for people to work from and it gives an example of how many kcalories are
reasonable for this group. An output side of the energy balance equation, how much energy
people should expend, has not been established.
Protein RDA Protein recommendations are mainly based on the individuals body weight. The
protein RDA is high, to cover most person’s needs. The average requirement for protein is 0.6
grams per kilogram of body weight; the RDA is 0.8 grams this is said to meet 97.5% of the
population’s needs.
No RDA for Carbohydrate and Fat The amount of protein recommended represents a small
percentage of a person’s energy allowance; with the remainder acquired from carbohydrates
and fats. The general guideline for carbohydrate and fat is that more than half of daily energy
should come from carbohydrates, with no more than one-third from fat.
Water Recommendation The larger and more active a person the greater the need for water.
Most people need a least 6 to 8 eight-ounce glasses of liquids a day. This is truly an area
neglected by most individuals.
Fiber recommendation There is no recommendation for fiber, however it is recommended that
sufficient fiber be obtained from fruits, vegetables, legumes, and whole-grain products, which
also provide vitamins, minerals and water.
The RDA for vitamins and minerals
The recommendations for vitamins and minerals are specific, as they have been studied for
decades.
Predicting a minimal requirement These recommendations have been set on the basis of studies
taken from healthy people involving the various states of depletion of their nutrient stores. From
these studies an average is determined as to the body’s need for each nutrient, which is seen
as an amount sufficient to maintain body processes. Neglecting these intakes can lead to
deficiency symptoms.
Establishing a Generous Recommendation The average requirement for each nutrient is
probably closest to most people’s need, however if all persons were to stick to the average we
would probably have a situation where half the population would develop deficiencies of some
sort. A person should not have an intake more than the average recommended as this may
lead to a situation; if going above ‘upper safe’ level, where some nutrients can be toxic.
Individuality is the key, however the tables are suffice for providing an example as to what the
average nutrient intake should be, especially relating in terms of “safe and adequate” ranges,
“safe” meaning “not too high” and “adequate” meaning “not too low“.
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CHAPTER 4: FEL (FOOD EXCHANGE LISTS)

Food Exchange List

- A classification or grouping of common foods in terms of equivalent amounts of Carbohydrates,
Protein, Fat and Calories
- 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.
List 1 - Vegetable List Vegetable
Group A vegetables contain negligible carbohydrates, protein and energy if 1 Exchange
exchange or less is used. When 2 exchanges are used, compute as one Group B
Vegetables. The portion size for one exchange is: Vegetables
Vegetable A: 1 exchange = 1cup raw (25g) or 1/2 cup cooked (45g) are
Vegetable B: 1 exchange = 1/2 cup raw (40g) or 1/2 cup cooked (45g) important
(1) These vegetables are rich sources of fiber. (2) These vegetables are rich sources sources of
of pro Vitamin A. minerals
Group A CARBOHYDRATE (g) PROTEIN FAT (g) Energy and
(g) (Kcalories) vitamins.
0 0 0 0 Include two
Acelgas (Chinese to three
Cabbage) servings,
Alagaw leaves (1) one of
Alugbati leaves (2) which
should be
Ampalaya leaves (2)
dark green
Ampalya fruit
or yellow.
Baguio beans
(abitsuelas) Dark green
Balbalulang (seaweed) and deep
(1) yellow
Bamboo shoot (labong) vegetables
Banana heart (puso na are among
saging) the best
Batw pods (1) sources of
Cabbage pro-vitamin
Camote leaves (2) A such as
Cauliflower beta-
Celery carotene.
Chayote fruit (2) Some
vegetables
Chayote leaves
such as
Cucumber
cauli-flower,
Eggplant cabbage,
Gabi leaves (1) (2) green,
Garlic leaves (1) peppers,
Kangkong (2) turnuips
Katuray flowers (1) and
Katuray leaves (1) tomatoes
Lettuce (2) contain
vitamin C.
Malunggay leaves
Malunggay pods
Green leafy
Mushroom, fresh vegetables
Mustard leaves (2) such as
Okra kangkong,
Onion bulb kamote,
Papaya green malunggay,
Patola and saluyot,
Pepper fruit contain

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 NCM 105: NUTRITION AND DIET THERAPY
Peppper leaves (2) calcium
Petsay (2) and iron;
Pokpoklo (seaweed) and
Radish cabbage,
crrots,
Saluyot (1) (2)
spinach
Sigarilyas pods
and
Spinanch (2) tomatoes
Squash flowers (2) are good
Squash leaves (1) sources of
String beans leaves vitamin B6.
(sitaw, dahon) (2)
Sweet pae pods (sitsaro) Turnips and
Tomato (2) tomatoes
Upo also contain
potassium.
Spinach is a
Group B CHO (g) PRO (g) Fat (g) Energy
good
(Kcalories)
source of
Fresh: 3 1 0 16
zinc while
Carrot (2)
green
Coconut shoot (ubod) beans and
Cowpea, pods (paayap tomatoes
bunga) provide
Kamansi (1) magnesium.
Lima bean, pods
(patani, bunga)
Mungbean sprout (toge)
Pigeon pea pods
(kadyos, bunga) (1)
Singkamas tubber
(lamang ugat)
Squash fruit
String beans pod (sitaw,
bunga)

List 2 - Fruit List Fruit Exchanges

1 exchange = 10 grams carbohydrate = 40 kcalories
This list shows the kinds and amounts of foods to use for one fruit exchange. Fruits are
(1) These fruits are good sources of fiber. (2) These fruits are good sources of important for
pro-vitamin A. (3) These fruits are sources of vitamin C. Include at least one their vitamin,
exchange in the diet daily. mineral, and
Wt. Edible fiber contents.
Food Measure
(g) Portion Include at least
A.P E.P. two to three
Fresh: exchanges
1/2 of 8 cm diameter or 1 daily in the diet,
Apple 86 65
(6cm diameter) one of which
Atis (3) 70 45 1 (5 cm diameter) should be rich in
Balimbing (1) 153 135 1-1/2 of 9 x 5 cm vitamin C.
Banana: Anonas,
kamatsile,
Lakatan 51 40 1 (9 x 3 cm)
cashew, tiesa,
Latundan 55 40 1 (9x 3 cm)
datiles, guava,
Saba 70 40 1 (10 x 4 cm) pomelo,
Cashew (3) 78 70 1 (7 x 6-1/2 cm) guwayabano,
Chico 54 45 1 (4 cm diameter) siniguelas,
Dalanghita (3) 300 135 2 (6 diameter each) strawberry, atis,
Datiles (1)(3) 61 50 1 cup and dalanghita
Duhat 80 60 20 (2cm diameter each are good
21
 NCM 105: NUTRITION AND DIET THERAPY
1 segment of 6-1/2 x 4-1/2 sources of
Durian 150 30
cm vitamin C.
10 (2 cm diameter each) Mango and
Grapes (1) 69 55 or 4 (3 cm diameter papaya
each) contain both
Guava (1)(3) 81 80 2 (4 cm diameter each) vitamin A and
1 slice (8 x 6 x 2 cm) or 1/2 C. Tiesa is also
Guwayabano (3) 86 60 an excellent
cup
3 segments (6 cm source of
Jackfruit ripe 118 40 provitamin A.
diameter each)
Kamachile (3) 110 55 7 pods Bananas,
Lansones 103 70 7 (4 x 2 cm each) oranges and
Lychees 77 50 5( 2 cm diameter each) dried fruits are
sources of
Mabolo (1) 83 50 2/3 of 6 cm diameter)
potassium.
Makopa (1) 169 135 3 (4 cm diameter each) Bananas
Mango: contain
Green (3) 90 65 1 slice (11 x 6 cm) magnesium
Medium ripe 90 65 1 slice (11 x 6 cm) and vitamin B6.
1 slice (12 x 7 cm) or 1/2 Fruits may be
Ripe (2)(3) 103 60
cup cubed used fresh,
Indian 140 80 1 (6 cm diameter) dried, canned,
Mangosteen (1) 212 55 3 (6 cm diameter each) frozen or
Marang 45 35 1/2 of 12 x 10 cm cooked. Some
1 slice (12 x 10 x 3 cm) or fresh fruit juices
Melon 317 200 like Kalamansi
1-1/3 cup
1 slice (10 x 6 x 2 cm) or (Philippine
Papaya ripe (2)(3) 133 85 lemon), dayap
3/4 cup
Pear (1) 118 85 1 (6 cm diameter) and lemon may
be rated as
1slice (10 x 6 x 2 cm) or 1/2
Pineapple 129 75 “free food”
cup
when used as
Rambutan 139 50 8 (3 cm diameter each)
flavoring, sauce
Santol (1) 127 75 1 (7 cm diameter) or when diluted
1/2 of 9 cm diameter or 1 and sweetened
Singkamas tubber 124 110
cup with artificial
Siniguelas 78 50 5 (3 cm diameter each) sweeteners.
Star apple 123 65 1/2 of 6 cm diameter Fruits may
Strawberry (1)(3) 168 165 1-1/4 cups cause a
3 segments (8 x 4 x3 cm temporary
Suha (3) 160 90
each) increase in
Tamarind, ripe 34 15 2 of 6 segments each blood sugars,
Tiesa (1)(2)(3) 41 30 1/4 of 10 cm diameter thus meal plans
1 slice (12 x 6 x 3 cm) or 1 for patients with
Watermelon (1) 226 140 diabetes
cup
Canned, drained: mellitus allow no
more than 5
Apple sauce 45 3 tablespoons
exchanges a
Fruit cocktail 40 3 tablespoons
day.
Peach halves 65 1-1/3 halves The truths are:
Pineapple, crushed 60 3 tablespoons kalamansi or
Pineapple, sliced 35 1 slice (7 cm diameter) any sour fruit
Dried: juice does not
Champoy, salted 10 4 (2 cm diameter each) have special
Mango chips 10 2 (2 x 8 cm each) reducing
Prunes seedless 15 3 pieces properties; the
natural
Raisins seedless 15 2 tablesppons
sweetness of
Canned juices:
fruit is not
Sweetened (apple, mango,
contraindicated
pineapple-grapefruit,pineapple- 60 1/4 cup
for diabetes;
orange)
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 NCM 105: NUTRITION AND DIET THERAPY
Unsweetened (orange,pineapple, each exchange
80 1/3 cup
prune) of fruit contains
Bottled (sweetened): 40 kilocalories,
Orange, guwayabano, mango 80 1/3 cup thus fruits should
Others: be computed
Banana cue 20 1/2 of 9-1/2 x 4 cm into the meal
plan. Like any
Buko water 180 1 cup
other foods the
1/4 of 10-1/2 x 9 -1/2 x 1
Maruya 20 use of fruits
cm
should be
regulated.
Some
physicians and
dietitians prefer
to use whole
fruits rather juice
in diets for
patients with
diabetes
because the
latter have a
greater
glycemic
effect.

Fruit juice
consists of
unfermented
but fermentable
liquid obtained
from native
fresh fruit, with
nothing added
or subtracted.
Fruit juice is also
Turon 20 1/2 of 9-1/2x3-1/2 x 1 cm commercially
available I the
form of fruit
juice drink and
fruit juice
concentrate.
Fruit drink is a
ready-to-drink
beverage
prepared by
mixing water
with fruit
concentrate
and into which
sugar and citric
acid may be
added to adjust
the soluble solid
content and
acidity of the
product. The
main ingredient
consists of fruit
juice
concentrate,
essential oils,

23
 NCM 105: NUTRITION AND DIET THERAPY
essences of
extracts, with or
without added
sugar.
Concentrated
fruit juice is the
fruit juice which
is concentrated
by the removal
of part of water
but not dried.

List 3 - Milk Exchange

This list shows the kinds and amount of milk or milk products to use for 1 milk
exchange.
+ Equivalent to 1 cup cow's milk plus 2 exchanges of fat or 1/2 cup evaporated
milk plus 2 exchanges of fat.
++ Buttermilk refers to pasteurized skim milk that has been sourced by lactic
acid producing bacteria.
1 exchange of each of the Milk Exchanges
sub-groups of milk CHO (g) PRO (g) Fat (g) Energy (Kcalories)
contains: Milk is an excellent
Whole Milk 12 8 10 170 source of protein
Low fat milk 12 8 5 125 and calcium. It
very low fat milk 12 8 80 also a good
source of
Wt. (g) phosphorous,
Whole Milk measure
E.P some of the B-
Milk, evaporated, undiluted 125 1/2 cup complex vitamins,
Milk, evaporated, filled, and vitamins A
125 1/2 cup and D. Milk also
undiluted
Milk, evaporated, recombined, contains some
125 1/2 cup magnesium.
undiluted
+ Milk, fresh carabao's 250 1 cup The milk
Milk, fresh cow's 250 1 cup allowance in the
meal plan can be
Milk, powdered 30 1/4 cup
used as a drink.
Added to cereals,
Low fat Milk: or mixed with
Powdered 30 1/4 cup coffee or tea and
lite Low fat Milk 250 1 tetra-brick other foods.

Skimmed (Non-Fat)/Very
Low Fat Milk:
++ Buttermilk: liquid 185 2/3 cup
powdered 25 1/4 cup
Long life skimmed milk 250 1 cup
Yoghurt 125 1/2 cup

List 4 - Rice Exchange Rice Exchanges

1 exchange = 23 grams carbohydrate, 2 grams protein =100 calories
This list shows the kinds anf amount of rice, rice equivalents, bread and Rice, other
bakery products to use for 1 exchange. cereals and
(1) These foods are good sources of fiber. products made
Food from these are
Wt (g) the major sources
A. Rice and rice products Measure of carbohydrate
E.P

24
 NCM 105: NUTRITION AND DIET THERAPY
Rice, cooked 80 1/2 cup which is the
Lugaw 435 3 cups cheapest source
Rice Products of calories. In
1 slice (1/4 of 15cm diameter,2cm addition, whole
Bibingka 40 grains or enriched
thick
Biko 40 1 slice (10 x 5 x 1 cm rice and cereals
are good sources
Casava cake 45 1/2 of 15 x 3 x 2 cm
of iron, thiamin
Espasol (1) 35 2 (11 x 2-1/2 x 1-1/2 cm each and riboflavin,
Kalamay: latik 50 1 (4 x 6 x 2 cm) whole grain
Ube 55 1 slice (7 x 3 x 1-1/2 cm) products have
Kutsinta 60 1 (6 cm diameter x 2-1/2 cm) more fiber than
Palitaw 55 4 (7-1/2 x 4 x 0.3 cm each) products made
Puto: bumbong 40 2 (11 x 2 x 1 cm each) from refined
Puto: Puti 45 1 slice (9-1/2 x 3 x 3-1/2 cm) flours.
Sapin-sapin 75 1 slice (5 x 3 x 4 cm each)
Ssuman: kamoteng kahoy 45 1/2 of 15 x 3 x 2 cm
Tikoy 40 1 slice (10 x 3 x 1-1/2 cm)
Rice equivalents
Bread
Pan amerikano 40 2 pcs
Pan de Limon 40 1 pc
Pan de sal 40 3 pcs
Rolls 40 1 pc
Whole wheat bread 45 2 slice
Bakery products
Sponge cake 40 1 slice
Pasensiya 30 22 pcs
Lady fingers 30 5 pcs
Mamon tostado 30 3 pcs
Hopia 35 1 1/2 round
Ensaymada 35 1 pcs
Corn products
Corn boiled 65 1 pc
Baby corn 90 1 cup
Noodles, cooked:
Bihon, macaroni, sotanghon,
75 1 cup
spaghetti
Others
Breakfast cereals 25 1/2 cup
Cornstarch 25 5 teaspoon
Flour, all purpose 25 3 tablespoon
Sago, cooked 120 1/2 cup cooked

List 5 - Meat and Fish Exchange Meat

This list is sub-divided into 3 sub groups based on the amount of fat and Exchanges
calories: low fat, medium fat, and high fat meat and fish.
1 exchange of meat and fish or substitute in the sub-groups contains: Foods high in
Energy protein (except
PRO (g) Fat (g)
(kcalorie) milk) compose
Low Fat Meat and Fish 8 1 41 the meat and
Medium-Fat Meat and Fish 8 6 86 fish exchange
High-Fat Meat and Fish 8 10 122 list. These foods

25
 NCM 105: NUTRITION AND DIET THERAPY
A. LOW FAT MEAT AND FISH include meat,
EXCHANGES fish, eggs,
Wt. (g) poultry, and
Food Measure
E.P. Ckd legumes.
1. Lean meat
a. beef 30 1 slice, matchbox size In addition to
Shank (bias), lean meat protein majority
(5 x 3 1/2 x 1-1/2 cm of the foods in
(laman),
Round (pierna corta at pierna the list are also
larga), good sources
tenderloin (solomilyo), of iron, zinc,
porterhouse steak (tagiliran, and other B-
gitna), complex
sirloin steak (tagiliran, hulihan), vitamins. Those
from animal
centerloin (tagiliran, unahan)
origin are
b. Carabeef particularly rich
Shank (bias), round (hita), 30 1 slice matchbox size in vitamin B12.
meat (laman: bahagya, (5 x 3 -1/2 x 1-1/2 cm Seafoods, nuts,
katamtaman at walang taba), legumes and
shoulder (paypay), round soybeans are
(pierna corta at pierna larga), good sources
rump (tapadera) of magnesium,
c. Lean pork zinc and iron.
Organ meats
Tenderloin, well trimmed 30 1 slice, matchbox size
like liver as well
(lomo) 6-1/2 x 3 x 1-1/2 cm as egg, clams,
d. Chicken soybeans and
1 small leg (13-1/2 cm long x 3 cm nuts are rich in
Leg (hita) or 30
diameter iron.
1 slice, matchbox size (5 x 3-1/2 x 1-
meat (laman) or 30
1/2 cm Foods from
breast meat (pitso) 30 1/4 breast - 6 cm long animal sources
2. Variety meats / Internal contain
35 3/4 cup
organs cholesterol, the
Blood (dugo) - prk, beef, richest sources
chicken of which are
Gizzard (balun-balunan) - egg yolk, liver,
chicken kidney, brains,
Heart (puso) - pork, beef, sweetbreads
carabeef and fish roe
Liver (atay) - pork, bef, while smaller
carabeef, amounts are
chicken found in meat.
Lungs (baga) - pork, beef, Foods from
carabeef plant sources
Omassum (librilyo) - beef, contain
carabeef negligible
Small intestine (bitukang cholesterol.
maliit)-
pork, beef, carabeef
Spleen (lapay) - pork, beef,
carabeef
Tripe (goto) - beef
Uterus (bahay guya) - prok,
beef
3. Fish
Large variety 35 1 slice (7 x 3 x 2 cm)
(e.g. bakoko, bangus,
dalag, labahita, lapu-lapu,
etc.)
26
 NCM 105: NUTRITION AND DIET THERAPY
Meduim variety:
Hasa-hasa, dalangang bukid 35 1 (18 x 4-1/2 cm
Galunggong 35 1 (14 x 3-1/2 cm
Hito 35 1/2 of 22 x 5 cm
Small variety:
Sapsap 35 2 (10 x 5 cm each)
Tilapya 35 2 (12 x 5 cm each)
Tamban 35 2 (12-1/2 x 3 cm each
Dilis 35 1/4 cup
4. Other Seafoods
Alamang, tagunton 30 1-1/4 tablespoons
Aligue: Alimango 15 1 tablespoons
Alimasag 50 3 tablespoons
Alimango / Alimasag, laman 20 1/4 cup or 1/2 piece medium
Lobster 30 2 tablespoons
Talangka 30 75 pcs A.P
Shrimps: Puti 25 5 (12 cm each)
Sugpo 25 2 (13 cm each)
Suwahe 25 5 (13 cm each)
Octopus (pugita) 30 1/2 cup
Squid (pusit) 25 3 (7 x 3 cm each)
Shells: halaan 75 1/3 cup shelled or 3 cups w/ shell
kuhol 50 1/2 cup shelled or 3 cups w/ shell
Susong pilipit 65 1/3 cup shelled or 2 cups w/ shell
Paros 60 1 cup shelled or 2-3/3 cups w/ shell
5. Beans
Pigeon pea seeds, dried 55 1/3 cup
(kadyos, buto, tuyo
6. Cheese
Cottage cheese 60 1/3 cup
A. Fish Products
Dried:
Daing:
Alakaak, alumahan, bisugo, 20 1(15-1/2 x 8 cm)
biyang puti
Lapu-lapu 20 1/4 of 30 x 40 cm
Sapsap 20 3 (9 x 5 cm each)
Tamban 20 1 (16 x 3 cm)
Tanigi 20 1 slice (16 x 6 cm)
Tinapa:
Bangus 30 1/4 of 20 x 8 cm
Galunggong 30 1 (16 x 4 cm)
Tamban 25 1 (16 x 5 cm)
Tuyo:
Alamang 15 1/3 cup
Ayungin, dilis, sapsap, 20 3(11-1/2 x 8 cm each)
tunsoy
pusit 15 1 (8 x 1 cm)
Canned:
Salmon 40 1/3 cup flaked
Tuna in brine 30 1/3 cup flaked
B. Meat Products
Tocino (lean) 45 1 slice (11 x 4 x 0.5 cm)
B. MEDIUM FAT MEAT AND FISH
EXCHANGES

27
 NCM 105: NUTRITION AND DIET THERAPY
Food
1. Medium Fat Meat 30 1 slice, matchbox size
a. Beef (5 x 3 -1/2 x 1-1/2 cm)
Flank (kabilugan)
brisket (punta y pecho),
plate (tadyang),
chuck (paypay)
b. Pork
Leg (pata) 30 1 slice (4 cm diameter x 2 cm thick)
2. Variety meats / internal
organs
Brain (utak) - pork, beef,
35 3/4 cup
carabeef
3. Fish
Karpa 35 1 slice (15 x 7 x 2 cm)
4. Egg
Chicken 60 1 pc.
Quail's egg 70 9 pcs.
salted duck's egg 60 1 pc.
5. Cheese
Cheese, cheddar 35 1 slice (6 x 3 x 2 cm)
6. Chicken
Wings 25 I medium or 2 small
Head 35 2 heads
7. Beans
Soybean (utaw) 40 1/2 cup
8. Processed Foods
a. Fish Products
Sardines canned in oil / tomato
45 1 (10 x 4-1/2 cm)
sauce
Tuna sardines 50 1-1/2 of 6 x 4 x 3 cm each
Tuna spread, canned 30 2 tablespoons
b. Meat Products
Corned beef 40 3 tablespoons
3 of 9 cm diameter x 0.3 cm thick
Ham sausage 55
each
c. Bean Products
Soybean cheese, soft (tofu) 100 1/2 cup
Soybean cheese, soft (tokwa) 60 1 (6 x 6 x 2 cm)
C. HIGH FAT MEAT AND FISH
EXCHANGES
Food
1. Pork 35 1 slice (3 cm cube)
Ham (pigue)
2. Variety meats / internal organ
Tongue (dila) - pork, beef 35 3/4 cup
3. Egg
Duck's egg 70 1 pc.
Balut 65 1 pc.
Penoy 60 1 pc.
4. Nuts
Peanuts, roasted 25 1/3 cup
5. Cheese
Cheese, filled 50 1 slice (6 x 3 x 2-1/2 cm)
Cheese, pimiento flavored 40 1 slice 6 x 3 x 2 cm
6. Processed Foods

28
 NCM 105: NUTRITION AND DIET THERAPY
Meat Products
Longanisa, chorizo style 25 1 (12 x 2 cm)
Frankfurters 60 1-1/2 of 12 x 1-1/3 cm
Salami 50 3 slices of 8 x 8 x 1 cm each
Vienna sausage 70 4 (5 x 2 x 2 cm)

List 6 - Fat Exchange List Fat is a

This list shows the kind and amount of fat to use for 1 fat exchange. concentrated
1 exchange = 5 grams fat = 45 kcalories source of energy.
Wt (g) Each gram of fat
Food Measure provides almost 2-
E.P
Saturated Fats 1/2 times as much
Bacon 10 1 strip - 10 x 3 cm energy as an
Butter 5 1 tsp equal weight of
either
Coconut, grated 20 2 tbsps
carbohydrate or
Coconut, cream 15 1 tbsp protein. Fats may
Coconut oil 5 1 tsp be or plant origin
Cream cheese 15 1 tbsp and may be liquid
Latik 10 2 tsps or solid.
Margarine 5 1 tsp Margarine, butter
Mayonaise 5 1 tsp and cream
Sandwhich spread 15 1 tbsp contain some
Sitsaron 10 2 (5 x 3 cm each) vitamins in
addtion to fat.
Whipping cream, heavy /
15 1 tbsp Peanut butter is
light
particulary a
POLYUNSATURATED FATS
good source of
Oil (corn, marine, soybean, 5 1 tsp magnesium,
rapesed-canola potassium and
MONOSATURATED FATS zinc and contains
Avocado 65 1/2 of 12 x 7 cm protein.
Peanut Buter 10 2 tsps Fats may be
Pili nut 5 5 pcs classified into
Peanut oil, olive oil 5 1 tsp polyunsaturated,
monosaturated or
saturated. The fats
found in animal
source except fish
consist mainly of
saturated fatty
acids while
vegetables oils
except coconut
oil contain more
of unsaturated
fatty acids.
Coconut oils is
Shortening 5 1 tsp unique in that it
has shorter chain
lenght fatty acids
and is the only
vegetable oil that
has 15-20 %
medium chain
triglycerides (MCT)
is long chain fatty
acids such as
those found in
animal sources.
MCt is digested,
29
 NCM 105: NUTRITION AND DIET THERAPY
absorbed and
transported easily
and oxidized
rapidly as source
of energy and has
very low tendecy
to be deposited in
adipose and other
tissues.
Some vegetable
oils, particulary
oilve oil and
peanut oil are
good sources of
monosaturated
fatty acids.
The role of
unsaturated (poly
and mono) fatty
acids in lowering
plasma
cholesterol level
has been
demonstrated in
patients with
diabetes,
atherosclerosis
and
hyperlimidemia.
However,
excessive intake
of
polyunsaturated
fats is not
recommend as
they may lower
HDl cholesterol,
commonly known
as "good
cholesterol".
One Exchange of
meat and fish
when fried or
sauteed will
absorb
approximately
ONE exchange of
fat.
Alcoholic Beverages
This list gives the fat equivalent of some commonly used alcoholic beverages.
Fat
Beverage Wt. (g) Measure Kcalories
Exchanges
Basi 170 1 glass - 6 oz 4 185
1 bottle - 11
Beer, cerveza 320 3.5 163
oz
1 brandy
Brandy, cognac 30 1.5 75
glass
1 cocktail
Daiquiri 56 3 124
glass
Gin, dry 43 1 jigger 2.5 107

30
 NCM 105: NUTRITION AND DIET THERAPY
1 bottle - 12
Gin, (ginebra) 360 18.5 832
oz
High Ball 240 1 glass 4 170
1 cocktail
Manhattan 56 4 167
glass
1 cocktail
Martini 56 3 143
glass
Mint Julep 240 1 glass 5 217
Old Fashioned 240 1 glass 4 183
Rum 43 1 jigger 2.5 107
1 tall glass - 10
Tom Collins 300 4 182
oz
Tuba 240 1 glass 2 89
Whisky, scotch 43 1 jigger 2.5 107
Wine, red 100 1 wine glass 1.5 73
Wine, white 100 1 wine glass 2 85
Wine, champagne
100 1 wine glass 2 85
(sweet & dry)
Wine, port 100 1 wine glass 3.5 160
Wine, rose 100 1 wine glass 2 85
Wine, vermouth, french 100 1 wine glass 2.5 108
Wine, vermouth 100 1 wine glass 4 170

List - 7 Sugar Exchage List

Sugar
One teaspoon of suger is equivalent to 1 exchange. Exchanges
The following list shows the kinds and amounts of sweets and other forms of sugar Sugar and
to use for 1 sugar exchange. sweets are
1 exchange = 5 grams carbohydrate = 20 kcalories good sources of
Banana chip 5 1 ( 6 x 3-1/2 cm) carbohydrates
Bukayo 5 1 (3-1/2 x 1 cm) in the diet. All
Caramel 5 1 (2 x 2 cm) sugars provide
Champoy 5 1 (2 cm diameter) the same
Chewing Gum, bubble amount of
5 1 pc
gum energy per unit
Condesed milk 10 2 tsps weight but
Hard candy 5 1 (3 x 2 x 0.5 cm) differ in degree
Honey 5 1 tsp of sweetness
and solubility.
Jams, jellies, preserves 10 2 tsps
Pure Sugars are
2-1/2 cm diameter
Maraschino cherries 20 most
each
concentrated
1 (2-1/2 cm
Marshmallow 5 form of
diameter)
carbohydrates.
Matamis sa bao 5 1 tsp
Jellies, jams, and
Nata de coco 15 2 tbsps candies are
Nata de pinya 10 2 tbsps made up largely
Panutsa, grated 5 1 tsp of
Pastillas, duryan 5 1 (5 x 1 x 1 cm) carbohydrates.
Pastillas, gatas 5 1 (5 x 1 x 1 cm) Sweets are useful
Pastillas, langka 5 1 (5 x 1 x 1 cm) in enhancing the
1 (1-1/2 cm long x 1 palatability of
Sampaloc candy 5 diets, but well
cm thick)
Sugars (white, brown, pure planned meals
5 1 tsp can be
cane, syrup)
Taho w/ syrup & sago 40 1/4 cup nutritionally
adequate even
Tira - tira 5 1 pc
without them.
1( 2-1/2 x 1-1/2 x 1
Tofee candy 5 Individual who
cm)
31
 NCM 105: NUTRITION AND DIET THERAPY
Ube, haleya 10 1 tsp need to reduce
Yema 5 1 (5 x 1-1/4 cm) or avoid sugar
Wt. (g) Sugar may use artificial
Food Measure Kcalories sweeteners.
E.P. Exchanges
Halo-Halo 410 2-1/3 cups 4 80
Ice Candy (frostee) 100 1 pc 3 60
Ice drop 100 1 pc 4 80
Kundol, matamis 20 1 (7 x 5 cm) 4 80
Pulvoron 10 1 (4 x 2-1/2 x 1 cm2 40
Beverage List
+ Ntritional information taken from product label. ++Nutritional information taken
from distributor company.
Net Content Sugar
Measure Kcalories
(ml) Exchanges
1 bottle
A. Soft drink 237 5 100
regular size
B. Fruit Flavored Drink
Concentrate
Grape 5 1 tsp 1 20
Grapefruit, lemon, orange,
10 2 tsps 1 20
strawberry
Mango, guwayabano,
20 4 tsps 1 20
pineapple-pomelo, pomelo
Powder 5 1 tsp 1 20
Tetra-brick +
Apple 250 1 tetra-brick 6.5 130
Guwayabano 250 1 tetra-brick 7.5 150
Mango 200 1 tetra-brick 5.5 110
Melon 200 1 tetra-brick 8.5 170
Orange 250 1 tetra-brick 6.5 140
Pineapple 250 1 tetra-brick 6.5 120
Plastic Bottle
1 small plastic
Mr. Juicy orange 225 4.5 90
bottle
Net
Beverage Contents Measure Kcal PRO Fat CHO
(ml)
C. Flavored Milk Drink +
Chocolate 250 1 tetra-brick 200 8 5 31
Fruit
Banana split 230 1 tetra-brick 160 6 2 29
Melon Recomb. 250 1 tetra-brick 200 8 5 31
Strawberry Full Cream 250 1 tetra-brick 220 8 8 31
Mocca 230 1 tetra-brick 210 7 7 28
Vanilla 230 1 tetra-brick 210 7 7 28
Chocolate 230 1 tetra-brick 210 8 7 29
D. Powdered Drink
Klime Lite++ 25 4 tbsps 103 8 3 12
Cocoa 25 5 tbsps 68 5 5 12
Milo 15 2-1/2 tbsps 57 2 0.1 12
Ovaltine 15 2 tbsps 57 2 0.1 12
E. Yoghurt Drink +
Natural 125 1 bottle 100 2 <1 20
Fruit flavored 100 1 bottle 70 <1 <1 17
Strawberry 125 1 bottle 70 <1 <1 17
Guwayabano 237 1 bottle 2 0.2 0 0.2
Diet Cola ++ 330 1 can 3 0.3 0 0.3
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 NCM 105: NUTRITION AND DIET THERAPY

Nutritional Labeling

- Primary means of communication between the producer or

manufacturer and the consumer.

Nutrition Facts Panel

provides such information as serving sizes, Daily Values, and
nutrient quantities.

Serving Sizes Food labels must identify the serving size (food
quantity) for which nutrition information is presented. The FDA has
established specific serving sizes for various foods and requires
that all labels for a given product use the same serving size.

2 Components of Nutritional Labeling:

1. Nutrient Declaration – a standardized statement or listing of the nutrient content of food.
2. Nutrition Claim – representation which states or implies that a food has some particular nutritional
proponents.

Nutrient density is a measure of the nutrients a food provides compared to the calories it provides.
Foods low in calories and high in nutrients are nutrient dense, while foods high in calories and low
in nutrients are nutrient poor.

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 NCM 105: NUTRITION AND DIET THERAPY
APPLICATION OF FOOD EXCHANGE LISTS AND MAKING SAMPLE MENU
The food exchange system is a used tool used by dietitians to facilitate meal planning. In this system
foods with similar composition are grouped together under a “List”.
A publication of the Food and Nutrition Research Institute entitled “Meal planning with Exchange
Lists” contains a comprehensive listing of foods together with amount of each that constitutes an
exchange.

DIET PRESCRIPTION:
Step 1 : Get the DBW of the patient
Step 2 : Compute his/her TERR (based on his occupation/activity)
Step 3 : Identify his percentage requirement (based on his/her health condition or dietary
Requirement
Step 4: Distribution of TER on CHO, PRO, FATS
TER x% CHO
TER x % PRO
TER x % FAT
Percentage Distribution
CHO 50-70% = 60% (average)
PRO 10% (infant/children)
10-15% (adolescent/adult)
FAT 20-35% (adult)
30-35% (children)

Step 5: Gram distribution

% CHO / 4 (fuel value) = _____ gm.
% PRO / 4 (fuel value) = _____ gm.
% FAT /9 (fuel value) = _____ gm.

Step 6: Meal Distribution

COMPOSITION OF FOOD EXCHANGE LIST
LIST FOOD MEASURE CHO PRO FAT CAL
IA Veg A 1 c. raw, ½ c - - - 16
cooked
IB Veg B ½ c raw & 3
cooked
II Fruit varies 10 - - 40
III Milk
Full Cream Varies 12 8 10 170
Low Fat 4 tablespoons 12 8 5 125
Skimmed 4 tablespoons 12 8 - 80
IV Rice Varies 23 2 - 100
V Meat
Low Fat Varies - 8 1 41
Medium Fat - 8 6 86
High Fat - 8 19 122
VI Fat 1 teaspoon - - 5 45
VII Sugar 1 teaspoon 5 - - 20

FOOD DISTRIBUTION
Example: 336g 84 g 63 g 2,240
LIST FOOD MEASURE CHO PRO FAT CAL
IA Veg A 3 - - - 48
IB Veg B 3 9
II Fruit 5 50 200
III Milk 1 12 8 5 125
Full Cream Sub: 71
Low Fat (336-71)=265
Skimmed 265/23 = 11
IV Rice 10 230 20 1000
Sub: 28

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 NCM 105: NUTRITION AND DIET THERAPY
(84-28)=56
(56/8)=7
V Meat 7 56 42 602
Low Fat Sub: 47
Medium Fat (63-47)=16
High Fat (16/5)=3
VI Fat 3 15 135
VII Sugar 4 40 80
341 84 62 2,190

MEAL DISTRIBUTION
FOOD BREAKFAST LUNCH DINNER AM SNACK PM SNACK
Veg A 1 1 1
Veg B 1 1 1
Fruit 1 1 1 1 1
Milk 1
Rice 2 2 2 2 2
Meat 2 1 1 1 1
Fat 1 1 1
Sugar 1 1 1 1

NUTRITIONAL ASSESSMENT
What is Nutritional Assessment?
is an in-depth evaluation of both objective and subjective data related to an individual's food and
nutrient intake, lifestyle, and medical history

Aims of Nutritional Assessment

1. To identify certain specific nutritional problem.
2. To map out magnitude and geographical distribution of malnutrition
3. To determine ecological factors responsible for malnutrition.

Methods of Assessment:
Direct Assessment -- based on physical sign
a) Diet History - This method evaluates the primary factor of nutritional inadequacy.
b) Physical Method or Anthropometric-- Taking weight & height data
c) Medical History - record of the person's past illnesses
d) Clinical Examination - physical signs associated with malnutrition
e) Biochemical Tests - blood plasma, tissue biopsy, urinalysis

B. Indirect Assessment -- use of data. statistics and other information. Includes food consumption,
eating practices
1) Vital Statistics
a) age specific mortality - no. of death/'age and sex group
ave. population of the same age

b) Infant Mortality Rate -- __no. of deaths below 1 yr.__

over the number of live births

c) Maternal Morality Rate - no. of deaths among women due to pregnancy, labor/ total live birth
d) Morbidity Rate -- no. of reported cases of a given disease present at a given time per 100,000
population

2. Conditioning infections -- diarrhea, measles, tb

3. Food Balance Sheet -- rough estimate of food supplies available for consumption
4. Dietary Survey - 24 hr. food recall
5. Cultural and anthropological influences
6. Socio economic factors- population, family, education
7. Food production
8. Health and educational services

Methods of Assessing Dietary Intake:

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 NCM 105: NUTRITION AND DIET THERAPY
1. 24 Hr. Recall - recall of all what he/she had eaten within 24 hrs.
2. Food Frequency Questionnaire
3. Diet History
- It is more complete than the two previous method. It contains the following:
• Economic ( income, amount of money for food)
• Physical Activity (occupation, exercise, sleep) V Ethnic & Cultural Background (religion, educ)
Home life & Meal Patterns (no.per household, person who does the cooking, type of house)
• Appetite (good, poor)
• allergies, intolerances, food avoidance
• Dental/Oral health
• Gastrointestinal ( heartburn, diarrhea, constipation)
• Chronic Diseases
• Medication

4. Food Diary - The subject is asked to write down everything that he eats for a certain time. It could be
3 days, two weeks
5. Observation of food intake - most accurate but most time consuming. It requires knowing the
amount and kind of food presented and the record of the amount actually eaten.

MALNUTRITION
Malnutrition -- It is the condition of the body resulting from a lack of one or more essential nutrients or
due to excessive nutrient supply.
2 Conditions of Nutritional Status
1) Optimum or Good Nutrition - body has adequate supply of essential nutrients for growth & health
2) Malnutrition - A condition of the body resulting from a lack of one or more nutrients or it may be due
to an excessive nutrient supply creating toxic or harmful effects

Forms of Malnutrition
1. Under nutrition - resulting fro inadequate quantity of food, over an extended period of time
(kwashiorkor, marasmus)
2. Specific Deficiency - resulting from a relative or absolute lack of an individual
nutrient (iron deficiency)
3. Over nutrition - resulting from the consumption of an excessive quantity of food,
calorie excess (obesity)
4. Imbalance -resulting from a disproportion among essential nutrients, with or without absolute
deficiency of any nutrient.

Types of Malnutrition
1. Acute Malnutrition- related to present state nutrition ex. Loss of weight
2. Chronic Malnutrition -- related to the past state of nutrition
3. Primary Malnutrition - caused by lack or unavailability of food (dietary malnutrition)
4. Secondary Malnutrition - caused by certain conditioning factors other than food alone

Nutritional Deficiencies
1) Primary Factor- refers to faulty diet
a. Poverty
b. Ignorance
c. Poor food Habits
d. Limited food supply
e. Poor distribution of foods f. Cultural Taboos
g. Low level of education
h. Urbanization
i. Infectious diseases / parasitism

2) Secondary Factors:
a) Interfere with normal digestion
1. Gastrointestinal disorder
2. Lack of appetite
3. Poor teeth
4.Lack of digestive enzymes

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 NCM 105: NUTRITION AND DIET THERAPY
b) Factors that interfere with absorption
1. Diarrhea
2. Mal absorption Syndrome
3. Intestinal Surgery
4.Laxative
5. Parasitism

Factors that affect metabolism & utilization in the cells

1) Liver diseases
2) Malignancy
3) Some drugs
4) Alcoholism
5) Toxins
6) Diabetes Mellitus

Pathogenesis of Nutritional Deficiency

Primary (Dietary)
↓
Nutritional inadequacy → tissue depletion (loss of weight)
↓
biochemical changes (laboratory)
↓
functional symptoms (symptoms appear)
↓
anatomical lesions (physical signs)

Effects of Malnutrition
1. Increase susceptibility to infections
2. Inhibits mental development
3. Imposes heavy social and economic burdens

Prevention &Treatment of Malnutrition

Prevention:
1) Increase economic stability
2) Educate the people
3) Practice good sanitation and hygiene
4) Increase food production
5) Eat balance diet
6) Exercise
7) Social Awareness (thin is not in")

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