Diet, Health and Disease
Background
Carbohydrates were historically only seen as a source of dietary energy. More and more data are becoming available on the relationship between the glycaemic response and health, but its significance is far from clear. There are many developments around indigestible carbohydrates and other substances known as dietary fibre.
Objectives
The aim of the Dietary Carbohydrate Task Force is to increase insight in the effects of carbohydrates on health. What are the effects of differences in glycaemic response on health and disease, and what are optimal ways to measure such responses? What are the physiological and health benefits of natural and synthetic non-digestible carbohydrates and fibres? How does the postprandial stage influence health? These activities and a wide dissemination of the results can help industry, food authorities and consumer to produce, label and choose better foods that contribute to maintain or improve health.
The output of this task force and related expert groups will help scientists and regulators:
- To gain a better understanding of dietary fibre;
- To gain insight on health effects of differences in Glycaemic Response;
- To understand the physiology of postprandial glucose kinetics in people with normal and impaired glucose metabolism.
Activities
Quantifying the Impact of Reduced Post-prandial Glycaemia and Insulinaemia on Disease Progression in the General Population
There is a general consensus, supported by recent ILSI-sponsored analyses and reviews, that (food-based) reductions in post-prandial glycaemic (PPG) and relative insulinaemic (PPI) responses are likely to be beneficial for reducing the risks of disease in the general population. However, while drug trials provide a modicum of quantitative data to estimate the impact of such interventions on the development of cardiovascular disease and transition from pre-diabetes to diabetes, quantitative estimates of the impact achievable through dietary effects in the general population do not exist. Nevertheless, it should be possible to develop these for a range of dietary scenarios by modelling, based on specific assumptions. Given the significant and rising prevalence of pre-diabetic and diabetic individuals in the general population, such models would also include these individuals in deriving an overall predicted impact for a given change in PPG and PPI.
The current activity proposal is to use existing data in the public domain and a set of transparent, justified assumptions and potential scenarios, as the basis for modelling and generating quantitative estimates of the general population benefit of defined reductions in PPG and PPI achievable through changes in foods and diet.
The purpose of this activity would be to generate data and a publication to be used in:
- Communicating on PPG and PPI with experts, in terms of quantitative risk reduction in the general population (public health / food approach), and particularly for differentiating this from treatment of diagnosed individuals (medical / pharma approach);
- Making the benefits of reductions in PPG and PPI more concrete by quantifying these in terms of potential public health impact, based on a transparent, and objective analysis;
- Improving estimation of ‘biologically significant’ and meaningful (vs ‘statistically significant’) effect sizes, for use in foods innovation research, clinical trial design and interpretation, and engagement with regulators;
- Communicating with other stakeholders, e.g. with government, NGOs, academics and consumers.
Glycaemic Impact of Ingestion of Carbohydrates Foods on Health in ‘Healthy’ Subjects: Are postprandial glucose kinetics of relevance to health for healthy people?
It is common practice to measure blood glucose and related blood parameters in the fasting state, especially in observational studies. However, the largest part of the day is spent in postprandial stages. It is also known that controlling blood glucose levels is important for people with diabetes. Most research investigating blood glucose kinetics have been done in people with impaired glucose metabolism.
The task force commissioned an expert group (EG) to work on the functional impact of postprandial carbohydrate metabolism by investigating whether the physiological effects found in people with impaired glucose metabolism (e.g. people with diabetes) are also true for ‘healthy’ people.
The expert group investigates the different aspects of glucose response on the biomarkers related to the following fields:
- Oxidative stress and inflammation modulation;
- Diabetes and insulin resistance prevention;
- Cardiovascular prevention;
- Weight management;
- Physical performance;
- Mental performance/cognition.
The biomarkers and corresponding effects will be considered in function of short-term effects (few hours after ingestion) and then, on longer-term effects (couple of days, months after ingestion) in healthy subjects including children.
The work of the expert group has been submitted in a peer-review journal. It addresses the role of postprandial metabolism in healthy people, the relationships between postprandial outcomes and specific health outcomes, and the physiological relevance of biomarker changes. Also, specific focus will be given to the effect of meal frequency, including the impact of previous meals on the postprandial responses of the following meals.
Health Effects of Dietary Fibre
Western populations rarely reach recommended daily dietary fibre intakes, the latter varying across the world between 20 and 40 g/day for adults. In particular, fruit and vegetable intake fails to meet the recommendations. Analytically, dietary fibre is typically defined as non-starch polysaccharides determined by appropriate analytical methods, usually those adopted by the Association of Analytical Communities (AOAC). Even though precise definition and analytical methods have been under continuous discussion, this fibre interpretation at large has turned out impractical as it simultaneously aimed to take into account scientific evidence and recommendations, allowed communication of this important class of nutrients to the consumer, and aimed to raise their awareness for dietary fibre in a healthy diet. Next to this, different types of fibre provide different types of benefits. It is important to better understand the physiological response to different fibres through a better understanding of their physico-chemical properties.
It has recently been questioned whether health effects attributed to fibre in general can also be attributed to isolated and synthetic fibres. The EU has, nevertheless, endorsed the classical definition of fibre based on indigestible carbohydrate polymers (2008/100/EC), and, in 2008, Codex Alimentarius also returned to this basis. Irrespective of these developments, there is still a need for a thorough and comprehensive review of the physiological effects of non-intrinsic fibres and their impact on health.
ILSI Europe gave a presentation on ‘Physiological effects of fibre and their relevance for human health’ at the Dietary Fibre Conference in July 2009, in Vienna (AT). Recently, with the collaboration of the Carbohydrates Committee from ILSI North America, the task force presented the Implementation issues of Codex Dietary Fiber definition at a joint ILSI Europe – ILSI North America session during the 9th Vahouny Symposium in June 2010 in Bethesda, Maryland (US). The session helped getting an overview of the delegates’ opinion on carbohydrate polymers with degree of polymerisation comprised between 3 and 9, and types of physiological effects that should be part of the definition. The outcome of this session has been published in November 2010 in the Food and Nutrition Research Journal (Howlett et al. 2010;54:5750), and widely disseminated. In order to reach a broader audience and as the definition of a dietary fibre is a worldwide concern, it is being translated in Spanish and Portuguese and posted on the different ILSI branches' publication page.
Concise Monograph - Glycaemic Response and Health
Interest in the glycaemic properties of foods and beverages has been growing the last decade. The glycaemic response to the diet may influence the risk of developing disorders such as Type 2 diabetes and cardiovascular disease, and might play a role in body weight management.
It is important that communication on glycemic response is scientifically substantiated and that consumer expectations are realistic. Therefore, following an expert consultation on glycaemic index methodology (Nutrition Research Reviews 2005;18:145-71), the task force commissioned a series of meta-analyses of human intervention studies to quantitatively summarise effects of glycaemic response on health outcomes. After being discussed in a workshop, key findings and papers presented have been published in the American Journal of Clinical Nutrition ( Howlett et al. 2008;87:S201-74, Suppl.1). The full reports on the meta-analyses that served as the basis for the workshop are available
here.
In order to disseminate the key findings of the workshop to a much wider audience, a Concise Monograph has been produced.
Task Force Collaborators
Members - 2012
Dr. Toine Hulshof - Chair - |
Kellogg Europe |
NL |
|
|
|
Dr. Jean-Michel Antoine |
Danone |
FR |
Dr. Victoria Anne Betteridge |
Tate & Lyle Ingredients |
UK |
Dr. Douwina Bosscher |
Cargill |
BE |
Dr. Pietro De Albertis |
Barilla G & R Fratelli |
IT |
Ms. Ellie Hadjilucas |
Coca-Cola Europe |
BE |
Dr. Gunhild Kozianowski |
Südzucker/BENEO Group |
DE |
Dr. David Mela |
Unilever |
NL |
Ms. Frédérique Respondek |
Tereos-Syral |
FR |
| Dr. Myriam Richelle |
Nestlé |
CH |
Mrs. Fiona Samuels |
Mars |
NL |
Dr. Julian Stowell |
DuPont Nutrition Biosciences |
UK |
Dr. Kathleen Terpend |
Nexira |
FR |
Dr. Sophie Vinoy |
Kraft Foods Europe |
FR |
|
|
|
Ms. Agnès Méheust |
ILSI Europe |
BE |
Ms. Toula Aslanidis |
ILSI Europe |
BE |
Expert Group on Glycaemic Impact of Ingestion of Carbohydrates Foods on Health in Healthy Subjects
Dr. Ellen Blaak - Chair - |
Maastricht University |
NL |
|
|
|
Dr. Jean-Michel Antoine |
Danone |
FR |
Prof. David Benton |
University of Wales Swansea |
UK |
Prof. Inger Björck |
University of Lund |
SE |
Dr. Fred Brouns |
Maastricht University |
NL |
Prof. Michaela Diamant |
VU University Medical Center (VUMC) |
NL |
Prof. Louise Dye |
University of Leeds |
UK |
Ms. Ellie Hadjilucas |
Coca-Cola Europe |
BE |
Dr. Jens Juul Holst |
University of Copenhagen |
DK |
Dr. Toine Hulshof |
Kellogg Europe |
NL |
Prof. Martine Laville |
University of Lyon |
FR |
Dr. Clare Lawton |
University of Leeds |
UK |
Dr. Angela Rivellese |
Frederico II University of Naples |
IT |
Dr. Stephan Theis |
Südzucker/BENEO Group |
DE |
Dr. Sophie Vinoy |
Kraft Foods Europe |
FR |
|
|
|
Ms. Agnès Méheust |
ILSI Europe |
BE |
Concise Monograph on Glycaemic Response and Health
Author |
|
|
Dr. Michele Sadler |
Consultant |
UK |
Scientific Editor |
|
|
Prof. Edith Feskens |
University of Wageningen |
NL |
Scientific Reviewers |
|
|
Prof. Jacqueline Dekker |
Free University of Amsterdam |
NL |
Prof. Martine Laville |
University of Lyon |
FR |
Task Force Coordinator |
|
|
Dr. Julian Stowell |
DuPont Nutrition Biosciences |
UK |
Publication Committee Coordinator |
|
|
Dr. Kevin Yates |
|
UK |
Series Editor |
|
|
Mr. John Howlett |
Consultant |
UK |
Coordinator |
|
|
Ms. Agnès Méheust |
ILSI Europe |
BE
|
Publications
M. Sadler. Food, Glycaemic Response and Health. ILSI Europe Concise Monograph Series 2011:1-30.
J.F. Howlett, V.A. Betteridge, M. Champ, S.A.S. Craig, A. Meheust and J. Miller Jones. The Definition of Dietary Fiber - Discussions at the Ninth Vahouny Fiber Symposium: Building Scientific Agreement. Food & Nutrition Research 2010;54: 5750 - DOI: 10.3402/fnr.v54i0.5750.
G. Livesey, R. Taylor and T. Hulsof. Meta-analyses on Glycemic Response and Health - Workshop working documents*
J. Howlett, T. Hulshof, T. Wolever, J. Stowell and L. Pijls, Guest Editors. Glycemic Response and Health. Americal Journal of Clinical Nutrition 2008;87(1S):201S-274S.
J. Gray. Dietary Fibre. ILSI Europe Concise Monograph Series 2006:1-44.
F. Brouns, I. Bjorck, K.N. Frayn et al. Glycaemic Index Methodology. Nutrition Research Reviews 2005;18(1):145-171.
J. Gray. Carbohydrates: Nutritional and Health Aspects. ILSI Europe Concise Monograph Series 2003:1-30.
M. Gurr. Nutritional and Health Aspects of Sugars - Evaluation of New Findings. ILSI Europe Concise Monograph Series 1995:1-25.
* As this document is not compatible with the ILSI Europe Concise Monograph and Report Series, it was decided to place it on the ILSI Europe website for the information of those interested in this important topic. It has not been independently reviewed.
For more information, please contact info@ilsieurope.be