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01-10-2020 | Insulins | Original Contribution

Application of the ≤ 10:1 carbohydrate to fiber ratio to identify healthy grain foods and its association with cardiometabolic risk factors

Authors: Mariane de Mello Fontanelli, Renata Micha, Cristiane Hermes Sales, Junxiu Liu, Dariush Mozaffarian, Regina Mara Fisberg

Published in: European Journal of Nutrition | Issue 7/2020

Abstract

Purpose

Optimal metrics to assess healthfulness of carbohydrate-rich products are not well established. We investigated how the content per 10 g of carbohydrate of at least 1 g of fiber (≤ 10:1-ratio) related to nutritional quality in grain foods as well as cardiometabolic risk factors in São Paulo, Brazil.

Methods

Data were from the cross-sectional population-based study 2015 Health Survey of São Paulo, including a probabilistic sample of urban residents in the city. Participants (n = 1188) aged 20 + years completed a 24-h dietary recall and a subsample of 603 participants had blood samples, anthropometrics, and blood pressure measurements collected, and answered a second 24-h recall. Energy and nutrient contents of grain foods meeting or not meeting the ≤ 10:1-ratio were evaluated using linear regression models. The association between consumption (percent energy, %E) of grain foods meeting the ≤ 10:1-ratio and cardiometabolic risk factors were investigated using linear regression models.

Results

Foods meeting the ≤ 10:1-ratio had less available carbohydrate (− 3.0 g/serving), total sugar (− 7.4 g/serving), added sugar (− 7.2 g/serving) and saturated fat (− 0.7 g/serving), and more dietary fiber (+ 3.5 g/serving), protein (+ 2.1 g/serving), potassium (+ 100.1 mg/serving), iron (+ 0.9 mg/serving), selenium (+ 4.2 µg/serving), magnesium (+ 38.7 mg/serving), and zinc (+ 1.1 mg/serving). Each increase in 1%E consumption of grain foods meeting the ≤ 10:1-ratio was associated with lower levels of blood triacylglycerol (− 10.7%), the triacylglycerol/high-density lipoprotein cholesterol ratio (− 14.9%), fasting insulin (− 13.6%), and homeostasis model assessment for insulin resistance (− 14.0%).

Conclusion

The ≤ 10:1-ratio identified grain foods with higher nutritional quality and higher intakes of these foods were associated with cardiometabolic risk factors related to atherogenic dyslipidemia and insulin resistance.

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Greenwood DC, Threapleton DE, Evans CE, Cleghorn CL, Nykjaer C, Woodhead C, Burley VJ (2013) Glycemic index, glycemic load, carbohydrates, and type 2 diabetes: systematic review and dose-response meta-analysis of prospective studies. Diabetes Careiabetes Care 36(12):4166–4171. https://doi.org/10.2337/dc13-0325CrossRef

Micha R, Shulkin ML, Penalvo JL, Khatibzadeh S, Singh GM, Rao M, Fahimi S, Powles J, Mozaffarian D (2017) Etiologic effects and optimal intakes of foods and nutrients for risk of cardiovascular diseases and diabetes: systematic reviews and meta-analyses from the Nutrition and Chronic Diseases Expert Group (NutriCoDE). PLoS ONE 12(4):e0175149. https://doi.org/10.1371/journal.pone.0175149CrossRefPubMedPubMedCentral

AlEssa HB, Cohen R, Malik VS, Adebamowo SN, Rimm EB, Manson JE, Willett WC, Hu FB (2018) Carbohydrate quality and quantity and risk of coronary heart disease among US women and men. Am J Clin Nutr 107(2):257–267. https://doi.org/10.1093/ajcn/nqx060CrossRefPubMedPubMedCentral

Aune D, Norat T, Romundstad P, Vatten LJ (2013) Whole grain and refined grain consumption and the risk of type 2 diabetes: a systematic review and dose-response meta-analysis of cohort studies. Eur J Epidemiol 28(11):845–858. https://doi.org/10.1007/s10654-013-9852-5CrossRefPubMed

Schlesinger S, Neuenschwander M, Schwedhelm C, Hoffmann G, Bechthold A, Boeing H, Schwingshackl L (2019) Food groups and risk of overweight, obesity, and weight gain: a systematic review and dose-response meta-analysis of prospective studies. Adv Nutr 10(2):205–218. https://doi.org/10.1093/advances/nmy092CrossRefPubMedPubMedCentral

Buyken AE, Mela DJ, Dussort P, Johnson IT, Macdonald IA, Stowell JD, Brouns FJPH (2018) Dietary carbohydrates: a review of international recommendations and the methods used to derive them. Eur J Clin Nutr 72(12):1625–1643. https://doi.org/10.1038/s41430-017-0035-4CrossRefPubMedPubMedCentral

Ferruzzi MG, Jonnalagadda SS, Liu S, Marquart L, McKeown N, Reicks M, Riccardi G, Seal C, Slavin J, Thielecke F, van der Kamp JW, Webb D (2014) Developing a standard definition of whole-grain foods for dietary recommendations: summary report of a multidisciplinary expert roundtable discussion. Adv Nutr 5(2):164–176. https://doi.org/10.3945/an.113.005223CrossRefPubMedPubMedCentral

Ross AB, van der Kamp JW, King R, Le KA, Mejborn H, Seal CJ, Thielecke F, Forum H (2017) Perspective: a definition for whole-grain food products-recommendations from the healthgrain forum. Adv Nutr 8(4):525–531. https://doi.org/10.3945/an.116.014001CrossRefPubMedPubMedCentral

Mozaffarian RS, Lee RM, Kennedy MA, Ludwig DS, Mozaffarian D, Gortmaker SL (2013) Identifying whole grain foods: a comparison of different approaches for selecting more healthful whole grain products. Public Health Nutr 16(12):2255–2264. https://doi.org/10.1017/S1368980012005447CrossRefPubMedPubMedCentral

10.

Hornick B, Dolven C, Liska D (2012) The fiber deficit; Part II: consumer misperceptions about whole grains and fiber. Nutr Today 47(3):104–109. https://doi.org/10.1097/NT.0b013e31825744cfCrossRef

11.

Lloyd-Jones DM, Hong Y, Labarthe D, Mozaffarian D, Appel LJ, Van Horn L, Greenlund K, Daniels S, Nichol G, Tomaselli GF (2010) Defining and setting national goals for cardiovascular health promotion and disease reduction: the American Heart Association's strategic Impact Goal through 2020 and beyond. Circulation 121(4):586–613. https://doi.org/10.1161/CIRCULATIONAHA.109.192703CrossRefPubMed

12.

Scientific Advisory Committee on Health (SACN) (2015) Carbohydrates and health. The Stationery Office, London

13.

Ghodsian B, Madden AM (2018) Evaluating the ≤10:1 wholegrain criterion in identifying nutrient quality and health implications of UK breads and breakfast cereals. Public Health Nutr 21(6):1186–1193. https://doi.org/10.1017/S1368980017003718CrossRefPubMed

14.

Malta DC, Felisbino-Mendes MS, Machado IE, Passos VMA, Abreu DMX, Ishitani LH, Velásquez-Meléndez G, Carneiro M, Mooney M, Naghavi M (2015) Risk factors related to the global burden of disease in Brazil and its Federated Units. Rev Bras Epidemiol Suppl 20(1):217–232. https://doi.org/10.1590/1980-5497201700050018CrossRef

15.

Alves M, Escuder MML, Goldbaum M, Barros MBA, Fisberg RM, Cesar CLG (2018) Sampling plan in health surveys, city of Sao Paulo, Brazil, 2015. Rev Saude Publica 52:81. https://doi.org/10.11606/s1518-8787.2018052000471CrossRefPubMedPubMedCentral

16.

Fisberg RM, Sales CH, Fontanelli MM, Pereira JL, Alves M, Escuder MML, César CLG, Goldbaum M (2018) 2015 Health survey of Sao Paulo with focus in nutrition: rationale, design, and procedures. Nutrients 10(2):pii: E169. https://doi.org/10.3390/nu10020169CrossRef

17.

Raper N, Perloff B, Ingwersen L, Steinfeldt L, Anand J (2004) An overview of USDA’s dietary intake data system. J Food Compos Anal 17:545–555. https://doi.org/10.1016/j.jfca.2004.02.013CrossRef

18.

Moshfegh AJ, Rhodes DG, Baer DJ, Murayi T, Clemens JC, Rumpler WV, Paul DR, Sebastian RS, Kuczynski KJ, Ingwersen LA, Staples RC, Cleveland LE (2008) The US department of agriculture automated multiple-pass method reduces bias in the collection of energy intakes. Am J Clin Nutr 88(2):324–332. https://doi.org/10.1093/ajcn/88.2.324CrossRefPubMed

19.

U.S. Department of Agriculture, Agricultural Research Service. 2013. USDA National Nutrient Database for Standard Reference, Release 26. Nutrient Data Laboratory Home Page, https://www.ars.usda.gov/ba/bhnrc/ndl. Accessed 5 Dec 2019

20.

Center for Food Study and Research (NEPA), State University of Campinas (UNICAMP) (2011) Brazilian food composition table. NEPA, Campinas (In Portuguese)

21.

São Paulo University (USP). Food Research Center (FoRC) (2017) Brazilian food composition table (TBCA). https://www.fcf.usp.br/tbca/. Accessed 11 Sep 2018 (In Portuguese)

22.

Fisberg RM, Villar BS (2002) Handbook of recipes and household measurements for food surveys: handbook designed to assist food surveys. Signus, São Paulo (In Portuguese)

23.

Pinheiro ABV, Lacerda EMA, Benzecry EH, Gomes MCS, Costa VM (2000) Table for food intake assessment in household measurements, 4th edn. Atheneu, São Paulo (In Portuguese)

24.

Tooze JA, Kipnis V, Buckman DW, Carroll RJ, Freedman LS, Guenther PM, Krebs-Smith SM, Subar AF, Dodd KW (2010) A mixed-effects model approach for estimating the distribution of usual intake of nutrients: the NCI method. Stat Med 29(27):2857–2868. https://doi.org/10.1002/sim.4063CrossRefPubMed

25.

World Health Organization (WHO) (1995) Physical status: the use and interpretation of anthropometry. Report of a WHO Expert Committee. World Health Organization, Geneva

26.

Cardiologia SBd, Hipertensao SBd, Nefrologia SBd (2010) VI Brazilian Guidelines on hypertension. Arq Bras Cardiol 95(1 Suppl):1–51. https://doi.org/10.1590/S0066-782X2010001700001(In Portuguese)CrossRef

27.

Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC (1985) Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 28(7):412–419CrossRefPubMed

28.

Wallace TM, Levy JC, Matthews DR (2004) Use and abuse of HOMA modeling. Diabetes Care 27(6):1487–1495. https://doi.org/10.2337/diacare.27.6.1487CrossRefPubMed

29.

Brazil (2012) Law # 12.711, 29 Aug 2012. Provides for the entry into federal universities and institutions and makes other arrangements. Brasília, Federal District: Union Official Journal; Aug 30th 1. (In Portuguese)

30.

World Health Organization (WHO) (2001) AUDIT: the alcohol use disorders identification test: guidelines for use in primary health care, 2nd edn. World Health Organization, Geneva

31.

Matsudo S, Araújo T, Matsudo V, Andrade D, Oliveira LC, Braggion G (2001) International physical activity questionnaire (IPAQ): validation and reproducibility in Brazil. Braz Soc Phys Act Health 6:13 (In Portuguese)

32.

World Health Organization (WHO) (2010) Global recommendations on physical activity for health. World Health Organization, Geneva

33.

Kelly MT, Rennie KL, Wallace JM, Robson PJ, Welch RW, Hannon-Fletcher MP, Livingstone MB (2009) Associations between the portion sizes of food groups consumed and measures of adiposity in the British National Diet and Nutrition Survey. Br J Nutr 101(9):1413–1420. https://doi.org/10.1017/S0007114508060777CrossRefPubMed

34.

Institute of Medicine (2005) Dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein, and amino acids. The National Academies Press, Washington, DC

35.

Previdelli AN, Andrade SC, Pires MM, Ferreira SRG, Fisberg RM, Marchioni DM (2011) A revised version of the healthy eating index for the Brazilian population. Rev Saude Publica 45:794–798. https://doi.org/10.1590/S0034-89102011005000035CrossRefPubMed

36.

Andrade SC, Previdelli AN, Marchioni DM, Fisberg RM (2013) Evaluation of the reliability and validity of the Brazilian healthy eating index revised. Rev Saude Publica. 47(4):675–683. https://doi.org/10.1590/S0034-8910.2013047004267CrossRefPubMed

37.

Hu FB, Stampfer MJ, Rimm E, Ascherio A, Rosner BA, Spiegelman D, Willett WC (1999) Dietary fat and coronary heart disease: a comparison of approaches for adjusting for total energy intake and modeling repeated dietary measurements. Am J Epidemiol 149(6):531–540. https://doi.org/10.1093/oxfordjournals.aje.a009849CrossRefPubMed

38.

AlEssa HB, Ley SH, Rosner B, Malik VS, Willett WC, Campos H, Hu FB (2016) High fiber and low starch intakes are associated with circulating intermediate biomarkers of type 2 diabetes among women. J Nutr 146(2):306–317. https://doi.org/10.3945/jn.115.219915CrossRefPubMedPubMedCentral

39.

Fardet A (2010) New hypotheses for the health-protective mechanisms of whole-grain cereals: what is beyond fibre? Nutr Res Rev 23(1):65–134. https://doi.org/10.1017/S0954422410000041CrossRefPubMed

40.

Marques-Lopes I, Ansorena D, Astiasaran I, Forga L, Martínez JA (2001) Postprandial de novo lipogenesis and metabolic changes induced by a high-carbohydrate, low-fat meal in lean and overweight men. Am J Clin Nutr 73(2):253–261. https://doi.org/10.1093/ajcn/73.2.253CrossRefPubMed

41.

Gommers LM, Hoenderop JG, Bindels RJ, de Baaij JH (2016) Hypomagnesemia in type 2 diabetes: a vicious circle? Diabetes 65(1):3–13. https://doi.org/10.2337/db15-1028CrossRefPubMed

42.

GBD (2017) Diet Collaborators (2019) Health effects of dietary risks in 195 countries, 1990–2017: a systematic analysis for the global burden of disease study 2017. Lancet 393(10184):1958–1972. https://doi.org/10.1016/S0140-6736(19)30041-8CrossRef

43.

Mello AV, Sarti FM, Pereira JL, Goldbaum M, Cesar CLG, Alves M, Fisberg RM (2018) Determinants of inequalities in the quality of Brazilian diet: trends in 12-year population-based study (2003–2015). Int J Equity Health 17(1):72CrossRefPubMedPubMedCentral

44.

Tester JM, Leung CW, Leak TM, Laraia BA (2017) Recent uptrend in whole-grain intake is absent for low-income adolescents, national health and nutrition examination survey, 2005–2012. Prev Chronic Dis 14:E55. https://doi.org/10.5888/pcd14.160540externaliconCrossRefPubMedPubMedCentral

45.

Rehm CD, Penalvo JL, Afshin A, Mozaffarian D (2016) Dietary intake among US adults, 1999–2012. JAMA 315(23):2542–2553. https://doi.org/10.1001/jama.2016.7491CrossRefPubMedPubMedCentral

46.

Suthers R, Broom M, Beck E (2018) Key characteristics of public health interventions aimed at increasing whole grain intake: a systematic review. J Nutr Educ Behav 50(8):813–823. https://doi.org/10.1016/j.jneb.2018.05.013CrossRefPubMed

47.

Brazilian Institute of Geography and Statistics (Instituto Brasileiro de Geografia e Estatística - IBGE), Coordination of Population and Social Indicators (2016) Summary of social indicators: an analysis of the living conditions of the Brazilian population: 2016. Rio de Janeiro. (In Portuguese)

48.

National Institutes of Health, National Cancer Institute. Dietary Assessment Primer, Principles Underlying Recommendations. https://dietassessmentprimer.cancer.gov/. Accessed 15 Mar 2019.

Title: Application of the ≤ 10:1 carbohydrate to fiber ratio to identify healthy grain foods and its association with cardiometabolic risk factors
Authors: Mariane de Mello Fontanelli
Renata Micha
Cristiane Hermes Sales
Junxiu Liu
Dariush Mozaffarian
Regina Mara Fisberg
Publication date: 01-10-2020
Publisher: Springer Berlin Heidelberg
Keywords: Insulins
Insulins
Published in: European Journal of Nutrition / Issue 7/2020
Print ISSN: 1436-6207
Electronic ISSN: 1436-6215
DOI: https://doi.org/10.1007/s00394-019-02165-4

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Application of the ≤ 10:1 carbohydrate to fiber ratio to identify healthy grain foods and its association with cardiometabolic risk factors

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Purpose

Methods

Results

Conclusion

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