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ACKNOWLEDGMENTSc ~)

The publication of this manual was made possible through the unselfishcooperation and support of various agencies and Individuals. We wish tospecifically acknowledge the invaluable contributions of the Following:

Provincial Health Offlce of Sta. Cruz, Laguna led by Dr. Clrlla Jorvina,Mayor Bayanl Almonte of Blnan, Laguna and the RHU staff of Dona AuroraHealth Center led by the late Dr. Jose Lopez and San Antonio HealthCenter led by Dr. Lolita Macaraig For their helpful suggestions duringthe orientation/briefing and pretesting of the diet slips;

The various DOH central offlces. specifically all the offices under theOfflce For Public Health Services, Health Manpower Development andTraining Service, Hospital Management Service, Community HealthService and the Public lnformatlon Health Education Service For theirinvaluable comments which led to the revisions of the diet slips;

The Food and Nutrition Research Institute, Helen Keller International,Inc.. Nutrition Center of the Philippines, Nutritionist-Dietitians Associationof the Philippines and National Nutrition Council, the Philippine GeneralHospital, Philippine Kidney Institute, Philippine Heart Center for Asia andthe Philippine Children's Medical Center which made very Important anduseful comments on the contents of the diet slips to make them moreappropriate to the needs of the intended users and clients and lastly to:

The Nutrition Service -Dlet Counseling Task Force headed by Ma.Socorro Ignacio and Rosemarie Holandes and Its members: AzucenaBanga, Georglna Ramiro, Agnes Ma. Oliva del Rosario and Josephine Guiaofor their dedication and hardwork which led to the development of dietslips and this manual, and Ma. Evelyn Ueno of the Nutrition Promotionand Advocacy unit For the final preparation of this manual, And lastly, V)the encoders whose time, energy and diligence made possible thecontents of this manual: Emelinda Alba, Heidi Cabanting, Lilibeth Joseand Olga MontecIaro.

Diet Counseling at the RHU Is a "dream come true" of the undersignedand special mention is being given to Irene Sanchez who made the initialdrafting of the different diet slips In consultation with a WHO Nutritionistfacilitated by Dr. Ian Darnton-HiIi, Regional Nutrition Advisor,

a~(!,;(~ADELISA C, RAMOS. M,P,tf" M.P.A" CESO IV

Director IIINutrition Servlce-Department of Health

RATIONALE

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Health statistics in 1992 revealed that diseases of the heart,diseases of the vascular system, tuberculosis and diarrheal diseasesare among the ten leading causes of mortality in the Philippines.Likewise, diarrheal diseases, tuberculosis and diseases of the heartare among the ten leading causes of morbidity in the country(Philippine Health Statistics. 1992). The large number of the populationaffected include the adults in their 20's to 50's as well as thevulnerable groups (infants, preschoolers. pregnant, lactating mothersand the elderly).

Studies have likewise shown that diet is one big factor among thecauses of most diseases. WHO experts cited the consumption of more foodshigh in fat. sugar. and alcohol along with smoking and changing lifestyles ofpeople as directly influencing the onset of these diseases. These findingswould seem to indicate the importance of diet for a healthy nutritional well­being.

Treatment of most diseases, when complemented with dietarymanagement through diet counseling will hasten early recovery andrehabilitation of the diseased conditions. Diet counseling is defined as theprocess of providing individualized professional guidance to a person inadjusting his daily food consumption to meet his nutritional requirement ina given health condition. Thus. diet counseling plays an essential role in themaintenance of good health and the nutritional well-being of an individual.However, this is not a part of the health service delivery system of theDepartment of Health.

Hospitals normally provide diet counseling service to patients duringconfinement and upon discharge. rtowever.expertence indicates thatdischarged patients seldom go back to the hospitals for continued dietcounseling that can assure them of continuous and full recovery at home.Thus. the concept of providing diet counseling at the Rural Health Unit forthose whose disease conditions can be best treated by proper dietmanagement is highly significant.

In addition, diet counseling service within the RHU aims to strengthenthe nutrition service delivery in the community and help reduce mortalityand morbidity. This redounds in general to the improvement of the healthand nutritional well-being of the population.

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3. Implementation. This process of diet counseling means that theclient is able to follow what has been planned, that he is conscious of thekinds of food he has to eat and aware of the nutrition information labels onpacks of food products he buys. It means that the client applies each daythe modifications made on his diet.

4. Evaluation. The progress of a client towards achieving the desirednutritional change should be evaluated from time to time by the counselorthrough Interviews with the client. The evaluation confirms the degree ofsuccess by which the client has successfully achieved what he has plannedto do so as far as his nutritional Improvement is concerned. It also involvesnecessary revisions If evaluation indicates the need to do so. Eachevaluation becomes in effect a reassessment or addition to the initialassessment. This may lead to a revision of the plan, If needed, and thenchanges in Implementation.

TOOLS USED IN DIET COUNSELING

Various tools are used in Diet Counseling and these include thefollowing:

1. Diet slips. Thirty-five (35) types of diet slips were developed bythe Nutrition Service since 1988 for use within the RNU. They are'classified as Normal Diet Slips (20), Simple Therapeutic Diet Slips (8),and Special Therapeutic Diet Slips (7). These diet slips were pre-testedand were reduced to twenty-four upon consultation with experts fromvarious agencies and Institutions.

2. Food Exchange List. A list of food Items from which a client canchoose freely what he can eat within the prescribed amounts.

3. Diet Computation Guide. A reference for computing diets basedon physical activity and height standards. The guide covers theprocedure Involved In doing computations and a list of computed dietstranslated into calories, carbohydrates, protein and fats with thecorresponding number of food exchanges expressed In grams andcalories as units of measurement.

4. Diet Counseling ServIce Information Slip. Consists of personalinformation about the client Including anthropometricmeasurements,usual dally food Intake and the prescribed dally meal planin food exchanges and household measures.

5. Patient Record. A me about the client available at the RNUjBNSwhich contains medical and laboratory examinations done on the clientwhich aids in the clinical assessment of the client.

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FLOW OF DIET COUNSELING AT rne RtlU

RIIURlIM

Oient/l'alient For MedicalRegistration

ConsulationWeight & Height

Taking

IRlIP

Oinical Assessmentand

Medical Management

ND PHN/RlIMDiet COunseling for Diet Couns~1jng for

Special Therapeutic Diets Simple Therapeutic Diets

ROLES AND RESPONSIBILITIES

The roles and functions of those involved in the delivery -of dietcounseling services at the RHU are:

A. RURAL HEALTH PHYSICIAN

Conducts clinical examination/diagnosis of patient. Prescribesdiet appropriate to the disease condition of patient. Instructspatient requiring Individualiy computed diet/special therapeuticdiet to come on specific dates to consult NO for diet counseling.Refers patient with normal diet. dietary management of simpledisease (fever, diarrhea, colds. and constipation) and nutritionaldeficiencies (PEM, VAD, IDA, and IDD) to the nurse/midwife fordiet counseling. Refers patient on special therapeutic diet toNutritionist-Dietitian at the health office or hospital.

B. PUBLIC HEALTH NURSE

Conducts nutritional assessment of patients. Provides dietcounseling to patients with normal diets, dietary management ofsimple diseases and nutritional deficiencies. Assists In the follow-

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amino acids as the building units linked together in peptide bonds.They function chiefly for the growth and repair of all body tissues.They act as buffers in maintaining body neutrality. regulates waterbalance and provide sources of heat and energy.

FATS. Belong to a larger group of organic compounds chemicallycalled lipids which are insoluble in water but soluble In fat solventslike chloroform. ether. benzene and others and are utlllzable by livingorganisms. Fats function mainly as a concentrated source of energy. Asadipose tissues. it is the largest reservoir of potential energy. It is asource of essential fatty acids which the body cannot synthesized.

(Refer to food sources of CliO.PRO.FATS)

Mlcronutrlents

Are those trace vitamins and minerals which are present in verysmall concentrations or minute amounts and range in measurementsfrom microgram (ug) to milligram (mg). They are essential for regulatingbody processes.

Of particular importance to public health are three micronutrlentswhich when found deficient in the diet have proven to result to severemental and physical disabilities to individuals. These are Vitamin A.Iron and Iodine.

VITAMIN A. Is one among several fat-soluble vitamins. It ismeasured In International Units (I. U.) and is abundant in green andyellow pigments of fruits and vegetables as provjtamln A such as alpha.beta. gamma-carotene and cryptoxanthin.

Vitamin A is needed for normal night vision as it maintains thevisual purple in the retina. Its other functions include the maintenanceof the normal epithelial tissues which form the body' s primary barrierto infection. It is also Important in the normal bone development andtooth formation and Is also essential in lactation..

IRON. Belongs to a group of minerals which while needed by thebody only in minute amounts perform certain vital functions. Ironfunctions chiefly in the body as a constituent of hemoglobin which hasthe important role of carrying oxygen for cellular respiration andmetabolism. It is also a constituent of myoglobin. a source of oxygen formuscle contraction.

IODINE. Is normally concentrated in the thyroid gland and is alsowidely diffused throughout all tissues. especially In ovaries. muscles and

Among the vitamins, intake of foods rich in Vitamin A and C shouldalso be increased since they are found to be least adequate in the dietsof both pregnant and lactating mothers.

(Refer to diet slips for pregnant and lactating mothers)

W~ANlnG AG~ Ct:lILDR~n

Complementary foods are introduced to the infant between 4·6months of age in addition to breastmilk to meet his increasingnutritional demand for his growth and development. These foods aregiven to accustom the infant to a variety of food flavors and texturesuntil he can take three meals a day by the time he reaches the age ofone year.

A well nourished infant attains a steady gain in weight and height.Breastfeeding and adequate supplementary feeding will give the infantthe best start in life.

DIet Plan

For energy giving food, lugao can be introduced as the first solidfood to be given to the infant with mashed potato or camote. Milk canalso be added. Introduce one new food at a time and Introduce anotherone after 3 to 5 days interval. Once the infant accepts the new food itshould be given frequently until he becomes familiar with it. Sweetfoods must be avoided to prevent dental carles. When teeth begins toappear, toasted bread or crackers can be given. Margarine and buttercan be added to the infant's food beginning at six month old.

Body-building foods can. be introduced at six months, comprlslng ofegg yolk, flaked fish, ground meat and poultry cooked very well.

Vegetables like squash, carrots and other green leafy vegetables canbe given as early as six months. These vegetables should be cookedvery well and mashed. Include vegetable broth with the mashedvegetables.

(Refer to diet slip on Complementary Foods)

TODDL~RS (1-3 Yrs) and P~Ct:lOOL~RS (4-5 Yrs)

Good nutrition is one of the most important factors for the health,growth and development of children 1-5 years of age.

Because of the rapid growth and development at this stage, the needfor more energy-glvlng foods as weil as body -building foods is of utmost

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importance. This is also the time when the child's food habits andattitude are being influenced by environmental factors so it becomesnecessary for mothers to teach good eating habits to their children.

Children within these age groups are also at risk for Vitamin Adeficiency, deficiencies In Thiamine, 62 and Vitamin C. Thesedeficiencies may occur due to the poor Intake of green leafy vegetablesand fruits as weil as fats which is the carrier of Vitamin A.

Calcium and Iron should also be Increased since these minerals arealso found to be deficient in their diet.

(Refer to Diet Silp for Toddlers and Preschoolers )

SCftOOL Cf1ILDREN (6-12 Years)

The ages of 6-12 years are characterized by a period of steadygrowth. Increased body proportions, enhanced mental capabilities andbetter motor coordination.

As such. they need more calories to meet the demand for physicalactivities In school and at home. However there are also variations Inphysical actlvltles among these children so It Is Important that energyailowances must be individuaily adjusted.

The need for higher amounts of protein especially protein of highbiological value Is very important at this stage because of the need tosustain strength. for the continued growth and' development, to repairworn out tissues and for resistance against Infections.

Iron Intake especially for girls should be considered becausemenstruation usuaily starts at age 11-12 years. Foods rich In vitamins Aand C should also be given as weil as those rich In iodine (l.e. Iodizedsalt).

(Refer to Diet Slip for Schoolers)

ADOLESCENTS (13-19 Years)

The adolescence stage Is between the ages of 13-19 years. This Is theperiod wherein height and weight changes are at their peak, and theirsecondary sex Characteristics usually start to appear. They are the groupthat has the lowest nutrient Intake among household members, since mostof them eat meals In the school canteens. The popularity of soft drinks.candles, crackers and other starchy snacks among teenagers as weil asconsciousness of the way they look often lead to poor nutriture.

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Diet Plan

Due to the Increased demands for growth and active life duringadolescence, food needs also become high.

The amount of energy-glving foods needed by boys are higherthan girls because of their higher energy expenditure due to Intensephysical activities. However. protein requirements for both sexesare the same at age 13-15 years. For the 16-19 years group. boysneed more protein because of the Increased growth spurt and hencenew active body tissues during this period.

Foods rich in vitamin A, C, thiamine and 52 should be Increased aswell as those rich In iron and calcium for hemoglobin production andbone development.

(Refer to diet slip for Adolescents)

ADULTS (20-59 Years)

Dietary requirements of an Individual are based on the referenceman and woman. The reference man weighs 56 kg. and stands 163.5em. He is healthy and physically active. He spends 8 hours In a job ofmoderate activity. He needs an average 2580 calories per day which Isadequate forenergy repair and maintenance of body tissues.

The reference woman weighs about 48 kg. and stands 151.7 em.She is healthy, free from disease and physically fit for active work. Sheneeds an average of 1670 kcal. dally for an average 8 hour moderateactivity.

Protein requirements are 60 gms. and 52 gms for man and womanrespectively. These level of dietary protein intake will balance the lossesof nitrogen from the body of those maintaining energy balance atmodest level.

The recommended amounts of vitamin C for males and females are75 and 70 gms. respectively. This amount will provide buffer againstincrease needs during common stresses and provide protection againstInfecllon as well as to enhance iron absorption.

(Refer to diet slip for Adults)

ELDERLY (60 Years and above)

Elderly refers to older people aged 60 years and over. This is the

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INI'ECTIOUS DISEASES

Infection is defined as the entrance and development of pathogenicmicroorganisms and parasites in the body resulting in 'abnormalprocesses within.

The manifestations of infections are:

1. Presence of fever which is the elevation of body temperatureabove the normal average (37 C or 98 F when taken orally).The fever is generally a symptom of infections and signifiesthat heat production exceeds heat loss in the body.

2. The patient usually complains of weakness, headache, poorappetite, discomfort, restlessness, dizziness and thirst.

Infections are classified as follows:

1. Acute Infections. Usually of short duration with suddenonset and rapid progression.Examples are colds, influenza, tonsilitis,measles, chickenpox and typhoid fever.

2. Chronic Infections. Last for weeks and sometimes extendinto months but are milder.Examples are tuberculosis andhepatitis.

3. Recurrent Infections. Occur at periodic intervals.Example is malaria characterized byfever which appears and disappearswith some regularity over a period ofseveral months or over a year.

Diet Plan

Nutrient requirement during the onset of infectious diseases requireseveral changes which are as follows:

1. Calories. Energy requirement is increased due to highermetabolic rate. A caloric increase of about 50% of theRecommended Daily Allowance (RDA) or more is recommendeddepending on the severity of the fever or infection.

2. Protein. 100% additional protein is needed to replace lossesin catabolism (2gmjkg.DBW). Food sources of protein with highbiologic value is advised.

3. Carbohydrates. A liberal supply of easy to digestcarbohydrate sources is recommended to spare protein and providequick energy.

4. Fats. Intake of fats such as those found in eggs, cream, milk,margarine and butter is increased to supply additional calories.

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OVERNlJI'R1TION

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Obesity applies to a person with actual body weight equivalent to 21per cent or more over his desirable body weight.

Overweight refers to a person with actual body weight equivalent toI I to 20 per cent above desirable body weight.

Overnutrition (I.e. obesity and overweight) results from a positiveenergy balance. that is from the daily ingestion of more calories thanare expected for basal metabolic needs and physical activity or theremay be decreased physical activity in the presence of a constantcaloric intake.

RIsks of Overnutrition

Obesity is a serious health hazard. It Increases susceptibility to anumber of diseases among them diabetes mellitus. hypertension. renaldiseases. degenerative arthritis. gout. gall bladder diseases and cardio­vascular diseases. Obese persons frequently have elevated bloodtrlglycerldes and cholesterol level and a reduced carbohydrate tolerance.Persons with chronic pulmonary disorders such as emphysema andasthma suffer from greater respiratory stress with obesity.

Fat people are greater operative risks due to adverse reactions toanaesthesia. They should therefore lose weight before elective surgery.Overweight during pregnancy should also be carefully watched since thehazards of pregnancy and childbirth are increased in the presence ofexcessive adipose tissue. Obesity. besides being physically unattractive.apparentiy has an adverse effect on longevity in that it decreases lifeexpectancy.

Diet Plan

Energy restriction is the positive method of weight reduction. Thenumber of energy is decreased to the point where fat is no longerdeposited in the tissues. but the body is forced to draw on some ofits own fat stores to meet energy needs. rtowever. before this dietaryregimen to lose weight could be planned. it is necessary to determinefirst the basic cause of the overnutrition condition of the patient.This could be accomplished by a thorough physical and medicalexamination. and by taking the dietary history of the patient whichwill include his dietary habits and food preferences.

Planning the dally diet

It is often not advisable to administer Immediately a diet too low in

daily about 600 to 800 ml. of bile which the gallbladder normallyconcentrates fivefold and stores it until needed for digestion of fats.

Cholecystitis

An inflammation of the gallbladder, usually resulting from a lowgrade chronic Infection. Other elements influencing abnormal functioningInclude: overweight, pregnancy, constipation, constricting clothes,Improper diet and digestive upsets.

The walls of the gallbladder become red and swollen and sometimespus collects which causes distention. During such episodes, the patientis aware of pain in the region of the gallbladder, which is accompaniedby nausea, vomiting, flatulence and soreness in the upper right side ofthe abdomen. Jaundice (yellow pigmentation of the skin) may alsoappear.

Gallstones (Cholelithiasis, Cholecystolithlasls and Choledocholithiasis)

Stones develop in a sluggish, diseased gallbladder. It Is generallybelieved that gallstones form as a result of infection, stagnation of the bileor changes In the chemical composition of the bile. Overeating and pooreating habits contribute to their formation. A combination of infection andstones is known as cholecystollthiasls. The formation of gallstones withoutinfection is called cholelithiasis. Choledocholithiasis develops when stonesslip Into the common bile duct. producing obstruction and cramps.

The existence of stones may cause no symptoms and the patient maybe unaware of their presence. On the other hand, if the stones start totravel. the bile pathways maybe obstructed and a typical colic results.

Dietary Management

The principal aim of dietary management in gallbladder disease is toreduce discomfort by providing a diet restricted in fat. Plain, simple andeasily digested soft-flber foods are recommended while rich pastries,nuts, chocolate, fatty, fried, gas-forming foods, condiments, highlyseasoned and high residue foods oftentimes bring discomfort to mostpatients and therefore should be avoided. However, the disturbancevaries with the Individual patient and the dietary management Isindividualized. Individuals differ considerably as to the foods which are"gas-forming" or which cause discomfort. It Is best to determine foroneself the foods which cause disturbance and then to eliminate theoffending ones from the diet.

Principles of Dietary Modifications

Low Fat. Because fat is the principal cause of contraction of thedisease and subsequent pain, it should be greatly reduced. The patientreceives no food initially during acute attacks of cholecystitis.Progression to a 20 to 30 grams fat diet is then made. If this Istolerated, the fat can then be increased to 50 to 60 grams daily, thusimproving palatability of the diet. In chronic cholecystitis, some degreeof fat restriction is usually necessary,

Cholesterol. The chief component of most gallstones ischolesterol. Although some cholesterol Is supplied by the diet. muchmore Is synthesized in the body from fragments of carbohydrates, aminoacids and fat metabolism. Dietary restriction of cholesterol therefore isprobably not effective in prevention of gallstones. If a reduction incholesterol content of the diet is ordered, eggyolks, liver and otherorgans meats are omitted and skim milk and margarine are substitutedfor whole milk" and butter.

Protein and Carbohydrates. The protein allowance is kept at thenormal requirement or higher and the carbohydrate allowance is normal,decreased or increased to maintain the patient's weight at the desiredlevel. Increasing the amount of carbohydrates serves as a therapeuticmeasure in cases where complications with jaundice occur.

. Calories. If weight loss is indicated, the calories will be reducedaccording to need.

post-operatlve Cholecystectomy Diet

If the patient has surgical removal of the gallbladder, It Is stilladvisable to continue the low-fat diet regimen for several monthsfollowing the operation to permit the inflammation to subside.Thereafter, most Individuals can tolerate a regular diet.

(Refer to Diet Slip on Fat Restricted Diet)

DISEASES OF TilE LIVER

The Liver is the largest organ of the body, accounting' for 2-3% ofbody weight. Its functions Include the following:

Manufacture of vital body substance (bile, prothrombin, fibrinogen,heparin and urea formation).

Regulation of bodily processes (detoxification, reticuloendotelialactivity, blood volume and blood sugar level).

Seat of metabolism (carbohydrate, protein, lipid, vitamins andminerals).

Storage of nutrients and other substances (protein reserves, glycogen,iron and copper, ascorbic acid, vitamins A, D, K and some B-complexvitamins).

Hepatitis

A disease condition characterized by an Inflammation of the liveraccompanied by rapid destruction of cells.

The most common example of hepatitis is hepatitis A or Infectioushepatitis which is transmitted through contaminated drinking water, foodor sewage.

Another is type B serum hepatitis which can be transmitted throughblood or serum transfusion from a person who is a carrier of the virus ormay also be acquired from Improperly sterilized medical instruments andskin puncturing Instruments that have come In contact withcontaminated blood. Both types of hepatic diseases manifest similarsymptoms such as nausea, vomiting, anorexia, fever, headache, weightloss, fatlque, abdominal discomfort and jaundice.

Cirrhosis

A chronic disease of the liver In which increased fibrous connectivetissues replaces the functioning liver cells. It is the most serious orfinal stage of liver injury and degeneration. The causes includeinfections, hepatitis, chronic alcoholism associated with malnutrition,underlying metabolic disturbances such as hemochromatosis orWilson' s disease, hepatotoxins derived from certain plants and fungiand prolonged biliary stasis.

The most common type of cirrhosis is Laennec' s (alcoholic, portal)cirrhosis.

Dietary Management

Nutritional care is the same for both diseases. Every attempt ismade to spare the liver. Patients should be given a diet high inprotein and carbohydrate and moderate in fat. All forms of alcoholare strictly prohibited among Laennec's cirrhotics. This diet mustbe maintained until liver function tests return to normal levels.However, if liver failure threatens or if there are complications from

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esophageal varices, it Is essential that the protein content of thediet be reduced immediately.

Principles of Dietary Modification

NIgh Protein. Protein Is essential for repair of hepatic cells and forliver cells regeneration. The allowance of \-2 grams per kilogram bodyweight is recommended. Protein should be immediately and drasticallycurtailed if the patient particularly the cirrhotic one has impending signsof coma.

High Carbohydrate. Sufficient available glucose must be providedto ensure adequate glycogen reserves needed for the maintenance ofhepatic function and the protection of the liver against further injury.Moreover, large amounts of carbohydrate will spare the protein for liverregeneration and supply the bulk of the caloric need. An intake of 300to 400 grams daily should be encouraged.

High Calorie. About 45 to 50 Kcal per kg. desired body weight perday would suffice to rehabilitate the patient.

Vitamins and Iron. The use of vitamin supplements such asB- complex, vitamin K, ascorbic acid, and possibly Iron is nearly alwaysindicated because of most patient's poor physical condition andpreviously limited food Intake.

I'ood Selection. Foods known to cause discomfort, salty foods Ifsodium is restricted, rich gravies and desserts, fried and highlyseasoned foods and alcohol should be avoided.

(Refer to Diet Slip on High Calorie-High Protein Diet)

DISEASES 01' THE HEART

The diseases of the heart which diet plays an important role arehypertension, coronary heart disease and congestive heart failure.

Hypertension

A symptom complex than a disease which Is one of the mostcommon causes of heart diseases affecting all age groups. In thiscondition, an increase In the diastolic pressure, which is a more reliablegauge in the determination of the presence or absence of hypertension,Is observed. The normal blood pressure (B.P.) range in mm Hg is shownbelow:

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The following measures are suggested:

1. Adjustment of calorie intake to bring about weight reductionIf patient Is obese. This will improve the condition of thepatient since the work of the heart is also reduced. If areduction In calories Is to be made. the reduction must notbe drastic as this may cause disatlsfactlon to the patient.Llkewlse,remember that any Increase In intake will alsoIncrease digestion, absorption and metabolism and thereforewould Increase the work of the heart.

Protein allowance need not be restricted. The normalallowance of 1.1 gram protein per kilogram bodywelght Isdesirable. Carbohydrate and fat must be proportionate to thetotal calories.

2. Restriction of sodium In the diet to prevent or treat edemaand ascites.

(Refer to diet slip on Sodium Restricted Diet for specificInstructions on the diet).

3. Fluid- intake of the usual variety should be allowed. However,alcoholic beverages should be avoided if hypertension Iscomplicated. Likewise, if the patient Is nervous, Irritable orsuffers from Insomia, the use of coffee or tea should berestricted.

4. Vitamins must be adequately provided In the diet or bymeans of supplementation.

5. Plan program of exercise and do It in moderation as advisedby the doctor.

6. Change job or domestic setting If working or living underconsiderable stress. Stress tends to raise blood pressure andalso increase constrictions of the arterioles.

Coronary Heart Disease

The narrowing or occlusion of the coronary artery, usually due toarteriosclerosis, resulting In Imbalance between blood supply and cardiacmuscle demands.

Arteriosclerosis. A generic term for a variety of chronic pathologicconditions affecting primarily either the intima or the -media or arteriesand characterized by thickening, hardening and loss of elasticity. The

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elastic and muscular medial coat Is affected, This is moreencompassing than artherosclerosls.

Atherosclerosis, A form of arteriosclerosis characterized by anaccumulation of lipid in the intimal layer of the artery, These lipidsInclude free cholesterol, cholesterol esters and trlqlycerldes. Whenthese lesions proliferate and enlarge they encroach upon the lumencausing the formation of thrombi resulting In the thickening and loss ofelasticity of the arterial walls, With time, an artery may be shut offcompletely, When this happens, the tissues dependent upon theInvolved artery for Its blood supply and oxygen die (ischemia), Thenecrotic tissue or the dying tissue Is called an Infarct If It Involves theheart, then It Is termed myocardial infarction and If It affects the brainIt Is called a cerebrovascular accident (CVA or stroke),

factors which are known to Increase the risk of coronary Heart Disease

I, Cigarette Smoking

Incidence of myocardial Infarction and death from CND havebeen shown to be higher in smokers than In non-smokers andthat the risk is proportionate to the number of cigarettessmoked, They believe that this Is due to the vasoconstrictoreffect of nicotine or to some undesirable effect on thecoagulability of the blood or the survival of the platelets,

2, Dietary habits

Excessive Intake of saturated fats and carbohydratesespecially sugar and lack of fiber,

The role of diet In Increasing the Incidence of CND has beenproven, Positive correlations have been shown between a highIntake of fat predominantly saturated or coming from animalsources, a high Intake of dietary cholesterol, hydrogenation ofoils, a high carbohydrate Intake particularly sucrose conttibuted tothe Increase of CtlD,

.3, Lack of Physical Exercise

"'ersons who are less active are more prone to eND andthis has been shown In postmortem examinations whichIndicated that the previous occupations are correlated withatheroscterosls.

4. Occupational Hazards

Persons working In processing plants where carbondlsulflde Ispresent have higher mortality rates from CHD than those workingin non-process departments.

5. Soft Drinking Water

Hardness of water due to the effect of calcium or magnesiumand other trace minerals has a protective action against CHD.More mortality from eHD was observed In those towns with softwater than In those with harder water.

6. Large Coffee Intake

Several studIes have shown that the Incidence of myocardialInfarction is greater In those who consumed large amounts ofcoffee.

7. Emotional Stress and Tension

Persons who are SUbject to stress and strain or the type Abehavior pattern Is associated with Increased risk of myocardialInfarction and once atherosclerosis has set In, emotion especiallyanger, can trigger a clinical symptom.

8. Hemoglobin Level

An Increased hemoglobin level (more than 17 gm/IOO ml)has been linked with an increased Incidence of coronary heartdisease but data are not sufficient to support It.

Dietary Management

The major approaches In diet therapy are:

I. lowering dietary cholesterol and other fats

Cholesterol Is a fatty substance manufactured by the bodyand present In many foods of animal origin.. Medical authoritieshave agreed that reducing the Intake of cholesterol-rich foodssuch as Internal organs, egg yolks and fats of animal origin canprevent' high blood cholesterol level.

2. Substitution of saturated fat with polyunsaturated fat

Pats of animal origin are known as saturated fatty acids (SPA)and are mostly found In butter, fatty meats, whole milk andchocolates. Saturated fats also tend to raise the level ofcholesterol In the blood.

main source or sodium is sodium chloride, the patient should beInstructed to limit or avoid sodium chloride and all foods preparedwith it. The patient must also be instructed to read labels ascommercially prepared foods contain sodium either as preservativeor as a flavor enhancer.

The patient on a sodium-restricted diet must also refrain from takingsodium-bearing medicinals like sodium bicarbonate, sodium barbiturates,some antibiotics, sulfonamides. salicylates and bromides, toothpastesand powders and even mineralized drinking water.

(Refer to diet slip on Sodium Restricted Diet).oour

Gout Is a disorder of purine metabolism In which excess uric acidappears In the blood and sodium urates are deposited as tophi in the smalljoints and the surrounding tissues.

Manifestations

1. An Increase in serum uric acid concentrations.

2. Recurrent attacks of the characteristic type of acute arthritis.

3. Deposits of sodium urate monohydrates which appear chiefly In andaround the joints of the extremities and may lead to joint destructionand severe crippling.

4. Renal disease involving glomerular, tubular and Interstitial tissues(sometimes including deposits of urate crystals) and blood vesselsand in which hypertension and urolithiasis and kidney stones arecommon.

The normal serum uric acid varies from 2 to 6 mg per 100 ml of plasmaor serum. Patients with gout have levels of 6 to 10 mg. and rarely up to20 mg per 100 ml of serum or plasma.

Dietary Management

Because purines are synthesized in the body from simple metabolites,It is unlikely that avoidance of foods high in purine will decrease the uricacid pool. but since purine metabolism is disturbed, restriction of foodscontaining nucleoprotelns which give rise to purine is Indicated. Fats arebelieved to prevent the normal excretion of urates: it should therefore beused in moderation. Protein should be adequate but not excessive.Sufficient calories and carbohydrates should be provided for in the dietwhich have a tendency to increase uric acid excretion.

(Refer to Diet Slip on Low Purine Diet)

FRUIT eXCtlANGES

Fruits are important for their vitamin, minerai and fiber contents.Include at least two to three exchanges dally In the diet, one of whichshould be rich In Vitamin C.

Anonas, kamatslle, cashew, tlesa, datlles, guava, pomelo. guwayabano,slnlguelas, strawberry, atls and dalanghlta are good sources of Vitamin C.Mango and papaya contain both vitamins A and C. Tlesa is also anexcellent source of provitamin A. Bananas, oranges and dried fruits areS(;lUrces of potassium. Bananas contain magnesium and vitamin B

6•

Fruits may be used fresh, dried, canned, frozen or cooked. Somefresh fruit juices like kalamansl (Philippine lemon), dayap and lemon maybe rated as 'free food' when used as flavoring, sauce or when diluted andsweetened with artificial sweeteners. fruits may cause a temporary increasein blood sugars, thus meal plans for patients with diabetes mellitus allow nomore than 5 exchanges a day.

Some misconceptions about fruits are the following:1. Kalamansl or any other sour fruit juice when taken flrst thing In

the morning is a sure reducing formula.2. fruits, since they are sweet, should be avoided by diabetics.3. fruits contain no calorie and thus can be taken freely.

The truths are: kalamansl or any other sour fruit juice does not havespecial reducing properties: the natural sweetness of fruit Is notcontraindicated for diabetes: each exchange of fruit contains 40 kilocalories,thus fruits should be computed Into the meal plan. Like any other foodsthe use of fruits should be regulated. Some physicians and dietitians preferto use whole fruits rather than juice In diets for patients with diabetesbecause the latter have a greater glycemic effect.

Fruit juice consists of unfermented but fermentable liquid obtainedfrom native fresh fruit, with nothing added or subtracted. fruit juice Is alsocommercially available In the form of fruit juice drink and fruit juiceconcentrate. Fruit juice drink Is a ready-to-drink beverage prepared bymixing water with fruit concentrate and Into which sugar and citric acid maybe added to adjust the soluble solid content and acidity of the product.The main Ingredients consist of fruit juice concentrate, essential oils,essences of extracts, with or without added sugar. Concentrated fruit juiceIs the fruit juice which Is. concentrated by the removal of part of water butnot dried.

• I

o "">,.Q

'Pc ....

LIST 2 I'RUIT EXCtfAl"IGe LIST

This list shows the kinds and amounts of foods to use for one fruit exchange.

~ 1'l'!1(ill).[j,':xJfc" iFJ}'o •

, . ~.. .

l"resh:Anonas v- 65 35 1/2 of 5 x 8 emApple 86 65 1/2 of 8 em diameter

or 1 (6 em diameter)Atlsc 70 45 1 (5 em diameter)Balimblng' 153 135 1-1/2 of9 x 5 emBanana:

bungulan 60 40 1/2 of 15 x 4 emlakatan 51 40 1 (9 x 3 em)latundan 55 40 1 (9 x 3 em)saba 70 40 1 (10 x 4 em)

Cashew< 78 70 1 (7 x 6-1/2 em)Chico' 54 45 1 (4 em dIameter)Dalanghlta" 300 135 2 (6 em diameter each)Datilesv" 61 50 1 cupDuhat 80 60 20 (2 em diameter each)Durian 150 30 1 segment of 6-1/2 x 4-1/2 em

or 1-1/2 tablespoonsGrapes' 69 55 10 (2 em dIameter each)

or 4 (3 em diameter each)Guava"c 81 80 2 (4 em diameter each)Ouwayabano'' 86 60 1 slice (8 x 6 x 2 em) or 1/2 cupJaekfruit, ripe 118 40 3 segments (6 em diameter each)Kamaehllec 110 55 7 podsLansones 103 70 7 (4 x 2 em each)Lyehees 77 50 5 (3 em diameter each)Mabolo' 83 50 2/3 of 6 em diameterMakopa' 169 135 3 (4.em diameter each)Mango:

greenC 90 65 1 slice (11 x 6 em)medium ripe 90 65 1 slice (11 x 6 em)

• Unless specified. all measures refer to whole fruit.• These fruits are good sources of fiber.e These fruits are rich sources of Vitamin C. Include at least one exchange In the diet dally.

~;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;~0;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;~

Food Wt.(g) Measure+A.P. e.r,

ripe b.c 10.3 60 I slice (12 x 7 em) or 1/2 cup cubedindian 140 80 I (6 em diameter)paho' 92 70 9 small

Mangosteen' 212 55 .3 (6 em diameter each)Marang (2 I ) 45 .35 1/2 of 12 x 10 emMelon kastila .317 200 I sliee (12 x 10 x.3 ern)

or 1-1/.3 eupPapaya. ripe e.c 1.3.3 85 I slice (lOx 6 x 2 cm) or .3/4 eupPear' 118 85 I (6 em diameter)Pineapple 129 75 I sllee (lOx 6 x 2 em)

or 1/2 cupRambutan 1.39 50 8 (.3 cm diameter each)Santol' 127 75 I (7 cm diameter)Singkamas tuber 124 110 1/2 of 9 em diameter or I eupSiniguelas 78 50 5 (.3 em diameter each)Star apple 12.3 65 1/2 of 6 em diameterStrawberry- 168 165 1-1/4cupsSuha' 160 90 .3 segments (8 x 4 x .3 cm each)Tamarind. ripe .34 15 2 of 6 segments eachTiesa ab.c 41 .30 1/4 of 10 em diameterWatermelon' 226 140 I slice (12 x 6 x.3 em) or I eup

canned, drained:

Apple sauee 45 .3 tablespoonsFruit eocktail 40 .3 tablespoonsPeach halves 65 1-1/.3 halvesPineapple. crushed 60 .3 tablespoonsPineapple. slieed .35 I slice (7 em diameter)

+ Unless specified. all measures refer to whole fruit.• These fruits are good sources of fiber.b These fruits are good sources of pro-vitamin A.e These fruits are rich sources of vitamin C. Include at least one exchange In the diet dally.

Food Wt. (g) Measure'E. P.

Kalamay : Latik 50 I (4 x 6 x 2 em)Ube 55 I slice (7 x 3

x 1-1/2 em)Kutsinta 60 I (6 em diameter x 2-1/2 em)Palltaw, walang niyog 55 4 (7-1/2 x 4 x 0.3 em each)Puto Bumbong 40 2 (II x 2 x I em each)

Pula 45 3 (4 x 3 em each)Puti 45 I slice (9-1/2 x 3 x 3-1/2 em) or

1-1/2 round for 5 emdiameter x 3 em thick)

Seko, bilog 25 3 (3-1/2 em diameterx 1-1/2 em thick each)

Seko haba, 25 5 (5 em long x 2 emmay nlyog' diameter eachSapln-sapin 75 I slice (5 x 3 x 4 em)Suman lbos 60 I (8 x 4 x 2 em)

Kamoteng kahoy 45 1/2 of 15 x 3 x 2 emLlhiya' 55 I (8 x 4 x 2 em)Marwekos' 50 2 (9 x 3 x 2 em each)

Tamales 100 2 (7 x 6 em each)Tlkoy 40 I 'sltce (10 x 3 x 1-1/2 em)Tuplg 35 1/2 of 14x 3x I em

B. meE EQUIVALENTS:

I. BreadPan arnerlkanoPan de bonete'

Pan de lechePan de limonPan demonayPan de salRoils (hotdog!hamburger)

.. Unless specified, all measures refer to piece.• These foods are good sources of fiber.

4040

4040404040

2 (9 x 8 x I em each)I (6 em diameter basex 7 em thick)I (3 x 8 x 8 em)I (6 x 5 x 4 em)I (10 x 9 x 4 em) !3 (5 x 5 em each)I (II x 4 x 3 em)

III

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Shells: Halaan 75 1/3 cup shelledor 3 cups with shell

Kuholb 50 1/2 cup shelledor 3 cups with shell

Susong Piliplt 65 1/3 cup shelledor 2 cups with shell

Paros 60 1 cup shelledor 2-2/3 cupswith shell

5. BeansPigeon pea seeds. dried' 55 1/3 cup(kadyos. buto, tuyo)

.-

6. CheeseCottage cheese 60 1/3 cup

7. Processed Foods

A. Fish ProductsDried:

Dalng:Alakaak, alumahan. blsugo. 20 I (15-1/2 x 8 ern)biyang putiLapu-lapu 20 1/4 of :30 x 40 cmSapsap 20 3 (9 x 5 cm each)Tamban 20 1 (16 x 3 ern)Tanigi 20 1 slice (16 x 6 ern)

Tinapa:Bangos 30 1/4 of 20 x 8 cmGalunggong 30 1 (16 x 4 cm)Tamban 25 1 (16 x 5 cm)

Tuyo:Alamang 15 1/3 cupAyungln, dills. sapsap. 20 3 (11-1/2 x 8 ern each)tunsoy

+ Unless specified, all measures refer to piece .• These foods are good sources of fiber."This food is a good source of vitamin A.

Food Wt. (g) Measure +

E.P. Ckd.

Salted duck's egg 60 I piece

5. CheeseCheese, cheddar 35 I slice (6 x 3 x 2 em)

6. ChickenWings (pakpak) 25 I medium or 2 smallHead (ulo) 35 2 heads

7. BeansSoybean' (utaw) 40 1/2 cup

8. Processed Foodsa, Fish Products

Sardines canned in oil/tomato sauce 45 I (10 x 4-1/2 cm)Tuna sardines 50 1-1/2 of6 x4 x3 cm

eachTuna spread, canned ~ 30 2 tablespoons

b. Meat ProductsCorned beef 40 3 tablespoonsHam sausage 55 3 of 9 cm diameter

x 0.3 cm thick each

c. Bean ProductsSoybean cheese, soft (tofu) 100 1/2 cupSoybean cheese, soft' (tokwa) 60 I (6 x 6 x 2 em)

For other MEDIUM FAT MEAT FOODS see APPENDIX C: COMPOSITiON OFSELECTED/PROCESSED FOODS IN EXCHANGES (pp. 69-70)

C. HIGH FAT MEAT AND FISH EXCHANGES

This llst shows the kinds and amounts of high fat meat and fish to use for onehigh fat meat and fish exchange.

+ Unless specified. all measures refer to piece."These foods are good sources of fiber

=• , I

;; "~' ";' .' mtlI!5','" ~o \<

, • ;. ,f,. • ~,@k!1 ~ ~ . . ;"

I. PorkHam (pigue) 35 I slice (3 cm cube)

2, Variety meats/Internal organ 35 3/4 cupTongue (dlla) . pork, beef

3. EggDuck's egg 70 I piece (

Balut 65 I piecePenoy 60 I piece

4, NutsPeanuts, roasted 25 1/3 cup

5. CheeseCheese, filled 50 I slice

(6 x 3 x 2-1/2 em)Cheese, pimiento flavored 40

0

I slice (6 x 3 x 2 ern)

6. Processed FoodsMeat Products

Longanlsa, chorlzo style 25 I (12, x 2 ern)Frankfurters 60 1·1/2 or 12 x 1·1/3 cmSalami 50 3 slices of 8 x 8

x I cm eachVienna sausage 70 4 (5 x 2 x 2 em)

Refer to APPENDIX C: COMPOSITION OF SELECTED/PROCESSED FOODS INEXCHANGES for other HIGH FATMEAT FOODS (pp. 70·7 I )

+ Unless speclffed, all measures refer to piece.

The following are considerations in the use of alcoholic beverages bydiabetic or overweight individuals: .

Alcohol furnishes 7 calories per gram. It is metabolized like fat andshould be computed as fat exchange when used. Its use should be plannedby the dietitian in consultation with the physician taking into considerationthe patient" s food habits. The high caloric density should be consideredwhen used. by obese individuals. Since alcohol inhibits gluconeogenesis, itcan cause hypoglycemia in the patient with insulin-dependent diabetes.

I. Use alcohol only when the diabetes is under control.2. Use alcohol in moderation and only with meals and snacks.3. Avoid or limit wines, liquors, beer and all sweetened mixed drinks

because the high sugar content may cause hyperglycemia.4. A small amount of alcohol may be incorporated occasionally in the

meal plan if the person is at his ideal body weight and provided itis allowed by the physician.

Because alcohol contains calories and stimulates appetite, itshould be avoided by individuals on weight reduction diet.

5. If alcohol is used, subtract its calorie equivalent from the fatallowance.

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ALCOHOLIC BEVERAGES,

ALCOHOLIC BEVERAGE LIST

This list gives the fat equivalents of some commonly used alcoholic beverages.

Beverage Wt. (g) Measure+ Fat KcalorlesExchanges

Basi 170 I glass - 6 oz 4 185Beer, cerveza 320 I bottle - I I oz 3-1/2 163Brandy, cognac 30 I brandy glass 1-1/2 75Daiquiri 56 I cocktail glass 3 124Gin, dry 43 I jigger 2-1/2 107Gin, (Ginebra) 360 I bottle - 12 oz 18-1/2 832High ball 240 I glass 4 170Manhattan 56 I cocktail glass 4 167Martini 56 I cocktail glass 3 143Mint Julep 240 I glass 5 217Old Fashioned 240 I glass 4 183

. Unless specrned: 1 glass-8 oz: brandy glass» I 02; cocktail glass", 2 02; 'Jigger -

wine gla55",,3-1/2 02

0

Rum 43 I jigger 2·1/2 107Tom Collins 300 I tall glass-I 0 oz 4 182Tuba 240 I glass 2 89Whisky, scotch 43 I jigger 2·1/2 107Wine, red 100 I wine glass 1·1/2 73Wine, white 100 I wine glass 2 85Wine, champagne 100 I wine glass 2 85

(sweet &: dry)Wine, port 100 I wine glass 3·1/2 160Wine, rose 100 I wine glass 2 85Wine, vermouth, 100 I wine glass 2·1/2 108

FrenchWine, vermouth 100 I wine glass 4 170

. Unless specified: I glass..8 OZ; brandy glass-l oz: cocktail glass_2 oz: jlgger_I·I/2 oz:wine glass=3-1/2 oz

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· -- -'-"-_.... ---'"_.~

Matamls sa bao 5 ·1 teaspoonNata de coco 15 2 tablespoonsNata de pinya 10 2 tablespoonsPakaskas 5 I teaspoonPanutsa, grated 5 I teaspoonPastillas, duryan 5 I (5 x I x I em)Pastillas, gatas 5 I (5 x I x I em)Pastillas, langka 5 I (5 x I x I em)Sampaloc candy 5 I (1-1/2 em long

x I em thick)Sugars (white, brown, 5 I teaspoon

pure cane, syrup)Taho with syrup & sago 40 1/4 cupTlra-tira 5 I pieceToffee candy 5 I (2-1/2

x 1·1/2 x I em)Ube, haleya 10 I teaspoonVema 5 I (5 x 1-1/4 em)

This list gives the sugar equivalents of common serving portions of sweetsand other forms of sugar.

Halo-halo 410 2-1/3 cups 4 80Ice candy (Frostee) 100 I piece 3 60Ice drop 100 I piece 4 80Kundol, matamis 20 I (7 x 5 em) 4 80Pulvoron 10 I (4 x 2-1/2 x I em) 2 40Rlmas, matamis 40 I (8 x 4 em) 8 160Ubedol 20 I bar (5 x 2 em) 4 80

..Unless specified, all measures refer to piece.

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BAPPENDIX

BEVERAGE LIST

This list gives the sugar equivalents/nutrient composition of some commonly usedbeverages.

A. Soft drink 237 1 bottle- 5 100regular size

B. Fruit Flavored DrinkConcentrate

Grape 5 1 teaspoon 1 20Grapefruit, 10 2 teaspoons 1 20

lemon, orange,strawberry

Mango, 20 4 teaspoons 1 20'guwayabano, .pineapple-pomelo,pomeloPowder 5 1 teaspoon 1 20Tetra-Brick-

Apple 250 1 tetra-brick 6-1/2 130Guwayabano 250 1 tetra-brick 7-1/2 150Mango 200 1 tetra-brick 5-1/2 110Melon 200 1 tetra-brick 8-1/2 170Orange 250 1 tetra-brick 6-1/2 140Pineapple 250 1 tetra-brick 6 120

Plastic BottleMr. Juicyorange 225 1 small plastic 4-1/2 90

bottle+ Nutrition information taken from product label.

EJSource: Food Exchange Lists forMeal Planning (3rd Revision)Department of Science and Technology, FNRI Publication No. 57 ND 8(3) 1994

This list gives the nutrient composition of other commercially available flavored milkdrink, yoghurt/diet soft drink.

NetBeverage Contents ''''Measure Kcal PRO Fat CHO

(ml)

C. Flavored Milk Drink'

Chocolate 250 1 tetra-brick 200 8 5 31Fruit

Banana split 230 1 tetra-brick 160 6 2 29Melon Recomb. 250 1 tetra-brick 200 8 5 31Strawberry 250 1 tetra-brick 220 8 8 31

Full CreamMecca 230 1 tetra-brick 210 7 7 28Vanilla 230 1 tetra-brick 210 7 7 28Chocolate 230 1 tetra-brick 210 8 7 29

O. Powdered DrinkKlim LiteH 25 4 tablespoons 103 8 3 12Cocoa 25 5 tablespoons 68 5 5 12Milo 15 2-1/2 tablespoons 57 2 0.1 12Ovaltine 15 2 tablespoons 57 2 0.1 12

E. Yoghurt Drink'Natural 125 1 bottle 100 2 <1 20Fruit flavored'

Strawberry 100 1 bottle 70 <1 <1 17Guwayabano 125 1 bottle 70 <1 <1 17

F. Fruit Flavored Yoqhurt'Mandarin orange 100 7 tablespoons 120 5 3 17Mango bits 125 1/2 cup 170 6 4 29

G. Yoghurt Lite n' Rite'Apricot 125 1/2 cup 50 5 <1 6Grape 100 7 tablespoons 40 4 <1 5Natural 125 1/2 cup 100 2 <1 20Orange 100 7 tablespoons 40 4 <1 5Strawberry 125 1/2 cup 50 5 <1 6

H. Diet CoiaH 237 1 bottle 2 0.2 0 0.2330 1 can 3 0.3 0 0.3

+ Nutrition information taken from product label.++Nutrition information taken from distributor company.

0

CAPPENDIX

COMPOSITION OF SELECTEDIPROCESSED FOODS

IN EXCHANGES#

Food

FRUIT:Buko meat a

Wt. (g)E.P.

100

Measure'

1/2 cup

Exchanges Kcalories

1 fruit, 1 fat 85

RICE PRODUCTS, BAKERY PRODUCTS:

Biskotso 30 2-1/2(8x7x 1 rice, 1/2 fat 1221-1/2 cm each) •

Butse, Kamote 45 1 (7 x 1 cm) 1 rice, 1/2 fat 122Camote Cue 55 4 (5 x 3 x 1 ern each) trice, 1/2 fat 122Cream puff 45 2 (6 cm diameter each) 1 rice, 1/2 fat 122Eggpie 60 1/2 slice of 10 x 3-1/2 cm 1 rice, 1/2 fat 122Jacobina. special 30 3 (5 x 4 x 1 cm each) 1 rice, 1/2 fat 122Kababayan 30 2 (4-1/2 cm diameter 1 rice, 1/2 fat 122

x 1-1/2 cm thickness each)Kamatsile 30 6 (6 x 2 cm each) 1 rice, 1/2 fat 122Kekyam 90 2(17x4cm) 1 rice, 1/2 fat 122Gem cookies, plain 30 15 (2-1/2 ern diameter 1 rice, 1/2 fat 122

x 1 cm thick each)Mamon 35 2 (6 x 3 cm each) 1 rice, 1/2 fat 122Mongo bread 40 1 slice (10 x 8 x 1-1/2 cm) 1 rice, 1/2 fat 122Oatmeal, raw a 30 5 tablespoons 1 rice, 1/2 fat 122Oatmeal, cooked a 1 rice, 1/2 fat 122

# Listed according to increasing caloric content by food group.+ Unless specified, all measures refer to piece.-This food is a good source offibar.

EJSoun:e: Food Exchange Lists for Meal Planning (3rd Revision)De artm~nt or-Cscienceand Technology, FNRI Publication No. 57 NO 8(3) 1994

;-;="<;;'

i);bOd WI. (g) . Measltre' Exchanges Kcalorles(0:/r E.P. :;",;",,;,:';¥,'

"\. c

++ thick consis- 185 1 cuptency

+++ thin consis- 255 1-1/2 cupstency

Ogoy-ogoy 30 6 (5 x 3 x 1 cm each) 1 rice, 1/2 fat 122Pan de coco 40 1 (7 x 6 cm) 1 rice, 1/2 fat 122Pretzels 30 9 (9-1/2 x 0.7 cm each) 1 rice, 1/2 fat 122Rosquillos 30 7 (5 cm diameter each) 1 rice, 1/2 fat 122Salted crackers 30 8 (5 x 4 x 1/2 cm each) 1 rice, 1/2 fat 122Sweetened 30 2cups 1 rice, 1/2 fat 122

popcornTugi' 135 2(11 x3cmeach) 1 rice, 1/2 fat 122Banana cake 50 1 slice (7 x 6·1/2 x 2 cm) 1 rice, 1 fat 145Bitso-bitso 40 1 (13 x 5 cm) 1 rice, 1 fat 145Buko pie 60 1/2 slice of 10 1 rice, 1 fat 145

x3-1/2cmButse, Monggo 50 1 (7 x 1 cm) 1 rice, 1 fat 145Canton 100 1 cup 1 rice, 1 fat 145Chocolate cake 40 1 slice (3 x 2 x 2 cm) 1 rice, 1 fat 145Cinnamon roll 40 1 (9 x 6 cm) 1 rice, 1 fat 145Coco honey biscuit 30 4 (8-1/2 x 5 x 0.5 cm 1 rice, 1 fat 145

each)Crackers 35 8 (5 x 4 x 1/2 cm each) 1 rice, 1 fat 145Fruit cake 45 1 slice (4 x 2 x 2 cm) 1 rice, 1 fat 145Hopia : Baboy 35 1 (5 x 3 x 2 ern}' 1 rice, 1 fat 145

Munggo 35 1 (5 cm diameter) 1 rice, 1 fat 145Hot cake 55 1 (10 cm diameter) 1 rice, 1 fat 145Karyoka 40 3 (4 cm diameter each) 1 rice, 1 fat 145Miki 100 1 cup 1 rice, 1 fat 145Pilipit 30 1 (10 x 3 cm) 1 rice, 1 fat 145Pretzels, chocolate 35 10 (10 cm long each) 1 rice, 1 fat 145Salted popcorn 35 2cups 1 rice, 1 fat 145Spanish bread 40 1 (10 x 4 ern) 1 rice, 1 fat 145Brownies 40 1/2 slice of 8 1 rice, 168

x 7 x 2-1/2 cm) 1-1/2 fatCheesecake 40 1 (5 cm diameter) 1 rice, 1-1/2 fat 168Cornick 35 1/2 cup 1 rice, 1-1/2 fat 168French fries 65 1 cup 1 rice, 1-1/2 tat 168

+ Unless specified. all measures refer topiece.++ 5 tablespoons rawoatmeal + 1 cup water.+++ 5 tablespoons rawoatmeal + 1-1/2cups water.•Thesefoods aregood sources offiber.

~

Food Wt. (g) Measure' Exchanges KcaloriesE.P.

Instant noodles 40 1/2 of 80 gm. pack 1 rice, 1-1/2 fat 168(chicken/beef flavor)Skyflakes 35 4 pieces 1 rice, 1-1/2 fat 168Cheese roll 50 1 (10-1/2 x 5-1/2 cm) 1 rice, 184

1/2 HF·... meat1/2 fat

Butter cookies 35 7 (8 x 2 cm each) 1 rice, 2 fat 190Doughnut 45 1/2 of 9 x 3 cm 1 rice, 2 fat 190Gurgurya 35 23 (4 x 1 cm each) 1 rice, 2 fat 190Piii nut cookies 35 6 (5 x 1 cm each) 1 rice, 2 fat 190Wafer 35 7 (5 cm square each) 1 rice, 2 fat 190Corn chips 40 1-1/3cups 1 rice, 2-1/2 fat 212(cheese flavor)

,Eclair 100 1 (18 x 2 cm) 1 rice, 2-1/2 fat 212Sunflower biscuit 40 9 (7-1/2 x 4-1/2 cm each) 1 rice, 2-1/2 fat 212Croissant, plain 65 1 (10x5-1/2cm) 1 rice, 3 fat 235Pork pie 55 1 (7 x 11 x 2 cm) 1 rice, 3 fat 235Potato chips 45 1-1/2 cups 1 rice, 3 fat 235Muffin 110 1 (8 cm diameter) 2 rice, 2 fat 290

MEAT, FISH, POULTRY PRODUCTS, BEANS;

White kidney 55 1/3 cup 1/2 LF"meat, 71beans seeds- I 1/2 ricedried (abitsuelas,buto puti, tuyo)Chili con carne 105 1 cup 1 LF meat,

1/2 rice 91Mung bean' 75 3/4 cup 1 LF meat, 91(munggo) 1/2 riceOyster 105 2/3 cup 1 LF meat, 91

1/2 riceSalt .water mussel 45 1/4 cup 1 LF meat, 91(tahonq) 1/2 riceTaho, plain 275 2-3/4 cups 1 LF meat, 91

1/2 riceLuncheon meat 55 2 slices 1 MF+++meat, 106

(9 x 5 x 1 cm each) 1 tsp. sugarMurkon 60 2 slices 1 MF meat, 106

(5-1/2 x 1-1/2 cm each) 1 tsp. sugar

+ Unless specified, all measures referto piece.++ Low fat+++ Medium fat++++ High fat..These foods are good sources of fiber.

EJ

Food Wt. (g) Measure·E.P.

Cheese spread 55 4 tablespoons

Meat loaf, canned 70 2 slices(9 x 5 x 1-1/4 cm each)

Potted meat 75 5 tablespoons

Lima beans, 75 1/2 cupseeds," dried(patani, buto)Century egg 65 1 piece

Chickpea seeds, 65 1/2 cupboiled (garbansos,buto, linaga)Clam (tulya) 70 1/4 cup, shelled or

5-1/2 cups with shellCow pea seeds" 65 1/2 cup(paayap, buto)Fishball 95 6 (3-1/2 cm diameter each)Hotdog 70 2 (10 x 4 cm each)

Peanut Cracker 35 1/3 cup

Cheese, native 60 2 slices(4 x 4 x 1 cm each)

Peanuts, boiled 60 1/2 cup

Spam 55 3 slices(8 x 5 x 1 cm each)

Lite hotdog 55 1 piece

Chicken spread 70 5 tablespoons

Embutido 60 2-1/2 slices(5 x 1-1/2 cm each)

Hamburger 50 2·1/2 (4-1/2 x 1 cm each)

Longanisa, Bilbao 40 2 (6 x 2 em each)

+ Unless specified, all measures refer topiece.•These foods are good sources offiber.++ lowfal+++ Medium fat++++ High fal

G

Exchar,ges Kcalories

1 MF meat, 1161-1/2 tsp. sugar

1 MF meat, 1161-1/2 tsp. sugar

1 MF meat, 1161-1/2 tsp. sugar

1/2 LF meat, 1201 rice

1 MF meat, 1361/2 rice

1 LF meat, 1411 rice

1 LF++meat, 1411 rice1 LF meat, 1411 rice1 LF meat, 1 rice 1411 HF++++meat, 144

1/2 fat1 HF meat, 162

2 tsp. sugar1 HF meat, 1671 fat1 HF meat, 167

1/4 rice, 1 tat1 HF meat, 1 fat 167

1-1/2 MF+++ meat, 1692 tsp. sugar

1 HF meat, 1/2 tat 1741-1/2 tsp. sugar

1 HF meat, 1 tat 1871 tsp. sugar

1 HF meat, 1 fat 1871 tsp. sugar

1 HF meat, 2 fat 212

Food' Wt. (g) Measure· Exchanges KcaloriesE.P.

Pork : Kasim 55 1 slice (4·1/2 x 4 1 HF++++meat, 212

Ix 2-1/2 cm) 2 fat

: Liempo sa 55 1 slice (9-1/2 x 3 1 HF meat, 212j Tiyan x 1/2 cm) 2 fat

I: Tadyang 90 4 (12 x 2 x 2 cm each) 1 HF meat, 212

APcooked 2 fat

I Liverspread 65 4-1/2 tablespoons 1 HF meat, 2171 fat, 1/2 riceI

I Cashew, roasted 40 1/3 cup 1 HF meat, 2 fat 232I 2 tsp. sugarI Pork : Buntot 70 1 slice (10 x 4 x 2 cm) 1 HF meat, 257

i AP cooked 3 fatI : Paypay 80 1 slice (7 x 6 x 3-1/2 cm) 1 HF meat, 3 fat 257I : Liempo sa 75 1 slice (8 x 4 1 HF meat, 347

I Hulihan x 2·1/2 cm) 5 fat: Likod 95 1 slice (8 1/2 x 6 x 2 cm) 1 HF meat, 347

5 fat: Tagiliran, 90 1 slice (7 x 6 1 HF meat, 347

laman x 2 1/2cm) 5 fatLonganisa: Native 75 3 (2-1/2 ern each) 1 HF meat, 7 fat 437

Makaw 60 2·1/2 1 HF meat, 470(12 x 2 cm each) 7-1/2 fat,

1/2 tsp. sugar

+ Unless specified, all measures refer to piece.++++ High fat

Food

FAT:

WI. (g)E.P.

Measure Exchanges Kcalories

Kropeck 20 4 (7-1/2 x 11-1/2 cm each) 1 fat, 1/2 rice 145

~'

SUGARY PRODUCTS:

Banana crackers 10 2 tablespoons 1 sugar, 1/2 fat 42Chocolate candy 10 2 pieces-round 1 sugar, 1/2 fat 42

with milkChocolate, 10 1/2 of 10-112x 1 sugar, 42orange crunch 1/2 x 4 cm each 1/2 fatPeanut brittle 10 2 (4 x 1 x 0.5 cm each) 1 sugar, 1/2 fat 42Pili nut candy 15 2 tablespoons 1 sugar, 1-112 fat aa

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oAPPENDIX

COMPOSITION OFCOMBINATION FOODS

This list gives the macronutrient composition ofsome common combination

foods.

Food WI. (9) Measure + Kcalories PRO Fat CHOE.P.

Adobong Saboy 75 1/2 cup 302 8 24 14Gallos de

Garbanzos- 220 1 cup 260 8 0.5 56Dinuguan 185 1 cup 124 14 6 3Ginataang

Halo-halo 95 1/2 cup 103 0.9 0.8 23Kare-kare

w/ Sagoong 80 1/2 cup 103 8 6 5Kilawin, Int.

Organs 85 1/2 cup 113 2 3 18Litsong Saboy 50 1 (4 x 5-1/2 273 8 26 1

x 1-1/2 cm)Lumpia, Fresh 260 1 (14x6cm) 273 3 2 61

w/ SauceLumpia, Fried, 50 1 (7-1/2 x 3-1/2 cm 137 2 8 13

Toge diameter)Lumpia

w/ Peanut 260 1 (14x 6 cm) 403 26 19 33Sauce

Menudo 160 2/3 cup 144 8 4 22Menudo (More of

Potatoes) 85 1/3 cup 189 8 14 7Okay w/ Tagunton 85 1 (8 cm diameter 184 5 9 20

xt ern thick)Putsero 120 1 cup 282 8 17 23

+ Unless specified. all measures refer to piece."This food is a good source of fiber.

EJSource; Food Exchange Lists for Meat Planning (3rd Revision)

Department of Science and Technology, FNRI Publication No. 57 NO 8(3) 1994

EAPPENDIX

FATTY ACID CONTENTOF COMMON FATS AND OILS

PerTablespoon

Mono·

Product Saturated Cholesterol .Polyunsaturated unsaturatedfatty acids fatty acids fatty acids

(g) (mg) (g) (g)

Rapeseed 0.9 a 4.5 7.6(Canola oil)

Safflower oil 1.2 a 10.1 1.6Sunflower oil 1.4 a 5.5 6.2Peanut butler 1.5 a 2.3 3.7

(smooth)Corn oil 1.7 a 6.0 3.3Olive oil 1.6 a 1.1 9.9Margarine 1.6 a 3.9 4.6

(soft)Sesame oil 1.9 a 5.7 5.4Soybean oil 2.0 a 7.9 3.2Margarine 2.1 a 3.6 5.1

(stick)Peanut oil 2.3 a 4.3 6.2Lard 5.0 12 1.4 5.6Butler 7.1 31 0.4 3.3Coconut oil 11.6 a 0.2 0.6

This table gives the fat content of the most common fats and oils available in themarket, starting from those with a low saturated fat (i.e., saturated fatly acids) contentto those with a hiqh saturated fat content. All fats and oils are high in calories (135Kcalories per tablespoon).

G

FAPPENDIX

CALCULATED DIETSFOR QUICK REFERENCE +

FOOD EXCHANGES

Prescription VEG. FRUIT MILK SUGAR RICE MEAT FAT'A B LF" MF-

6300 kj1500kcal 2 4 5 7 3 3245-55-35

6700kj1600kcal 2 4 6 7-1/2 3-1/2 3260-60-35

7100kj1700kcal 2 4-1/2 6 8 3 2 3275-65-40

7500kj1800kcal 2 4-1/2 6-1/2 8-1/2 3-1/2 2 3290-70-40

7900kj1900kcal 2 5 7 9 3-1/2 2 3310-70-40

8400kj2000kcal 2 6 8 9 4 2 4325·75·45

+ Refers to grams ofcarbohydrate, protein andfatrespectively which follows the% distribution of 65%CHO, 15%PROand 20%Fat.

++ Low fat+++ Medium fat

Source: Food Exchange Lists for Meal Planning (3rd Revision)Department of peienceand Technology, FNRI Publication No. 57 NO 8{3 1994

~~~~~

. SUGAR.

PrjlscripliOn VEG. FRUIT MILK RICE MEAT - FAT-: ",

;-'\:~'~;!'- A B .'. .' .. >!'i . . LF" MF~·,

8800kj2100kcal 2 6 8-1/2 9-1/2 4-1/2 2 4-1/2340-80-50

9200kj2200kcal 2 6-1/2 2 9 9-1/2 4-1/2 1 4360-80-50

9600kj2300kcal 2 1 7 2 9 10 5 4375-85-50

10000 kj2400kcaJ 2 1 7 2 9 10-1/2 5-1/2 1 4-1/2390-90-55

++ Low fat+++ Medium fat

. I

GAPPENDIX

WEIGHT-FOR-HEIGHTFOR FILIPINOS

(25-65 Years)

WEIGHT (kg)0

HEIGHT HEIGHT WEIGHT (kg)(cm) MALE FEMALE .: (cm) MALE FEMALE.

129 29.5-36.0 160 48.4-59.2 47.9-58.5130 30.1-36.8 161 49.1-60.1 48.5-59.3131 30.7-37.5 162 49.9-60.9 49.1-60.0132 31.3-38.2 163 50.6-61.8 49.7-60.7133 31.9-38.9 164 51.3-62.7 50.3-61.4134 30.1-36.8 32.5-39.7 165 52.0-63.5 50.8-62.2135 30.8-37.7 33.1-40.4 . 166 52.7-64.4 51.4-62.9136 31.5-38.5 33.6-41.4 167 53.4-65.2 52.0-63.6137 32.2-39.4 34.2-41.8 168 54.1-66.1 52.6-64.3138 32.9-40.3 34.8-42.6 169 54.8-67.0 53.2-65.0139 .33.6-41.1 35.4-43.3 170 55.5-67.8 53.8-65.8140 34.4-42.0 36.0-44.0 . 171 56.2-68.7141 35.1-42.8 36.6-44.8 172 56.9-69.6142 35.8-43.7 37.2-45.5 173 57.6-70.4143 36.5-44.6 37.8-46.2 174 58.3-71.3144 37.2-45.4 38.4-47.3 175 59.0-72.1145 37.9-46.3 39.0-47.6 176 59.7-73.0146 38.6-47.2 39.6-48.4 177 60.4-73.9147 39.3-48.0 40.2-49.1 178 61.1-74.7148 40.0-48.9 40.8-49.8 179 61.8-75.6149 40.7-49.7 41.4-50.5 180 62.6-76.4150 41.4-50.6 41.9-51.3 181 63.2-77.3151 42.1-51-5 42.6-52.0 182 64.0-78.2152 42.8-52.3 43.1-52.7153 43.5-53.2 43.7-53.4154 44.2-54.0 44.3-54.1155 44.9-54.9 44.9-54.9156 45.6-55.8 45.5-55.6157 46.3-56.3 46.1-56.4158 47.0-57.5 46.7-57.1159 47.8-58.4 47.3-57.8

EJSource: Food Exchange Lists for Meal Planning (3rd Revision)Department oreScienee and Technology. FNRI Publication No. 57 ND 8(3) 1994

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Nutrition - the science of food, the nutrients and other substances therein,their action, Interaction and balance In relation to health and disease and theprocesses by which an organism Ingests, digests, absorbs, transports, utilizesand excretes food substances.

Nutritional Assessment - an evaluation of ones nutritional state which Isusually accomplished by one or more of the following methods: dietary survey( to detect a faulty diet, I.e. primary factor), medical and clinical examination(to detect conditioning factors), biochemical tests ( to detect tissue levels),and anthropometric tests (to detect anatomic changes).

Nutritional Deficiency - condition of the body that may arise as caused by aprimary factor or secondary (conditioning) factors. The primary factor refers toa faulty diet" I.e. nutrient Intake Is lacking In quality and/or quantity for a givenindividual. Factors that bring about faulty diet are: poverty, Ignorance, poorfood habits, limited food supply due to overpopulation or low food production,poor distribution of food, cultural taboos and many other factors causing nutrientIntake to be less than what Is needed.

The secondary factors are multiple and include all conditions within thebody that reduce the ultimate supply of nutrients to the cell after the food goesbeyond the mouth. The factors that Interfere with normal digestion are:gastrointestinal disorders, lack of appetite. poor teeth, lack of digestive enzymes,etc. Factors that Interfere with absorption are: diarrhea, malabsorption syndrome,Intestinal surgery, laxatives, parasitisms, etc. Factors that affect metabolismand utilization In the cells are: liver diseases, malignancy, some drugs,alcoholism, toxins. diabetes mellitus, etc.Factors that Increase excretion and result in nutrient loss are: polyuria, excessiveperspiration, certain drugs, etc.

Nutritional Status - or nutriture Is the condition of the body resulting fromthe utilization of essential nutrients. One may be classified as having good, fairor poor nutriture depending upon the primary or secondary factors discussedunder nutiritlonal deficiency.

Nutltlonlst-Dletltlan • a specialist educated for a profession responsible forthe nutritional care of Individuals and groups. This care includes the applicationof the science and art of human riutrition in helping people select and obtainfood for the primary purpose of nourishing their bodies In health or diseasethroughout the life cycle. This participation maybe in single or combinedfunctions: In food service systems management; In extending knowledge onfood and nutrition principles; in teaching these principles for applicationaccording to particular situation; or in dietary counselling.

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