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Chapter 6 - Recommendations

The following recommendations are derived from the Consultation discussions and resulting conclusions detailed in the report. Specific recommendations are grouped under the appropriate report headings.

The role of carbohydrates in nutrition

The Consultation RECOMMENDS:

1. That the terminology used to describe dietary carbohydrate be standardized with carbohydrates classified primarily by molecular size (degree of polymerization or DP) into sugars (DP 1-2), oligosaccharides (DP 3-9) and polysaccharides (DP 10+). Further subdivision can be made on the basis of monosaccharide composition. Nutritional groupings can then be made on the basis of physiological properties.

2. That the concept of glycemic carbohydrate, meaning "providing carbohydrate for metabolism" be adopted.

3. Against the use of the terms extrinsic and intrinsic sugars, complex carbohydrate and available and unavailable carbohydrate.

4. That food laboratories measure total carbohydrate in the diet as the sum of the individual carbohydrates and not "by difference".

5. That the use of the term dietary fibre should always be qualified by a statement itemizing those carbohydrates and other substances intended for inclusion. Dietary fibre is a nutritional concept, not an exact description of a component of the diet.

6. That the use of the terms soluble and insoluble dietary fibre be gradually phased out. The Consultation recognized that these terms are presently used but does not consider them a useful division either analytically or physiologically

7. That the analysis and labelling of dietary carbohydrate, for whatever purpose, be based on the chemical divisions recommended. Additional groupings such as polyols, resistant starch, non-digestible oligosaccharides and dietary fibre can be used, provided the included components are clearly defined.

8. That the energy value of all carbohydrate in the diet be reassessed using modern nutritional and other techniques. However, for carbohydrates which reach the colon, the Consultation recommends that the energy value be set at 2 kcal/g (8 kJ/g) for nutritional and labelling purposes.

9. That the continued production and consumption of root crops and pulses be encouraged to ensure the adequacy and diversity of the supply of carbohydrate.

10. That the continued consumption of traditional foods rich in carbohydrate should be encouraged where populations are in transition from a subsistence rural economy to more prosperous urban lifestyles. Processed foods are likely to be a substantial part of the diet and processing can be used to optimize nutritional properties.

The role of carbohydrates in the maintenance of health

The Consultation RECOMMENDS:

11. That the many health benefits of dietary carbohydrates should be recognized and promoted. Carbohydrate foods provide more than energy alone.

12. An optimum diet of at least 55% of total energy from a variety of carbohydrate sources for all ages except for children under the age of two. Fat should not be specifically restricted below the age of 2 years. The optimum diet should be gradually introduced beginning at 2 years of age.

13. That energy balance be maintained by consuming a diet containing at least 55% total energy from carbohydrate from various sources and engaging in regular physical activity.

14. Against consuming carbohydrate levels above the optimum, including carbohydrate-containing beverages, for purposes of recreational physical activity. Higher carbohydrate intakes are only needed for long-term extreme endurance physical activities.

15. That, as a general rule, a nutrient-dense, high carbohydrate diet be considered optimal for the elderly, but that individualization is recommended because their specific nutritional needs are complex.

Dietary carbohydrate and disease

The Consultation RECOMMENDS:

16. That a wide range of carbohydrate-containing foods be consumed so that the diet is sufficient in essential nutrients as well as total energy, especially when carbohydrate intake is high.

17. That the bulk of carbohydrate-containing foods consumed be those rich in non-starch polysaccharides and with a low glycemic index. Appropriately processed cereals, vegetables, legumes, and fruits are particularly good food choices.

18. That excess energy intake in any form will cause body fat accumulation, so that excess consumption of low fat foods, while not as obesity-producing as excess consumption of high fat products, will lead to obesity if energy expenditure is not increased. Excessive intakes of sugars which compromise micronutrient density should be avoided. There is no evidence of a direct involvement of sucrose, other sugars and starch in the etiology of lifestyle-related diseases.

19. That national governments provide populations in transition from traditional diets to those characteristic of developed countries, with dietary recommendations to ensure nutritional adequacy and retention of an appropriate balance of macronutrients.

The role of glycemic index in food choice

The Consultation RECOMMENDS:

20. That for healthy food choices, both the chemical composition and physiologic effects of food carbohydrates be considered, because the chemical nature of the carbohydrates in foods does not completely describe their physiological effects.

21. That, in making food choices, the glycemic index be used as a useful indicator of the impact of foods on the integrated response of blood glucose. Clinical application includes diabetes and impaired glucose tolerance. It is recommended that the glycemic index be used to compare foods of similar composition within food groups.

22. That published glycemic response data be supplemented where possible with tests of local foods as normally prepared, because of the important effects that food variety and cooking can have on glycemic responses.

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