This review of whole grain and dietary fiber recommendations and intake levels was presented at the symposium on whole grains, dietary fiber, and public health, convened in Beijing, China, on May 11, 2018. The review reflects on inconsistencies among the definitions of whole grains and fiber as well as recommended intake levels in different countries. The lack of consistent dietary recommendations from authoritative sources may delay the regional implementation and consumer adoption of diets that include whole grains and fiber. Currently, few countries include specific intake recommendations for whole grain, and even among those countries with guidance the recommendations can be vague and qualitative. As a result of the well-documented associations between increasing whole grain intake and reduced disease risk, there is compelling evidence to create clear, actionable dietary recommendations for both whole grains and fiber. Furthermore, work is ongoing to develop uniform standards for whole grain and whole-grain food to ensure recommendations are being met. Health and regulatory authorities are encouraged to acknowledge the public health benefits that could be derived from strong, clear whole-grain and dietary fiber recommendations; examine existing definitions (whole grain as an ingredient, whole-grain food, and dietary fiber); and adopt the most appropriate approach to best serve public health needs for their respective populations.

Proposed global definitions of whole grain as an ingredient and whole grain food are presented by the authors on behalf of the Whole Grain Initiative. Whole grains are an important pillar of healthy and sustainable diets. Internationally accepted credible definitions of whole grains as food ingredients and whole-grain foods are necessary to ensure that all global stakeholders have shared standards, and that consumers find them clear, credible, and useful. Based on widely accepted, existing definitions and new developments, the Definitions Working Group of the global Whole Grain Initiative, with experts from academia, government agencies and industry, developed definitions for global application. The key statements of the definition documents are as follows: “Whole grains shall consist of the intact, ground, cracked, flaked or otherwise processed kernel after the removal of inedible parts such as the hull and husk; all anatomical components, including the endosperm, germ, and bran must be present in the same relative proportions as in the intact kernel” and “A whole-grain food shall contain at least 50% whole-grain ingredients based on dry weight. Foods containing 25–50% whole-grain ingredients based on dry weight, may make a front-of-pack claim on the presence of whole grain but cannot be designated ‘whole grain’ in the product name”. The definition documents have been ratified by the leading international scientific associations in this area. We urge that these consensus Whole Grain Initiative definitions be adopted as the basis for definitions used by national regulatory authorities and for health promotion organisations worldwide to use in nutrition education and food labelling.

Sustainable food systems are often defined by greenhouse gases, land use, effects on biodiversity, and water use. However, this approach does not recognize the reason food is produced—the provision of nutrients. Recently, the relationship between diets and sustainability has been recognized. Most accepted models of ‘sustainable diets’ focus on four domains: public health, the environment, food affordability, and cultural relevance. Aligned with the FAO’s perspective, truly sustainable diets comprise foods that are affordable, nutritious, developed with ingredients produced in an environmentally friendly manner, and consumer preferred. Identifying solutions to address all four domains simultaneously remains a challenge. Furthermore, the recent pandemic exposed the fragility of the food supply when food accessibility and affordability became primary concerns. There have been increasing calls for more nutrient-dense and sustainable foods, but scant recognition of the consumer’s role in adopting and integrating these foods into their diet. Dietary recommendations promoting sustainable themes often overlook how and why people eat what they do. Taste, cost, and health motivate consumer food purchase and the food system must address those considerations. Sustainable foods are perceived to be expensive, thus marginalizing acceptance by the people, which is needed for broad adoption into diets for impactful change. Transformational change is needed in food systems and supply chains to address the complex issues related to sustainability, taste, and cost. An emerging movement called regenerative agriculture (a holistic, nature-based approach to farming) provides a pathway to delivering sustainable foods at an affordable cost to consumers. A broad coalition among academia, government, and the food industry can help to ensure that the food supply concurrently prioritizes sustainability and nutrient density in the framework of consumer-preferred foods. The coalition can also help to ensure sustainable diets are broadly adopted by consumers. This commentary will focus on the challenges and opportunities for the food industry and partners to deliver a sustainable supply of nutrient-dense foods while meeting consumer expectations.

Dietary carbohydrates are components of healthy foods, but many carbohydrate foods have recently been stigmatized as primary causes of diet-related risk factors for chronic disease. There is an opportunity to enhance efforts within the food landscape to encourage the consumption of higher quality carbohydrate foods. The use of labelling is one strategy that permits consumers to identify healthy carbohydrate foods at the point-of-purchase. This review discusses the regulatory frameworks and examples of associated non-mandatory food labelling claims that are currently employed to highlight healthy carbohydrate foods to consumers. The existing labelling frameworks discussed here align with established measures of carbohydrate quality, such as 1. dietary fibre nutrient content claims and associated dietary fibre-based health claims; 2. the presence of whole carbohydrate foods and ingredients that are intact or reconstituted, such as whole grains; and 3. low glycemic index and glycemic response claims. Standards from Codex Alimentarius, and regulations from Australia and New Zealand, Canada, Europe, and the United States will be used to illustrate the means by which food labelling can be used by consumers to identify quality carbohydrate foods.

There is an increasing interest in plant-based diets and higher levels of plant proteins due to rising concerns around health and environmental sustainability issues. We determined the effects of increasing quartiles of plant protein in the diet on nutrient adequacy using a large nationally representative observational dataset. Twenty-four-hour dietary-recall data from NHANES 2013–2018 from 19,493 participants aged 9+ years were used to assess nutrient intakes. Nutritional adequacy was assessed by estimating the percentage of the population with intakes below the EAR or above the AI. A quartile trend was assessed using regression and the significance was set at P_{quartile trend} < 0.05. With increasing quartiles of plant protein, the adequacy decreased for calcium, potassium, and vitamin D and increased for copper and magnesium for adolescents. Among the adults aged 19–50 years, the adequacy decreased for protein, choline, selenium, vitamin B₁₂, and zinc and increased for copper, folate, iron, magnesium, thiamin, and vitamin C with increasing quartiles of plant protein. The adequacy for calcium, vitamin A, and zinc decreased and it increased for copper, folate, magnesium, thiamin, and vitamin C with increasing quartiles of plant protein among adults aged 51+ years. The results indicate that diets of mixed protein sources (from both animals and plants) are the most nutritionally adequate.

这篇关于全谷物和膳食纤维推荐摄入量的综述于2018 年5 月11 日在中国北京的“全谷物、膳食纤维与健康”研讨会上公开发表的。该 综述反映了不同国家对全谷物和膳食纤维的定义以及其推荐摄入量之 间的差别。缺乏来自权威机构的一致的推荐摄入量可能会影响消费者 选择全谷物、膳食纤维饮食和其在区域内的全面实施。目前，很少有 国家提出具体的全谷物推荐摄入量，在那些有全谷物膳食指导的国家 中，建议也可能是模糊和定性的。增加全谷物摄入量和降低疾病风险 之间的联系已得到充分证明，因此，可为增加全谷物和膳食纤维摄入 提出明确的、可操作的饮食建议提供充足的证据。制定全谷物和全谷 物食品的统一标准，确保膳食指导建议得到落实。鼓励卫生和管理当 局:认可从全谷物和膳食纤维饮食建议中可获得的公共健康益处；研 究和讨论已有的全谷物原料、全谷物食品、膳食纤维定义；并采取最 佳方法为各地人口提供最佳的公共卫生服务。