Carbohydrates and Health

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Contents Membership of Scientific Advisory Committee on Nutrition: Carbohydrates Working Group Membership of Scientific Advisory Committee on Nutrition Summary Background to this review Terms of reference Methodology Conclusions and recommendations ix xi 1 1 1 2 2 1 Introduction and methods 7 Background 7 Terms of Reference 7 Methodology 7 Interpretation of studies 8 2 Classification, biochemistry, absorption, metabolism and definitions of carbohydrates Chemical classification Digestion and absorption Metabolism Definitions used in different dietary recommendations A comparison of the previous UK dietary reference values for carbohydrate with dietary recommendations from other international authorities 3 Dietary sources and intakes of carbohydrates 23 10 11 13 14 17 4 Background on health outcomes (disease prevention) 30 Cardiovascular disease 30 Obesity 30 Type 2 diabetes mellitus 31 Colo-rectal health 31 Oral health 33 Markers and measures and their related health outcomes 34 5 Total carbohydrates 36 Adults 37 Cardiovascular disease events 37 Coronary events 38 Stroke 38 Vascular function 39 Blood pressure 39 Fasting blood lipids 43 Type 2 diabetes mellitus 56 Glycaemia and insulinaemia 57 Obesity 64 20 v
Colo-rectal health Children and adolescents Body mass index and body fatness Outcomes where there is insufficient or inconsistent evidence Summary and conclusions 70 71 71 72 74 6 Sugars and sugars-sweetened foods and beverages 76 Adults 76 Sugars 76 Individual sugars 82 Sugars-sweetened beverages 83 Children and adolescents 85 Body mass index and body fatness 85 Oral health 88 Outcomes where there is insufficient evidence 92 Summary and conclusions 94 7 Starch and starch-rich foods 97 Adults 97 Starch 97 Starch-rich foods 98 Outcomes where there is insufficient or inconsistent evidence 101 Summary and conclusions 102 8 Dietary fibre 104 Adults 104 Dietary fibre 104 Insoluble fibre 111 Soluble fibre 112 Fruit fibre 114 Vegetable fibre 115 Fruit and vegetable fibre 117 Legume fibre 118 Legume intake 119 Cereal fibre 120 Higher dietary fibre breakfast cereals 131 Whole grain bread 132 Total cereals 133 Whole grains 133 Children and adolescents 139 Body fatness and fat distribution 140 Outcomes where there is insufficient or inconsistent evidence 140 Summary and conclusions 143 9 Non-digestible oligosaccharides, resistant starch, polyols and polydextrose Adults Non-digestible oligosaccharides Resistant starch Polyols 145 146 146 154 157 vi
Page 1 and 2: Carbohydrates and Health 2015
Page 3 and 4: Published by TSO (The Stationery Of
Page 5: performed the systematic review on
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
Page 55 and 56: Higher carbohydrate, average protei
Page 57 and 58:
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
Page 117 and 118:
7.25 Findings from prospective coh
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2011; Park et al., 2011; Wallstrom
Page 121 and 122:
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 -
Page 181 and 182:
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
Page 189 and 190:
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 -
Page 195 and 196:
11 Dietary recommendations 11.1 T
Page 197 and 198:
energy compensation (degree of volu
Page 199 and 200:
Dietary fibre 11.17 In 1991 COMA s
Page 201 and 202:
with any adverse effects on growth
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Figure 11.4: Risk of type 2 diabete
Page 205 and 206:
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
Page 213 and 214:
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
Page 241 and 242:
likely to progress in subjects who
Page 243 and 244:
Table A4.6: continued Study Interve
Page 245 and 246:
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
Page 255 and 256:
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
Page 267 and 268:
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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Page 275 and 276:
Page 277 and 278:
Page 279 and 280:
Page 281 and 282:
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Table 3.13b: Total quantities consu
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Page 287 and 288:
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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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Carbohydrates and Health

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