Research Category: Healthy Dietary Patterns
A large percentage of daily vegetable intake is attributed to white potatoes, but limited information is available on how potatoes are incorporated into dietary patterns in the US. Therefore, the objective of this study was to determine food patterns that include potatoes and to compare the associated diet quality and association with biomarkers to a food pattern without potatoes. Data from American subjects 2-18 and 19 years and older who participated in the What We Eat in America portion of the National Health and Nutrition Examination Survey cycles 2001-2018 were utilized in the current study. Diet quality was assessed using the Healthy Eating Index-2015. Anthropometric variables included body mass index (BMI), waist circumference, and weight. Biomarkers analyzed included glucose, insulin, triglycerides, HDL-, LDL-, and total cholesterol. Multiple food clusters containing potatoes were identified with several having higher and lower diet quality as compared to a food pattern without potatoes. Children and adolescents in one potato cluster had lower BMI, waist circumference, and body weight compared to those in a no potato dietary pattern, whereas adults in 3 potato clusters had higher anthropometric variables than those in a no potato pattern. In adults, some dietary patterns including potatoes were also associated with lower and higher HDL and total cholesterol and higher insulin levels. The percentage of calories from potatoes across patterns was small, ∼9-12%, suggesting the differences observed in diet quality and biomarkers were due to other food categories consumed in the pattern. This study suggests there are ways to incorporate potatoes as part of a healthy eating pattern but depends more on the other foods included in the diet.View Publication
- Agarwal, S.; Fulgoni, V.L., III. Intake of Potatoes Is Associated with Higher Diet Quality, and Improved Nutrient Intake and Adequacy among US Adolescents: NHANES 2001–2018 Analysis. Nutrients 2021, 13, 2614. https://doi.org/10.3390/nu13082614View
The glycemic index gives some healthy carbohydrates a poor score, while elevating other, less-nutritious foods. Understanding the complexity of foods and their interaction with lifestyle would be far more helpful for health-care professionals who are advising their patients on what — and what not — to eat.View Publication
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Background: Starchy vegetables, including white potatoes, are often categorized as “lower-quality” carbohydrate foods, along with refined grains, 100% fruit juices, sweetened beverages, and sugars, snacks and sweets. Among “higher-quality” carbohydrates are whole grains, non-starchy vegetables, legumes, and whole fruits.
Objective: To apply multiple nutrient profiling (NP) models of carbohydrate quality to foods containing >40% carbohydrate by dry weight in the USDA Food and Nutrient Database for Dietary Studies (FNDDS 2017-18).
Methods: Carbohydrate foods in the FNDDS (n = 2423) were screened using four recent Carbohydrate Quality Indices (CQI) and a new Carbohydrate Food Quality Score (CFQS-4). Cereal products containing >25% whole grains by dry weight were classified as whole grain foods.
Results: Based on percent items meeting the criteria for 4 CQI scores, legumes, non-starchy and starchy vegetables, whole fruit, and whole grain foods qualified as “high quality” carbohydrate foods. Distribution of mean CFQS-4 values showed that starchy vegetables, including white potatoes placed closer to non-starchy vegetables and fruit than to candy and soda.
Conclusion: Published a priori determinations of carbohydrate quality do not always correspond to published carbohydrate quality metrics. Based on CQI metrics, specifically designed to assess carbohydrate quality, starchy vegetables, including white potatoes, merit a category reassignment and a more prominent place in dietary guidance.View Publication
- Drewnowski A, Maillot M and Vieux F (2022) Multiple Metrics of Carbohydrate Quality Place Starchy Vegetables Alongside Non-starchy Vegetables, Legumes, and Whole Fruit. Front. Nutr. 9:867378. doi: 10.3389/fnut.2022.867378View
This perspective examines the utility of the glycemic index (GI) as a carbohydrate quality indicator to improve Dietary Guidelines for Americans (DGA) adherence and diet quality. Achieving affordable, high-quality dietary patterns can address multiple nutrition and health priorities. Carbohydrate-containing foods make important energy, macronutrient, micronutrient, phytochemical, and bioactive contributions to dietary patterns, thus improving carbohydrate food quality may improve diet quality. Following DGA guidance helps meet nutrient needs, achieve good health, and reduce risk for diet-related non-communicable diseases in healthy people, yet adherence by Americans is low. A simple indicator that identifies high-quality carbohydrate foods and improves food choice may improve DGA adherence, but there is no consensus on a definition. The GI is a measure of the ability of the available carbohydrate in a food to increase blood glucose. The GI is well established in research literature and popular resources, and some have called for including the GI on food labels and in food-based dietary guidelines. The GI has increased understanding about physiological responses to carbohydrate-containing foods, yet its role in food-based dietary guidance and diet quality is unresolved. A one-dimensional indicator like the GI runs the risk of being interpreted to mean foods are “good” or “bad,” and it does not characterize the multiple contributions of carbohydrate-containing foods to diet quality, including nutrient density, a core concept in the DGA. New ways to define and communicate carbohydrate food quality shown to help improve adherence to high-quality dietary patterns such as described in the DGA would benefit public health.View Publication
- Nicholls J (2022) Perspective: The Glycemic Index Falls Short as a Carbohydrate Food Quality Indicator to Improve Diet Quality. Front. Nutr. 9:896333. doi: 10.3389/fnut.2022.896333View
Epidemiologic observations suggest increased potato consumption correlates with weight gain, adiposity, and diabetes risk, while nut consumption is associated with weight control and metabolic health. Randomized controlled trial (RCT) data indicate humans respond to changes in energy intake in single dietary components and compensate for extra energy consumed.
- Daniel L Smith, Jr, Rebecca L Hanson, Stephanie L Dickinson, Xiwei Chen, Amy M Goss, John B Cleek, W Timothy Garvey, David B Allison, French-fried potatoes consumption and energy balance: a randomized controlled trial, The American Journal of Clinical Nutrition, 2022;, nqac045, https://doi.org/10.1093/ajcn/nqac045View
We examined the association between potato consumption in two different age periods during adolescence and risk of obesity and cardiometabolic dysfunction in White and Black girls. We used data from the biracial prospective National Growth and Health Study. Average potato consumption was derived from multiple 3-d food records in two age periods, 9–11 and 9–17 years, and included white and sweet potatoes from all sources. Multivariable logistic regression models were used to estimate OR for becoming overweight, developing prehypertension, elevated TAG levels or impaired fasting glucose (IFG) at 18–20 years of age according to the category of daily potato intake. We also stratified by cooking method (fried/non-fried) and race. ANCOVA was also used to estimate adjusted mean levels of BMI, systolic blood pressure, diastolic blood pressure, log-transformed TAG, the TAG:HDL ratio and fasting glucose levels associated with potato intake category. Higher potato consumption was associated with higher fruit and non-starchy vegetable intakes and higher Healthy Eating Index scores in Black girls. There were no statistically significant associations overall between moderate or higher (v. lower) intakes of potatoes and risks of overweight, prehypertension, elevated fasting TAG, high TAG:HDL ratio or IFG. Also, no adverse associations were found between fried or non-fried potato intake and cardiometabolic outcomes. Potato consumption has been the subject of much controversy in recent years. This study adds evidence that potato consumption among healthy girls during the critical period of adolescence was not associated with cardiometabolic risk.View Publication
- Yiannakou, I., Yuan, M., Pickering, R., Singer, M., & Moore, L. (2021). Potato consumption is not associated with elevated cardiometabolic risk in adolescent girls. British Journal of Nutrition, 1-10. doi:10.1017/S0007114521003445View
Carbohydrate-containing crops provide the bulk of dietary energy worldwide. In addition to their various carbohydrate forms (sugars, starches, fibers) and ratios, these foods may also contain varying amounts and combinations of proteins, fats, vitamins, minerals, phytochemicals, prebiotics, and anti-nutritional factors that may impact diet quality and health. Currently, there is no standardized or unified way to assess the quality of carbohydrate foods for the overall purpose of improving diet quality and health outcomes, creating an urgent need for the development of metrics and tools to better define and classify high-quality carbohydrate foods. The present report is based on a series of expert panel meetings and a scoping review of the literature focused on carbohydrate quality indicators and metrics produced over the last 10 years. The report outlines various approaches to assessing food quality, and proposes next steps and principles for developing improved metrics for assessing carbohydrate food quality. The expert panel concluded that a composite metric based on nutrient profiling methods featuring inputs such as carbohydrate–fiber–sugar ratios, micronutrients, and/or food group classification could provide useful and informative measures for guiding researchers, policymakers, industry, and consumers towards a better understanding of carbohydrate food quality and overall healthier diets. The identification of higher quality carbohydrate foods could improve evidence-based public health policies and programming—such as the 2025–2030 Dietary Guidelines for Americans.View Publication
- Comerford, K.B.; Papanikolaou, Y.; Jones, J.M.; Rodriguez, J.; Slavin, J.; Angadi, S.; Drewnowski, A. Toward an Evidence-Based Definition and Classification of Carbohydrate Food Quality: An Expert Panel Report. Nutrients 2021, 13, 2667.View
Potatoes are nutrient rich white vegetables, however, research on their impact on public
health is limited. The objective of this study was to provide updated evaluation of the cross-sectional
association between potato consumption and diet quality, nutrient intake and adequacy. Twenty-four
hour diet recall data from adolescents (n = 16,633; age 9–18 years) were used to assess intakes. Usual
intakes of nutrients were determined using the National Cancer Institute method and diet quality
was calculated using the Healthy Eating Index-2015 (HEI-2015) after adjusting for demographic
factors. Consumers of potatoes (baked or boiled potatoes, mashed potatoes and potato mixtures,
fried potatoes, and potato chips) had higher (p < 0.05) HEI-2015 total score and subcomponent
scores for total vegetables, total protein foods, and refined grain than non-consumers. Consumers
also had higher (p < 0.05) intake of energy, dietary fiber, protein, copper, magnesium, phosphorus,
potassium, selenium, sodium, zinc, niacin, vitamin B6, vitamin C, vitamin K and total choline; and
higher (p < 0.05) adequacy for protein, copper, magnesium, phosphorus, potassium, zinc, thiamine,
niacin, vitamin B6, vitamin C, and vitamin K than non-consumers. In conclusion, adolescent potato
consumption was associated with higher diet quality, nutrient intake, and adequacy and therefore
encouraging their consumption may be an effective strategy for improving nutritional status.
- Agarwal, S.; Fulgoni, V.L., III. Intake of Potatoes Is Associated with Higher Diet Quality, and Improved Nutrient Intake and Adequacy among US Adolescents: NHANES 2001–2018 Analysis. Nutrients 2021, 13, 2614.View
Plant foods are universally promoted for their links to improved human health, yet carbohydrate-containing foods are often maligned based on isolated, reductionist methods that fail to assess carbohydrate foods as a matrix of nutrients and food components. Currently accepted positive carbohydrate quality indices include plant food, whole-grain content, and dietary fiber, while negative health outcomes are linked to high intakes of added sugar and high glycemic index. More recently, negative health aspects have been linked to ultra-processed foods, which are often high in carbohydrates. Yet, carbohydrate staples such as grains and dairy products are both enriched and fortified, resulting in these carbohydrate foods containing important nutrients of concern such as dietary fiber, potassium, vitamin D, and calcium. This Perspective analyzes carbohydrate metrics used in dietary guidance and labeling and finds limitations in accepted indices included in standardized quality carbohydrate definitions and also proposes additional indices to benefit both human and environmental health. As nutrition recommendations shift away from a single-nutrient focus to a more holistic dietary pattern approach that is flexible and adaptable for each individual, it is necessary to determine the quality components that make up these patterns. This review concludes that current approaches that demonize staple carbohydrate foods do little to promote the recommended patterns of foods known to improve health status and reduce disease risk.View Publication
- Schulz, Joanne Slavin, Perspective: Defining Carbohydrate Quality for Human Health and Environmental Sustainability, Advances in Nutrition, 2021; nmab050.View
Guidelines for reducing postprandial blood glucose concentrations include avoiding high glycemic index (GI) foods, such as white potatoes. However, GI testing is often undertaken in the morning with foods consumed in isolation by non-clinical cohorts. We investigated the impact of potato preparation and consumption as part of a mixed-evening meal on postprandial and nocturnal glycemic responses, and postprandial insulin response, in individuals with Type 2 Diabetes Mellitus (T2DM). In a randomized, cross-over design, 24 males and females (age 58.3 ± 9.3 y; BMI: 31.7 ± 6.8 kg/m2) with T2DM (diet or metformin controlled) completed four experimental trials after consuming a standardized breakfast (25% daily energy intake (EI)) and lunch (35% EI). Dinner (40% EI) was consumed at 1800 h being either: 1) boiled potato (BOIL); 2) roasted potato (ROAST); 3) boiled potato cooled for 24 h (COOLED); or 4) basmati rice (CONTROL). Each meal contained 50% carbohydrate, 30% fat and 20% protein. Blood samples were collected prior to, immediately post meal and at 30-min intervals for a further 120 min. A continuous glucose monitor was worn to assess nocturnal interstitial glucose concentrations. No differences were detected in postprandial venous glucose area under the curve (iAUC) between CONTROL and all three potato conditions. Postprandial insulin iAUC was greater following COOLED compared to CONTROL (P = 0.003; 95% CI: 18.9-111.72 miU/mL). No significant differences between CONTROL and BOIL or ROAST were detected for postprandial insulin concentrations. All potato meals resulted in lower nocturnal glucose AUC than CONTROL (P < 0.001; 95% CI 4.15-15.67 mmol/L x h). Compared to an isoenergetic rice meal, boiled, roasted or boiled then cooled potato-based meals were not associated with unfavourable postprandial glucose responses or nocturnal glycemic control, and can be considered suitable for individuals with T2DM when consumed as part of a mixed-evening meal.View Publication
- Devlin BL, Parr EB, Radford BE, Hawley JA. Lower nocturnal blood glucose response to a potato-based mixed evening meal compared to rice in individuals with type 2 diabetes. Clin Nutr. 2020. doi: 10.1016/j.clnu.2020.09.049.View