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van Dam RM, Seidell JC (2007). Carbohydrate intake and obesity. Eur J Clin Nutr. van den Heuvel EG, Muijs T, Van Dokkum W, Schaafsma G (1999). Lactulose stimulates calcium absorption in postmenopausal women. J Bone Miner Res 14, 1211–1216. Venn BJ, Green TJ (2007). Glycemic index and glycemic load: measurement issues and their effect on diet–disease relationships. Eur J Clin Nutr. Vinjamoori DV, Byrum JR, Hayes T, Das PK (2004). Challenges and opportunities in the analysis of raffinose oligosaccharides, pentosans, phytate, and glucosinolates. J Anim Sci 82, 319–328. Wacker M, Wanek P, Eder E, Hylla S, Gostner A, Scheppach W (2002). Effect of enzyme-resistant starch on formation of 1,N(2)-propanodeoxyguanosine adducts of trans-4-hydroxy-2-nonenal and cell proliferation in the colonic mucosa of healthy volunteers. Cancer Epidemiol Biomarkers Prev 11, 915–920. Nutritional characterization and measurement of dietary carbohydrates K Englyst et al Wasan HS, Goodlad RA (1996). Fibre-supplemented foods may damage your health. Lancet 348, 319–320. WHO Technical report series 916 (2003). Diet Nutrition and the Prevention of Chronic Disease. WHO: Geneva. Willett W, Manson J, Liu S (2002). Glycemic index, glycemic load, and risk of type 2 diabetes. Am J Clin Nutr 76, S274–S280. Wolk A, Manson JE, Stampfer MJ, Colditz GA, Hu FB, Speizer FE et al. (1999). Long-term intake of dietary fiber and decreased risk of coronary heart disease among women. JAMA 281, 1998–2004. Wong JM, de Souza R, Kendall CW, Emam A, Jenkins DJ (2006). Colonic health: fermentation and short chain fatty acids. J Clin Gastroenterol 40, 235–243. Wood R, Englyst HN, Southgate DAT, Cummings JH (1993). Determination of dietary fibre in foods—collaborative trials. IV. Comparison of Englyst GLC and colorimetric measurement with the Prosky procedure. J Assoc Pub Anal 29, 57–141. S39 European Journal of Clinical Nutrition
REVIEW Physiological aspects of energy metabolism and gastrointestinal effects of carbohydrates M Elia 1 and JH Cummings 2 1 2 Institute of Human Nutrition, University of Southampton, Southampton, UK and Department of Pathology and Neuroscience, Ninewells Hospital and Medical School, Dundee, UK The energy values of carbohydrates continue to be debated. This is because of the use of different energy systems, for example, combustible, digestible, metabolizable, and so on. Furthermore, ingested macronutrients may not be fully available to tissues, and the tissues themselves may not be able fully to oxidize substrates made available to them. Therefore, for certain carbohydrates, the discrepancies between combustible energy (cEI), digestible energy (DE), metabolizable energy (ME) and net metabolizable energy (NME) may be considerable. Three food energy systems are in use in food tables and for food labelling in different world regions based on selective interpretation of the digestive physiology and metabolism of food carbohydrates. This is clearly unsatisfactory and confusing to the consumer. While it has been suggested that an enormous amount of work would have to be undertaken to change the current ME system into an NME system, the additional changes may not be as great as anticipated. In experimental work, carbohydrate is high in the macronutrient hierarchy of satiation. However, studies of eating behaviour indicate that it does not unconditionally depend on the oxidation of one nutrient, and argue against the operation of a simple carbohydrate oxidation or storage model of feeding behaviour to the exclusion of other macronutrients. The site, rate and extent of carbohydrate digestion in, and absorption from the gut are key to understanding the many roles of carbohydrate, although the concept of digestibility has different meanings. Within the nutrition community, the characteristic patterns of digestion that occur in the small (upper) vs large (lower) bowel are known to impact in contrasting ways on metabolism, while in the discussion of the energy value of foods, digestibility is defined as the proportion of combustible energy that is absorbed over the entire length of the gastrointestinal tract. Carbohydrates that reach the large bowel are fermented to short-chain fatty acids. The exact amounts and types of carbohydrate that reach the caecum are unknown, but are probably between 20 and 40 g/day in countries with ‘westernized’ diets, whereas they may reach 50 g/day where traditional staples are largely cereal or diets are high in fruit and vegetables. Non-starch polysaccharides clearly affect bowel habit and so, to a lesser extent, does resistant starch. However, the short-chain carbohydrates, which are also found in breast milk, have little if any laxative role, although do effect the balance of the flora. This latter property has led to the term ‘prebiotic’, which is defined as the capacity to increase selectively the numbers of bifidobacteria and lactobacilli without growth of other genera. This now well-established physiological property has not so far led through to clear health benefits, but current studies are focused on their potential to prevent diarrhoeal illnesses, improve well-being and immunomodulation, particularly in atopic children and on increased calcium absorption. European Journal of Clinical Nutrition (2007) 61 (Suppl 1), S40–S74; doi:10.1038/sj.ejcn.1602938 Keywords: carbohydrate; energy; short-chain fatty acids; glycaemic index; food labelling; prebiotic Introduction European Journal of Clinical Nutrition (2007) 61 (Suppl 1), S40–S74 & 2007 Nature Publishing Group All rights reserved 0954-3007/07 $30.00 www.nature.com/ejcn All organisms require fuels to maintain their life cycles. For humans, carbohydrates are the major fuels, typically accounting for 45–70% of the total energy intake and Correspondence: Professor M Elia, Institute of Human Nutrition, University of Southampton, Southampton General Hospital, MP 113 (F Level), Tremona Rd, Southampton SO16 6YD, UK. E-mail: elia@soton.ac.uk expenditure. Despite their importance in energy metabolism, the energy values of some carbohydrates continue to be debated and are confused due to the existence of different energy systems, which are not entirely consistent with each other (for example, combustible, digestible energy (DE), metabolizable energy (ME), net metabolizable energy (NME) systems; general and specific Atwater systems). The choice of energy system is of considerable importance because it not only affects the energy values of carbohydrates, but also those of fats, proteins and alcohol (FAO,
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Comision Federal de la mejora regul
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Subject: MEXICO - Comments on PROY
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Item of PROY‐ NOM‐051 A.3.1 & A
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Annex 1.1: Ziesenitz, S.C.; 1996;
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Page 30 and 31: S1 S5 S19 S40 S75 S100 S112 S122 S1
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Page 36 and 37: REVIEW Carbohydrate terminology and
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Page 42 and 43: Table 3 Principal physiological pro
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Page 50 and 51: REVIEW Nutritional characterization
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Page 62 and 63: account for any supplemented materi
Page 64 and 65: eaction vessels, with successive tr
Page 66 and 67: similar to the situation with sugar
Page 68 and 69: company working on dietary carbohyd
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Page 94 and 95: Table 5 Effect of NSP (dietary fibr
Page 96 and 97: As already described, almost any ca
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Page 106 and 107: REVIEW Carbohydrate intake and obes
Page 108 and 109: Total carbohydrate intake Introduct
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Page 114 and 115: postmenopausal US women (Howard et
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its carbohydrate content, whereas a
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Table 4 Continued Duration Interven
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Despite a substantially lower GL fo
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increased physical activity has bee
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with normal glucose tolerance: the
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Westerterp KR, Verboeket-van de Ven
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especially the NSP, complicates com
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1.21, 1.35, 1.40 and 1.64. The patt
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esidual confounding provide the jus
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carbohydrate have generated broadly
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There is no good evidence of benefi
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Meyer KA, Kushi LH, Jacobs Jr DR, S
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from prospective studies which have
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Table 3 Prospective studies of diet
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of sucrose-containing foods, such a
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Acrylamide Acrylamide is a chemical
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Nicodemus KK, Jacobs Jr DR, Folsom
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carbohydrate and fat may have a low
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Foods having very different nutrien
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esearch activities and food selecti
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highest satiety score was boiled po
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patients: a new basis for carbohydr
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and lipid levels, to a greater exte
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insufficient for the use of glycaem
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Dr Hans Englyst: Director and share
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Annex 1.4: US‐FDA GRAS Notificati
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FDA/CFSAN/OFAS: Agency Response Let
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Annex 1.5: US Health Claims Regulat
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jlentini on PROD1PC65 with RULES 30
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Annex 1.6: “PalatinoseTM (isomalt
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Isomaltulose is tooth friendly, unl
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CONFIDENTIAL Regulatory Affairs & N
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CONFIDENTIAL General or usual name:
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CONFIDENTIAL Plasma glucose change
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CONFIDENTIAL Rise in blood glucose
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CONFIDENTIAL References Regulatory
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Annex 1.8: Report from Imfeld (Univ
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Annex 2.2: Roberfroid, M.B., 1999;
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Annex 3.2: “Letter of no objectio
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1 Nutrition and Health Claims (CAC/
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Annex 3.2: “Letter of no objectio
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