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. 2020 May 21;15(5):e0231572.
doi: 10.1371/journal.pone.0231572. eCollection 2020.

A comparison of different practical indices for assessing carbohydrate quality among carbohydrate-rich processed products in the US

Junxiu Liu  1 , Colin D Rehm  2 , Peilin Shi  1 , Nicola M McKeown  3 , Dariush Mozaffarian  1 , Renata Micha  1
Affiliations

A comparison of different practical indices for assessing carbohydrate quality among carbohydrate-rich processed products in the US

Junxiu Liu et al. PLoS One. .

Abstract

Healthier carbohydrate (carb)-rich foods are essential for health, but practical, validated indices for their identification are not established. We compared four pragmatic metrics, based on, per 10g of carb:(a) ≥1g fiber (10:1 carb:fiber), (b) ≥1g fiber and <1g free sugars (10:1:1 carb:fiber:free sugars), (c) ≥1g fiber and <2g free sugars (10:1:2 carb:fiber:free sugars); and (d) ≥1g fiber and, per each 1 g of fiber, <2g free sugars (10:1 carb:fiber, 1:2 fiber:free sugars; or 10:1|1:2). Using 2013-2016 National Health and Nutrition Examination Survey /Food and Nutrient Database for Dietary Studies, we assessed, overall and for 12 food categories, whether each metric discriminated carb-rich products higher or lower (per 100g) in calories, total fat, saturated fat, protein, sugar, fiber, sodium, potassium, magnesium, folate, and 8 vitamins/minerals. Among 2,208 carb-rich products, more met 10:1 (23.2%) and 10:1|1:2 (21.3%), followed by 10:1:2 (19.2%) and 10:1:1 (16.4%) ratios, with variation by product sub-categories. The 10:1 and 10:1|1:2 ratios similarly identified products with lower calories, fat, free sugars, and sodium; and higher protein, fiber, potassium, magnesium, iron, vitamin B6, vitamin E, zinc and iron. The 10:1:2 and 10:1:1 ratios identified products with even larger differences in calories and free sugars, but smaller differences in other nutrients above and lower folate, thiamine, riboflavin, and niacin; the latter findings were attenuated after excluding breakfast cereals (~9% of products). These novel findings inform dietary guidance for consumers, policy, and industry to identify and promote the development of the healthier carb-rich foods.

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Conflict of interest statement

Dr. Micha reports research funding from Bill & Melinda Gates Foundation and Danone; and personal fees from Bunge, and Development Initiatives for serving as the co-chair of the Global Nutrition Report; all outside the submitted work; Dr. Mozaffarian reports research funding from the National Institutes of Health and the Gates Foundation; personal fees from GOED, Bunge, Indigo Agriculture, Motif FoodWorks, Amarin, Acasti Pharma, Cleveland Clinic Foundation, America’s Test Kitchen, and Danone; scientific advisory board, Brightseed, DayTwo, Elysium Health, Filtricine, HumanCo, and Tiny Organics; and chapter royalties from UpToDate; all outside the submitted work; Dr. McKeown receives funding, in part, from the General Mills Bell Institute of Health and Nutrition, ILSI North America, Food Minds, and has an unrestricted gift from P&G; and serves on the scientific advisory board for the Whole Grains Council, all outside the submitted work; and Dr. Rehm reports consulting fees from the Dairy Management Institute, PepsiCo, General Mills, Unilever and Florida Department of Citrus; all outside the submitted work. The remaining authors have no conflicts of interest to disclose. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Comparisons of consumed carbohydrate-rich products meeting each of the three nutrient profiling systems classified as either meeting or not meeting each of the four proposed metrics.
These four different carb metrics were based on, per 10g of carb:(a) ≥1g fiber (10:1 carb:fiber), (b) ≥1g fiber and <1g free sugars (10:1:1 carb:fiber:free sugars), (c) ≥1g fiber and <2g free sugars (10:1:2 carb:fiber:free sugars); and (d) ≥1g fiber and, per each 1 g of fiber, <2g free sugars (10:1 carb:fiber, 1:2 fiber:free sugars; or 10:1|1:2). Children included individuals aged 2–19 years old and adults included individuals aged 20 years and older. Ofcom model was developed for the regulation of television advertising to children in the United Kingdom. Foods with a final score of <4 points and beverages scoring <1 point are considered as healthy. The FSANZ (Food Standards Australia New Zealand) model was developed for the regulation of health claims on foods in Australia and New Zealand. Foods with a final score of <4 points and beverages scoring <1 point are meeting score criteria to carry a health claim. The HSR (Health Star Rating) is a government led initiative that scores the nutritional value of packaged foods. It is designed to help consumers make healthier choices when shopping within a category. The score of HSR ranges from ½ star to 5 starts. Foods and beverages with a final score of 3.5 points or more is considered as green or nutritious.
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