Carbohydrates and Health

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Table 7.1: Insufficient evidence - cohort studies Risk factor/health outcome/measure Cardiovascular disease Coronary events Stroke Incident hypertension Type 2 diabetes mellitus Impaired glucose tolerance Glycaemia Insulinaemia Glycosylated blood proteins Colo-rectal cancer Coronary events Weight gain Fat distribution Percentage body fat Waist circumference Exposure starch rice refined grains rice potatoes starch refined grains rice potatoes refined grains starch-rich foods potatoes starch potatoes starch starch starch refined grains rice potatoes starch starch starch refined grains Table 7.2: Insufficient evidence - randomised controlled trials Health outcome Dental caries Exposure starch Table 7.3: Inconsistent evidence Health outcome Cardiovascular disease Exposure potatoes 102 Summary and conclusions 7.24 There is a lack of available evidence on the relationship between starch or starch-rich foods and colo-rectal and oral health outcomes or cardiovascular risk factors. There were no prospective cohort studies or randomised controlled trials conducted in children and adolescents. With observational studies there is substantial potential for biases and the possibility of confounding by an extraneous variable that correlates with both the dependent variable and the independent variable (residual confounding). Any associations must therefore be interpreted with caution.
7.25 Findings from prospective cohort studies suggest there is no association between total starch intake and incidence of coronary events or type 2 diabetes mellitus. Cohort studies also indicate there is no association between the intake of refined grains and risk of type 2 diabetes mellitus. There is insufficient evidence to draw a conclusion on the association between starch intake and weight gain. 7.26 An association between greater consumption of white rice and greater risk of type 2 diabetes mellitus was observed in cohort studies, but this finding is largely based on data from Asian populations (Japanese and Chinese) consuming levels of rice which are not generally observed in the UK. Higher consumption of brown rice is associated with a reduction in the risk for incident type 2 diabetes mellitus, but the evidence is limited due to the small number of studies. A higher consumption of potatoes is associated with a greater risk of type 2 diabetes mellitus, but it is not possible to exclude confounding by other dietary variables and the evidence is limited due to the small number of studies. 103
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Carbohydrates and Health 2015
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Published by TSO (The Stationery Of
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performed the systematic review on
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Colo-rectal health Children and ado
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5 Fibre isolates 233 Psyllium 233
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Dr David Mela Prof. Angus Walls (si
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Prof. Ian Macdonald Prof. of Metab
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Summary S.1 Carbohydrates are a ma
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Sugars and sugars-sweetened foods a
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S.21 It is recommended that dietar
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1 Introduction and methods Backgrou
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used as the primary dietary assessm
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2.3 Carbohydrates can be classifie
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β-glucans are a heterogeneous grou
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2.19 The amount of energy yielded
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Definitions used in different dieta
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2.32 In the United States ‘total
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is associated with higher incidence
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3 Dietary sources and intakes of ca
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3.12 In adults aged 19-64 years, s
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3.24 At a broad food category leve
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were also significant contributors.
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4.5 Obesity occurs when energy int
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loose stools with fast transit thro
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Risk factors and measures considere
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important in trials assessing effec
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5.18 Two cohort studies were identi
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Higher carbohydrate, average protei
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Fasting blood lipids 5.32 Fifty ei
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evidence of an effect of higher car
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Higher carbohydrate, average protei
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to exclude confounding by concomita
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Page 67 and 68: Fasting LDL-cholesterol:HDL-cholest
Page 69 and 70: Carbohydrate diets and C-reactive p
Page 71 and 72: not be included in a meta-analysis
Page 73 and 74: Phillips et al., 2008; Due et al.,
Page 75 and 76: concomitant weight loss on fasting
Page 77 and 78: 5.105 Due to variation between the
Page 79 and 80: carbohydrates was less than 5% betw
Page 81 and 82: 5.121 The heterogeneity is above t
Page 83 and 84: Higher carbohydrate and lower fat d
Page 85 and 86: 5.138 No significant association is
Page 87 and 88: Table 5.2: Insufficient evidence -
Page 89 and 90: 5.151 The trials do provide eviden
Page 91 and 92: 6.7 No significant association is o
Page 93 and 94: al., 2006), which left an insuffici
Page 95 and 96: Sugars and energy intake • Effect
Page 97 and 98: Sucrose (g/day) and type 2 diabetes
Page 99 and 100: Sugars-sweetened beverages (ml/day)
Page 101 and 102: sugars-sweetened and non-caloricall
Page 103 and 104: 6.53 No meta-analyses have been con
Page 105 and 106: foods. Five of these adjusted their
Page 107 and 108: Table 6.1: continued Risk factor/he
Page 109 and 110: that met the inclusion criteria. As
Page 111 and 112: 7 Starch and starch-rich foods 7.1
Page 113 and 114: 7.11 No association was found betwe
Page 115: were combined into a meta-analysis
Page 119 and 120: 2011; Park et al., 2011; Wallstrom
Page 121 and 122: Hays et al., 2006). The data were i
Page 123 and 124: Dietary fibre and fasting insulin c
Page 125 and 126: 2007; Schatzkin et al., 2007; Wakai
Page 127 and 128: metabolic review, cardiovascular di
Page 129 and 130: Fruit fibre (g/day) and coronary ev
Page 131 and 132: (Salmeron et al., 1997a; Salmeron e
Page 133 and 134: Faecal weight and intestinal transi
Page 135 and 136: Coronary events 8.76 Eight cohort s
Page 137 and 138: Oat bran and β-glucans and fasting
Page 139 and 140: Oat bran and β-glucans and fasting
Page 141 and 142: al., 2008). The data on dietary int
Page 143 and 144: observes an increase in bowel movem
Page 145 and 146: Cereal fibre (g/day) and colo-recta
Page 147 and 148: Total cereals Cardiovascular diseas
Page 149 and 150: Whole grains (serving/day) and hype
Page 151 and 152: increases in vegetable, fruit, and
Page 153 and 154: 8.150 Due to variation between the
Page 155 and 156: Table 8.1: continued Risk factor/he
Page 157 and 158: Table 8.3: Inconsistent evidence Ri
Page 159 and 160: 9 Non-digestible oligosaccharides,
Page 161 and 162: Forcheron & Beylot, 2007). One tria
Page 163 and 164: trial administers 21g/day inulin co
Page 165 and 166: coffee (Walton et al., 2010). All t
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Arabinoxylan-oligosaccharides 9.33
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9.42 An effect of raw resistant sta
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1999c) or retrograde resistant star
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9.61 All three trials demonstrate
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Non-digestible oligosaccharide (fru
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9.76 Of the five trials that inves
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Table 9.2: Inconsistent evidence -
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10 Glycaemic index and glycaemic lo
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Stroke 10.10 Three cohort studies w
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10.18 No significant effect of GI i
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Glycaemic index (unit/day) and fast
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10.38 No significant effect is demo
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health review (Greenwood et al., 20
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Table 10.1: Insufficient evidence -
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11 Dietary recommendations 11.1 T
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energy compensation (degree of volu
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Dietary fibre 11.17 In 1991 COMA s
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with any adverse effects on growth
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Figure 11.4: Risk of type 2 diabete
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12 Overall summary and conclusions
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permanent dentitions. There is a la
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supplements on recurrence of colo-r
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• With the proposed reduction in
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sweet spreads, fruit juice, confect
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ANNEX 1 Cardio-metabolic, colo-rect
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frequency and age. For oral cancer,
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framework for the evaluation of evi
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• Whether the effect or associati
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Commentary on the evidence on fruct
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A3.9 There are few data from trial
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mechanism may have been acting for
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Table A4.1: Prospective cohort stud
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Randomised controlled trials A4.14
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Table A4.3: continued Study Trial d
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Table A4.3: continued Study Trial d
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TableA4.4: Risk of bias assessment
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TableA4.5: Results from prospective
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likely to progress in subjects who
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Table A4.6: continued Study Interve
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A4.37 The effect of one litre a day
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Fibre isolates ANNEX 5 A5.1 Prospe
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Constipation A5.9 Four randomised c
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Isolated gums and gelling agent sup
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a meta-analysis. Overall, the trial
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Mixed isolated gums and gelling age
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Risk factor/health outcome/measure
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IL-6 Interleukin 6 J Joule kcal Kil
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A7.4 Higher birth weight is associ
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A7.17 One cohort study observed tha
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Carbohydrate intake (% energy) and
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Summary and conclusions A7.31 This
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P P er er c c ent ent Top tw Top tw
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Table 3.2: Average daily intake of
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Table 3.13b: Total quantities consu
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Table 3.16: continued Aged 1.5 year
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Table 3.19b: Top 20 contributors to
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Table 3.19d: Top 20 contributors to
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Table 3.20a: Top 20 contributors to
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Table 3.20c: Top 20 contributors to
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Table 3.20e: Top 20 contributors to
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Table 3.21b: Top 20 contributors to
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Table 3.21d: Top 20 contributors to
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Table 3.22a: Top 20 contributors to
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Table 3.22c: Top 20 contributors to
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Table 3.22e: Top 20 contributors to
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A9.1 The meta-analysis was perform
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A9.3 The difference in sugars inta
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References Abete I, Parra D & Marti
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Asayama K, Thijs L, Brguljan-Hitij
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Beiswanger BB, Boneta AE, Jau MS, K
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Campain AC, Morgan MV, Evans RW, Ug
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COMA (1991) Dietary Reference Value
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Davy BM, Melby CL, Beske SD, Ho RC,
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Due A, Toubro S, Skov AR & Astrup A
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Esrey KL, Joseph L & Grover SA (199
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Carbohydrates and Health

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