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Keywords: carbohydrates; human nutrition; chronic diseases; FAO; WHO; scientific update
The Scientific Update involved consideration of a number of provides a practical basis for measurement and labelling, but
key issues that have arisen since the Joint FAO/WHO Expert does not allow a simple translation into nutritional effects.
Consultation on Carbohydrates in Human Nutrition was Each chemical class of carbohydrate has overlapping phy-
held in 1997 (FAO, 1998) or where new data may have siological properties and health effects. As a result several
altered conclusions drawn some 10 years ago. The Scientific terms have been used to describe their functional properties.
Update enabled some firm conclusions to be drawn and For example, many terms exist to describe sugars in the diet.
identified a number of areas where more research is required While it is straightforward from an analytical point of view
to enable definitive recommendations. The review papers to determine the total sugar content of food and their
prepared as part of this Scientific Update applied the criteria division into monosaccharides and disaccharides, it is
used by the 2002 WHO/FAO Expert Consultation on Diet, acknowledged that the nature of the food matrix may
Nutrition and the Prevention of Chronic Diseases to describe influence the nutritional effects of foods-containing sugars.
strength of evidence for drawing the conclusions of the The term free sugars, defined as all monosaccharides and
scientific review (WHO, 2003). The following are agreed- disaccharides added to foods by the manufacturer, cook or
upon summaries of both the review papers, and discussions consumer, plus sugars naturally present in honey, syrups and
from the authors meeting (Geneva, 1718 July 2006) on fruit juices (WHO, 2003), describes sugars which may have
each issue area. different physiological consequences from sugars incorpo-
The experts who participated at the authors meeting were: rated within intact plant cell walls. This concept, which has
John H Cummings, Hans Englyst Timothy Key, Simin Liu, been recommended by the 2002 WHO/FAO Expert Con-
Jim Mann (Chairman), Rob van Dam, Bernard Venn, Carolyn sultation (WHO, 2003), is theoretically useful to nutritionists
Summerbell (Rapporteur), Gabriele Riccardi, Ricardo Uauy, but there is currently no standardized approach to their
HH Vorster (Rapporteur) and Martin Wiseman. The FAO determination.
Secretariat members were Kraisid Tontisirin and Frank The terms prebiotic, resistant starch and dietary fibre
Martinez Nocito and the WHO Secretariat members were are used to indicate some of the physiological properties and
Chizuru Nishida and Denise Costa Coitinho.
health effects of oligosaccharides and polysaccharides. The
concepts of prebiotic and resistant starch are quite clearly
defined. However, the current existence of several defini-
tions of dietary fibre, reflecting different physiological and
Terminology and classification
botanical properties or health effects of a range of naturally
Terminology and classification of carbohydrates remain occurring and synthetic carbohydrates and their associated
difficult issues. The Scientific Update endorsed the primary substances has resulted in confusion. The Scientific Update
classification, recommended by the 1997 Expert Consulta- considered that the term dietary fibre should be reserved for
tion, based on chemical form, while acknowledging that the cell wall polysaccharides of vegetables, fruits and whole-
classification of carbohydrates based on chemistry should grains, the health benefits of which have been clearly
also have dimensions of physical effects (food matrix), established, rather than synthetic, isolated or purified
functional/physiological effects and health outcomes oligosaccharides and polysaccharides with diverse, and in
(Cummings and Stephen, 2007). The chemical classification some cases unique, physiological effects. Thus, the Scientific
Update agreed to define dietary fibre as intrinsic plant cell
wall polysaccharides.
Correspondence: Professor J Mann, Department of Human Nutrition, Edgar
National Centre for Diabetes Research, University of Otago, New Zealand. It is acknowledged that certain fibre rich whole foods (for
E-mail: jim.mann@stonebow.otago.ac.nz example, pulses) can affect glycaemic control in diabetes,
Scientific Update on carbohydrate in human diet
J Mann et al
S133
and lipid levels, to a greater extent than cereal-based fibre- In view of the considerable interest in the health effects of
containing foods. All forms of dietary fibre influence bowel dietary fibre, much discussion centred around the various
habit, and other aspects of large bowel function. However, approaches to its measurement. Indigestibility in the small
the analytical distinction between soluble and insoluble intestine was not considered to be a satisfactory basis for the
forms of dietary fibre may not always be useful since the definition of dietary fibre. It was agreed that the term
separation of soluble and insoluble fractions is pH depen- dietary fibre be limited to polysaccharides that are intrinsic
dent and the link with specific physiological properties is to the plant cell wall, and the methods for measuring dietary
inconsistent. Further research is needed to determine the fibre are, therefore, those which can reliably quantify the
exact properties of different non-starch polysaccharides component polysaccharides. Direct chemical measurement
and their food sources, to explain their metabolic and was favoured over empirical gravimetric methods for this
physiological effects. The whole-grain concept, along with purpose.
fruit and vegetables is central to the healthy diet message,
but the term whole-grain requires much clearer definition.
In particular, the extent to which health properties are Physiology
influenced by milling as compared with consumption of the
intact grain should be established. Carbohydrates are the principal energy source in the diets of
most people and have a special role to play in energy
metabolism and homoeostasis. Despite this the energy
values of some carbohydrates continue to be debated. This
Characterization and measurement is because of the use of different energy systems such as
combustible, digestible and metabolizable. Furthermore,
Carbohydrate determinations should describe chemical ingested macronutrients may not be fully available to tissues
composition accurately, and provide information of nutri- and the tissues themselves may not be fully able to oxidize
tional relevance (Englyst et al., 2007). The traditional substrates made available to them. Therefore, for certain
calculation of carbohydrate by difference does not conform carbohydrates the discrepancies between combustible en-
to either of these criteria as it combines the analytical ergy, digestible energy, metabolizable energy (ME) and net
uncertainties of the other macronutrient measures and any metabolizable energy (NME) may be considerable.
unidentified material present, and a single value for In defining the role that carbohydrate plays in metabolism
carbohydrate cannot reflect the range of carbohydrate it is important to realize that the site, rate and extent of
components or their diverse nutritional properties. carbohydrate digestion in and absorption from the gut is key
The first principle of chemical analysis is to ensure that the to understanding the many roles that this group of
fraction of interest is completely extracted from the food chemically related compounds and their metabolic products
matrix in its native form (for example, sugars), or dispersed play in the body. However, even the concept of digestibility
to such an extent that it can be hydrolysed (for example, has different meanings. Within the nutrition community it
total starch and non-starch polysaccharide). Once appro- is an accepted convention that digestion occurs in the small
priately isolated, oligosaccharides and polysaccharides may (upper) bowel, while fermentation occurs in the large (lower)
be subjected to enzymatic (adds specificity) or acidic (when bowel. Although both processes result in the breakdown of
appropriate enzyme is unavailable) hydrolysis to release their food and absorption of energy yielding substrates, the term
constituent sugars. Detection is then by gas chromatography digestibility is reserved for events occurring in the upper gut.
or high-performance liquid chromatography, which can be However, in the discussion of the energy value of foods
used to measure specific monosaccharides, disaccharides and digestibility is defined as the proportion of combustible
small oligosaccharides. More rapid colorimetric assays can be energy that is absorbed over the entire length of the
used to measure sugars with reducing groups, and individual gastrointestinal tract. For the sake of determining energy
sugar species can be determined with enzyme-linked assays. values of carbohydrate that are of practical use, and of
There is more diversity of opinion regarding measurement ascribing health benefits to individual classes of them, some
of dietary components defined on the basis of functionality coherence needs to be brought to the use of the terms
rather than chemical composition. However, the scientific digestible, digestion and digestibility and to integrating the
update did recognize the nutritional importance of con- whole of the gut process into the equation of energy balance.
sidering both chemical and food matrix aspects of carbo- Three food energy systems are in use in food tables and for
hydrate-containing foods. Fundamental to any approach, food labelling in different countries and regions in the world
where categorization is based on physiological or nutritional based on selective interpretation of the digestive physiology
properties, is that they should be measured as chemically and metabolism of food carbohydrates. These are the
identified components. Such nutritional categories can systems which employ the Atwater specific factors; the
reflect physiological fate (e.g. resistant starch), specific Atwater general factors (17, 17, 37 kJ/g for carbohydrate,
functionalities (e.g. prebiotics) or botanical origin (e.g. free protein and fat, respectively); NME factors (typically applied
sugars, dietary fibre). to polyols) (Elia and Cummings, 2007). This is clearly
Discussion Experts
Professor John Cummings: Chairman, Biotherapeutics
The Scientific Update has enabled us to draw a number of Committee, Danone; Member, Working Group on Foods
important conclusions. The importance of improving the with Health Benefits, Danone; funding for research work at
definition of dietary fibre was discussed and it was agreed the University of Dundee, ORAFTI (2004).