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(Arteriosclerosis, Thrombosis, and Vascular Biology. 2006;26:1958.)
© 2006 American Heart Association, Inc.

Brief Reviews

The Changing Roles of Dietary Carbohydrates

From Simple to Complex

Amy E. Griel; Elizabeth H. Ruder; Penny M. Kris-Etherton

From the Department of Nutritional Sciences (A.E.G., E.H.R., P.M.K.-E.) and Department of Integrative Biosciences (A.E.G., P.M.K.-E.), the Pennsylvania State University, University Park, Pa.

Correspondence to Penny Kris-Etherton, the Pennsylvania State University, University Park, PA 16802. E-mail pmk3{at}psu.edu

Series Editor: Margo Denke
Nutrition and Atherosclerosis
ATVB In Focus

Previous Brief Reviews in this Series:

•Isganaitis E, Lustig RH. Fast food, central nervous system insulin resistance, and obesity. 2005;25:2451–2462.
•Levine JA, Vander Weg MW, Hill JO, Klesges RC. Non-exercise activity thermogenesis: the crouching tiger hidden dragon of societal weight gain. 2006;26:729–736.
•Basu A, Devaraj S, Jialal I. Dietary factors that promote or retard inflammation. 2006;26:995–1001.

The dietary recommendations made for carbohydrate intake by many organizations/agencies have changed over time. Early recommendations were based on the need to ensure dietary sufficiency and focused on meeting micronutrient intake requirements. Because carbohydrate-containing foods are a rich source of micronutrients, starches, grains, fruits, and vegetables became the foundation of dietary guidance, including the base of the US Department of Agriculture’s Food Guide Pyramid. Dietary sufficiency recommendations were followed by recommendations to reduce cholesterol levels and the risk for cardiovascular disease; reduction in total fat (and hence saturated fat) predominated. Beginning in the 1970s, carbohydrates were recommended as the preferred substitute for fat by the American Heart Association and others to achieve the recommended successive reductions in total fat and low-density lipoprotein cholesterol (LDL-C). Additional research on fats and fatty acids found that monounsaturated fatty acids could serve as an alternative substitution for saturated fats, providing equivalent lowering of LDL-C without concomitant reductions in high-density lipoprotein cholesterol and increases in triglycerides witnessed when carbohydrates replace saturated fat. This research led to a sharper focus in the guidelines in the 1990s toward restricting saturated fat and liberalizing a range of intake of total fat. Higher-fat diets, still low in saturated fatty acids, became alternative strategies to lower-fat diets. As the population has become increasingly overweight and obese, the emergence of the metabolic syndrome and its associated disruptions in glucose and lipid metabolism has led to reconsiderations of the role of carbohydrate-containing foods in the American diet. Consequently, a review of the evidence for and against high-carbohydrate diets is important to put this controversy into perspective. The current dietary recommendations for carbohydrate intake are supported by the evidence.

Dietary recommendations for carbohydrate intake have evolved across the decades. Early recommendations focused on meeting micronutrient intake requirements; recent guidelines acknowledge of the role of carbohydrates and dietary fat in reducing risk for cardiovascular disease. A review of the evidence is important to address the controversies associated with a high-carbohydrate diet.

Key Words: carbohydrates • dietary patterns • nutrition • cardiovascular risk

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