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Total dietary carbohydrate, sugar, starch and fibre intakes in the European Prospective Investigation into Cancer and Nutrition

Abstract

Objective:

To describe dietary carbohydrate intakes and their food sources among 27 centres in 10 countries participating in the European Prospective Investigation into Cancer and Nutrition (EPIC) study.

Methods:

Between 1995 and 2000, 36 034 subjects, aged between 35–74 years, were administered a standardized, 24-h dietary recall using a computerized interview software programme (EPIC-SOFT). Intakes (g/day) of total carbohydrate, sugars, starch and fibre were estimated using the standardized EPIC Nutrient Database (ENDB). Mean intakes were adjusted for age, total energy intake, height and weight, and were weighted by season and day of recall.

Results:

Adjusted mean total carbohydrate intakes were highest in Italy and in the UK health-conscious cohort, and were lowest in Spain, Greece and France. Total fibre intakes were highest in the UK health-conscious cohort and lowest in Sweden and the UK general population. Bread contributed the highest proportion of carbohydrates (mainly starches) in every centre. Fruit consumption contributed a greater proportion of total carbohydrates (mainly sugars) among women than among men, and in southern centres compared with northern centres. Bread, fruits and vegetables represented the largest sources of fibre, but food sources varied considerably between centres. In stratified analyses, carbohydrate intakes tended to be higher among subjects who were physically active, never-smokers or non-drinkers of alcohol.

Conclusions:

Dietary carbohydrate intakes and in particular their food sources varied considerably between these 10 European countries. Intakes also varied according to gender and lifestyle factors. These data will form the basis for future aetiological analyses of the role of dietary carbohydrates in influencing health and disease.

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References

  • Augustin LS, Franceschi S, Jenkins DJ, Kendall CW, La Vecchia C (2002). Glycemic index in chronic disease: a review. Eur J Clin Nutr 56, 1049–1071.

    Article  CAS  PubMed  Google Scholar 

  • Becker W (1999). Dietary guidelines and patterns of food and nutrient intake in Sweden. Br J Nutr 81 (Suppl 2), S113–S117.

    Article  PubMed  Google Scholar 

  • Brustad M, Skeie G, Braaten T, Slimani N, Lund E (2003). Comparison of telephone vs face-to-face interviews in the assessment of dietary intake by the 24 h recall EPIC SOFT program-the Norwegian calibration study. Eur J Clin Nutr 57, 107–113.

    Article  CAS  PubMed  Google Scholar 

  • Cust AE, Slimani N, Kaaks R, van Bakel M, Biessy C, Ferrari P et al. (2007). Dietary carbohydrates, glycemic index, glycemic load, and endometrial cancer risk within the European Prospective Investigation into Cancer and Nutrition Cohort. Am J Epidemiol 166, 912–923.

    Article  PubMed  Google Scholar 

  • Daly M (2003). Sugars, insulin sensitivity, and the postprandial state. Am J Clin Nutr 78, S865–S872.

    Article  Google Scholar 

  • Daly ME, Vale C, Walker M, Alberti KG, Mathers JC (1997). Dietary carbohydrates and insulin sensitivity: a review of the evidence and clinical implications. Am J Clin Nutr 66, 1072–1085.

    Article  CAS  PubMed  Google Scholar 

  • Deharveng G, Charrondiere UR, Slimani N, Southgate DA, Riboli E (1999). Comparison of nutrients in the food composition tables available in the nine European countries participating in EPIC. European Prospective Investigation into Cancer and Nutrition. Eur J Clin Nutr 53, 60–79.

    Article  CAS  PubMed  Google Scholar 

  • DeVries JW, Rader JI (2005). Historical perspective as a guide for identifying and developing applicable methods for dietary fiber. J AOAC Int 88, 1349–1366.

    CAS  PubMed  Google Scholar 

  • Dreon DM, Frey-Hewitt B, Ellsworth N, Williams PT, Terry RB, Wood PD (1988). Dietary fat:carbohydrate ratio and obesity in middle-aged men. Am J Clin Nutr 47, 995–1000.

    Article  CAS  PubMed  Google Scholar 

  • Englyst KN, Liu S, Englyst HN (2007). Nutritional characterization and measurement of dietary carbohydrates. Eur J Clin Nutr 61 (Suppl 1), S19–S39.

    Article  CAS  PubMed  Google Scholar 

  • Ferrari P, Kaaks R, Fahey MT, Slimani N, Day NE, Pera G et al. (2004). Within- and between-cohort variation in measured macronutrient intakes, taking account of measurement errors, in the European Prospective Investigation into Cancer and Nutrition study. Am J Epidemiol 160, 814–822.

    Article  PubMed  Google Scholar 

  • Ferrari P, Roddam A, Fahey MT, Jenab M, Bamia C, Ocké M et al. (2009). A bivariate measurement error model for nitrogen and potassium intakes to evaluate the performance of regression calibration in the European Prospective Investigation into Cancer and Nutrition study. Eur J Clin Nutr 63 (Suppl 4), S179–S187.

    Article  CAS  PubMed  Google Scholar 

  • Ferrari P, Slimani N, Ciampi A, Trichopoulou A, Naska A, Lauria C et al. (2002). Evaluation of under- and overreporting of energy intake in the 24-hour diet recalls in the European Prospective Investigation into Cancer and Nutrition (EPIC). Public Health Nutr 5 (Suppl), S1329–S1345.

    Article  Google Scholar 

  • Haftenberger M, Lahmann PH, Panico S, Gonzalez CA, Seidell JC, Boeing H et al. (2002a). Overweight, obesity and fat distribution in 50- to 64-year-old participants in the European Prospective Investigation into Cancer and Nutrition (EPIC). Public Health Nutr 5 (Suppl), S1147–S1162.

    Article  Google Scholar 

  • Haftenberger M, Schuit AJ, Tormo MJ, Boeing H, Wareham N, Bueno-de-Mesquita HB et al. (2002b). Physical activity of subjects aged 50–64 years involved in the European Prospective Investigation into Cancer and Nutrition (EPIC). Public Health Nutr 5 (Suppl), S1163–S1176.

    Article  Google Scholar 

  • Haraldsdottir J (1999). Dietary guidelines and patterns of intake in Denmark. Br J Nutr 81 (Suppl 2), S43–S48.

    Article  PubMed  Google Scholar 

  • Henderson L, Gregory J, Irving K, Swan G (2003). The National Diet & Nutrition Survey: Adults Aged 19 to 64 years: Energy, Protein, Carbohydrate, Fat and Alcohol Intake 2, Stationery Office: London.

    Google Scholar 

  • Holt SH, Miller JC, Petocz P (1997). An insulin index of foods: the insulin demand generated by 1000-kJ portions of common foods. Am J Clin Nutr 66, 1264–1276.

    Article  CAS  PubMed  Google Scholar 

  • Hu FB, van Dam RM, Liu S (2001). Diet and risk of type II diabetes: the role of types of fat and carbohydrate. Diabetologia 44, 805–817.

    Article  CAS  PubMed  Google Scholar 

  • Johansson L, Solvoll K, Bjorneboe GEA, Drevon CA (1997). Dietary habits among Norwegian men and women. Scand J Nutr 41, 63–70.

    Google Scholar 

  • Kaaks R, Plummer M, Riboli E, Esteve J, van Staveren W (1994). Adjustment for bias due to errors in exposure assessments in multicenter cohort studies on diet and cancer: a calibration approach. Am J Clin Nutr 59, S245–S250.

    Article  Google Scholar 

  • Kaaks R, Riboli E, van Staveren W (1995). Calibration of dietary intake measurements in prospective cohort studies. Am J Epidemiol 142, 548–556.

    Article  CAS  PubMed  Google Scholar 

  • Key TJ, Spencer EA (2007). Carbohydrates and cancer: an overview of the epidemiological evidence. Eur J Clin Nutr 61 (Suppl 1), S112–S121.

    Article  CAS  PubMed  Google Scholar 

  • Lissner L (2002). Measuring food intake in studies of obesity. Public Health Nutr 5, 889–892.

    Article  PubMed  Google Scholar 

  • Mann J, Cummings JH, Englyst HN, Key T, Liu S, Riccardi G et al. (2007). FAO/WHO scientific update on carbohydrates in human nutrition: conclusions. Eur J Clin Nutr 61 (Suppl 1), S132–S137.

    Article  CAS  PubMed  Google Scholar 

  • Marti-Henneberg C, Capdevila F, Arija V, Perez S, Cuco G, Vizmanos B et al. (1999). Energy density of the diet, food volume and energy intake by age and sex in a healthy population. Eur J Clin Nutr 53, 421–428.

    Article  CAS  PubMed  Google Scholar 

  • Mazlan N, Horgan G, Whybrow S, Stubbs J (2006). Effects of increasing increments of fat- and sugar-rich snacks in the diet on energy and macronutrient intake in lean and overweight men. Br J Nutr 96, 596–606.

    CAS  PubMed  Google Scholar 

  • Meyer KA, Kushi LH, Jacobs Jr DR, Slavin J, Sellers TA, Folsom AR (2000). Carbohydrates, dietary fiber, and incident type 2 diabetes in older women. Am J Clin Nutr 71, 921–930.

    Article  CAS  PubMed  Google Scholar 

  • Moreno LA, Sarria A, Popkin BM (2002). The nutrition transition in Spain: a European Mediterranean country. Eur J Clin Nutr 56, 992–1003.

    Article  CAS  PubMed  Google Scholar 

  • Nishida C, Martinez Nocito F (2007). FAO/WHO scientific update on carbohydrates in human nutrition: introduction. Eur J Clin Nutr 61 (Suppl 1), S1–S4.

    Article  PubMed  Google Scholar 

  • Ocké MC, Larrañaga N, Grioni S, van den Berg SW, Ferrari P, Salvini S et al. (2009). Energy intake and sources of energy intake in the European Prospective Investigation into Cancer and Nutrition. Eur J Clin Nutr 63 (Suppl 4), S3–S15.

    Article  PubMed  Google Scholar 

  • Riboli E, Hunt KJ, Slimani N, Ferrari P, Norat T, Fahey M et al. (2002). European Prospective Investigation into Cancer and Nutrition (EPIC): study populations and data collection. Public Health Nutr 5 (Suppl), S1113–S1124.

    Article  Google Scholar 

  • Rimm EB, Ascherio A, Giovannucci E, Spiegelman D, Stampfer MJ, Willett WC (1996). Vegetable, fruit, and cereal fiber intake and risk of coronary heart disease among men. JAMA 275, 447–451.

    Article  CAS  PubMed  Google Scholar 

  • Saris WH (1989). Physiological aspects of exercise in weight cycling. Am J Clin Nutr 49, 1099–1104.

    Article  CAS  PubMed  Google Scholar 

  • Saris WH (2003). Sugars, energy metabolism, and body weight control. Am J Clin Nutr 78, S850–S857.

    Article  Google Scholar 

  • Selwitz RH, Ismail AI, Pitts NB (2007). Dental caries. Lancet 369, 51–59.

    Article  CAS  PubMed  Google Scholar 

  • Slimani N, Bingham S, Runswick S, Ferrari P, Day NE, Welch AA et al. (2003). Group level validation of protein intakes estimated by 24-hour diet recall and dietary questionnaires against 24-hour urinary nitrogen in the European Prospective Investigation into Cancer and Nutrition (EPIC) calibration study. Cancer Epidemiol Biomarkers Prev 12, 784–795.

    PubMed  Google Scholar 

  • Slimani N, Deharveng G, Charrondiere RU, van Kappel AL, Ocke MC, Welch A et al. (1999). Structure of the standardized computerized 24-h diet recall interview used as reference method in the 22 centers participating in the EPIC project. European Prospective Investigation into Cancer and Nutrition. Comput Methods Programs Biomed 58, 251–266.

    Article  CAS  PubMed  Google Scholar 

  • Slimani N, Deharveng G, Unwin I, Southgate DA, Vignat J, Skeie G et al. (2007). The EPIC nutrient database project (ENDB): a first attempt to standardize nutrient databases across the 10 European countries participating in the EPIC study. Eur J Clin Nutr 61, 1037–1056.

    Article  CAS  PubMed  Google Scholar 

  • Slimani N, Fahey M, Welch AA, Wirfalt E, Stripp C, Bergstrom E et al. (2002a). Diversity of dietary patterns observed in the European Prospective Investigation into Cancer and Nutrition (EPIC) project. Public Health Nutr 5 (Suppl), S1311–S1328.

    Article  Google Scholar 

  • Slimani N, Ferrari P, Ocke M, Welch A, Boeing H, Liere M et al. (2000). Standardization of the 24-hour diet recall calibration method used in the European Prospective Investigation into Cancer and Nutrition (EPIC): general concepts and preliminary results. Eur J Clin Nutr 54, 900–917.

    Article  CAS  PubMed  Google Scholar 

  • Slimani N, Kaaks R, Ferrari P, Casagrande C, Clavel-Chapelon F, Lotze G et al. (2002b). European Prospective Investigation into Cancer and Nutrition (EPIC) calibration study: rationale, design and population characteristics. Public Health Nutr 5, 1125–1145.

    Article  CAS  PubMed  Google Scholar 

  • Slimani N, Valsta L, EFCOSUM Group (2002c). Perspectives of using the EPIC-SOFT programme in the context of pan-European nutritional monitoring surveys: methodological and practical implications. Eur J Clin Nutr 56, S63–S74.

    Article  PubMed  Google Scholar 

  • Smith U (1994). Carbohydrates, fat, and insulin action. Am J Clin Nutr 59, S686–S689.

    Article  Google Scholar 

  • Spiegelman D (2004). Commentary: correlated errors and energy adjustment-where are the data? Int J Epidemiol 33, 1387–1388.

    Article  PubMed  Google Scholar 

  • Stephen AM, Sieber GM, Gerster YA, Morgan DR (1995). Intake of carbohydrate and its components-international comparisons, trends over time, and effects of changing to low-fat diets. Am J Clin Nutr 62, S851–S867.

    Article  Google Scholar 

  • Troisi RJ, Heinold JW, Vokonas PS, Weiss ST (1991). Cigarette smoking, dietary intake, and physical activity: effects on body fat distribution-the Normative Aging Study. Am J Clin Nutr 53, 1104–1111.

    Article  CAS  PubMed  Google Scholar 

  • Turrini A, Leclercq C, D’Amicis A (1999). Patterns of food and nutrient intakes in Italy and their application to the development of food-based dietary guidelines. Br J Nutr 81 (Suppl 2), S83–S89.

    Article  PubMed  Google Scholar 

  • van Dam RM, Seidell JC (2007). Carbohydrate intake and obesity. Eur J Clin Nutr 61 (Suppl 1), S75–S99.

    Article  CAS  PubMed  Google Scholar 

  • Volatier JL, Verger P (1999). Recent national French food and nutrient intake data. Br J Nutr 81 (Suppl 2), S57–S59.

    Article  PubMed  Google Scholar 

  • Willett W (1998). Nutritional Epidemiology, 2nd edn. Oxford University Press: New York.

    Book  Google Scholar 

  • Wirfalt E, McTaggart A, Pala V, Gullberg B, Frasca G, Panico S et al. (2002). Food sources of carbohydrates in a European cohort of adults. Public Health Nutr 5, 1197–1215.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

This work was carried out with the financial support of the European Commission: Public Health and Consumer Protection Directorate 1993–2004; Research Directorate-General 2005; Ligue contre le Cancer (France); Société 3M (France); Mutuelle Générale de l’Education Nationale; Institut National de la Santé et de la Recherche Médicale (INSERM); Institut Gustave Roussy; German Cancer Aid; German Cancer Research Center; German Federal Ministry of Education and Research; Danish Cancer Society; Health Research Fund (FIS) of the Spanish Ministry of Health; Spanish Regional Governments of Andalucía, Asturias, Basque Country, Murcia and Navarra and the Catalan Institute of Oncology; and ISCIII RETIC (RD06/0020), Spain; Cancer Research UK; Medical Research Council, UK; the Stroke Association, UK; British Heart Foundation; Department of Health, UK; Food Standards Agency, UK; the Wellcome Trust, UK; Greek Ministry of Health; Hellenic Health Foundation; Italian Association for Research on Cancer; Italian National Research Council, Regione Sicilia (Sicilian government); Associazione Iblea per la Ricerca Epidemiologica—ONLUS (Hyblean association for epidemiological research, NPO); Dutch Ministry of Health, Welfare and Sport; Dutch Prevention Funds; LK Research Funds; Dutch ZON (Zorg Onderzoek Nederland); World Cancer Research Fund (WCRF); Swedish Cancer Society; Swedish Research Council; Regional Government of Skane and the County Council of Vasterbotten, Sweden; Norwegian Cancer Society; the Norwegian Research Council and the Norwegian Foundation for Health and Rehabilitation. Anne Cust received a PhD scholarship from the University of Sydney, a Research Scholar Award from the Cancer Institute NSW, and a NHMRC Public Health Research Fellowship (520018), Australia. We thank Sarah Somerville, Nicole Suty and Karima Abdedayem for their assistance with editing, Kimberley Bouckaert and Heinz Freisling for their technical assistance, and Carine Biessy for statistical support.

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Correspondence to A E Cust.

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Guarantor: AE Cust.

Contributions: AEC carried out the statistical analysis, preparation of tables and figures, and wrote the paper, taking into account comments from all co-authors. NS was the overall coordinator of this project and of the EPIC nutritional databases (ENDB) project. MRS, MvB, JH, AO, CA, TP, EB, ES, MDC were members of the writing group and gave input on the statistical analysis, drafting of the manuscript and interpretation of results. The other EPIC authors were local EPIC collaborators involved in the collection of dietary and other data, and in the ENDB project. ER is the overall coordinator of the EPIC study. All co-authors provided comments and suggestions on the manuscript and approved the final version.

Appendix

Appendix

Tables A1a, A1b, A1c and A1d

Table a1a Fully adjusteda mean daily intakes of total carbohydrates (g/day) by centre, ordered from south to north, gender and age group
Table a1b Fully adjusteda mean daily intakes of total sugars (g/day) by centre, ordered from south to north, gender and age group
Table a1c Fully adjusteda mean daily intakes of total starch (g/day) by centre, ordered from south to north, gender and age group
Table a1d Fully adjusteda mean daily intakes of total fibre (g/day) by centre, ordered from south to north, gender and age group

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Cust, A., Skilton, M., van Bakel, M. et al. Total dietary carbohydrate, sugar, starch and fibre intakes in the European Prospective Investigation into Cancer and Nutrition. Eur J Clin Nutr 63 (Suppl 4), S37–S60 (2009). https://doi.org/10.1038/ejcn.2009.74

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