Cultural adaptations of food exchange lists: A scoping review of applications in non-communicable disease management.

BACKGROUND AND

OBJECTIVES

Non-communicable diseases (NCDs), including diabetes, cardiovascular diseases, and obesity, remain major global health challenges largely driven by suboptimal dietary patterns. The Food Exchange List (FEL) is a structured dietary planning tool originally developed for diabetes management to support balanced nutrient intake. Although FELs are widely used across diverse cultural and clinical contexts, evidence regarding their direct role in NCD prevention and management is limited. This scoping review examines the historical development, core principles, and global applications of FELs, with a focus on their use in dietary planning and NCD control, aiming to identify gaps in the existing literature.

METHODS AND STUDY

DESIGN

Following Joanna Briggs Institute (JBI) methodology and the PRISMA-ScR checklist, four databases (PubMed, ProQuest, Web of Science, and Cochrane Library) were searched between November 18, 2024, and January 2, 2026, to identify primary research published from 1990 to 2026. Of 500 records screened, 38 studies met the inclusion criteria. Notably, 60% (n = 24) focused exclusively on FEL development without evaluating clinical or behavioral outcomes.

RESULTS

Findings from randomized and quasi-experimental studies, as well as small pilot interventions, suggest that FELs can support meal planning, nutritional adequacy, and attainment of specific dietary targets. However, their cognitive complexity may negatively affect adherence and contribute to higher dropout rates. Evidence for FEL effectiveness in NCD management remains limited, particularly among low-literacy populations.

CONCLUSIONS

Overall, there is a clear need for long-term studies evaluating culturally adapted and simplified FELs and their independent effects on clinical outcomes, including glycemic control, cardiovascular risk, quality of life, and medication use.