Carbohydrates and Health

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Preface Dietary carbohydrates and their role in health were last considered by the Committee on the Medical Aspects of Food Policy in reports published in the 1980s and 1990s. Since then, considerable evidence has emerged on the role of carbohydrates in cardiometabolic, colo-rectal and oral health. The present report details the evidence SACN has considered and the approach SACN has taken to reviewing the relationships between dietary carbohydrates and health. The evidence was assessed using the SACN Framework for the Evaluation of Evidence and graded according to a system developed specifically for this review. SACN commissioned systematic reviews of the evidence on cardiometabolic, colo-rectal and oral health to inform this report and this is the first time the committee has taken that approach. The findings of the systematic reviews have been used to inform the very detailed main body of the text which thereby provides a comprehensive and transparent account of the evidence and how SACN drew its conclusions. As a result of its deliberations, SACN is now recommending that a new definition of dietary fibre be adopted in the UK and that a definition of ‘free sugars’ be used in nutrition advice in place of ‘non-milk extrinsic sugars’. Following careful consideration of the evidence, SACN is also recommending that the dietary reference value for carbohydrates be maintained at a population average of approximately 50% of total dietary energy intake and that the dietary reference value for dietary fibre for adults should be increased to 30g/day. Furthermore, SACN is recommending that population average intake of free sugars should not exceed 5% of total dietary energy. This advice, that people’s intake of ‘free sugars’ should be lower than that currently recommended for non-milk extrinsic sugars, is based on SACN’s assessment of evidence on the effect of free sugars on the risk of dental caries and on total energy intake. A higher sugars intake increases the risk of higher energy intakes - the higher the consumption of sugars, the more likely people are to exceed their estimated average requirement (EAR) for energy. Therefore, if intakes of free sugars are lowered, the more likely it is that the EAR for energy will not be exceeded, and this could go some way to addressing the significant public health problem of obesity. I would like to thank those who provided comments on the draft version of this report during the public consultation. All the comments were carefully considered before the report was finalised. The process assisted the Committee in refining the text and its approach to making recommendations. This has been a challenging and large undertaking for SACN and I would like to thank the Carbohydrates Working Group, particularly the Chair, Professor Ian Macdonald, and the Secretariat for their great commitment in producing this report. Particular thanks also go to those in the Nutritional Epidemiology Group at the University of Leeds who iii
performed the systematic review on cardio-metabolic health and the update search, and to Dr Peter Sanderson who performed the colo-rectal health and oral health systematic reviews; they thereby made substantial contributions to this report. Dr Ann Prentice Chair of the Scientific Advisory Committee on Nutrition iv
Page 1 and 2: Carbohydrates and Health 2015
Page 3: Published by TSO (The Stationery Of
Page 7 and 8: Colo-rectal health Children and ado
Page 9 and 10: 5 Fibre isolates 233 Psyllium 233
Page 11 and 12: Dr David Mela Prof. Angus Walls (si
Page 13 and 14: Prof. Ian Macdonald Prof. of Metab
Page 15 and 16: Summary S.1 Carbohydrates are a ma
Page 17 and 18: Sugars and sugars-sweetened foods a
Page 19 and 20: S.21 It is recommended that dietar
Page 21 and 22: 1 Introduction and methods Backgrou
Page 23 and 24: used as the primary dietary assessm
Page 25 and 26: 2.3 Carbohydrates can be classifie
Page 27 and 28: β-glucans are a heterogeneous grou
Page 29 and 30: 2.19 The amount of energy yielded
Page 31 and 32: Definitions used in different dieta
Page 33 and 34: 2.32 In the United States ‘total
Page 35 and 36: is associated with higher incidence
Page 37 and 38: 3 Dietary sources and intakes of ca
Page 39 and 40: 3.12 In adults aged 19-64 years, s
Page 41 and 42: 3.24 At a broad food category leve
Page 43 and 44: were also significant contributors.
Page 45 and 46: 4.5 Obesity occurs when energy int
Page 47 and 48: loose stools with fast transit thro
Page 49 and 50: Risk factors and measures considere
Page 51 and 52: important in trials assessing effec
Page 53 and 54: 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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Fasting LDL-cholesterol 5.57 Twenty
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Fasting LDL-cholesterol:HDL-cholest
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Carbohydrate diets and C-reactive p
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not be included in a meta-analysis
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Phillips et al., 2008; Due et al.,
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concomitant weight loss on fasting
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5.105 Due to variation between the
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carbohydrates was less than 5% betw
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5.121 The heterogeneity is above t
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Higher carbohydrate and lower fat d
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5.138 No significant association is
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Table 5.2: Insufficient evidence -
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5.151 The trials do provide eviden
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6.7 No significant association is o
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al., 2006), which left an insuffici
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Sugars and energy intake • Effect
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Sucrose (g/day) and type 2 diabetes
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Sugars-sweetened beverages (ml/day)
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sugars-sweetened and non-caloricall
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6.53 No meta-analyses have been con
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foods. Five of these adjusted their
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Table 6.1: continued Risk factor/he
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that met the inclusion criteria. As
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7 Starch and starch-rich foods 7.1
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7.11 No association was found betwe
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were combined into a meta-analysis
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7.25 Findings from prospective coh
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2011; Park et al., 2011; Wallstrom
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Hays et al., 2006). The data were i
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Dietary fibre and fasting insulin c
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2007; Schatzkin et al., 2007; Wakai
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metabolic review, cardiovascular di
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Fruit fibre (g/day) and coronary ev
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(Salmeron et al., 1997a; Salmeron e
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Faecal weight and intestinal transi
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Coronary events 8.76 Eight cohort s
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Oat bran and β-glucans and fasting
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Oat bran and β-glucans and fasting
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al., 2008). The data on dietary int
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observes an increase in bowel movem
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Cereal fibre (g/day) and colo-recta
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Total cereals Cardiovascular diseas
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Whole grains (serving/day) and hype
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increases in vegetable, fruit, and
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8.150 Due to variation between the
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Table 8.1: continued Risk factor/he
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Table 8.3: Inconsistent evidence Ri
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9 Non-digestible oligosaccharides,
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Forcheron & Beylot, 2007). One tria
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trial administers 21g/day inulin co
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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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