Download A model for discriminating between carbohydrate

A model for discriminating between
carbohydrate-rich foods
Bill Shrapnel, Manny Noakes
This study was partly funded by Kellogg Australia
Change in risk of CHD death when replacing saturated fat with
monos, polys and carbohydrate (5% en)
(ns)
(ns)
5
% Change in risk
for death from CHD
0
-5
-10
-15
-20
-25
-26%
-30
Mono
Poly
Carb
Jakobsen et al. Am J Clin Nutr 2009;89:1-8
% change in hazard ratios for MI when replacing SAFA
with low, medium and high GI carbohydrate (5% en)
33%
35
30
% Change in risk
for MI
25
20
15
10
5
0
-2%
-5
-10
-12% (ns)
-15
Low GI
Medium GI
High GI
Jakobsen et al. Am J Clin Nutr 2010; 91: 1764
Carbohydrates: new paradigm
 Some carbohydrates may be protective
 Some carbohydrates may increase risk
 There is a need to discriminate between
carbohydrate-rich foods
What is ‘good’ carbohydrate?
 Sugars, complex carbohydrate?
 Low glycaemic index?
 High fibre?
 Wholegrain?
 High nutrient density?
Aim:
To develop a model for ranking the nutritional
quality of carbohydrate-rich foods
 Nutrient density
 Glycaemic index
Aim:
To develop a model for ranking the nutritional
quality of carbohydrate-rich foods
• Nutrient density
• Glycaemic index
“... the glycaemic index of foods be used in conjunction
with information about food composition to guide food
choices”
WHO 2003
Determining a nutrient density score:
1.
2.
3.
4.
5.
6.
Include nutrients with NRVs
Assess within food groups
Identify distinguishing nutrients of food groups
Develop an algorithm for nutrient density
Use a fixed amount of energy
Assess against recognised standards
Drewnowski A, Fulgoni V. Nutr Rev 2008
________________________________________________________________________
Food group
Distinguishing nutrients
________________________________________________________________________
Legumes
Iron, fibre, folate, magnesium, vitamin B6,
potassium
Bread, cereal products
Thiamin, riboflavin, niacin, iron, fibre, folate
Fruits
Vitamin C, folate, fibre, vitamin B6, potassium,
vitamin E
Starchy vegetables
Vitamin C, fibre, vitamin B6, potassium,
magnesium, thiamin
Dairy foods
Calcium, vitamin B12, riboflavin, vitamin A,
potassium, zinc
Confectionery, condiments
Six major micronutrients in each food
_________________________________________________________________________
________________________________________________________________________
Food group
Distinguishing nutrients
________________________________________________________________________
Legumes
Iron, fibre, folate, magnesium, vitamin B6,
potassium
Bread, cereal products
Thiamin, riboflavin, niacin, iron, fibre, folate
Fruits
Vitamin C, folate, fibre, vitamin B6, potassium,
vitamin E
Starchy vegetables
Vitamin C, fibre, vitamin B6, potassium,
magnesium, thiamin
Dairy foods
Calcium, vitamin B12, riboflavin, vitamin A,
potassium, zinc
Confectionery, condiments
Six major micronutrients in each food
_________________________________________________________________________
Results
Carbohydrate quality quadrants
30
40
Glycaemic
Index
50
60
70
80
90
0
10
20
30
Nutrient Density Score
40
50
Carbohydrate quality quadrants
Higher nutrient density
30
40
Glycaemic
Index
50
60
70
80
90
0
10
20
30
Nutrient Density Score
40
50
Carbohydrate quality quadrants
30
Lower GI
40
Glycaemic
Index
50
60
70
80
90
0
10
20
30
Nutrient Density Score
40
50
Carbohydrate quality quadrants
30
Highest quality
40
Glycaemic
Index
1
50
4
60
70
Lowest quality
80
90
0
10
20
30
Nutrient Density Score
40
50
Carbohydrate quality quadrants
30
Second lowest quality
Highest quality
40
Glycaemic
Index
50
3
1
60
4
2
70
Lowest quality
Second highest quality
80
90
0
10
20
30
Nutrient Density Score
40
50
Legumes
Legumes
Soya beans, boiled
Soya beans, canned
Lentils
30
Red kidney beans, boiled
Split peas
Haricot beans
40
Chickpeas, canned
Glycaemic
Index
Baked beans, canned
50
Red kidney beans, canned
60
70
80
90
0
10
20
30
Nutrient Density Score
40
50
Soft drinks, confectionery,
condiments
Soft drinks, confectionery and condiments
30
40
Glycaemic
Index
Milk chocolate
Jam, strawberry
50
60
Soft drink, cola
Mars Bar
70
Sweets, peppermints
Honey
80
Sweets, jelly beans
90
0
10
20
30
Nutrient Density Score
40
50
Dairy products
Dairy products
30
Milk, skim
Milk, red. fat
Milk, full fat
Yoghurt, natural
Milk, flavoured
Yoghurt, low fat,
natural
Yoghurt, low fat, sweetened
40
Glycaemic
Index
50
60
70
80
90
0
10
20
30
Nutrient Density Score
40
50
Starchy vegetables
Starchy vegetables
30
40
Carrot (80)
Glycaemic
Index
Peas (71)
50
Sweet corn
60
70
Sweet potato
Parsnip
Pumpkin
80
Potato, boiled
90
0
10
20
30
101
Nutrient Density Score
40
50
Fruits
Fruits
30
Dried apricots
Apple
Orange
40
Apple juice
Glycaemic
Index
Peach
Pear
Nectarine
Grapes
50
Mango
Banana
Sultanas
Orange juice
60
Cordial (40% juice)
Rockmelon
70
Watermelon
80
90
0
10
20
30
Nutrient Density Score
40
50
Fruits without vitamin C (5-nutrient score)
30
Dried apricots
Apple
40
Pear
Apple juice
Glycaemic
Index
Grapes
50
Orange
Peach
Nectarine
Mango
Banana
Sultanas
Orange juice
60
Cordial (40% juice)
Rockmelon
70
Watermelon
80
90
0
10
20
30
Nutrient Density Score
40
50
‘Non-core’ cereal foods
Biscuits, cakes, pastries
‘Non-core’ cereal foods – biscuits, cakes, pastries
30
40
Sponge cake
Muffin, apple
Glycaemic
Index
Cake, banana
50
Biscuit, oatmeal
60
Biscuit, shortbread
Croissant
Biscuit, flaky cracker
70
Donut
Biscuit, wafer, vanilla
Biscuit, cracker
80
Biscuit, plain, sweet
90
0
10
20
30
Nutrient Density Score
40
50
‘Core’ cereal foods
Grains, breads, breakfast cereals
‘Core’ cereal foods – grains, breads, breakfast cereals
All Bran
30
Bread, ‘Soy-Lin’
40
Glycaemic
Index
50
Pasta, white
Pasta, wholemeal
Rolled oats
Bread, sourdough, white
Sustain
Special K
Semolina
60
Bread, multigrain
Couscous
Polenta
70
Brown rice
Vitabrits
Just Right
muesli, toasted
WeetBix
Bread, white
80
Nutrigrain
Sultana Bran
Cornflakes
Bread, wholemeal
White rice
Rice Bubbles
90
0
10
20
30
Nutrient Density Score
40
50
‘Core’ cereal foods – refined/not enriched
30
40
Glycaemic
Index
50
Pasta, white
Semolina
60
Couscous
Polenta
70
80
White rice
90
0
10
20
30
Nutrient Density Score
40
50
‘Core’ cereal foods – refined/not enriched vs
‘non-core’ cereals
30
40
Sponge cake
Glycaemic
Index
50
Cake, banana
Pasta, white
Biscuit,
oatmeal
60
Semolina
Biscuit, shortbread
Couscous
Croissant
Polenta
Biscuit, flaky cracker
70
Donut
Biscuit, cracker
80
White rice
Biscuit, plain, sweet
90
0
10
20
30
Nutrient Density Score
40
50
‘Core’ cereal foods – enriched
All Bran
30
Bread, ‘Soy-Lin’
40
Glycaemic
Index
Bread, sourdough, white
Sustain
50
60
Bread, multigrain
Special K
Just Right
Nutrigrain
Sultana Bran
WeetBix
70
Bread, white
80
Cornflakes
Bread, wholemeal
Rice Bubbles
90
0
10
20
30
Nutrient Density Score
40
50
‘Core’ cereal foods – white vs wholegrain
30
40
Glycaemic
Index
Pasta, wholemeal
50
Pasta, white
60
70
Brown rice
Bread, white
80
Bread, wholemeal
White rice
90
0
10
20
30
Nutrient Density Score
40
50
Sugar and nutrient dilution
Dairy products
Nutrient dilution by sugar
30
Milk, skim
Milk, red. fat
Milk, full fat
Yoghurt, natural
Milk, flavoured
Yoghurt, low fat,
natural
Yoghurt, low fat, sweetened
40
Glycaemic
Index
50
60
70
80
90
0
10
20
30
Nutrient Density Score
40
50
Dairy products
Nutrient dilution by sugar
30
Milk, skim
Milk, red. fat
Milk, full fat
Yoghurt, natural
Milk, flavoured
Yoghurt, low fat,
natural
Yoghurt, low fat, sweetened
40
Glycaemic
Index
50
60
70
80
90
0
10
20
30
Nutrient Density Score
40
50
‘Core’ cereal foods – refined/not enriched
30
40
Glycaemic
Index
50
Pasta, white
Semolina
60
Couscous
Polenta
70
80
White rice
90
0
10
20
30
Nutrient Density Score
40
50
‘Core’ cereal foods – refined/not enriched vs
‘non-core’ cereals
30
40
Sponge cake
Glycaemic
Index
50
Cake, banana
Pasta, white
Biscuit,
oatmeal
60
Semolina
Biscuit, shortbread
Couscous
Croissant
Polenta
Biscuit, flaky cracker
70
Donut
Biscuit, cracker
80
White rice
Biscuit, plain, sweet
90
0
10
20
30
Nutrient Density Score
40
50
‘Core’ cereal foods – breakfast cereals
All Bran
30
40
Glycaemic
Index
Rolled oats
50
Sustain
60
Special K
Just Right
Vitabrits
70
Nutrigrain
Sultana Bran
muesli, toasted
WeetBix
Cornflakes
80
Rice Bubbles
90
0
10
20
30
Nutrient Density Score
40
50
‘Core’ cereal foods – breakfast cereals
All Bran
30
40
Glycaemic
Index
Rolled oats
50
Sustain
60
Special K
Just Right
Vitabrits
70
Nutrigrain
Sultana Bran
muesli, toasted
WeetBix
Cornflakes
80
Rice Bubbles
90
0
10
20
30
Nutrient Density Score
40
50
Sugar and nutrient density
“Observed negative associations between added
sugar intake and micronutrient density of the
diet are mainly related to patterns of intake of
the foods from which added sugars in the diet
are derived rather than to intake of added
sugars per se.”
European Food Safety Authority (2010)
Food patterns, sugar and nutrient density
30
Flavoured milk,
fruit yoghurt
40
Glycemic
Index
50
60
Enriched breakfast cereals
70
80
90
0
10
20
30
Nutrient Density Score
40
50
Food patterns, sugar and nutrient density
30
Soft drink,
confectionery
40
Glycemic
Index
Flavoured milk,
fruit yoghurt
Biscuits, cakes,
pastries
50
60
Enriched breakfast cereals
70
80
90
0
10
20
30
Nutrient Density Score
40
50
‘No added sugar’ – potential for adverse effects
30
Milk, flavoured
40
Apple juice
Glycaemic
Index
50
60
70
80
90
0
10
20
30
Nutrient Density Score
40
50
Sugar in breakfast cereals
 10 vitamins and minerals
 50% wholegrain
Sugar in breakfast cereals
 10 vitamins and minerals
 50% wholegrain
 27% sugar!!
Final word
 If nutrient dilution is the concern, make
nutrient density a criterion on which
carbohydrate-rich foods are judged
 Science or dogma?