Although there is strong evidence that the amount and type of fat in the diet can have dramatic effects on metabolism, the case for carbohydrate subtypes influencing metabolic parameters is emerging. By definition, resistant starch (RS) is any starch that is not digested in the small intestine but passes to the large bowel. Here, RS is a good substrate for fermentation which gives rise to an increase in short-chain fatty acid production. The differing rates of absorption between RS and digestible starch are thought to denote their differential metabolic responses. RS intake is associated with several changes in metabolism which may confer some health benefits. RS intake seems to decrease postprandial glycemic and insulinemic responses, lower plasma cholesterol and triglyceride concentrations, improve whole body insulin sensitivity, increase satiety, and reduce fat storage. These properties make RS an attractive dietary target for the prevention of diseases associated with dyslipidemia and insulin resistance as well as the development of weight loss diets and dietary therapies for the treatment of Type 2 diabetes and coronary heart disease. This review analyzes the body of literature examining the metabolic effects of RS consumption and discusses possible mechanisms whereby increased short-chain fatty acid production in the bowel could account for some of these effects. The effects of RS in the large bowel per se are the topic of other reviews and are not addressed in this paper.

Background: Although the effects of resistant starch (RS) on postprandial glycemia and insulinemia have been extensively studied, little is known about the impact of RS on fat metabolism. This study examines the relationship between the RS content of a meal and postprandial/post-absorbative fat oxidation. Results: 12 subjects consumed meals containing 0%, 2.7%, 5.4%, and 10.7% RS (as a percentage of total carbohydrate). Blood samples were taken and analyzed for glucose, insulin, triacylglycerol (TAG) and free fatty acid (FFA) concentrations. Respiratory quotient was measured hourly. The 0%, 5.4%, and 10.7% meals contained 50 μCi [1-¹⁴C]-triolein with breath samples collected hourly following the meal, and gluteal fat biopsies obtained at 0 and 24 h. RS, regardless of dose, had no effect on fasting or postprandial insulin, glucose, FFA or TAG concentration, nor on meal fat storage. However, data from indirect calorimetry and oxidation of [1-¹⁴C]-triolein to ¹⁴CO₂ showed that addition of 5.4% RS to the diet significantly increased fat oxidation. In fact, postprandial oxidation of [1-¹⁴C]-triolein was 23% greater with the 5.4% RS meal than the 0% meal (p = 0.0062). Conclusions: These data indicate that replacement of 5.4% of total dietary carbohydrate with RS significantly increased post-prandial lipid oxidation and therefore could decrease fat accumulation in the long-term.

The obesity epidemic has prompted researchers to find effective weight-loss and maintenance tools. Weight loss and subsequent maintenance are reliant on energy balance—the net difference between energy intake and energy expenditure. Negative energy balance, lower intake than expenditure, results in weight loss whereas positive energy balance, greater intake than expenditure, results in weight gain. Resistant starch has many attributes, which could promote weight loss and/or maintenance including reduced postprandial insulinemia, increased release of gut satiety peptides, increased fat oxidation, lower fat storage in adipocytes, and preservation of lean body mass. Retention of lean body mass during weight loss or maintenance would prevent the decrease in basal metabolic rate and, therefore, the decrease in total energy expenditure, that occurs with weight loss. In addition, the fiber-like properties of resistant starch may increase the thermic effect of food, thereby increasing total energy expenditure. Due to its ability to increase fat oxidation and reduce fat storage in adipocytes, resistant starch has recently been promoted in the popular press as a “weight loss wonder food”. This review focuses on data describing the effects of resistant starch on body weight, energy intake, energy expenditure, and body composition to determine if there is sufficient evidence to warrant these claims.

Resistant starch represents a diverse range of indigestible starch-based dietary carbohydrates. Resistant starch has been investigated in the past for its effects on bowel health (pH, epithelial thickness, and apoptosis of colorectal cancer cells); reduction in postprandial glycemia; increased insulin sensitivity; and effects on the gut microbiome. This review highlights advances as resistant starch gains clinical relevance as a potential treatment/preventive tool for diseases such as colorectal cancer (CRC) and diabetes. Recent articles have evaluated the comparative physiological effects of different types of resistant starch and investigated the effects of resistant starch on blood lipids, body weight, and defining resistant starch-induced changes to the micriobiome that may be important in health and disease. The most novel and relevant recent data describe a role for resistant starch in ameliorating inflammation; the use of resistant starch for optimal bowel health and prevention of CRC; and, further, that the systemic effects of resistant starch may be important for the treatment of other forms of cancer, such as breast cancer. This review describes advances in resistant starch research highlighting the gastrointestinal effects that are now being linked to systemic, whole body effects with clinical relevance. These effects have important implications for overall health and the prevention or amelioration of various chronic diseases.

Video observations have been widely used for providing ground truth for wearable systems for monitoring food intake in controlled laboratory conditions; however, video observation requires participants be confined to a defined space. The purpose of this analysis was to test an alternative approach for establishing activity types and food intake bouts in a relatively unconstrained environment. The accuracy of a wearable system for assessing food intake was compared with that from video observation, and inter-rater reliability of annotation was also evaluated. Forty participants were enrolled. Multiple participants were simultaneously monitored in a 4-bedroom apartment using six cameras for three days each. Participants could leave the apartment overnight and for short periods of time during the day, during which time monitoring did not take place. A wearable system (Automatic Ingestion Monitor, AIM) was used to detect and monitor participants’ food intake at a resolution of 30 s using a neural network classifier. Two different food intake detection models were tested, one trained on the data from an earlier study and the other on current study data using leave-one-out cross validation. Three trained human raters annotated the videos for major activities of daily living including eating, drinking, resting, walking, and talking. They further annotated individual bites and chewing bouts for each food intake bout. Results for inter-rater reliability showed that, for activity annotation, the raters achieved an average (±standard deviation (STD)) kappa value of 0.74 (±0.02) and for food intake annotation the average kappa (Light’s kappa) of 0.82 (±0.04). Validity results showed that AIM food intake detection matched human video-annotated food intake with a kappa of 0.77 (±0.10) and 0.78 (±0.12) for activity annotation and for food intake bout annotation, respectively. Results of one-way ANOVA suggest that there are no statistically significant differences among the average eating duration estimated from raters’ annotations and AIM predictions (p-value = 0.19). These results suggest that the AIM provides accuracy comparable to video observation and may be used to reliably detect food intake in multi-day observational studies.

Long-term weight reduction remains elusive for many obese individuals. Resistant starch (RS) and exercise may be useful for weight maintenance. The effects of RS, with or without exercise, on weight regain was examined during relapse to obesity on a high carbohydrate, high fat (HC/HF) diet.