Last 4 digits of PSU ID# 4351

Nutrition 453, Spring 2014

Planning a Diet Using Exchanges
25 Pts
Clint has referred his sister-in-law, Debbie, to you as she was recently diagnosed with type 2
diabetes. Aside from the recent Diabetes diagnosis, Debbie is an otherwise healthy 60 year-old
female who participates in water aerobics daily at the local YMCA. Her doctor put her on
metformin to help control her glucose levels and expressed that he is willing to discuss the
discontinuation of oral medication if Debbie can master the Exchange system and control her
blood glucose levels through dietary invention alone. Using the diabetic exchanges, help Debbie
plan a diet with the following macronutrient distribution: 32% FAT, 52% CHO, and 16% PRO.
Base your TDE on Debbies most recent weight of 160 lbs and height of 68 inches. After
discussing Debbies case with her physician you decide you would like her to learn the exchange
system using the following prescribed CHO distribution pattern:
20% of CHO kcal for breakfast
15% of CHO kcal for snack
30% of CHO kcal for lunch
25% of CHO kcal for dinner
10% of CHO kcal for hs snack
1) Write a diet Rx for Debbie. Use your notes and be sure to include all of the macro and
micro nutrients that need to be included in a diabetic diet, as well as energy. Remember,
all macronutrients (e.g. CHO, PRO, FAT, SFA, PUFA, MUFA) must be expressed in grams
and as % total energy.
TDE:
TDE= REE+AF+IF
REE: ([9.99 X wt (kg)] + [6.25 X ht (cm)] - [4.92 X age] -161)xAFxIF=TDE
Activity Factor: 1.4
Injury Factor: 1.0 (no injury)
([9.99 X72.575)] + [6.25 X172.72)] - [4.92 X 60] -161)x1.4x1=
(725+1079.5-295.2-161)x1.5x1=
1350x1.4x1=2025
TDE=2025=1900 kcal
Macronutrients:
32% FAT
0.32x2050=608 kcal from fat
608/9kcal per g= 68 g fat/day
52%CHO
.52x1900=988 kcal/day from CHO
988/4kcal per g= 247 g CHO/day
16% PRO
.16x1900==304 kcal/ day from PRO
304/4kcal per g=76 g protein/day

HBV Protein
Recommendation: 60-80% of protein from HBV
60% - .6x76=46 g
80%- .8x76= 61 g
HBV: 46-61 g/day (of the 76 gm total protein)
PUFA=IOM recommendation 5-10% of daily kcal for diabetics
10% PUFA
.1x21900=190 kcal from PUFA
190/9 kcal per g=21 g PUFA/day (included as part of the 68 gm fat)
SFA=recommendation is same for diabetics as general population, so >10% of total kcal
>10% SFA
.1x1900=190 kcal from SFA
190/9 kcal per g=21 g SFA/day maximum (included as part of the 68 gm fat)
MUFA= recommended b/c MUFA-rich eating pattern may benefit diabetics
Remaining fat kcal that arent considered PUFA or SFA would be MUFA
So: 32%-10%-10%= 12% MUFA
12% MUFA
.12x1900= 228 kcal from MUFA
228/9kcal per g= 26 g MUFA/day (included as part of the 68 gm fat, rounded up so that
SFA+PUFA+MUFA=total fat)
Micronutrients:
Sodium recommendation for diabetics: limit to 2300 mg/day
Rx: 1900 kcal diet, 32% fat (68 g) with 10% from PUFA (21 g), no more than 10% from SFA
(21 g), and 12% from MUFA (26 g), 52% CHO (247 g), 16% protein (76 g) with 60-80% (4661 g) of protein from HBV, and a sodium restriction of 2300 mg.
2) Plan a diet and 1-day menu for Debbie using the 12 Step process (you will not do Step 11
in this assignment) in the Diet planning using exchanges slides that were covered in
lecture.
a. Be sure to distribute the exchanges throughout the day according to her prescribed
CHO distribution needs (Step 8).
b. Use the diabetic exchanges to evaluate the macronutrient composition of your sample
menu (Steps 9, 10).
c. Dont forget to perform Step 12. Be sure to compare your diet to your diet Rx.
STEP 1: See Rx above

Fat
Protein
CHO
Total

Macronutrients
% total kcal total g total kcal
32%
68
608
16%
76*
988
52%
247
304
100%
391
1900

Fat Breakdown
% of total kcal total kcal
total g
SFA
10%
190
21
MUFA
12%
228
26
PUFA
10%
190
21
Total
32%
608
68

* Of 76 g protein, 46-61 g from HBV

STEP 2: non-starch CHO
I used the data I calculated in this chart to help pick exchanges:
% CHO
CHO
Meal
kcal
kcal
CHO g
Breakfast
20%
198
50
Snack
15%
148
37
Lunch
30%
296
74
Dinner
25%
247
62
HS Snack
10%
99
25

Non-starch CHO
Breakfast: 2 fruit, 1 veg=35g
Snack: 2 veg, 1 milk (skim) =22g
Lunch: 2 fruit= 30 g
Dinner= 1 veg, 1 milk (skim), 1 other= 32 g
HS snack= 1 milk (low-fat), 1 fruit=27 g

5 fruit
3 milk (2 skim, 1 low fat)
4 veggies
1 other
TOTAL (g)

CHO g
PRO g FAT g
75
0
36
24
20
8
15
0
146
32

0
5
0
0
5

STEP 3: Starch
247g CHO (allowed) - 146 g CHO (above)= 101g CHO remaining
101/15=6.7= 7 starch exchanges

from step 2
from starch (7 exc.)
TOTAL (g)

CHO g PRO g
FAT g
146
32
5
105
14
7
251
46
12

STEP 4: Meat
76 g pro (allowed) 46 g (from above)= 30 g left
30 g/7g per meat= 4.3= 4 meat exchanges
From prev. steps
From meat exch (4 lean)
TOTAL (g)

CHO g
PRO g
FAT g
251
46
12
0
28
12
251
74
24

HBV check: 24 g from milk, 28 g from meat = 52 g HBV

52 is within 46-61 g range, also 52/74= 70.3%, which is within % range of 60-80%

STEP 5: Fat
68 g (allowed) 24 g (from previous exchanges)=44 g left
44/5 g per exchange= 8.8= 9 exchanges
CHO g
PRO g
FAT g
251
74
24
0
0
45
251
74
69

Previous
Fat exchanges
TOTAL (g)

STEP 6: Totals
CHO
TOTAL g
Multiply by
TOTAL kcal

PRO
251

x4

FAT

TOTAL

74
x4

1004

69
x9

296

621

1912 total kcal

Rx: 1900 kcal
Within 50 kcal of goal, so exchanges match Rx
Macronutrient distribution:
CHO: 1004/1921= .523= 52.3% (Within 1% of Rx)
PRO: 296/1921=.154 = 15.4% (Within 1% of Rx)
FAT: 621/1921= .323= 32.3% (Within 1% of Rx)

CHO
PRO
FAT
TOTAL

Rx goal Actual %
52%
52.3%
16%
15.4%
32%
32.3%
100%

Within Rx?
YES
YES
YES

STEP 7: The Plan

Group
Milk (Skim)
Milk (low fat)
Vegetable
Fruit
Other
Starch
Meat
Fat

# of exchanges
2
1
4
5
1
7
4
9

1921

STEP 8: Distribution
This chart contains data on Debbies recommended CHO distribution:
% CHO
CHO
Meal
kcal
kcal
CHO g
Breakfast
20%
198
50
Snack
15%
148
37
Lunch
30%
296
74
Dinner
25%
247
62
HS Snack
10%
99
25

This chart contains the distribution of exchanges in my example diet:

Distribution of Exchanges with Total CHO (g)
Exchange
Breakfast Snack
Lunch
Dinner Snack
Total
Milk (Skim)
0 1 (12 g)
0 1 (12 g)
0
2
Milk (Low fat)
0
0
0
0 1 (12 g)
1
Vegetable
1 (5 g)
2 (10 g)
0 1 (5g)
0
4
Fruit
2 (30 g)
0 2 (30 g)
0 1 (15 g)
5
Other
0
0
0 1 (15 g)
0
1
Starch
1 (15 g)
1 (15 g) 3 (45 g) 2 (30 g)
7
Meat
1
3
4
Fat
1
2
1
3
2
9
TOTAL CHO (g)
50
37
75
62
27
251

This chart compares the example diet to the recommended distribution:

Exchange
TOTAL CHO (g)
CHO % Calculation
CHO %
Goal %
Within Goal?

Breakfast Snack
Lunch Dinner Snack Total
50
37
75
62
27
251
50/251 37/251 75/251 62/251 27/251
19.92% 14.74% 29.88% 24.70% 10.75%
20%
15%
30%
25%
10%
YES
YES
YES
YES
YES

STEP 9: Meal Plan

Breakfast
Food
Grapefruit, 1 large
Strawberries, 1.25 cups
Vegetable juice, 1/2 cup
Bread, 1 slice
Peanut Butter, 1.5 tsp
TOTALS

Exchange
1 fruit
1 fruit
1 veg
1 starch
1 fat

CHO
PRO
Fat
(g)
(g)
(g)
15
0
0
15
0
0
5
2
0
15
2
1
0
0
5
50
4
6

Snack
Food
Baby carrots, 1 cup
Skim Milk, 1 cup
Celery sticks, 1 cup
Saltine Crackers, 6
Tahini, 4 tsp
TOTALS

Exchange
1 veg
1 milk
1 veg
1 starch
2 fat

CHO
(g)
5
12
5
15
0
37

PRO
(g)

Fat
(g)

2
8
2
2
0
14

0
0
0
1
10
11

Lunch
Food
Bread, 2 slices
Lettuce
Mayonnaise, 1 tsp
2 eggs, whites only, hard boiled
orange juice, 1/2 cup
Med. Apple
Green peas, 1/2 cup
TOTALS

Exchange
2 starch
free
1 fat
1 lean meat
1 fruit
1 fruit
1 starch

CHO
PRO
Fat
(g)
(g)
(g)
30
4
2
0
0
15
15
15
75

0
7
0
0
2
13

5
3
0
0
1
11

Dinner
Food
salad greens, 5 oz
sliced bell peppers, 1 cup
fat free salad dressing, 3 Tbsp.
Skim milk, 1 cup
mashed potatoes, 1 cup
chicken breast, 3 oz
margarine, 1 tsp
TOTALS

Exchange
free
1 veg
1 other
1 milk
2 starch +2
fat
3 lean meats
1 fat

CHO
(g)

PRO
(g)

Fat
(g)

5
15
12

2
0
8

0
0
0

30
0
0
62

4
21
0
35

12
9
5
26

HS Snack
Food
yogurt, plain, 6 oz
Banana, extra small
Almonds, 12
TOTALS

Exchange
1 low fat milk
1 fruit
2 fats

CHO
PRO
Fat
(g)
(g)
(g)
12
8
5
15
0
0
0
0
10
27
8
15

Daily Totals (g)in Meal Plan

CHO
PRO
FAT

251
74
69

STEP 10: Compare totals

From step 6:
CHO
TOTAL g
Multiply by
TOTAL kcal

PRO
251

x4

FAT
74

x4
1004

TOTAL
69

x9
296

621

1921

The total grams in Daily Totals in Meal Plan from step 9 (above) match the grams in this
chart (251 for CHO, 74 for pro, 69 for fat) so the measures from the example diet and the
exchange calculations are exactly the same:
CHO: 1004/1921= .523= 52.3% (Within 1% of Rx)
PRO: 296/1921=.154 = 15.4% (Within 1% of Rx)
FAT: 621/1921= .323= 32.3% (Within 1% of Rx)
52.3%+15.4%+32.3%=100%
STEP 12: Summary Table

Nutrient
Kcal
CHO
PRO
HBV
FAT
SFA
MUFA
PUFA
Na
CHO Dist:
Breakfast
CHO Dist: Snack
CHO Dist: Lunch
CHO Dist: Dinner
CHO Dist: HS
Snack

Goal
1900
52%
16%
60-80% of
protein
32%
>10%
12%
10%
2300 mg max

Summary Table
Meal Plan
Evaluation
Within 50 Kcal,
1921 ok
52.30% OK
15.40% OK
70.3% of
protein
OK
32.30% OK
13.59% Too high
7.50% Too low
1.24% OK

How to fix problem

None
None
None
None
None
Less animal products
More nuts/Nut
butters
None

20%
15%
30%
25%

19.92%
14.74%
29.88%
24.70%

OK
OK
OK
OK

None
None
None
None

10%

10.75% OK

None

I found the totals for the different types of fat by writing out the exchanges on the chart
below and adding up the totals for each type:

Types of Fat In Meal Plan

Classification
# exchanges
total (g)
x9 for total kcal
SFA
4
12
108
SFA
1 (low fat)
5
45
PUFA
1
1
9
PUFA
2
10
90
PUFA
1
5
45
PUFA
3
3
27
SFA
2
12
108
MUFA
1
1
9
MUFA
1
5
45
PUFA
1
5
45
MUFA
2
10
90

From Meats
From Milk
Saltine Crackers
Tahini
Mayonnaise
Bread
Mashed Potatoes
Green Peas
Peanut Butter
Margarine
Almonds

Fat
SFA
MUFA
PUFA

Kcal

Total Kcal of Fats

Divide by 1921 to find % of total
kcal
261
13.59%
144
7.50%
216
11.24%

What to hand in:

Hard copies: word files. You MUST show your work on all 12 steps to get credit. If you used
Excel to calculate the diet, then please hand that in, too. If you are having trouble formatting
your Excel file to fit within the page margins, one of us can show you how to fix it.
ANGEL drop box: Word files; if you used Excel to calculate the diet, then you must deposit your
Excel file in the drop box, as well, so that we can easily see what calculations you used in the
different cells.