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Korean food exchange system
Diabefes Research and Clinical Practice, 9 (1990) 103-107
103
Elsevier DIABET 00383
Korean Food Exchange System Hee Young Paik ’ and Hong Kyu Lee 2 ‘Department
of Food and Nutrition, Sookmyung
Womenk University, Seoul and ‘Department
of Internal Medicine, Seoul National
University College of Medicine, Seoul, Korea
(Received 18 July 1989) (Revision received 3 November 1989) (Accepted 5 November 1989)
Introduction The food exchange system which is used for meal planning, education and counseling [ 1,2 3 is one of the most widely used nutritional tools for persons with diabetes and other conditions. In Korea, several different systems have been used by various hospitals and organizations. The presence of different exchange systems has caused many problems - not only for diabetic patients who often visit more than one hospital but also for the doctors and dietitians who must explain the systems [ 31. To overcome these problems, a new Korean Food Exchange System (KFES) was developed by the joint effort of three related organizations - the Korean Diabetes Association, the Korean Society of Dietitians and the Korean Nutrition Society [4]. After reviewing the existing exchange systems and other related sources on dietary patterns and practices of Korean people, the Food and Nutrition Committee (KNC), composed of delegates from the three organizations, devised the KFES, which is thought to be a more suitable form of dietary planning. This is a summary of the activities of the Food and Nutrition Committee and an outline of
Address for correspondence: Hong Kyu Lee, M.D., Department of Internal Medicine, Seoul National University College of Medicine, 28 Yungun-Dong, Chongno-Ku, Seoul, Korea. 0168-8227/90/$03.50
0 1990 Elsevier Science Publishers
the KFES. The KNC has set the guidelines for the development of a new exchange system as follows: (1) simple and easy to understand; (2) suitable for the Korean dietary pattern; (3) consists of a complete and nutritionally sound diet; (4) adjustable to an individual’s dietary habits; (5) applicable to various social occasions, such as dining-out; (6) applicable to all types of diabetes.
Food groups In the food exchange system, food items with similar nutrient contents are grouped together and each group is regarded as having the same fixed value of caloric and major nutrient content [ 11. Meal planning can be done more easily by disregarding the small differences among the food items of the same group. Some members on the committee favored using less food groups. They favored the five basic food groups employed by the FAO Korean committee in its nutritional education, because this is taught in most nutrition departments of Korean colleges [5]. However, combining food items with different major nutrients - for example, cereals and fruits - in the same group may confuse the users in planning nutritionally sound diets because Korean meals do not consist of fruits, and the caloric values of fruits vary too widely. The committee thus agreed to have six food groups for KFES as shown in Table 1.
B.V. (Biomedical
Division)
104
TABLE 1 Korean Food Exchange System Food group
One exchange unit
kcal
Carbohydrate
Cereals Meat/fish Low-fat Medium-fat High-fat Vegetables Fat Milk Fruits
l/3 bowl cooked rice (70 g) meat (40 g), fish (50 g)
100
23
70 g 1 ts. (5 g) 1 cup (200 cc) l/2 medium apple (100 g)
The order of the food groups of the KFES are arranged to reflect the dietary habits of Koreans. Koreans have been eating three main meals a day for several hundred years. They basically consist of a bowl of rice along with one soup and vegetable side dishes, with or without some meat or fish. Thus, the food groups that are used in the main meal are listed first: cereals and grains are the staples; meat, fish and vegetables are the main ingredients for side dishes; fats and oils are used during cooking in a typical Korean diet. Milk and fruits are usually consumed separately as snacks. The order of the six food groups are also shown in Table 1. In the KFES the meat/fish group is divided into three subgroups - low fat, medium fat, and high fat (according to their fat and caloric contents). KNC recognizes that the consumption of high fat foods would increase the risk of atherosclerosis [6-81, even though the incidence of coronary heart disease at present in Korea is quite low [ 91. Therefore, it was recommended that education given to diabetics should emphasize the avoidance of food items which belong to the high fat group.
50 75 100 20 45 125 50
(g)
Protein (g) 2 8 8 8 2
3 11 12
2 5 8 5 7
6
hydrates, 15.5% from protein and 13.7% from fat [lo]. Considering the traditionally high carbohydrate intake in the Korean diet, as well as the recent international trend of allowing high levels of carbohydrate in the diabetic diet [2,1 l-141, carbohydrate intake is recommended to be 55-60x of total caloric intake. The Committee agreed that Koreans with diabetes, however, should be reminded to restrict their intake of simple sugars and consume complex carbohydrates from natural foods with high fiber content, as recommended by a recent A.D.A. diet guideline [2]. Protein intake should meet an individual’s need (1.2 g/kg body weight) [ lo] and the remainder of the energy should come from fat. The distribution of calories is given in ranges but representative values are also provided, mainly for educational purposes. These values can be adjusted depending on the individual’s
TABLE 2 Distribution
of energy intake
Nutrient
Range”
Representative value”
Carbohydrate Protein
55-60 15-20 (1.2 g/kg body wt.) 20-25
60 20
Distribution of caloric intake The KNC agreed to propose the distribution of the caloric intake as shown in Table 2. A recent national nutrition survey revealed that Koreans are deriving 70.8% of their energy from carbo-
Fat (g)
Fat
” ‘9; Daily total energy intake.
20
105
ability to achieve and maintain an ideal body weight. Committee members also paid attention to the fact that this kind of caloric distribution would increase the fat content of a meal, which then might not be applicable to rural Koreans.
Milk. The form of milk most widely consumed among Koreans is whole liquid milk, One unit of milk is decided to be 1 pack of milk which is supplied in 200 ml size pack (125 kcal). Fruits.
Exchange units The exchange unit of each food group is derived from the nutrient content of the food items most widely consumed in that group. Exchange units of each food group and their caloric and nutrient contents are presented in Table 1. Cereals. The exchange unit of the cereal group is based on cooked rice which is the main staple of the Korean diet. One bowl of cooked rice typically contains 210 gram and 300 kcal. One unit will consist of l/3 bowl of cooked rice and will provide 100 kcal. Meat,@.&. Food items in this group vary in their fat and caloric content and are thus divided into three subgroups, according to their fat content. The KFES followed the A.D.A. recommendation for meat exchanges, as no standardized serving size of meat/fish was obtainable from the Korean food study. Koreans consume fish/meat as side dishes, that are prepared in one bowl, and generally served to the whole family. For the ease of calculation, the minimum serving size is considered to be 40 g meat and 50 g of fish and the caloric values are rounded off to 50, 75 and 100 kcal according to the fat content. Vegetables. One unit of the vegetable group is determined by the total amount of vegetables consumed in one typical Korean meal - 70 grams. The caloric and nutrient contents of one unit are derived from the nutrient contents of vegetable items most frequently used in the Korean diet. Fat. Most of the fat in the Korean diet is from oils which are used in frying or for seasoning. One unit will be one teaspoon - 5 grams (45 kcal).
One exchange unit of fruit group is determined to be one half of medium sized apple which is the most common fruit in Korea. This amounts to 100 g (50 kcal).
Limitations and suggestions The Food and Nutrition Committee has held numerous meetings and two hearings before finalizing the KFES. The system is thought to be the best, given knowledge and circumstances. The problem of multiple dietary systems in one country was amended. The caloric value of each exchange unit appears more educational. However, KNC fully acknowledges that the KFES is by no means complete and should be updated and revised periodically to reflect the advances in scientific knowledge and to overcome the problems which may arise in its practical use. The following are some of the suggestions made by KNC, which may be helpful in future modifications: (1) more data are needed on the dietary patterns of Korean people. Basic materials such as: frequency of consumption of different food items, average serving sizes or amount of consumption per person in each meal, and analysis of the nutrient content of food items are very much needed but insul%cient. Accumulation of such data is essential for future improvement of the KFES ; (2) in order to be easily applicable to everyday life, the measurements should be based on cooked food. However, nutrient contents in the food composition table in Korea was found to be expressed in terms of the amount in 100 g of edible portion before cooking [ 5,151. The exchange caloric units of the KFES also follow this method, however the Committee acknowledges the differences between cooked and raw food and the consequence of these differences. Efforts should be made to improve this distinction;
106
Fig. 1. Two of several rice bowls designed measurement of food intake.
to help the
(3) other than a rice and soup bowl Koreans usually serve food to all family members from a single bowl. Therefore it is difficult to estimate the intake per individual. More emphasis should be placed on how to educate people in measuring and estimating their individual food intake. The KNC has designed several measuring rice bowls (Fig. 1) to aid this process; (4) currently very active studies are being conducted on important issues such as: glycemic effects of various foods [ 16-191 and effects of starch structure [ 19,201; physical factors [21] ; and dietary fibers [ 11,22,23] on glycemic responses and diabetic control. However, such data has not been incorporated into the KFES at this time. As more advances occur, they shall be considered in the future; (5) the KFES is a tool designed to help educate and aid in the meal planning of the patient. It is not meant to be mandatory. Practitioners may try to modify the system to accomodate their clients. The KNC believe only through such trials can information for improvement of the KFES be gathered in the future.
Acknowledgements Members of the Food and Nutrition Committee, Korean Diabetes Association: Bong Yun Cha, M.D., Catholic Medical College; Young Yun
Cho, R.D., Seoul National University Hospital; Young Ram Ear-m, R.D., Yonsei University Severance Hospital; Young Seol Kim, M.D., Kyung Hee University Medical School; Hong Kyu Lee, M.D., Seoul National University College of Medicine; Hyun Chul Lee, M.D., Yonsei University College of Medicine; Hyun Sook Lee, R.D., Ewha Women’s University Hospital; 11 Hah Lee, Ph.D., Chung-Ang University; Em Soo Moon, M.D., Sei-Jong Hospital; Hee Young Paik, Ph.D., Sookmyung University; Young Hee Park, R.D., Korea University Hospital; Hyung Joon Yoo, M.D., National Medical Center.
References Franz, M.J. (1987) Exchanges for all occasions. Meeting the challenge of diabetes. Diabetes Center, Inc. Franz, M.J., Holler, H., Powers, M.A. et al. (1987) Exchange lists: revised 1986. J.Am. Diet Assoc. 87, 28-34. Song, O.K., Kim, D.M., Yoo, H.J. et al. (1986) Food exchange system in diet therapy for diabetics. Diabetes. Korean Diabetes Assoc. 10, 181-186 (in Korean). Food and Nutrition Committee, Korean Diabetes Association (1988) The Korean Food Exchange System for Diabetics (in Korean). Recommended dietary allowances for Koreans (1985) (4th edn.), Ministry of Health and Social Welfare (in Korean). 6 Leland, O.S. and Maki, P.C. (1985) Heart disease and diabetes mellitus, In: Marble, A, Krall, L.P., Bradley, R.F., et al. (Eds.) Joslin’s Diabetes Mellitus (12th edn.) Lea and Fibiger, 1985. 7 Panzram, G. (1987) Mortality and survival in type 2 (non-insulin-dependent) diabetes mellitus. Diabetologia 30, 123-131. 8 Jarrett, R.H. and Shipley, M.J. (1988) Type 2 (noninsulin-dependent) diabetes mellitus and cardiovascular disease-putative association via common antecedents; further evidence from the Whitehall Study. Diabetologia 3 1, 737-740. National Bureau of Statistics, Economic Planning Board, Republic of Korea (1987) Annual report on the cause of death statistics (in Korean). Ministry of Health and Social Welfare, Republic of Korea (1986) National Nutrition Survey (in Korea). Simpson, H.C.R., Lousley, S., Geekie, M. et al. (1981) A high carbohydrate leguminous fibre diet improves all aspects of diabetic control. Lancet i, 1-5.
107 12 Coulston, A.M., Holienbeck, L.B., Liu, G.C. et al. (1984) Effect of source of dietary carbohydrate on plasma glucose, insulin, and gastric inhibitory polypeptide responses to test meals in subjects with non-insulin-dependent diabetes mellitus. Am. 3. Clin. Nutr. 40, 965-970. 13 American Diabetes Association. (1987) Principles of nutrition and dietary recommendations for individuals with diabetes mellitus. Diabetes Care 10, 126-132. 14 Mann, J.I. (1987) Diet and diabetes: some agreement, but controversies continue. The Diabetes Annual 3, 55-71. 15 Rural Nutrition Institute. Office of Rural Development, Korea (1981) Food Composition Table (2nd edn.). 16 American Diabetes Association (1984) Glycemic effects of carbohydrates. Diabetes Care 7, 607-608. 17 Jenkins, D.J.A., Wolever, T.M.S., Buckley, G. et al. (1988) Low-glycemic-index starchy foods in the diabetic diet. Am. J. Clin. Nutr. 48, 248-254. 18 Roh, S.N., Shin, S.H., Oh, Y.S. and Seung, J.J. (1988) Serum glucose, insulin, C-peptide responses to various
19
20
21
22 23
kinds of typical Korean staples in normal and type II diabetic subjects. J. Kor. Diab. 12, 61-78 (in Korean). Juliano, B.O. and Goddard, M.S. (1986) Cause ofvarietal difference in insulin and glucose responses to ingested rice. Quat. Plan Plant Food Hum. Nutr. 36, 35-41. Behall, K., Scholfield, D.J., Yuhaniak, I. and Canary, J. (1989) Diet containing high amylose vs. amylopectin starch: effects on metabolic variables in human subjects. Am. J. Clin. Nutr. 49, 337-344. Simpson, R.W., McDonald, J., Wahlqvist, M.L. et al. (1985) Food physical factors have different metabolic effects in nondiabetics and diabetics. Am. J. Clin. Nutr. 42,462-469. Jenkins, D.J.A. (1979) Dietary fiber and carbohydrate metabolism. Diabetes Care 2, 175-192. Schwartz, S.E., Levine, R.A., Weinstock, R.S. et al. (1988) Sustained pectin ingestion: effect on gastric emptying and glucose tolerance in non-insulin-dependent diabetic patients. Am. J. Clin. Nutr. 48, 1413-1417.
103
Elsevier DIABET 00383
Korean Food Exchange System Hee Young Paik ’ and Hong Kyu Lee 2 ‘Department
of Food and Nutrition, Sookmyung
Womenk University, Seoul and ‘Department
of Internal Medicine, Seoul National
University College of Medicine, Seoul, Korea
(Received 18 July 1989) (Revision received 3 November 1989) (Accepted 5 November 1989)
Introduction The food exchange system which is used for meal planning, education and counseling [ 1,2 3 is one of the most widely used nutritional tools for persons with diabetes and other conditions. In Korea, several different systems have been used by various hospitals and organizations. The presence of different exchange systems has caused many problems - not only for diabetic patients who often visit more than one hospital but also for the doctors and dietitians who must explain the systems [ 31. To overcome these problems, a new Korean Food Exchange System (KFES) was developed by the joint effort of three related organizations - the Korean Diabetes Association, the Korean Society of Dietitians and the Korean Nutrition Society [4]. After reviewing the existing exchange systems and other related sources on dietary patterns and practices of Korean people, the Food and Nutrition Committee (KNC), composed of delegates from the three organizations, devised the KFES, which is thought to be a more suitable form of dietary planning. This is a summary of the activities of the Food and Nutrition Committee and an outline of
Address for correspondence: Hong Kyu Lee, M.D., Department of Internal Medicine, Seoul National University College of Medicine, 28 Yungun-Dong, Chongno-Ku, Seoul, Korea. 0168-8227/90/$03.50
0 1990 Elsevier Science Publishers
the KFES. The KNC has set the guidelines for the development of a new exchange system as follows: (1) simple and easy to understand; (2) suitable for the Korean dietary pattern; (3) consists of a complete and nutritionally sound diet; (4) adjustable to an individual’s dietary habits; (5) applicable to various social occasions, such as dining-out; (6) applicable to all types of diabetes.
Food groups In the food exchange system, food items with similar nutrient contents are grouped together and each group is regarded as having the same fixed value of caloric and major nutrient content [ 11. Meal planning can be done more easily by disregarding the small differences among the food items of the same group. Some members on the committee favored using less food groups. They favored the five basic food groups employed by the FAO Korean committee in its nutritional education, because this is taught in most nutrition departments of Korean colleges [5]. However, combining food items with different major nutrients - for example, cereals and fruits - in the same group may confuse the users in planning nutritionally sound diets because Korean meals do not consist of fruits, and the caloric values of fruits vary too widely. The committee thus agreed to have six food groups for KFES as shown in Table 1.
B.V. (Biomedical
Division)
104
TABLE 1 Korean Food Exchange System Food group
One exchange unit
kcal
Carbohydrate
Cereals Meat/fish Low-fat Medium-fat High-fat Vegetables Fat Milk Fruits
l/3 bowl cooked rice (70 g) meat (40 g), fish (50 g)
100
23
70 g 1 ts. (5 g) 1 cup (200 cc) l/2 medium apple (100 g)
The order of the food groups of the KFES are arranged to reflect the dietary habits of Koreans. Koreans have been eating three main meals a day for several hundred years. They basically consist of a bowl of rice along with one soup and vegetable side dishes, with or without some meat or fish. Thus, the food groups that are used in the main meal are listed first: cereals and grains are the staples; meat, fish and vegetables are the main ingredients for side dishes; fats and oils are used during cooking in a typical Korean diet. Milk and fruits are usually consumed separately as snacks. The order of the six food groups are also shown in Table 1. In the KFES the meat/fish group is divided into three subgroups - low fat, medium fat, and high fat (according to their fat and caloric contents). KNC recognizes that the consumption of high fat foods would increase the risk of atherosclerosis [6-81, even though the incidence of coronary heart disease at present in Korea is quite low [ 91. Therefore, it was recommended that education given to diabetics should emphasize the avoidance of food items which belong to the high fat group.
50 75 100 20 45 125 50
(g)
Protein (g) 2 8 8 8 2
3 11 12
2 5 8 5 7
6
hydrates, 15.5% from protein and 13.7% from fat [lo]. Considering the traditionally high carbohydrate intake in the Korean diet, as well as the recent international trend of allowing high levels of carbohydrate in the diabetic diet [2,1 l-141, carbohydrate intake is recommended to be 55-60x of total caloric intake. The Committee agreed that Koreans with diabetes, however, should be reminded to restrict their intake of simple sugars and consume complex carbohydrates from natural foods with high fiber content, as recommended by a recent A.D.A. diet guideline [2]. Protein intake should meet an individual’s need (1.2 g/kg body weight) [ lo] and the remainder of the energy should come from fat. The distribution of calories is given in ranges but representative values are also provided, mainly for educational purposes. These values can be adjusted depending on the individual’s
TABLE 2 Distribution
of energy intake
Nutrient
Range”
Representative value”
Carbohydrate Protein
55-60 15-20 (1.2 g/kg body wt.) 20-25
60 20
Distribution of caloric intake The KNC agreed to propose the distribution of the caloric intake as shown in Table 2. A recent national nutrition survey revealed that Koreans are deriving 70.8% of their energy from carbo-
Fat (g)
Fat
” ‘9; Daily total energy intake.
20
105
ability to achieve and maintain an ideal body weight. Committee members also paid attention to the fact that this kind of caloric distribution would increase the fat content of a meal, which then might not be applicable to rural Koreans.
Milk. The form of milk most widely consumed among Koreans is whole liquid milk, One unit of milk is decided to be 1 pack of milk which is supplied in 200 ml size pack (125 kcal). Fruits.
Exchange units The exchange unit of each food group is derived from the nutrient content of the food items most widely consumed in that group. Exchange units of each food group and their caloric and nutrient contents are presented in Table 1. Cereals. The exchange unit of the cereal group is based on cooked rice which is the main staple of the Korean diet. One bowl of cooked rice typically contains 210 gram and 300 kcal. One unit will consist of l/3 bowl of cooked rice and will provide 100 kcal. Meat,@.&. Food items in this group vary in their fat and caloric content and are thus divided into three subgroups, according to their fat content. The KFES followed the A.D.A. recommendation for meat exchanges, as no standardized serving size of meat/fish was obtainable from the Korean food study. Koreans consume fish/meat as side dishes, that are prepared in one bowl, and generally served to the whole family. For the ease of calculation, the minimum serving size is considered to be 40 g meat and 50 g of fish and the caloric values are rounded off to 50, 75 and 100 kcal according to the fat content. Vegetables. One unit of the vegetable group is determined by the total amount of vegetables consumed in one typical Korean meal - 70 grams. The caloric and nutrient contents of one unit are derived from the nutrient contents of vegetable items most frequently used in the Korean diet. Fat. Most of the fat in the Korean diet is from oils which are used in frying or for seasoning. One unit will be one teaspoon - 5 grams (45 kcal).
One exchange unit of fruit group is determined to be one half of medium sized apple which is the most common fruit in Korea. This amounts to 100 g (50 kcal).
Limitations and suggestions The Food and Nutrition Committee has held numerous meetings and two hearings before finalizing the KFES. The system is thought to be the best, given knowledge and circumstances. The problem of multiple dietary systems in one country was amended. The caloric value of each exchange unit appears more educational. However, KNC fully acknowledges that the KFES is by no means complete and should be updated and revised periodically to reflect the advances in scientific knowledge and to overcome the problems which may arise in its practical use. The following are some of the suggestions made by KNC, which may be helpful in future modifications: (1) more data are needed on the dietary patterns of Korean people. Basic materials such as: frequency of consumption of different food items, average serving sizes or amount of consumption per person in each meal, and analysis of the nutrient content of food items are very much needed but insul%cient. Accumulation of such data is essential for future improvement of the KFES ; (2) in order to be easily applicable to everyday life, the measurements should be based on cooked food. However, nutrient contents in the food composition table in Korea was found to be expressed in terms of the amount in 100 g of edible portion before cooking [ 5,151. The exchange caloric units of the KFES also follow this method, however the Committee acknowledges the differences between cooked and raw food and the consequence of these differences. Efforts should be made to improve this distinction;
106
Fig. 1. Two of several rice bowls designed measurement of food intake.
to help the
(3) other than a rice and soup bowl Koreans usually serve food to all family members from a single bowl. Therefore it is difficult to estimate the intake per individual. More emphasis should be placed on how to educate people in measuring and estimating their individual food intake. The KNC has designed several measuring rice bowls (Fig. 1) to aid this process; (4) currently very active studies are being conducted on important issues such as: glycemic effects of various foods [ 16-191 and effects of starch structure [ 19,201; physical factors [21] ; and dietary fibers [ 11,22,23] on glycemic responses and diabetic control. However, such data has not been incorporated into the KFES at this time. As more advances occur, they shall be considered in the future; (5) the KFES is a tool designed to help educate and aid in the meal planning of the patient. It is not meant to be mandatory. Practitioners may try to modify the system to accomodate their clients. The KNC believe only through such trials can information for improvement of the KFES be gathered in the future.
Acknowledgements Members of the Food and Nutrition Committee, Korean Diabetes Association: Bong Yun Cha, M.D., Catholic Medical College; Young Yun
Cho, R.D., Seoul National University Hospital; Young Ram Ear-m, R.D., Yonsei University Severance Hospital; Young Seol Kim, M.D., Kyung Hee University Medical School; Hong Kyu Lee, M.D., Seoul National University College of Medicine; Hyun Chul Lee, M.D., Yonsei University College of Medicine; Hyun Sook Lee, R.D., Ewha Women’s University Hospital; 11 Hah Lee, Ph.D., Chung-Ang University; Em Soo Moon, M.D., Sei-Jong Hospital; Hee Young Paik, Ph.D., Sookmyung University; Young Hee Park, R.D., Korea University Hospital; Hyung Joon Yoo, M.D., National Medical Center.
References Franz, M.J. (1987) Exchanges for all occasions. Meeting the challenge of diabetes. Diabetes Center, Inc. Franz, M.J., Holler, H., Powers, M.A. et al. (1987) Exchange lists: revised 1986. J.Am. Diet Assoc. 87, 28-34. Song, O.K., Kim, D.M., Yoo, H.J. et al. (1986) Food exchange system in diet therapy for diabetics. Diabetes. Korean Diabetes Assoc. 10, 181-186 (in Korean). Food and Nutrition Committee, Korean Diabetes Association (1988) The Korean Food Exchange System for Diabetics (in Korean). Recommended dietary allowances for Koreans (1985) (4th edn.), Ministry of Health and Social Welfare (in Korean). 6 Leland, O.S. and Maki, P.C. (1985) Heart disease and diabetes mellitus, In: Marble, A, Krall, L.P., Bradley, R.F., et al. (Eds.) Joslin’s Diabetes Mellitus (12th edn.) Lea and Fibiger, 1985. 7 Panzram, G. (1987) Mortality and survival in type 2 (non-insulin-dependent) diabetes mellitus. Diabetologia 30, 123-131. 8 Jarrett, R.H. and Shipley, M.J. (1988) Type 2 (noninsulin-dependent) diabetes mellitus and cardiovascular disease-putative association via common antecedents; further evidence from the Whitehall Study. Diabetologia 3 1, 737-740. National Bureau of Statistics, Economic Planning Board, Republic of Korea (1987) Annual report on the cause of death statistics (in Korean). Ministry of Health and Social Welfare, Republic of Korea (1986) National Nutrition Survey (in Korea). Simpson, H.C.R., Lousley, S., Geekie, M. et al. (1981) A high carbohydrate leguminous fibre diet improves all aspects of diabetic control. Lancet i, 1-5.
107 12 Coulston, A.M., Holienbeck, L.B., Liu, G.C. et al. (1984) Effect of source of dietary carbohydrate on plasma glucose, insulin, and gastric inhibitory polypeptide responses to test meals in subjects with non-insulin-dependent diabetes mellitus. Am. 3. Clin. Nutr. 40, 965-970. 13 American Diabetes Association. (1987) Principles of nutrition and dietary recommendations for individuals with diabetes mellitus. Diabetes Care 10, 126-132. 14 Mann, J.I. (1987) Diet and diabetes: some agreement, but controversies continue. The Diabetes Annual 3, 55-71. 15 Rural Nutrition Institute. Office of Rural Development, Korea (1981) Food Composition Table (2nd edn.). 16 American Diabetes Association (1984) Glycemic effects of carbohydrates. Diabetes Care 7, 607-608. 17 Jenkins, D.J.A., Wolever, T.M.S., Buckley, G. et al. (1988) Low-glycemic-index starchy foods in the diabetic diet. Am. J. Clin. Nutr. 48, 248-254. 18 Roh, S.N., Shin, S.H., Oh, Y.S. and Seung, J.J. (1988) Serum glucose, insulin, C-peptide responses to various
19
20
21
22 23
kinds of typical Korean staples in normal and type II diabetic subjects. J. Kor. Diab. 12, 61-78 (in Korean). Juliano, B.O. and Goddard, M.S. (1986) Cause ofvarietal difference in insulin and glucose responses to ingested rice. Quat. Plan Plant Food Hum. Nutr. 36, 35-41. Behall, K., Scholfield, D.J., Yuhaniak, I. and Canary, J. (1989) Diet containing high amylose vs. amylopectin starch: effects on metabolic variables in human subjects. Am. J. Clin. Nutr. 49, 337-344. Simpson, R.W., McDonald, J., Wahlqvist, M.L. et al. (1985) Food physical factors have different metabolic effects in nondiabetics and diabetics. Am. J. Clin. Nutr. 42,462-469. Jenkins, D.J.A. (1979) Dietary fiber and carbohydrate metabolism. Diabetes Care 2, 175-192. Schwartz, S.E., Levine, R.A., Weinstock, R.S. et al. (1988) Sustained pectin ingestion: effect on gastric emptying and glucose tolerance in non-insulin-dependent diabetic patients. Am. J. Clin. Nutr. 48, 1413-1417.