Development of the South African renal exchange lists
Objective. The objective of this developmental study was the development of renal exchange lists for the South African population with renal failure. Subjects and design. A questionnaire was circulated to South African renal dietitians to establish the format and composition of the proposed exchange lists. Foodfinder 3 was used for assessment of nutrient composition of foods, and the NRIND Food Quantities Manual was used for assessment of portion sizes. Results from the Food Consumption Study were used to identify food items frequently consumed by the South African population, and dietitians with knowledge of the eating habits of Moslem, Indian, white, black and coloured groups were consulted regarding the inclusion of cultural foods. Portion sizes were determined by protein content of foods. The preliminary exchange lists were circulated for comment and tested for a period of 1 year. Results. Many new food items were added during revision of the exchange lists. Portion sizes were adapted to be more realistic, and in some cases additional sub-groups were added. Foodfinder 3 and renal exchange list values for all food items included in the exchange lists were then compared, and this showed highly significant correlations for all nutrients concerned. There was no significant difference between mean nutrient values for the two methods, with the exception of protein, the content of which was consistently and significantly underestimated by a mean of 0.1 g per food item. This underestimation is not considered to be of clinical importance. Conclusion. In this study renal exchange lists were developed for use in South African persons with renal failure. Despite the small but significant underestimation of protein content, the lists appear to be of sufficient precision for use in clinical practice.