It is clear that the sugars component of the diet has potentially deleterious effects on health. In the past, the dietary sugars were collectively referred to as non-milk extrinsic sugars (UK) or added sugars. The WHO first proposed a new term, free sugars, which is rather broader than added sugars, and also includes the sugars in fruit juices and purees, as well as honey and syrups. This review considers the potential problems that free sugars represent in relation to health risks, and the recent proposals that free sugars are a more appropriate focus than added or total as far as public health initiatives are concerned. This will require major activities in relation to measurement, labelling and communication to the consumer if attempts to reduce dietary free sugars content are to be successful.

Four isolipidic and isoenergetic diets with different protein:carbohydrate (CH) contents (48:38, 52:34, 56:30, 60:26) were fed to juvenile Senegalese sole (22·01 (sem 0·01) g) during 104 d. Oral glucose tolerance tests were performed at the beginning (4 d) and at the end (104 d) of the experiment to assess the effect of the dietary treatment on glucose tolerance. Samples of blood, liver and muscle of all dietary groups were also obtained at the initial and final phases of the trial at different postprandial times (0, 1, 5 and 10 h after feeding) in order to analyse glucose and NEFA in plasma, and metabolites and enzyme activities involved in glycogen metabolism, glycolysis, gluconeogenesis and lipogenesis pathways in liver and muscle. The results obtained in this study suggest a good glucose tolerance in Senegalese sole. This species tolerated important amounts of CH in the diet without showing any deleterious signs in terms of growth or any metabolic disorders. After 104 d of feeding diets with an important amount of CH (48:38 and 52:34), the control of glycaemia was maintained and even postprandial glucose levels in plasma were (in general) lower than at the beginning of the experiment. This reasonable tolerance to glucose is also reflected by an increased use of glucose through glycolysis in liver (indicated by glucokinase activity), and the absence of changes in lipogenic potential in the same tissue (indicated by ATP citrate lyase activity). No clear changes were induced in the muscle by the dietary treatments.

In the present study, we examined the associations of total carbohydrate intake, dietary glycaemic load (DGL) and white rice intake with metabolic syndrome risk factors by sex in Korean adolescents. For the present cross-sectional study, data from the Fourth Korea National Health and Nutrition Examination Survey (2007–9) were used. A total of 2209 adolescents (n 1164 boys and n 1045 girls) aged 10–18 years with complete anthropometric, biochemical and dietary intake data were included in the study. Dietary intake data were obtained using the 24 h recall method, and total carbohydrate intake, DGL and white rice intake were divided into quartiles by sex. The metabolic syndrome and its risk factors were defined using the International Diabetes Federation criteria for children and adolescents. Fasting insulin levels and insulin resistance were included as the metabolic syndrome risk factors. All statistical analyses considered the complex sampling design effect and appropriate sampling weights. Multivariate linear regression analysis was used to estimate means with their standard errors of the mean for the metabolic syndrome risk factors across the quartiles of total carbohydrate intake, DGL and white rice intake. While high DGL was significantly associated with increased fasting glucose levels in boys, high total carbohydrate intake, DGL and white rice intake were consistently associated with reduced HDL-cholesterol levels in girls. High white rice intake was significantly associated with an increased risk of insulin resistance and the metabolic syndrome in girls but not in boys. Optimising dietary carbohydrate intake with respect to the source or amount is fundamental to preventing and managing metabolic diseases in Asian adolescents.

Little is known about the effect of dietary carbohydrate, glycaemic index (GI) and glycaemic load (GL) on the risk of the metabolic syndrome, especially in populations with white rice as the staple food. The study examined the cross-sectional relationship between carbohydrate, GI, GL and risk of the metabolic syndrome. There were a total of 910 middle-aged Korean adults. Dietary carbohydrate, GI and GL were determined by an interview-administered FFQ. The metabolic syndrome was defined using the modified criteria published in the Third Report of the National Cholesterol Education Program Adult Treatment Panel III. The risk of developing the metabolic syndrome was positively related to dietary carbohydrate (P for trend = 0·03), GI (P for trend = 0·03) and GL intakes (P for trend = 0·02) in women after adjusting for potential confounding variables. Among the components of developing the metabolic syndrome, the risk of high TAG and low HDL-cholesterol were positively related to high GI and GL intakes in women. The risk of developing the metabolic syndrome was considerably higher in the highest quintiles of carbohydrate (OR 6·44; 95 % CI 2·16, 19·2), GI (OR 10·4; 95 % CI 3·24, 33·3) and GL intakes (OR 6·68; 95 % CI 2·30, 19·4) than in the lowest quintiles among women with a BMI ≥ 25 kg/m2. However, there was no difference in risk across quintiles of carbohydrate, GI and GL among women with a BMI < 25 kg/m2. In conclusion, both the quantity and quality of carbohydrate intake has a positive relationship with the risk of the metabolic syndrome in women but this relationship was dependent on the BMI level.

There is at present a justifiable debate as to the optimum level of total dietary fat which will reduce the risk of obesity without an elevation of plasma triacylglycerol or a depression of plasma HDL-cholesterol. Total plasma cholesterol and LDL-cholesterol levels are lowered and risk of fatal myocardial infarction is lowered when either saturated or trans-unsaturated fatty acids are replaced isoenergetically by either monounsaturated or polyunsaturated fatty acids. The triacylglycerol-raising and HDL-lowering effects of low-fat high-carbohydrate diets can be over-come with low intakes of n−3 polyunsaturated fatty acids and moderate exercise. Whilst a reduction in dietary fat is being attained in many countries, the reduction is uniform across all fatty acids, leaving dietary fat composition unchanged. The ability of low-fat diets to reduce cholesterol and cause a fall in body weight is not influenced by the carbohydrate ratio starch: sugars in the diet. However, weight-gain susceptibility to high intakes of dietary fat and the plasma cholesterol responsiveness to diet are considerably influenced by common genetic polymorphisms.

To evaluate the suitability for glycaemic index (GI) calculations of using blood sampling schedules and methods of calculating area under the curve (AUC) different from those recommended, the GI values of five foods were determined by recommended methods (capillary blood glucose measured seven times over 2·0 h) in forty-seven normal subjects and different calculations performed on the same data set. The AUC was calculated in four ways: incremental AUC (iAUC; recommended method), iAUC above the minimum blood glucose value (AUCmin), net AUC (netAUC) and iAUC including area only before the glycaemic response curve cuts the baseline (AUCcut). In addition, iAUC was calculated using four different sets of less than seven blood samples. GI values were derived using each AUC calculation. The mean GI values of the foods varied significantly according to the method of calculating GI. The standard deviation of GI values calculating using iAUC (20·4), was lower than six of the seven other methods, and significantly less (P<0·05) than that using netAUC (24·0). To be a valid index of food glycaemic response independent of subject characteristics, GI values in subjects should not be related to their AUC after oral glucose. However, calculating GI using AUCmin or less than seven blood samples resulted in significant (P<0·05) relationships between GI and mean AUC. It is concluded that, in subjects without diabetes, the recommended blood sampling schedule and method of AUC calculation yields more valid and/or more precise GI values than the seven other methods tested here. The only method whose results agreed reasonably well with the recommended method (ie. within ±5 %) was AUCcut.

Elucidating the role of carbohydrate quality in human nutrition requires a greater understanding of how the physico-chemical characteristics of foods relate to their physiological properties. It was hypothesised that rapidly available glucose (RAG) and slowly available glucose (SAG), in vitro measures describing the rate of glucose release from foods, are the main determinants of glycaemic index (GI) and insulinaemic index (II) for cereal products. Twenty-three products (five breakfast cereals, six bakery products and crackers, and twelve biscuits) had their GI and II values determined, and were characterised by their fat, protein, starch and sugar contents, with the carbohydrate fraction further divided into total fructose, RAG, SAG and resistant starch. Relationships between these characteristics and GI and II values were investigated by regression analysis. The cereal products had a range of GI (28–93) and II (61–115) values, which were positively correlated (r2 0·22, P<0·001). The biscuit group, which had the highest SAG content (8·6 (sd 3·7) g per portion) due to the presence of ungelatinised starch, was found to have the lowest GI value (51 (sd 14)). There was no significant association between GI and either starch or sugar, while RAG was positively (r2 0·54, P<0·001) and SAG was negatively (r2 0·63, P<0·001) correlated with GI. Fat was correlated with GI (r2 0·52, P<0·001), and combined SAG and fat accounted for 73·1 % of the variance in GI, with SAG as the dominant variable. RAG and protein together contributed equally in accounting for 45·0 % of the variance in II. In conclusion, the GI and II values of the cereal products investigated can be explained by the RAG and SAG contents. A high SAG content identifies low-GI foods that are rich in slowly released carbohydrates for which health benefits have been proposed.

The process by which dietary carbohydrate is transformed into fat in the human body is termed de novo lipogenesis. New methods for the measurement of this process in humans are available and have been used to investigate the role of the carbohydrate form (fed as a liquid or solid), the level of processing of carbohydrate in foods, and the role of lipogenesis in the control of liver triacylglycerol secretion. The present paper will discuss how research results are affected by both the physical state of the carbohydrate in the diet and by the metabolic state of individual research subjects. Of interest is the relationship between the glycemic index of a food (or indicators of a food's glycemic index) and that food's ability to stimulate lipogenesis in humans. Given the increasing prevalence of obesity worldwide, future scientific emphasis will expand methods to quantitate the lipogenic potential of specific foods and dietary patterns and investigate how the metabolic state of insulin resistance affects lipogenesis and/or contributes to obesity.

It was previously shown that a high plasma concentration of non-esterified fatty acids (NEFA) persisted after a fatty breakfast, but not after an isoenergetic carbohydrate breakfast, adversely affecting glucose tolerance. The higher concentration after the fatty breakfast may in part have been a result of different mobilization rates of fatty acids. This factor can be investigated as NEFA mobilized from tissues are monounsaturated to a greater extent than those deposited from a typical meal. Twenty-four middle-aged healthy Caucasian men were given oral glucose tolerance tests (OGTT), and for 28 d isoenergetic breakfasts of similar fat composition but of low (L) or moderate (M) fat content. The composition of NEFA in fasting and postprandial plasma was determined on days 1 and 29. No significant treatment differences in fasting NEFA composition occurred on day 29. During the OGTT and 0–1 h following breakfast there was an increase in plasma long-chain saturated NEFA but a decrease in monounsaturated NEFA (μg/100 μg total NEFA; P<0·001). Between 1 and 3 h following breakfast treatment differences occurred for total saturated and total monounsaturated fatty acids (μg/100 μg total NEFA; P<0·05), expressed as an increase in 18 : 1 and decreases in 16 : 0 and 17 : 0 in treatment M relative to treatment L (P<0·05). Serum insulin attained 35 and 65 mU/l in treatments M and L respectively during this period. Negative correlations were found between 16 : 0 in fasting plasma and both waist:hip circumference (P=0·0009) and insulin response curve area during OGTT (within treatment M, P=0·0001). It is concluded that a normal postprandial insulin response is associated with a rapid change in plasma saturated:monounsaturated NEFA. It is proposed that this change is the result of a variable suppression of fat mobilization, which may partly account for a large difference in postprandial total plasma NEFA between fatty and carbohydrate meals.

An experiment was conducted in twelve healthy middle-aged volunteers, six of each sex, with a mean BMI of 27kg/m2 to detect differences between morning and afternoon in postprandial blood glucose, insulin and C-peptide concentrations. These responses were measured following the consumption of isoenergetic meals that were high or low in fat content, at breakfast and at lunch. Over 4d each subject received the high-carbohydrate (L, 5·5 g mixed fat/meal) and moderately high-fat (M, 33 g mixed fat/meal) breakfasts and lunches, in three combinations (LL, MM, LM), or they fasted at breakfast time and received a moderately high-fat lunch (NM), in three Latin squares. Each evening a standard meal was given. Plasma glucose, insulin and C-peptide responses were greater following L than M meals and within both MM and LL treatments insulin and C-peptide responses were greater following breakfast than following lunch. The incremental C-peptide response to a fatty lunch following a fast at breakfast time (NM) was similar to that to a fatty breakfast, but the incremental insulin response for the same comparison was marginally lower at lunch (P=0·06). The relationship of C-peptide and insulin concentrations was assessed. Plasma glucose response to a fatty lunch was increased by a fatty breakfast. The relationships of these metabolic events with fat metabolism are discussed.

Three experiments were conducted in healthy middle-aged volunteers (six males and six females in Expt 1, six males and two females in Expt 2 and twelve males in Expt 3) with a mean BMI of 27 kg/m2 to determine whether there is a difference between morning and afternoon dietary fat clearance and utilization, and to determine in what way the fat and starch contents of the meal influence postprandial blood lipid metabolites over 4·5 h. Over 4 days in Expt 1 each subject received isoenergetic, high-carbohydrate (L, 5·5 g mixed fat/meal) and moderately high-fat (M, 33 g mixed fat/meal) breakfasts and lunches, in three combinations (LL, MM, LM), or they fasted at breakfast time and received a high fat lunch (NM) in a randomized and balanced arrangement. Each evening a standard meal was given. The following effects were significant (P<0·05): plasma triacylglycerol (TAG) responses were greater following M meals; plasma TAG concentrations were greater in the afternoon than in the morning, following two meals of the same composition, although the postprandial incremental response was less following lunch than following breakfast and peak responses were reached much earlier than after breakfast; a low-fat breakfast, or fasting at breakfast time, delayed the peak TAG response to a M lunch. The plasma concentrations of non-esterified fatty acids (NEFA) and of free glycerol were higher in the afternoon following M meals at breakfast and lunch, especially in males. This response was reduced, by the L breakfast preceding the M lunch. Two M meals in succession lowered plasma HDL-cholesterol concentration. In Expt 2 each subject received a very low-fat (VL) breakfast, followed by a lunch of the same composition. Each of these meals was followed, 110 min from the start of eating, by an infusion of Intralipid 10% emulsion at the rate of 1 ml/kg body weight over 60 s. Clearance rates of Intralipid were faster in the afternoon than in the morning (P= 0·024). In Expt 3 twelve subjects were randomly allocated to either treatment MM or LM meal patterns, as given in Expt 1. These were given daily for a period of 17 d, during which the change in fasting plasma TAG concentration was similar in both treatments. On days 1, 16 and 17 responses were measured to the M lunch and to a glucose tolerance test (GTT), conducted 2 h 17 min after lunch. The post-lunch responses confirmed those found in Expt 1; but immediately following the glucose dose there was an abrupt increase in plasma TAG that was greater in treatment LM than in treatment MM (P= 0·025), whereas plasma NEFA concentration decreased rapidly in both treatments at that time (P = 0·00066)

To evaluate the ability of the eel to use diets with high carbohydrate content, a comparative study was made by using the rainbow trout, a carnivorous fish, as a reference species. Four isoenergenetic diets (in terms of gross energy) were formulated incorporating different protein/carbohydrate ratios (450/200, 370/300, 290/400 and 210/500 as g/kg dry matter, respectively) and each one was tested in three replicates groups of eels and trout. The data on growth, food conversion and utilization of dietary protein and energy show that the eel has a comparatively greater ability than the rainbow trout for using diets with a high carbohydrate level. Thus it is postulated that higher carbohydrate levels could be used for formulating cheaper diets.

A study was carried out to examine whether the responsiveness of small intestinal epithelial cells to dietary carbohydrate varied during the daily 24 h cycle. The effect of sucrose on disaccharidase activities was compared during a period of decreasing disaccharidase activities, i.e. between 22.00 and 10.00 hours, and increasing disaccharidase activities, i.e. between 10.00 and 22.00 hours, in the jejunum of 7-week-old-rats. Rats were fed on a low-starch, high-fat diet (Lst; starch 5 and fat 73% of gross energy), or a high-starch, low-fat diet (Hst; starch 70 and fat 7% of gross energy). Both dietary groups exhibited typical diurnal variations in jejunal sucrase (EC 3.2.1.48), maltase (EC 3.2.1.20) and lactase (EC 3.2.1.23) activities, exhibiting a peak around 22.00 hours and a trough at approximately 10.00 hours. When rats were fed on diet Lst for 7 d and then force-fed on an isoenergetic sucrose diet (S; sucrose 40 and fat 37% of gross energy) for 6 or 12 h they exhibited increased sucrase, maltase and lactase activities compared with rats fed on diet Lst. The absolute increase in disaccharidase activities was similar regardless of the time diet S was given or whether rats were killed at 10.00 hours or at 22.00 hours. Analyses of sucrase and lactase activities along the villus–crypt columns showed that the distribution of cell cohorts that responded to diet S was not influenced by the time of introduction of diet S. These findings suggest that small intestinal epithelial cells possess the ability to respond to dietary carbohydrate throughout the daily 24 h cycle.

Two groups of six bulls were offered a fattening diet based on barley or sugar-beet pulp in the proportions of either 500: 200 g/kg or 200: 500 g/kg to compare the effects of starch and degradable fibre on rumen fermentations, plasma hormones and metabolites. The bulls were fed twice daily at 08.00 and 16.00 h.

The large proportion of sugar-beet pulp in the diet induced higher levels of acetic and butyric acids and less propionic acid than the high proportion of barley. The diurnal patterns over a 24-h period of rumen pH, volatile fatty acids, glucose and ammonia were characterized by two cycles. Sugar-beet pulp in large proportions induced more even fermentations as indicated by flatter curves with less extreme values than those produced by a large inclusion of barley in the diet. Ammonia concentration was high before feeding and decreased subsequently during 4 to 6 h after the meal.

No typical patterns were observed in plasma concentrations of glucose and alpha-amino nitrogen. Plasma urea concentration rose 2h after feeding and dropped during the following 6 to 8 h. There were no effects of dietary carbohydrate composition on growth hormone concentration but plasma insulin was significantly reduced with the diet high in sugar-beet pulp. Furthermore, the insulin profile showed peaks after each meal with the barley diet but only after the afternoon feeding with the diet high in sugar-beet pulp.

Four groups of seven dairy cows were given hay plus high-fibre concentrates based on sugar-beet feed (hay-concentrate, 40:60 w/w) or high-starch concentrates based on flaked maize (hay-concentrate, 20:80 w/w), with a crude protein (nitrogen x 6.25) content of either 160 or 220 g/kg dry matter, over weeks 4–18 of lactation. Performance during week 3 of lactation, when all cows were fed on a standard ration, was used as a covariate. For diets with a high-fibre content, higher protein concentrations led to increases in yields of milk and milk fat, with no effect on live-weight loss. For diets with a high-starch content, higher protein concentrations did not affect milk yield or composition but resulted in an increase in live weight rather than a decrease. Diets with a high-starch content led to increased proportions of propionic acid in the rumen and increased concentrations of insulin in the blood. It is concluded that the source of carbohydrate needs to be taken into account when predicting the response to protein supply by dairy cows.