Dietary carbohydrates: a review of international recommendations and the methods used to derive them

BACKGROUND/OBJECTIVES: Renewed dietary recommendations for carbohydrates have recently been published by various international health authorities. The present work (1) reviews the methods and processes (systematic approach/review, inclusion of public consultation) used to identify, select and grade the evidence underpinning the recommendations, particularly for total carbohydrate (CHO), fibre and sugar consumption, and (2) examines the extent to which variation in the methods and processes applied relates to any differences in the final recommendations. SUBJECTS/METHODS: A search of WHO, US, Canada, Australia and European sources identified 19 documents from 13 authorities with the desired detailed information. Processes and methods applied to derive recommendations were compiled and compared. RESULTS: (1) A relatively high total CHO and fibre intake and limited intake of (added or free) sugars are generally recommended. (2) Even where recommendations are similar, the specific justifications for quantitative/qualitative recommendations differ across authorities. (3) Differences in recommendations mainly arise from differences in the underlying definitions of CHO exposure and classifications, the degree to which specific CHO-providing foods and food components were considered, and the choice and number of health outcomes selected. (4) Differences in the selection of source material, time frames or data aggregation and grading methods appeared to have minor influence. CONCLUSIONS: Despite general consistency, apparent differences among the recommendations of different authorities would likely be minimized by: (1) More explicit quantitative justifications for numerical recommendations and communication of uncertainty, and (2) greater international harmonization, particularly in the underlying definitions of exposures and range of relevant nutrition-related outcomes.