Carbohydrates and Dietary Fiber

  • P.M. Suter
Part of the Handbook of Experimental Pharmacology book series (HEP, volume 170)


The most widely spread eating habit is characterized by a reduced intake of dietary fiber, an increased intake of simple sugars, a high intake of refined grain products, an altered fat composition of the diet, and a dietary pattern characterized by a high glycemic load, an increased body weight and reduced physical activity. In this chapter the effects of this eating pattern on disease risk will be outlined. There are no epidemiological studies showing that the increase of glucose, fructose or sucrose intake is directly and independently associated with an increased risk of atherosclerosis or coronary heart disease (CHD). On the other hand a large number of studies has reported a reduction of fatal and non-fatal CHD events as a function of the intake of complex carbohydrates—respectively ‘dietary fiber’ or selected fiber-rich food (e.g., whole grain cereals). It seems that eating too much ‘fast’ carbohydrate [i.e., carbohydrates with a high glycemic index (GI)] may have deleterious long-term consequences. Indeed the last decades have shown that a low fat (and consecutively high carbohydrate) diet alone is not the best strategy to combat modern diseases including atherosclerosis. Quantity and quality issues in carbohydrate nutrient content are as important as they are for fat. Multiple lines of evidence suggest that for cardiovascular disease prevention a high sugar intake should be avoided. There is growing evidence of the high impact of dietary fiber and foods with a low GI on single risk factors (e.g., lipid pattern, diabetes, inflammation, endothelial function etc.) as well as also the development of the endpoints of atherosclerosis especially CHD.


Carbohydrates Dietary fiber Glucose Fructose Glycemic index Obesity Metabolic syndrome Diabetes mellitus 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Acheson K, Flatt JP, Jéquier E (1982) Glycogen synthesis versus lipogenesis after a 500 gram carbohydrate meal in man. Metabolism 31:1234–1240PubMedGoogle Scholar
  2. Adult-Treatment-Panel-III (2002) Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation 106:3143–3421Google Scholar
  3. Albrink MJ, Ullrich IH (1986) Interaction of dietary sucrose and fiber on serum lipids in healthy young men fed high carbohydrate diets. Am J Clin Nutr 43:419–428PubMedGoogle Scholar
  4. Alexander JK (2001) Obesity and coronary heart disease. Am J Med Sci 321:215–224CrossRefPubMedGoogle Scholar
  5. Anderson JW (2000) Dietary Fiber prevents carbohydrate-induced hypertriglyceridemia. Curr Athero Rep 2:536–541Google Scholar
  6. Anderson JW, Story L, Sieling B, Chen WJ, Petro MS, Story J (1984) Hypocholesterolemic effects of oat-bran or bean intake for hypercholesterolemic men. Am J Clin Nutr 40:1146–1155PubMedGoogle Scholar
  7. Anderson JW, Davidson MH Blonde L, Brown WV, Howard WJ, Ginsberg H, Allgood LD, Weingand KW (2000) Long-term cholesterol-lowering effects of psyllium as an adjunct to diet therapy in the treatment of hypercholesterolemia. Am J Clin Nutr 71:1433–1438PubMedGoogle Scholar
  8. Appel LJ, Moore TJ, Obarzanek E, Vollmer WM, Svetkey LP, Sacks FM, Bray GA, Vogt TM, Cutler JA, Windhauser MM (1997) A clinical trial of the effects of dietary patterns on blood pressure. N Engl J Med 336:1117–1124PubMedGoogle Scholar
  9. Archer SL, Liu K, Dyer AR, Ruth KJ, Jacobs DR, Van-Horn L, Hilner JE, Savage PJ (1998) Relationship between changes in dietary sucrose and high density lipoprotein cholesterol: the CARDIA Study. Coronary Artery Risk Development in Young Adults. Ann Epidemiol 8:433–438PubMedGoogle Scholar
  10. Aronson D, Rayfield EJ (2002) How hyperglycemia promotes atherosclerosis: molecular mechanisms. Cardiovascular Diabetology 1:1–10CrossRefPubMedGoogle Scholar
  11. Asztalos BF, Schaefer EJ (2003) HDL in atherosclerosis: actor or bystander? Atheroscler 4(Suppl):21–29CrossRefGoogle Scholar
  12. Augustin LS, Franceschi S, Jenkins DJA, Kendall CWC, La-Vecchia C (2002) Glycemic index in chronic disease: A review. Eur J Clin Nutr 56:1049–1071CrossRefPubMedGoogle Scholar
  13. Austin MA, Holkanson JE, Edwards KL (1998) Hypertriglyceridemia as a cardiovascular risk factor. Am J Cardiol 81:7B–12BCrossRefPubMedGoogle Scholar
  14. Ball SD, Keller KR, Moyer-Mileur LJ, Ding YW, Donaldsen D, Jackson DW (2003) Prolongation of Satiety After Long Versus Moderately High Glycemic Index Meals in Obese Adolescents. Pediatrics 111:488–494CrossRefPubMedGoogle Scholar
  15. Bantle JP, Raatz SK, Thomas W, Georgopoulos A (2000) Effects of dietary fructose on plasma lipids in healthy subjects. Am J Clin Nutr 72:1128–1134PubMedGoogle Scholar
  16. Barnard RJ, DiLauro SC, Inkeles SB (1997) Effects of intensive diet and exercise intervention in patients taking cholesterol-lowering drugs. Am J Cardiol 15:1112–1114CrossRefGoogle Scholar
  17. Bartnikowska E (1999) The role of dietary fiber in the prevention of lipid metabolism disorders. In: Cho SS, Prosky L, Dreher M. Complex carbohydrates in foods. Marcel Dekker Inc., NewYork, pp 53–62Google Scholar
  18. Bazzano LA, He J, Ogden LG, Loria CM, Whelton PK (2003) Dietary fiber intake and reduced risk of coronary heart disease in US men and women. Arch Intern Med 163:1897–1904PubMedGoogle Scholar
  19. Bell S, Goldman VM, Bistrian BR, Arnold AH, Ostroff G, Forse RA (1999) Effect of beta-glucan from oats and yeast on serum lipids. Crit Rev Food Sci Nutr 39:189–202PubMedGoogle Scholar
  20. Bermudez OI, Tucker KL (2003) Trends in dietary patterns of Latin American populations. Cad Saude Publica 19(Suppl 1):S87–S99PubMedGoogle Scholar
  21. Bjoerck I, Elmstahl HL (2003) The glycemic index: importance of dietary fiber and other food properties. Proceeding of the Nutrition Society 62:201–206Google Scholar
  22. Bolton-Smith C, Woodward M(1994) Coronary heart disease: prevalence and dietary sugars in Scotland. J Epidemiol Community Health 48:119–222PubMedGoogle Scholar
  23. Bosello O, Zamboni M (2000) Visceral obesity and metabolic syndrome. Obes Rev 1:47–56CrossRefPubMedGoogle Scholar
  24. Bosello O, Ostuzzi R, Armellini F, Micciolo R, Scuro LA (1980) Glucose tolerance and blood lipids in bran-fed patients with impaired glucose tolerance. Diabetes Care 26:272–277Google Scholar
  25. Bourdon I, Yokoyama W, Davis P, Hudson C, Backus R, Richter D, Knuckles B, Schneeman BO (1999) Postprandial lipid, glucose, insulin, and cholecystokinin responses in men fed barley pasta enriched with beta-glucan. Am J Clin Nutr 69:55–63PubMedGoogle Scholar
  26. Brand-Miller J, Hayne S, Petocz P, Colagiuri S (2003) Low-glycemic index diets in the management of diabetes: a meta-analysis of randomized controlled trials. Diabetes Care 26:2261–2267PubMedGoogle Scholar
  27. Brown L, Rosner B, Willett W, Sacks FM (1999) Cholesterol-lowering effects of dietary fiber: a meta-analysis. Am J Clin Nutr 69:30–42PubMedGoogle Scholar
  28. Brunzell JD, Hazzard WR, Porte D, Bierman EL (1973) Evidence for a common, saturable, triglyceride removal mechanism for chylomicrons and very low density lipoproteins in man. J Clin Invest 52:1578–1585PubMedGoogle Scholar
  29. Capewell S, Morrison CE, McMurray JJ (1999) Contributions of modern cardiovascular treatment and risk factor changes in the decline in coronary heart disease mortality in Scotland between 1975 and 1994. Heart 81:380–386PubMedGoogle Scholar
  30. Castro-Cabezas M, Halkes CJ, Erkelens DW (2001) Obesity and free fatty acids: double trouble. Nutr Metab Cardiovasc Dis 11:134–142PubMedGoogle Scholar
  31. Center for Science in Public Interest (CSPI), Website accessed October 20, 20013. Scholar
  32. Chen HL, Sheu WH, Tai TS, Liaw YP, Chen YC (2003) Konjac supplement alleviated hypercholesterolemia and hyperglycemia in type 2 diabetic subjects—a randomized double-blind trial. J Am Coll Nutr 22:36–42PubMedGoogle Scholar
  33. Cho SS, Prosky L, Dreher M (1999) Complex carbohydrates in foods. Marcel Dekker Inc., New YorkGoogle Scholar
  34. Ciccarone E, Di Castelnuovo A, Salcuni M, Siani A, Giacco A, Donati MB, De Gaetano G, Capani F, Iacoviello L (2003) A high-score Mediterranean dietary pattern is associated with a reduced risk of peripheral arterial disease in Italian patients with Type 2 diabetes. J Thromb Haemostasis 1:1744–1752CrossRefGoogle Scholar
  35. Cicero AF, Gaddi A (2001) Rice bran oil and gamma-oryzanol in the treatment of hyperlipoproteinaemias and other conditions. Phytother Res 15:277–289CrossRefPubMedGoogle Scholar
  36. Clemmer KF, Binkoski AE, Coval SM, Zhao G, Kris-Etherton PM (2001) Diet and drug therapy: A dynamic duo for reducing coronary heart disease risk. Curr Athero Rep 3:507–513Google Scholar
  37. Clifton PM (2003) Diet and C-reactive protein. Curr Atheroscler Rep 5:431–436PubMedGoogle Scholar
  38. Clifton P, Noakes M, Nestel P(1994) Gender anddiet interactionswith simvastatin treatment. Atherosclerosis 110:25–33PubMedGoogle Scholar
  39. Davidson MH, Dugan LD, Burns JH, Bova J, Story K, Drennan KB (1991) The hypocholesterolemic effects of beta-glucan in oatmeal and oat bran. A dose controlled study. JAMA 265:1833–1839CrossRefPubMedGoogle Scholar
  40. Delaney B, Nicolosi RJ, Wilson TA, Carlson T, Frazer S, Zheng GH, Hess R, Ostergren K, Haworth J, Knutson N (2003) Beta-glucan fractions from barley and oats are similarly antiatherogenic in hypercholesterolemic Syrian golden hamsters. J Nutr 133:468–475PubMedGoogle Scholar
  41. de-Lorgeril M, Salen P, Martin JL, Monjaud I, Delaye J, Mamelle N (1999) Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarction: final report of the Lyon Diet Heart Study. Circulation 99:779–785PubMedGoogle Scholar
  42. DeVries JW(2003) On defining dietary fibre. Proc Nutr Soc 62:37–43Google Scholar
  43. Dubois C, Beaumier G et al. (1998) Effects of graded amounts (0–50 g) of dietary fat on postprandial lipemia and lipoproteins in normolipidemic adults. Am J Clin Nutr 67:31–38PubMedGoogle Scholar
  44. Dumesnil JG, Turgeon J, Tremblay A, Poirier P, Gilbert M, Gagnon L, St-Pierre S, Garneau C, Lemieux I, Pascot A (2001) Effect of a low-glycaemic index-low-fat-high protein diet on the atherogenic metabolic risk profile of abdominally obese men. Br J Nutr 86:557–568PubMedGoogle Scholar
  45. Durstine JL, Grandjean PW, Cox CA, Thompson PD(2002) Lipids, lipoproteins, and exercise. J Cardiopulm Rehabil 22:385–398CrossRefPubMedGoogle Scholar
  46. Dwyer T, Emmanuel SC, Janus ED, Wu Z, Hynes KL, Zhang C (2003) The emergence of coronary heart disease in populations of Chinese descent. Atherosclerosis 167:303–310CrossRefPubMedGoogle Scholar
  47. Ebbeling CB, Leidig MM, Sinclair KB, Hangen JP, Ludwig DS (2003) A reduced-glycemic load diet in the treatment of adolescent obesity. Arch Pediatr Adolesc Med 157:773–779CrossRefPubMedGoogle Scholar
  48. Economic-Research-Service (2003) U.S. Department of Agriculture. Briefing room: Food consumption. (2003) Economic-Research-Service, 3743 (Accessed October 10, 2003)Google Scholar
  49. Egusa G, Watanabe H, Ohshita K, Fujikawa R, Yamane K, Okubo M, Kohno N (2002) Influence of the extent of westernization of lifestyle on the progression of preclinical atherosclerosis in Japanese subjects. J Atheroscler Thromb 9:299–304PubMedGoogle Scholar
  50. Engelyst KN, Vinoy S, Engelyst HN, Lang V (2003) Glycemic index of cereal products explained by their content of rapidly and slowly available glucose. Br J Nutr 89:329–339CrossRefPubMedGoogle Scholar
  51. Ernst N, Fisher M, Smith W, Gordon T, Rifkind BM, Little JA, Mishkel MA, Williams OD (1980) The association of plasma high-density lipoprotein cholesterol with dietary intake and alcohol consumption. The Lipid Research Clinics Prevalence Study. Circulation 62:41–52Google Scholar
  52. Esposito K, Pontillo A, Di-Palo C, Giugliano G, Masella M, Marfella R, Giugliano D (2003) Effect of weight loss and lifestyle changes on vascular inflammatory markers in obese women: a randomized trial. JAMA 289:1799–1804CrossRefPubMedGoogle Scholar
  53. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (2001) Executive summary of the third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III) JAMA 285:2486–2497Google Scholar
  54. Fernandez ML (2001) Soluble fiber and nondigestible carbohydrate effects on plasma lipids and cardiovascular risk. Curr Opinion Lipidol 12:35–40CrossRefGoogle Scholar
  55. Flatt JP (1993) The impact of dietary fat and carbohydrates on body weight maintenance. In: Altschul AM. Low-calorie foods handbook. Marcel Dekker Inc., New York, pp 441–477Google Scholar
  56. Flatt JP (1993) The impact of dietary fat and carbohydrates on body weight maintenance. In: Altschul AM (ed.) Low-calorie foods handbook. Marcel Dekker Inc., New York,:441–477Google Scholar
  57. Food and Drug Administration (2002). Food labeling: health claims; soluble dietary fiber from certain foods and coronary heart disease. Interim final rule. Fed Regist 67:61773–61783Google Scholar
  58. Ford ES, Liu S (2001) Glycemic index and serum high-density lipoprotein cholesterol concentration among us adults. Arch Intern Med 161:572–576CrossRefPubMedGoogle Scholar
  59. Ford ES, Giles WH, Dietz WH (2002)Prevalence of the metabolic syndromeamong US adults: findings from the third National Health and Nutrition Examination Survey. JAMA 2002 287:356–359PubMedGoogle Scholar
  60. Foster-Powell K, Holt SHA, Brand-Miller JC (2002) International table of glycemic index and glycemic load values: 2002. Am J Clin Nutr 76:5–56PubMedGoogle Scholar
  61. Foster GD, Wyatt HR, Hill JO, McGuckin BG, Brill C, Mohammed BS, Szapary PO, Rader DJ, Edman JS, Klein S (2003) A randomized trial of a low-carbohydrate diet for obesity. N Engl J Med 348:2082–2090CrossRefPubMedGoogle Scholar
  62. Franz MJ, Bantle JP, Wyatt HR, Hill JO, McGuckin BG, Brill C, Mohammed BS, Szapary PO, Rader Franz MJ, Bantle JP (1999) American Diabetes Association Guide to Medical Nutrition Therapy for Diabetes. American Diabetes Association, Alexandria, VAGoogle Scholar
  63. Frayn KN (2003) Metabolic regulation. A human perspective. 2nd edn. Blackwell Science Ltd., OxfordGoogle Scholar
  64. Frayn KN, Kingman SM (1995) Dietary sugars and lipid metabolism in humans. Am J Clin Nutr 62(Suppl):250S–261SPubMedGoogle Scholar
  65. Fung TT, Hu FB et al. (2002)Whole-grain intake and the risk of type 2 diabetes: a prospective study in men. Am J Clin Nutr 76:535–540PubMedGoogle Scholar
  66. Galal O (2003) Nutrition-related health patterns in the Middle East. Asia Pac J Clin Nutr 12:337–343PubMedGoogle Scholar
  67. Gill JMR, Hardman AE (2003) Exercise and postprandial lipid metabolism: an update on potential mechanisms and interactions with high-carbohydrate diets. J Nutr Biochem 14:122–132PubMedGoogle Scholar
  68. Hardman AE, Herd SL (1998) Exercise and postprandial lipid metabolism. Proc Nutr Soc 57:63–72PubMedGoogle Scholar
  69. Howard BV, Wylie-Rosett J (2002) Sugar and cardiovascular disease (AHA Scientific Statement). Circulation 106:523–527PubMedGoogle Scholar
  70. Hu FB, Willett WC (2002) Optimal diets for prevention of coronary heart disease. JAMA 288:2569–2578PubMedGoogle Scholar
  71. Hudgins LC, Hellerstein MK, Seidman C, Neese J, Diakun J, Hirsch J (1996) Human fatty acid synthesis is stimulated by a eucaloric low fat, high carbohydrate diet. J Clin Invest 97:2081–2091PubMedGoogle Scholar
  72. Hudgins LC, Seidman CE, Diakun J, Hirsch J (1998) Human fatty acid synthesis is reduced after the substitution of dietary starch for sugar. Am J Clin Nutr 67:631–639PubMedGoogle Scholar
  73. Hudgins LC, Hellerstein MK, Seidman CE, Neese RA, Tremaroli JD, Hirsch J (2000) Relationship between carbohydrate-induced hypertriglyceridemia and fatty acid synthesis in lean and obese subjects. J Lipid Res 41:595–604PubMedGoogle Scholar
  74. Humble CG, Malarcher AM, Tyroler HA (1993) Dietary fiber and coronary heart disease in middle-aged hypercholesterolemic men. Am J Prev Med 9:197–202PubMedGoogle Scholar
  75. Hunninghake DB, Stein EA, Dujovne CA, Harris WS, Feldman EB, Miller VT, Tobert JA, Laskarzewski PM, Quiter E, Held J (1993) The efficacy of intensive dietary therapy alone or combined with lovastatin in outpatients with hypercholesterolemia. N Engl J Med 238:1213–1219Google Scholar
  76. Hyson D, Rutledge JC et al. (2003) Postprandial Lipemia and Cardiovascular Disease. Curr Athero Rep 5:437–444Google Scholar
  77. Institute of Medicine (2002) Dietary reference intakes for energy, carbohydrates, fiber, fat, fatty acids, cholesterol, protein, and amino acids. National Academy Press, Washington, DCGoogle Scholar
  78. Jacobs DR, Meyer KA, Kushi LH, Folsom AR (1998)Whole-grain intakemay reduce the risk of ischemic heart disease death in postmenopausal women: The Iowa Women's Health Study. Am J Clin Nutr 68:248–257PubMedGoogle Scholar
  79. Jacobs DR, Pereira MA, Meyer KA, Kushi LH (2000) Fiber from whole grain, but not refined grains, is inversely associated with all-cause mortality in older women: The Iowawomen's health study. J Am Coll Nutr 19(Suppl 3):236S–330SGoogle Scholar
  80. Jacobs DR, Meyer HE, Solvoll K (2001) Reduced mortality among whole grain bread eaters in men and women in the Norwegian County Study. Eur J Clin Nutr 55:137–143CrossRefPubMedGoogle Scholar
  81. Jenkins DJ, Wolever, Vidgen E, Kendall CW, Ransom TP, Mehling CC, Mueller S, Cunnane SC, O'Connell NC, Setchell KD (1997) Effect of psyllium in hypercholesterolemia at two monounsaturated fatty acid intakes. Am J Clin Nutr 65:1524–1533PubMedGoogle Scholar
  82. Jenkins DJ, Wolever TM, Taylor RH, Barker H, Fielden H, Baldwin JM, Bowling AC, Newman HC, Jenkins AL, Goff DV (1981) Glycemic index of foods: a physiological basis for carbohydrate exchange. Am J Clin Nutr 4:362–366Google Scholar
  83. Jenkins AL, Jenkins DJ, Zdravkovic U, Wursch P, Vuksan V (2002) Depression of the glycemic index by high levels of beta-glucan fiber in two functional foods tested in type 2 diabetes. Eur J Clin Nutr 56:622–628CrossRefPubMedGoogle Scholar
  84. Jenkins DJ, Kendall CW, Augustin LS, Vuksan V (2002) High-complex carbohydrate or lente carbohydrate foods? Am J Med 30(Suppl 9B):30S–37SGoogle Scholar
  85. Jenkins DJ, Kendall CW, Marchie A, Faulkner DA, Wong JM, de-Souza R, Emam A, Parker TL, Vidgen E, Lapsley KG (2003) Effects of a dietary portfolio of cholesterol-lowering foods vs lovastatin on serum lipids and C-reactive protein. JAMA 290:502–510CrossRefPubMedGoogle Scholar
  86. Jenkins DJA, Kendall CWC, Marchie A,., Jenkins AL, Connelly PW, Jones PJH, Vuksan V (2003) The Garden of Eden—plant based diets, the genetic drive to conserve cholesterol and its implication for heart disease in the 21st century. Compar Biochem Physiol (Part A) 136:141–151Google Scholar
  87. Jeppesen J, Chen YI, Zhou MY, Schaaf P, Coulston A, Reaven GM (1995) Postprandial triglyceride and retinyl ester responses to oral fat: effects of fructose. Am J Clin Nutr. 61:787–791PubMedGoogle Scholar
  88. Jialal I, Devaraj S (2003) Role of C-reactive protein in the assessment of cardiovascular risk. Am J Cardiol 91:200–202CrossRefPubMedGoogle Scholar
  89. Joshipura KJ, Ascherio A, Manson JE, Stampfer MJ, Rimm EB, Speizer FE, Hennekens CH, Spiegelman D, Willett WC (1999) Fruit and vegetable intake in relation to risk of ischemic stroke. JAMA 282:1233–1239CrossRefPubMedGoogle Scholar
  90. Joshipura KJ, Hu FB, Manson J, E, Stampfer M, J, Rimm EB, Speizer FE, Colditz G, Ascherio A, Rosner B, Spiegelman D et al. (2001) The effect of fruit and vegetable intake on risk for coronary heart disease. Ann Intern Med 134:1106–1114PubMedGoogle Scholar
  91. Keogh GF, Cooper GJ, Mulvey TB, McArdle BH, Coles GD, Monro JA, Poppitt SD (2003) Randomized controlled crossover study of the effect of a highly beta-glucan-enriched barley on cardiovascular disease risk factors in mildly hypercholesterolemic men. Am J Clin Nutr 78:711–718PubMedGoogle Scholar
  92. Kerckhoffs DA, Hornstra G, Mensink RP (2003) Cholesterol-lowering effect of beta-glucan from oat bran in mildly hypercholesterolemic subjects may decrease when beta-glucan is incorporated into bread and cookies. Am J Clin Nutr 78:221–227PubMedGoogle Scholar
  93. Khaw KT, Barrett-Connor E (1987)Dietary fiber and reduced ischemic heart disease mortality rates in men and women: a 12 year prospective study. Am J Epidemiol 126:1093–1102PubMedGoogle Scholar
  94. Koutsari C, Hardman AE (2001) Exercise prevents the augmentation of postprandial lipemia attributable to a low-fat high-carbohydrate diet. Br J Nutr 86:197–205PubMedGoogle Scholar
  95. Koutsari C, Malkova D et al. (2000)Postprandial lipemia after short-term variation in dietary fat and carbohydrates. Metabolism 49:1150–1155CrossRefPubMedGoogle Scholar
  96. Kuczmarski RJ, Flegal KM et al. (1994) Increasing prevalence of overweight among US adults: the National Health and Nutrition Examination Survey, 1960–1991. JAMA 272:205–211CrossRefPubMedGoogle Scholar
  97. Kushi LH, Meyer KA, Jacobs DR (1999) Cereals, legumes, and chronic disease risk reduction: Evidence from epidemiological studies. Am J Clin Nutr 70:451S–458SPubMedGoogle Scholar
  98. Laaksonen DE, Lakka HM, Salonen JT, Niskanen LK, Rauramaa R, Lakka TA (2002) Low levels of leisure-time physical activity and cardiorespiratory fitness predict development of the metabolic syndrome. Diabetes care 25:1612–1618PubMedGoogle Scholar
  99. Lakka HM, Salonen JT et al. (2002) Obesity and weight gain are associated with increased incidence of hyperinsulinemia in non-diabetic men. Horm Metab Res 34:492–498PubMedGoogle Scholar
  100. Lamarche B, Uffelman KD, Carpentier A, Cohn JS, Steiner G, Barrett PH, Lewis GF (1999) Triglyceride enrichment of HDL enhances in vivo metabolic clearance of HDL apo A-I in healthy men. J Clin Invest 103:1191–1199PubMedGoogle Scholar
  101. Leinonen K, Liukkonen K, Poutanen K, Uusitupa M, Mykkanen H (1999) Rye bread decreases postprandial insulin response but does not alter glucose response in healthy Finnish subjects. Eur J Clin Nutr 53:262–267CrossRefPubMedGoogle Scholar
  102. Leinonen KS, Poutanen KS, Mykkanen HM (2000) Rye bread decreases serum total and LDL cholesterol in men with moderately elevated serum cholesterol. J Nutr 130:164–170PubMedGoogle Scholar
  103. Lemieux I, Couillard C et al. (2000) The small, dense LDL phenotype as a correlate of postprandial lipemia in men. Atherosclerosis 153:423–432CrossRefPubMedGoogle Scholar
  104. Lichtenstein AH, Ausman LM, Carrasco W, Jenner JL, Ordovas JM, Schaefer EJ (1994) Short-term consumption of a low-fat diet beneficially affects plasma lipid concentrations only when accompanied by weight loss. Hypercholesterolemia, low-fat diet, and plasma lipids. Arterioscler Thromb 14:1751–1760PubMedGoogle Scholar
  105. Liese AD, Roach AK, Sparks KC, Marquart L, D'Agostino RB, Mayer-Davis EJ (2003)Wholegrain intake and insulin sensitivity: the Insulin Resistance Atherosclerosis Study. Am J Clin Nutr 78:965–971PubMedGoogle Scholar
  106. Liu S (2002) Intake of refined carbohydrates and whole grain foods in relation to risk of type 2 diabetes mellitus and coronary heart disease. J Am Coll Nutr 21:298–306CrossRefPubMedGoogle Scholar
  107. Liu S, Stampfer MJ, Hu FB, Giovannuci E, Rimm E, Manson JAE, Hennekens CH, Willett WC (1999) Whole-grain consumption and risk of coronary heart disease: results from the Nurses Health Study. Am J Clin Nutr 70:412–419PubMedGoogle Scholar
  108. Liu S, Manson JE, Stampfer MJ, Rexrode KM, Hu FB, Rimm EB, Willett WC (2000) Whole grain consumption and risk of ischemic stroke in women: A prospective study. JAMA 284:1534–1540CrossRefPubMedGoogle Scholar
  109. Liu S, Willett WC, Stampfer MJ, Hu FB, Franz M, Sampson L, Hennekens CH, Manson JE (2000) A prospective study of dietary glycemic load, carbohydrate intake, and risk of coronary heart disease in US women. Am J Clin Nutr 71:1455–1461PubMedGoogle Scholar
  110. Lucas EA, Wild RD, Hammond LJ, Khalil DA, Juma S, Daggy BP, Stoecker BJ, Arjmandi BH (2002) Flaxseed improves lipid profile without altering biomarkers of bone metabolism in postmenopausal women. J Clin Endocrinol Metab 87:1527–1532CrossRefPubMedGoogle Scholar
  111. Ludwig DS (2003) Dietary glycemic index and the regulation of body weight. Lipids 38:117–121PubMedGoogle Scholar
  112. Mamo JCL, Yu KCW et al. (1997) Is atherosclerosis exclusively a postprandial phenomenon? Clin Exper Pharmacol Physiol 24:288–293Google Scholar
  113. Mann J (2001) Carbohydrates. In: Bowman BA, Russell RM (eds) Present knowledge in nutrition, 8th edn. ILSI Press, Washington, D.C., pp 59–82Google Scholar
  114. Marckmann P, Raben A, Astrup A (2000) Ad libidum intake of low-fat diets rich in either starch foods or sucrose: effects on blood lipids, factor VII coagulant activity, and fibrinogen. Metabolism 49:731–735CrossRefPubMedGoogle Scholar
  115. Marlett JA, Fischer MH (2003) The active fraction of psyllium seed husk. Proceedings of the Nutrition Society 62:207–209CrossRefPubMedGoogle Scholar
  116. McLellan F (2002) Obesity rising to alarming levels around the world. Lancet 359:1412CrossRefPubMedGoogle Scholar
  117. Michels KB, Wolk A (2002) A prospective study of variety of healthy foods and mortality in women. Int J Epidemiol 31:847–854CrossRefPubMedGoogle Scholar
  118. Miesenböck G, Patsch JR (1992) Postprandial hyperlipidemia: the search for the atherogenic lipoprotein. Curr Opin Lipidol 3:196–201Google Scholar
  119. Mokdad AH, Ford ES, Bowman BA, Dietz WH, Vinicor F, Bales VS, Marks JS (2003)Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001. JAMA 289:76–79CrossRefPubMedGoogle Scholar
  120. Moore MC, Charrington AD, Mann SL, Davis SN (2000) Acute fructose administration decreases the glycemic response to an oral glucose tolerance test in normal adults. J Clin Endocrinol Metab 85:4515–1519CrossRefPubMedGoogle Scholar
  121. Negri E, La-Vecchia C, Pelucchi C, Bertuzzi M, Tavani A (2003) Fiber intake and the risk of nonfatal acute myocardial infarction. Eur J Clin Nutr 57:464–470CrossRefPubMedGoogle Scholar
  122. Newby PK, Muller D, Hallfrisch J, Qiao N, Andres R, Tucker KL (2003) Dietary patterns and changes in body mass index and waist circumference in adults. Am J Clin Nutr 77:1417–1425PubMedGoogle Scholar
  123. Parks EJ (2001) Recent findings in the study of postprandial lipemia. Curr Athersoscler Rep 3:462–470Google Scholar
  124. Parks EJ, Hellerstein MK (2000) Carbohydrate-induced hypertriacylglycerolemia: historical perspectives and review of the biological mechanisms. Am J Clin Nutr 71:412–433PubMedGoogle Scholar
  125. Perry IJ (2002) Healthy diet and lifestyle clustering and glucose intolerance. Proceedings of the Nutrition Society 61:543–551CrossRefPubMedGoogle Scholar
  126. Petitt DS, Cureton KJ (2003) Effects of prior exercise on postprandial lipemia: a quantitative review. Metabolism 52:418–424CrossRefPubMedGoogle Scholar
  127. Popkin BM, Doak CM (1998) The obesity epidemic is a worldwide phenomenon. Nutr Rev 56:106–114PubMedGoogle Scholar
  128. Prasad K (2000) Flaxseed: A source of hypocholesterolemic and antiatherogenic agents. Drug News Perspect 13:99–104CrossRefPubMedGoogle Scholar
  129. Putnam J, Allshouse J, Kantor LS (2002) U.S. per capita supply trends: more calories, refined carbohydrates, and fats. Food Rev 25:2–15Google Scholar
  130. Raben A (2002) Should obese patients be counselled to follow a low-glycaemic index diet? No. Obes Rev 3:245–256CrossRefGoogle Scholar
  131. Raben A, Holst JJ, Madsen J, Astrup A (1998) Diurnal metabolic profiles after 14d of an ad libidum high starch, high-sucrose, or high-fat diet in normal-weight never-obese and postobese women. Am J Clin Nutr 73:177–189Google Scholar
  132. Rajnarayana K, Prabhakar MC, Krishna DR (2001) Influence of rice bran oil on serum lipid peroxides and lipids in human subjects. Indian J Physiol Pharmacol 45:442–444PubMedGoogle Scholar
  133. Reaven G (2002) Metabolic syndrome: pathophysiology and implications for management of cardiovascular disease. Circulation 106:286–288CrossRefPubMedGoogle Scholar
  134. Reiser S, Powell AS, Scholfield DJ, Panda P, Ellwood KC, Canary JJ (1989) Blood lipids, lipoproteins, apoproteins, and uric acid in men fed diets containing fructose or highamylose cornstarch. Am J Clin Nutr 49:832–839PubMedGoogle Scholar
  135. Retzlaff BM, Walden CE, Dowdy AA, McCann BS, Anderson KV, Knopp RH(1995) Changes in plasma triacylglycerol concentrations among free-living hyperlipidemic men adopting different carbohydrate intakes over 2 y: the Dietary Alternatives Study. Am J Clin Nutr 62:988–995PubMedGoogle Scholar
  136. Reusch JE (2002) Current concepts in insulin resistance, type 2 diabetes mellitus, and the metabolic syndrome. Am J Cardiol 90(5A):19G–26GCrossRefPubMedGoogle Scholar
  137. Rimm EB, Acherio A, Giovannucci E, Spiegleman D, Stampfer MJ, Willett WC (1996) Vegetable, fruit, and cereal fiber and risk of coronary heart disease among men. JAMA 275:447–451CrossRefPubMedGoogle Scholar
  138. Ripsin CM, Keenan JM, Jacobs DR, Elmer PJ, Welch RR, Van-Horn L, Liu K, Turnbull WH, Thye FW, Kestin M (1992) Oat products and lipid lowering. A meta-analysis. JAMA 267:3317–3325CrossRefPubMedGoogle Scholar
  139. Roberts CK, Vaziri ND et al. (2002) Effect of diet and exercise intervention on blood pressure, insulin, oxidative stress, and nitric oxide availability. Circulation 106:2530–2532CrossRefPubMedGoogle Scholar
  140. Roust LR, Kottke BA, Jensen MD (1994) Serum lipid responses to a eucaloric high-complex carbohydrate diet in different obesity phenotypes. Mayo Clin Proc 69:930–936PubMedGoogle Scholar
  141. Sacks FM, Katan M (2002) Randomized clinical trials on the effects of dietary fat and carbohydrate on plasma lipoproteins and cardiovascular disease. Am J Med 113(Suppl9B): 13S–24SPubMedGoogle Scholar
  142. Sacks FM, Svetkey LP, Vollmer W. M., Appel LJ, Bray GA, Harsha D, Obarzanek E, Conlin PR, Miller ER, Simons-Morton DG (2001) Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. N Engl J Med 344:3–10CrossRefPubMedGoogle Scholar
  143. Saito M, Ishimitsu T, Minami J, Ono H, Ohrui M, Matsuoka H (2003) Relations of plasma high-sensitivity C-reactive protein to traditional cardiovascular risk factors. Atherosclerosis 167:73–79CrossRefPubMedGoogle Scholar
  144. Salmeron J, Manson JE, Stampfer MJ, Colditz GA, Wing AL, Willett WC (1997) Dietary fiber, glycemic load and the risk of non-insulin-dependent diabetes mellitus. JAMA 277:472–477CrossRefPubMedGoogle Scholar
  145. Saris WH, Astrup A, Prentice AM, Zunft HJ, Formiguera X, Verboeket-van-de-Venne WP, Raben A, Poppitt SD, Seppelt B, Johnston S (2000) Randomized controlled trial of changes in dietary carbohydrate/fat ratio and simple vs complex carbohydrates on body weight and blood lipids: the CARMEN study. The Carbohydrate Ratio Management in European National diets. Int J Obes Relat Metab Disord 10:1310–1318CrossRefGoogle Scholar
  146. Schulze MB, Hu FB(2002)Dietary patterns and risk of hypertension, type 2 diabetes mellitus, and coronary heart disease. Curr Atheroscler Rep 4:462–467PubMedGoogle Scholar
  147. Sciarrone SE, Strahan MT, Beilin LJ, Burke V, Rogers P, Rouse IR (1993) Ambulatory blood pressure and heart rate responses to vegetarian meals. J Hypertens 11:277–285PubMedGoogle Scholar
  148. Sigman-Grant M, Morita J (2003) Defining and interpreting intakes of sugars. Am J Clin Nutr 78(Suppl):815S–826SPubMedGoogle Scholar
  149. Slavin J (2003) Why whole grains are protective: biological mechanisms. Proceedings of the Nutrition Society 62:129–134CrossRefPubMedGoogle Scholar
  150. Solymoss BC, Bourassa MG, Campeau L, Lesperance J, Marcil M, Varga S (2003) Incidence, coronary risk profile and angiographic characteristics of prediabetic and diabetic patients in a population with ischemic heart disease. Can J Cardiol 19:1155–1160PubMedGoogle Scholar
  151. Spiller GA (ed) (1993) Dietary fiber in human nutrition. CRC Press Inc., Boca RatonGoogle Scholar
  152. Spiller GA (2002)Whole grains, whole wheat, and white flours in history. Whole grain foods in health and diseases. In: Marquart L, Slavin JL, Fulcher RG (eds) American Association of Cereal Chemists Inc., St. Paul (Minnesota, USA), pp 1–7Google Scholar
  153. Stevens J, Ahn K, Juhaeri, Houston D, Steffan L, Couper D (2002) Dietary fiber intake and glycemic index and incidence of diabetes in African-American and White adults. Diabetes Care 25:1715–1721PubMedGoogle Scholar
  154. Stolar MW, Chilton RJ (2003) Type 2 diabetes, cardiovascular risk, and the link to insulin resistance. Clin Ther 25(Suppl B):B4–B31CrossRefPubMedGoogle Scholar
  155. Suter PM, Gerritsen Zehnder M, Häsler E, Gürtler M, Vetter W, Hänseler E (2001) Effect of alcohol on postprandial lipemia with and without preprandial exercise. J Am Coll Nutr 20:58–64PubMedGoogle Scholar
  156. Trichopoulou A, Costacou T, Bamia C, Trichopoulos D (2003) Adherence to a Mediterranean diet and survival in a Greek population. N Engl J Med 348:2599–2608CrossRefPubMedGoogle Scholar
  157. Trichopoulou A, Naska A, Bamia C, Trichopoulos D (2003) Vegetable and fruit: the evidence in their favour and the public health perspective. Int J Vitam Nutr Res 73:63–69PubMedGoogle Scholar
  158. Trowell H (1972) Ischemic heart disease and dietary fiber. Am J Clin Nutr 25:926–932PubMedGoogle Scholar
  159. Truswell AS (2002) Cereal grains and coronary heart disease. Eur J Clin Nutr 56:1–14CrossRefPubMedGoogle Scholar
  160. Tucker KL, Dallal GE, Rush D (1992) Dietary pattern of elderly Boston-area residents defined by cluster analysis. J Am Diet Assoc 92:1487–1491PubMedGoogle Scholar
  161. van-Dam RM, Visscher AW, Feskens EJ, Verhoef P, Kromhout D (2000) Dietary glycemic index in relation to metabolic risk factors and incidence of coronary heart disease: the Zutphen Elderly Study. Eur J Clin Nutr 54:726–731CrossRefPubMedGoogle Scholar
  162. van Dam RM, Rimm EB, Willett WC, Stampfer MJ, Hu FB (2002) Dietary patterns and risk for type 2 diabetes mellitus in U.S. men. Ann Intern Med 136:201–209PubMedGoogle Scholar
  163. van-Dam RM, Grievink L, Feskens EJM (2003) Patterns of food consumption and risk factors for cardiovascular disease in the general Dutch population. Am J Clin Nutr 77:1156–1163PubMedGoogle Scholar
  164. van Horn L (1997) Fiber, lipids, and coronary heart disease: A statement for health care professionals from the Nutrition Committee, American Heart Association. Circulation 95:2701–2704PubMedGoogle Scholar
  165. Villaume C, Beck B, Gariot P, Desalme A, Debry G (1984) Long term evolution of the effect of bran ingestion on meal induced glucose and insulin responses in healthy man. Am J Clin Nutr 40:1023–1026PubMedGoogle Scholar
  166. Walker AP, Walker BF, Adam F (2003) Nutrition, diet, physical activity, smoking, and longevity: from primitive hunter-gatherer to present passive consumer—how far can we go? Nutrition 19:169–173CrossRefPubMedGoogle Scholar
  167. Volek JS, Sharman MJ et al. (2003) An isoenergetic very low carbohydrate diet improves serum hdl cholesterol and triacylglycerol concentration, the total cholesterol to HDL cholesterol ratio and postprandial lipemic responses compared with a low fat diet in normal weight, normolipidemic women. J Nutr 133:2756–2761PubMedGoogle Scholar
  168. Webster FH (2002) Whole-grain oats and oat products. Whole-grain foods in health and disease. In:Marquart L, Slavin JL, Fulcher RG. American Association of Cereal Chemists, Inc., St. Paul (Minnesota, USA), pp 83–123Google Scholar
  169. Wirfält E, Hedblad B, Gullberg B, Mattisson I, Andrén C, Rosander U, Janzon L, Berglund G (2001) Food patterns and components of the metabolic syndrome in men and women: a cross-sectional study within the Malmö Diet and Cancer Cohort. Am J Epidemiol 154:1150–1159CrossRefPubMedGoogle Scholar
  170. Wolk AJ, Manson E, Stampfer MJ, Colditz GA, Hu FB, Speizer FE, Hennekens CH, Willett WC (1999) Long-term intake of dietary fiber and decreased risk of coronary heart disease among women. JAMA 281:1998–2004CrossRefPubMedGoogle Scholar
  171. Wood P, Stefanick M, Williams P, Haskell W (1994) The effects on plasma lipoproteins of a prudent weight reducing diet with or without exercise, in overweight men and women. N Engl J Med 325:461–466Google Scholar
  172. Xie J, Liu L et al. (1998) Nutritional habits and serum lipid levels in low-fat intake Chinese population sample. Acta Cardiol 53:359–364PubMedGoogle Scholar
  173. Yin W, Yuan Z, Wang Z, Yang B, Yang Y (2002) A diet high in saturated fat and sucrose alters glucoregulation and induces aortic fatty streaks in New Zealand White rabbits. Int J Exp Diabetes Res 3:179–184CrossRefPubMedGoogle Scholar
  174. Yudkin J (1960) Sugar and ischaemic heart disease. Practitioner 198:680–683Google Scholar
  175. Yudkin J (1978) Dietary factors in atherosclerosis: sucrose. Lipids 13:370–372PubMedGoogle Scholar
  176. Zilversmit DB (1979) Atherosclerosis: A postprandial phenomenon. Circulation 60:473–485PubMedGoogle Scholar
  177. Zilversmit DB (1995) Atherogenic nature of triglycerides, postprandial lipidemia, and triglyceride-rich lipoproteins. Clin Chem 41:153–158PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2005

Authors and Affiliations

  • P.M. Suter
    • 1
  1. 1.Department of Medicine, Medical PoliclinicUniversity Hospital ZürichZürichSwitzerland

Personalised recommendations