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Application of the ≤ 10:1 carbohydrate to fiber ratio to identify healthy grain foods and its association with cardiometabolic risk factors

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Abstract

Purpose

Optimal metrics to assess healthfulness of carbohydrate-rich products are not well established. We investigated how the content per 10 g of carbohydrate of at least 1 g of fiber (≤ 10:1-ratio) related to nutritional quality in grain foods as well as cardiometabolic risk factors in São Paulo, Brazil.

Methods

Data were from the cross-sectional population-based study 2015 Health Survey of São Paulo, including a probabilistic sample of urban residents in the city. Participants (n = 1188) aged 20 + years completed a 24-h dietary recall and a subsample of 603 participants had blood samples, anthropometrics, and blood pressure measurements collected, and answered a second 24-h recall. Energy and nutrient contents of grain foods meeting or not meeting the ≤ 10:1-ratio were evaluated using linear regression models. The association between consumption (percent energy, %E) of grain foods meeting the ≤ 10:1-ratio and cardiometabolic risk factors were investigated using linear regression models.

Results

Foods meeting the ≤ 10:1-ratio had less available carbohydrate (− 3.0 g/serving), total sugar (− 7.4 g/serving), added sugar (− 7.2 g/serving) and saturated fat (− 0.7 g/serving), and more dietary fiber (+ 3.5 g/serving), protein (+ 2.1 g/serving), potassium (+ 100.1 mg/serving), iron (+ 0.9 mg/serving), selenium (+ 4.2 µg/serving), magnesium (+ 38.7 mg/serving), and zinc (+ 1.1 mg/serving). Each increase in 1%E consumption of grain foods meeting the ≤ 10:1-ratio was associated with lower levels of blood triacylglycerol (− 10.7%), the triacylglycerol/high-density lipoprotein cholesterol ratio (− 14.9%), fasting insulin (− 13.6%), and homeostasis model assessment for insulin resistance (− 14.0%).

Conclusion

The ≤ 10:1-ratio identified grain foods with higher nutritional quality and higher intakes of these foods were associated with cardiometabolic risk factors related to atherogenic dyslipidemia and insulin resistance.

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Acknowledgements

We would like to thank all fieldworkers and all participants. We acknowledge the work of Evaluation of Food Consumption Research Group at University of São Paulo with the dietary data, and the contribution of the Cardiovascular Disease Working Group at Tufts University, especially Victoria Miller for further considerations regarding adjustment for energy intake.

Funding

The 2015 Health Survey of São Paulo was supported by the São Paulo Municipal Health Department (Grant number 2013-0.235.936-0), São Paulo Research Foundation (Grant number 2012/22113-9), and National Council for Scientific and Technological Development (Grant numbers 472873/2012-1, 402674/2016-2). This work was supported by São Paulo Research Foundation (Grant numbers 2016/18742-1, 2018/08268-6).

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Authors and Affiliations

  1. Department of Nutrition, School of Public Health, University of São Paulo, Avenida Dr. Arnaldo, 715, Cerqueira Cesar, São Paulo, SP, 01246-904, Brazil

    Mariane de Mello Fontanelli, Cristiane Hermes Sales & Regina Mara Fisberg

  2. Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Avenue, Boston, MA, 02111, USA

    Renata Micha, Junxiu Liu & Dariush Mozaffarian

Authors
  1. Mariane de Mello Fontanelli
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  2. Renata Micha
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  3. Cristiane Hermes Sales
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  4. Junxiu Liu
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  5. Dariush Mozaffarian
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  6. Regina Mara Fisberg
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Contributions

MMF, RM, DM, and RMF conceptualized the study. MMF, CHS, JL performed data management and statistical analysis. RM, DM, and RMF supervised the analyses. MMF wrote the original draft. JL, CHS, RM, DM, and RMF critically reviewed the manuscript for important intellectual content. All authors approved the version to be published.

Corresponding author

Correspondence to Regina Mara Fisberg.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The 2015 ISA-Capital and the present study were approved by the School of Public Health, University of São, Brazil Institutional Review Board (certificate of presentation for ethical appreciation #32344014.3.0000.5421, #36607614.5.0000.5421, and #65484517.5.0000.5421). All participants provided written informed consent.

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Fontanelli, M.M., Micha, R., Sales, C.H. et al. Application of the ≤ 10:1 carbohydrate to fiber ratio to identify healthy grain foods and its association with cardiometabolic risk factors. Eur J Nutr 59, 3269–3279 (2020). https://doi.org/10.1007/s00394-019-02165-4

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