HEALTH CLAIMS RELATED TO CARBOHYDRATES AND CVD

8.4 HEALTH CLAIMS RELATED TO CARBOHYDRATES AND CVD

The European guideline on cardiovascular disease prevention includes recommen- dations on the intake of carbohydrates and dietary fibers. 104 The consumption of

whole-grain cereals and bread should be encouraged, and saturated fat should be replaced partly by complex carbohydrates.

The WHO 1 lists several factors related to dietary fiber that probably decrease the risk for developing cardiovascular diseases, i.e., nonstarch polysaccharides and whole-grain cereals. According to the WHO, more convincing evidence exists for the intake of fruit and vegetables and a decreased risk of developing CVD.

However, the U.S. Food and Drug Administration (FDA) has approved several health claims related to dietary fiber and coronary heart disease (Table 8.5). 105 A

general claim is related to fruits, vegetables, and grain products that contain fiber, particularly soluble fiber, and risk of coronary heart disease. The food without fortification should have a content of 0.6 g of soluble dietary fiber per reference amount and be low in saturated fat, cholesterol, and total fat. In 1999, the FDA also approved a health claim for whole-grain foods: “Diets rich in whole-grain foods and other plant foods and low in total fat, saturated fat, and cholesterol may reduce the risk of heart disease and some cancers.” Whole-grain foods should contain 51% or more whole-grain ingredients by weight per reference amount, with a dietary fiber content of 3.0 g/50 g or 1.7 g/35 g, and the food should also be low in fat.

Enough evidence of the cholesterol-lowering effects of psyllium had been gath- ered to authorize a health claim from the FDA in 1998, stating that psyllium can reduce the risk of heart disease if consumed in an otherwise healthy diet. 106 The FDA based this health claim on a review of 21 human studies. It found no reliable data to establish a dose–response relationship, but an intake of 10.2 g daily of psyllium seed husk as part of a diet low in saturated fat and cholesterol seemed to have significant effects on blood total and LDL cholesterol levels. This amount of psyllium husk contains about 7 g of soluble fiber, and a food should provide at least

1.7 g of soluble fiber from psyllium per serving to be able to use the health claim.

Functional Food Carbohydrates

TABLE 8.5 Health Claims Approved by the U.S. Food and Drug Administration on the

Relation between Intake of Dietary Fiber and Coronary Heart Disease 105

Health Claim Requirements

Fruit, vegetables, and grain products that A fruit, vegetable, or grain product that contains fiber contain fiber, particularly soluble fiber, and

Low in saturated fat, cholesterol, and total fat risk of coronary heart disease

At least 0.6 g of soluble fiber per reference amount (RA) (without fortification)

Whole-grain foods and risk of heart disease Contains 51% or more whole-grain ingredients by and certain cancers

weight per RA Low in total fat Dietary fiber content at least:

3.0 g/RA of 55 g 2.8 g/RA of 50 g 2.5 g/RA of 45 g 1.7 g/RA of 35 g

Soluble fiber from certain foods and risk of Low in saturated fat, cholesterol, and total fat coronary heart disease

Containing at least 0.75 g of whole-oat soluble fiber per RA or psyllium seed husk containing at least 1.7 g of psyllium husk soluble fiber per RA

A similar health claim also exists for oats. 107 The FDA reviewed 37 oat trials in 1996, and 17 studies showed a positive effect of oat bran and oatmeal on total and LDL cholesterol. The amount of oat bran or oat meal given in the studies ranged from 34 g (2.5 g of soluble fiber) to 123 g (10.3 g of soluble fiber). Five studies showed equivocal results in reducing serum cholesterol, 4 had a too short study period, and 11 showed no effect on serum lipid levels. But the overall conclusion was that oats could lower serum cholesterol levels, specifically LDL cholesterol, without any significant change in the HDL fraction. The FDA thus authorized a health claim stating: “Diets high in oat bran or oat meal and low in saturated fat and cholesterol may reduce the risk of heart disease.” To be able to use the health claim, a product must contain at least 0.75 g of beta-glucan soluble fiber per serving, and the recommended daily intake is 3 g. In 2005, barley was added as an eligible source of beta-glucan soluble fiber. In other countries, similar health claims on the relations between a high intake of dietary fiber or whole-grain foods and a decreased risk for coronary heart disease have been issued.