Understanding the links between carbohydrates and health

Background

The Dietary Carbohydrates Task Force has spent more than a decade developing science which focuses on the relationships of carbohydrates with public health. The task force particularly puts emphasis on glycaemic control and the role of dietary fibres.

Upcoming

Potential new activities are under discussion, such as ‘Differential Effects of Sugars on Metabolism’ which could address the issue of the biochemical effect of different saccharides, e.g. lactose, or ‘Recommendations and Health Benefits of Dietary Fibres for Children’ in the light of increasing health risks for this population.

What’s New

New activity on ‘Health Relevance of Lowering Post-Prandial Glycaemia in Children and Adolescents Through Diet’. Through an exhaustive systematic review of research literature, experts will assess both short- and long-term health impact of lowering post-prandial glycaemic responses during childhood and adolescence.
The task force will jointly tackle ‘Nutrition Guidelines for Diabetes – a Review of Methods’ with the Obesity and Diabetes Task Force. This activity aims to improve consistency across nutritional recommendations for (pre-)diabetes patients by bringing more clarity on the evidence-base methodology used to derive them.
New publication on ‘Dietary Carbohydrates: A Review of International Recommendations and the Methods Used to Derive Them’. The authors concluded that more explicit quantitative justifications should be given and pledged for greater international harmonisation, particularly in the underlying definitions of exposures and range of relevant nutrition-related outcomes.

Objectives

The task force aims to understand the links between carbohydrates and health, particularly the relevance of controlling glycaemia, and the types and quantities of carbohydrates that should be consumed to optimise health.

Impact

The scientific outcomes of this task force have impact through presentations in more than 20 international scientific events between 2011 and 2017.

For more detailed information, please contact Dr Pierre Dussort at pdussort@ilsieurope.be

Task Force Members

* Scientific Advisor

Expert Groups

Health Relevance of Lowering Post-Prandial Glycaemia in Children and Adolescents Through Diet New

Objectives
Diets that produce smaller excursions in postprandial plasma glucose and insulin concentrations are associated with a wide range of health benefits, including improved insulin secretion and sensitivity, and thus enhanced glycaemic control. However, in childhood, the immediate benefits of lowering blood glucose excursions may be relatively small, but longer-term effects can be potentially large when adopted and sustained over a lifetime. This activity aims to create a clear consensus on two main questions:

  • Are glycaemic index or other glycaemic response data in adults applicable to paediatric populations?;
  • What is the impact of glycaemic index or other glycaemic response data on health outcomes in children?

Activity
Experts will conduct an exhaustive systematic review of research literature assessing the health impact of lowering post-prandial glycaemic responses during childhood and adolescence (age 0-17). This work will include studies of both short- and long-term effects, and associations with disease risk markers.

Expected Output
This activity will bring clarity on the health impacts of reduced post-meal glucose in childhood on metabolic diseases. It will potentially give recommendations for diets that could lower the glycaemic response in childhood.

Nutrition Guidelines for Diabetes – A Review of Methods New
In collaboration with the Obesity and Diabetes Task Force

Objectives
Guidelines for dietary intake for diabetes (management and prevention) provide important guidance for health care providers, patients and the food industry. A lack of consistency between the methodologies used to develop global and national guidelines for diabetes, as well as unexplained differences between diabetes and general nutrition guidelines are confusing for patients and undesirable for efficiently communicating public health messages and hampers food innovation.

Activity
A dataset on the published dietary guidelines for diabetes will be created and reviewed. This dataset will include detailed recommendations for a limited selection of nutrients (proposed to focus on macronutrients; carbohydrate, fat content and quality protein). In addition, it will describe the methodology used to derivate these guidelines, e.g. type of studies included, grading, definition of exposure, population, outcomes, weighing of evidence on different outcomes, and whether guidelines were derived for population subgroups. The similarities and differences in methods applied will be described. The discussion will include a comparison of advice given in diabetes dietary recommendations with general nutrition recommendations. It is currently considered to discuss the initial conclusions in a workshop before finalising a peer-reviewed publication.

Expected Output
This review will contribute to understanding the range and basis of similarities and differences in specific dietary guidelines for diabetes. It will increase clarity in methodology for setting such recommendations and thereby support efforts of smaller, local organisations in setting guidelines. Ultimately, this review will contribute toward a better alignment of diabetes and general nutrition guidelines and different global and national diabetes nutrition guidelines. Consistency and transparency in guidelines for diabetes will reduce confusion for diabetes patients, enable stronger and more consistent public health messages, aid health care professionals and provide more globally harmonised guidance for food industry innovation.

Workshop – Dietary Sweetness: Is It an Issue?
In collaboration with the Eating Behaviour & Energy Balance Task Force

Objectives
Humans have an inborn liking and desire for sweetness that is persistent in all ethnic groups and cultures. Changes can be seen in the characteristics of liking and motivation for sweetness as we progress through life. Today, however, human attraction to sweet sources of energy is seen as a potential risk for developing less healthy eating patterns. In this context, there is often a failure to distinguish between putative effects of exposure to sources of sweetness (e.g. free sugars in the diet) and the effects of exposure to sweetness itself. This workshop assessed the evidence base linking sweetness with health and dietary preferences throughout life stages.

Activity
The workshop on ‘Dietary Sweetness: Is It an Issue?’ brought together international experts from different fields to discuss the great variety of scientific issues associated with this topic. Among them, it for instance addressed the relationships of variation in sweetness perception and exposure with food preference, diet quality and energy balance.

Expected Output
The workshop outcomes will be summarised in a peer-reviewed publication.

Characterisation of and Criteria for Glycaemic Exposure Markers in the Non-diabetic Population

Objectives
There is broad consensus that the maintenance of blood glucose concentrations within the normal range is beneficial for health. In particular, attention is given to the importance of minimising exposure to foods which produce a large glycaemic response. One accepted marker to evaluate the sustained maintenance of normal blood glucose concentrations is glycated hemoglobin A1c (HbA1c). However, the use of HbA1c as a marker may have drawbacks when applied to the non-diabetic population. The goal of this project is to reach evidence-based consensus on the relevance of and criteria for alternative markers and identify possible further research needs to establish these as accepted measures of diet-induced glycaemic exposures.

Activity
The expert group is reviewing and characterising different markers for glycaemia, such as HbA1c, 1,5-anhydroglucidol, continuous glucose monitoring or metabolomics. They are also identifying research gaps for their further validation and wider endorsement for use in the non-diabetic population.

Expected Output
The review and dissemination of this scientific work will improve the recognition of alternative markers and stimulate greater consideration of their potential use in intervention studies of foods and diets, particularly in the general (non-diabetic) population. It will highlight the relevance of differentiating food effects in the non-diabetic population from medical monitoring of glycaemic control in diabetes patients. The acceptance of more feasible outcome measures would ultimately enhance the ability of researchers to test, develop and prove the potential beneficial effects of foods on glycaemic control. This consensus review could support the development of guidance on the evaluation of claims relating to maintenance of normal blood glucose concentrations.

Quantifying the Health Impact of Reduced Post-Prandial Glycaemia

Objectives
It is widely accepted that reductions in post-prandial glycaemic (PPG) and relative insulinaemic (PPI) responses are likely to be beneficial in reducing the risks of several non-communicable diseases (e.g. diabetes or cardiovascular diseases) in the general population. It should be possible to estimate quantitatively the potential health impact of reducing PPG and PPI through diet.

Activity
The expert group is reviewing the types of data available, identifying and collecting key variables which support this exercise. This includes chronic PPG/PPI data linked to disease endpoints for nutritional and relevant pharmaceutical interventions (e.g. using acarbose and α-glucosidase inhibitors), all in subjects with impaired glucose tolerance or diabetes, as well as in healthy individuals.

Expected Output
The output will clarify the impact of PPG and PPI in terms of quantitative risk reduction in the general population (a public health approach). It will also allow for differentiating the potential effects of food from pharmaceutical treatment of diagnosed individuals.

Carbohydrate-Based Recommendations as a Basis for Dietary Guidelines: A Scientific Review Completed

Objectives

Lifestyle-related diseases are the leading cause of death worldwide. Nutrition is seen as a major modifiable determinant of non-communicable diseases and changes in diet can have profound effects on health, both positive and negative. Although the process for dietary guidelines development has evolved and improved over the past 20 years and although many countries have already adopted public health interventions, non-communicable diseases still proliferate. This project reviewed the scientific basis and the processes by which current dietary guidelines related to carbohydrates (CHO) were developed. It describes the methodology and the processes different authorities have used to derive dietary recommendations.

Activity
The expert group conducted a two-phase study. First, the experts developed an inventory of the methods that were applied for the establishment of current dietary guidelines related to CHOs. This includes the means of identifying scientific information (e.g. systematic reviews), types of studies included and the overall approach taken, such as deciding on how to communicate nutrient-based or food-based guidelines. It focuses on total carbohydrates, sugars and dietary fibres, also taking into consideration factors such as whole grains and glycaemic properties of the diet. Subsequently, consistencies and inconsistencies in approaches used by different authorities were evaluated, along with their potential implications for deriving recommendations.

Output
This project is designed to bring improved clarity on how CHO-based dietary guidelines have been developed by various health and national authorities and what lessons can be learnt from the applied processes. More clarity could help in building harmonised guidelines and hence gaining the confidence of health care professionals to communicate understandable messages to consumers, leading to positive changes in dietary practices. A key deliverable will be a peer-reviewed publication summarising the methodology used to develop the guidelines, identifying consistencies and inconsistencies across the processes to support future efforts in this area. Harmonisation of the guideline development process will strengthen confidence and potentially lead to the development of more widely accepted (global) standards.

Expert Group Members

Health Relevance of Lowering Post-Prandial Glycaemia in Children and Adolescents Through Diet New
The list of expert group members will soon be available.

Nutrition Guidelines for Diabetes – A Review of Methods New
The list of expert group members will soon be available.

Workshop
Sweet Taste Perception, Food Preference and Eating Behaviour 

Characterisation of and Criteria for Glycaemic Exposure Markers in the Non-diabetic Population

Quantifying the Health Impact of Reduced Post-Prandial Glycaemia

Carbohydrate-Based Recommendations as a Basis for Dietary Guidelines: A Scientific Review  Completed

Poster

Impact of Postprandial Glycaemia on Health: Role in Body Weight Control and Diabetes Prevention

Publications

All Publications

Dietary Fibre

ILSI Europe Concise Monograph. Translations available in English, Portuguese, and Japanese.

Read more

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