FAO/WHO expert consultation on carbohydrates in human nutrition

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CONTENTS

Acknowledgements	v
Participants	vii
Secretariat	ix
Contributors	xi
Reviewers	xiii
Preface	xv
Chapter 1
The Role of Carbohydrates in Nutrition	1
Description	1
Physiology	10
Chapter 2
The Role of Carbohydrates in Maintenance of Health	15
Carbohydrates in the diet	15
Energy balance	15
Physical activity	16
Carbohydrate and behaviour	16
Carbohydrate through the life cycle	17
Chapter 3
Dietary Carbohydrate and Disease	19
Obesity	19
Non-insulin dependent diabetes mellitus	19
Cardiovascular disease	21
Cancer	22
Gastrointestinal diseases other than cancer	22
Dental caries	22
Other conditions	23
Chapter 4
The Role of the Glycemic Index in Food Choice	25
Definition of the glycemic index	25
Factors influencing the blood glucose responses of foods	28
Calculation of glycemic index of meals or diets	28
Practical application of the glycemic index	29
Physiologic and therapeutic effects of low glycemic index foods	29

ii	FAO//WHO expert consultation on carbohydrates in human nutrition

Chapter 5
Goals and Guidelines for Carbohydrate Food Choices	31
Rationale and framework	31
Principles of carbohydrate food choices	31
Carbohydrate nutrient and food goals	32
Translation from carbohydrate nutrients to foods	33
Considerations for target audiences	33
Chapter 6
Recommendations	35
References	39

TABLES

1.	Sample blood glucose responses to the ingestion of 50 g carbohydrate	26
2.	Glucose response from capillary blood and venous plasma	26
3.	Food factors influencing glycemic responses	28
4.	Calculation of the glycemic index of meals	29

FIGURES

1.	The major dietary carbohydrates	1
2.	Sample calculations of incremental area under the curve	27

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	ANNEXES
1.	Intake of Carbohydrate and Its Components	45
	References	48
2.	Background Information	51
	Introduction	53
	Global Trends in Production and Consumption
	Carbohydrate Foods	55
	Dietary Carbohydrate Composition	67
	Dietary Fibre and Resistant Starch Analysis	75
	Effects of Food Processing on Dietary Carbohydrates	79
	Digestion, Absorption and Energy Value of Carbohydrates	83
	Physiological Effects of Dietary Fibre	89
	Carbohydrate Food Intake and Energy Balance	97
	The Role of Carbohydrates in Exercise and Physical Performance	105
	Sugar and Human Behaviour	111
	Carbohydrates and Non-communicable Diseases	115
	References	127

		TABLES
1.	Nutritive value of major cereals	58
2.	Nutritive value of root crops	59
3.	Nutritive value of selected pulses, nuts, bananas and plantains	60

4.Energy from carbohydrate by food group as a percentage of

	total carbohydrate - food balance data 1964 and 1994	63
5.	The most important carbohydrates in foods	67
6.	Some properties of whole granular starches	70
7.	Types of modified starches	72

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TABLES

8.	Glycemic index of selected foods	86
9.	Colonic fermentability of dietary fibres in humans	90
10.	Some dietary recommendations for diabetes	117
11.	Effect of food carbohydrates on cardiovascular risk factors	119
12.	Summary of a review of 58 studies of diet and colorectal cancer risk	122

FIGURES

1.	Major sources of carbohydrate - world production 1961-1994	56
2.	Starchy staples providing the highest proportion of food energy 1990-1992	61
3.	Energy from the dominant starchy staples, 1990-1992	62

4.Analysis of total dietary fibre, insoluble dietary fibre and soluble

	dietary fibre by AOAC method 32.1.17	76
5.	Method for the determination of resistant starch	78
6.	Mechanisms of action of dietary fibre on colonic transit time	94
7.	Muscle glycogen concentrations before and after constant
	load cycling to exhaustion, following three dietary conditions	106
8.	Cycling time to exhaustion at constant load under three dietary conditions	107

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Acknowledgements

FAO and WHO express their gratitude for the contribution of the experts who participated in this consultation and contributed to the development of the report. The organizations are also thankful for those participating as well as non-participating experts who have prepared draft background papers in the preparatory process for the consultation. Extracts of those papers have been used in creating the background information included in Annex 2 of the report. Special appreciation is offered to Dr. David Lineback and Dr. Ruth Oniang’o, who served as the Chairman and ViceChair, respectively, and to Drs. Thomas Wolever and Mark Wahlqvist who jointly undertook the demanding task of acting as Rapporteurs for the Consultation.

vi	FAO//WHO expert consultation on carbohydrates in human nutrition

	Participants
Nils-Georg ASP	Seyed Masoud KIMIAGAR
Chemical Centre	National Nutrition Institute
University of Lund	Dean, Nutrition and Food Science College
P.O. Box 124	P.O. Box 19395/4741
22100 Lund	Tehran
Sweden	Islamic Republic of Iran
John CUMMINGS	Shuhei KOBAYASHI
MRC Dunn Clinical Nutrition Centre	The National Institute of Health and
Hills Road	Nutrition
Cambridge CB2 2DH	1-23-1, Toyama, Shinjuku-ku
United Kingdom	Tokyo 162
	Japan
Erik Osvaldo DIAZ BUSTOS	David LINEBACK (Chairman)
Department of Nutrition	College of Agriculture
Faculty of Medicine	University of Idaho,
University of Chile	Moscow, Idaho, 83844-2331
Casilla 138-11	USA
Santiago 11
Chile
Mark DREHER	James I. MANN
Nutrition and Scientific Regulatory Affairs	Professor of Human Nutrition
Nabisco, Inc.	University of Otago
Technology Center	P.O.Box 56
200 DeForest Avenue	Dunedin
East Hanover, NJ 07936-1944	New Zealand
USA
Mukund GURJAR	Ruth ONIANG'O (Vice-Chair)
Indian Institute of Chemical Technology	Director
Council of Scientific and Industrial	Board of Postgraduate Studies
Research, Government of India	Jomo Kenyatta University of Agriculture
Hyderabad 500 007	and Technology
India	P.O. Box 62000
	Nairobi
	Kenya

FAO/WHO expert consultation on carbohydrates in human nutrition

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James HILL	Alison STEPHEN
Center of Human Nutrition	Division of Nutrition and Dietetics
University of Colorado Health Science	College of Pharmacy and Nutrition
Center	University of Saskatchewan
4200 East Ninth Avenue	110 Science Place
Campus Box C225	Saskatoon, Saskatchewan, S7N 5C9
Denver, Colorado 80262	Canada
USA
Kraisid TONTISIRIN	Mark WAHLQVIST
Institute of Nutrition	Monash Medical Centre
Mahidol University	Monash University
Salaya, Phutthamonthon 4	246 Clayton Road
Nakhon Pathom 73170	Clayton, Melbourne
Thailand	Victoria 3168
	Australia
Hester Hendrina VORSTER	Thomas WOLEVER
Potchefstroom University for Christian	Department of Nutritional Sciences
Higher Education	University of Toronto
Dept. of Nutrition and Family Ecology	150 College Street
Private Bag X6001	Toronto, Ontario, M5S 3E2
Potchefstroom 2520	Canada
Republic of South Africa

viii	FAO//WHO expert consultation on carbohydrates in human nutrition

Secretariat

FOOD AND AGRICULTURE	WORLD HEALTH
ORGANIZATION OF THE	ORGANIZATION
UNITED NATIONS
Guy NANTEL	Ratko BUZINA
Senior Officer	Consultant, Nutrition
Nutrition Planning, Assessment and	WHO, Geneva
Evaluation Service
Food and Nutrition Division	Graeme CLUGSTON
FAO, Rome	Director, Nutrition Programme
	WHO, Geneva.
John R. WEATHERWAX
Consultant to FAO, Rome.	Nicolai KHALTAEV
	Responsible Officer
	Chronic Noncommunicable Diseases.
	WHO, Geneva