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Total dietary carbohydrate, sugar, starch and fibre intakes in the European Prospective Investigation into Cancer and Nutrition

European Journal of Clinical Nutrition volume 63, pages S37–S60 (2009)Cite this article

Abstract

Objective:

To describe dietary carbohydrate intakes and their food sources among 27 centres in 10 countries participating in the European Prospective Investigation into Cancer and Nutrition (EPIC) study.

Methods:

Between 1995 and 2000, 36 034 subjects, aged between 35–74 years, were administered a standardized, 24-h dietary recall using a computerized interview software programme (EPIC-SOFT). Intakes (g/day) of total carbohydrate, sugars, starch and fibre were estimated using the standardized EPIC Nutrient Database (ENDB). Mean intakes were adjusted for age, total energy intake, height and weight, and were weighted by season and day of recall.

Results:

Adjusted mean total carbohydrate intakes were highest in Italy and in the UK health-conscious cohort, and were lowest in Spain, Greece and France. Total fibre intakes were highest in the UK health-conscious cohort and lowest in Sweden and the UK general population. Bread contributed the highest proportion of carbohydrates (mainly starches) in every centre. Fruit consumption contributed a greater proportion of total carbohydrates (mainly sugars) among women than among men, and in southern centres compared with northern centres. Bread, fruits and vegetables represented the largest sources of fibre, but food sources varied considerably between centres. In stratified analyses, carbohydrate intakes tended to be higher among subjects who were physically active, never-smokers or non-drinkers of alcohol.

Conclusions:

Dietary carbohydrate intakes and in particular their food sources varied considerably between these 10 European countries. Intakes also varied according to gender and lifestyle factors. These data will form the basis for future aetiological analyses of the role of dietary carbohydrates in influencing health and disease.

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Acknowledgements

This work was carried out with the financial support of the European Commission: Public Health and Consumer Protection Directorate 1993–2004; Research Directorate-General 2005; Ligue contre le Cancer (France); Société 3M (France); Mutuelle Générale de l’Education Nationale; Institut National de la Santé et de la Recherche Médicale (INSERM); Institut Gustave Roussy; German Cancer Aid; German Cancer Research Center; German Federal Ministry of Education and Research; Danish Cancer Society; Health Research Fund (FIS) of the Spanish Ministry of Health; Spanish Regional Governments of Andalucía, Asturias, Basque Country, Murcia and Navarra and the Catalan Institute of Oncology; and ISCIII RETIC (RD06/0020), Spain; Cancer Research UK; Medical Research Council, UK; the Stroke Association, UK; British Heart Foundation; Department of Health, UK; Food Standards Agency, UK; the Wellcome Trust, UK; Greek Ministry of Health; Hellenic Health Foundation; Italian Association for Research on Cancer; Italian National Research Council, Regione Sicilia (Sicilian government); Associazione Iblea per la Ricerca Epidemiologica—ONLUS (Hyblean association for epidemiological research, NPO); Dutch Ministry of Health, Welfare and Sport; Dutch Prevention Funds; LK Research Funds; Dutch ZON (Zorg Onderzoek Nederland); World Cancer Research Fund (WCRF); Swedish Cancer Society; Swedish Research Council; Regional Government of Skane and the County Council of Vasterbotten, Sweden; Norwegian Cancer Society; the Norwegian Research Council and the Norwegian Foundation for Health and Rehabilitation. Anne Cust received a PhD scholarship from the University of Sydney, a Research Scholar Award from the Cancer Institute NSW, and a NHMRC Public Health Research Fellowship (520018), Australia. We thank Sarah Somerville, Nicole Suty and Karima Abdedayem for their assistance with editing, Kimberley Bouckaert and Heinz Freisling for their technical assistance, and Carine Biessy for statistical support.

Author information

Author notes

  1. A E Cust

    Present address: 26Current address: Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, University of Melbourne, Melbourne, Australia.,

  2. M R Skilton

    Present address: 27Current address: Baker IDI Heart & Diabetes Institute, Melbourne, Australia.,

  3. S Bingham: The author is deceased.

Authors and Affiliations

  1. Dietary Exposure Assessment Group, International Agency for Research on Cancer, Lyon, France

    A E Cust, M M E van Bakel, S Rinaldi & N Slimani

  2. Centre for Research in Human Nutrition (CRNH) Rhône-Alpes, University Lyon 1, Lyon, France

    M R Skilton

  3. Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark

    J Halkjær, A Olsen & A Tjønneland

  4. Department of Preventive and Predictive Medicine, Nutritional Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy

    C Agnoli

  5. Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece

    T Psaltopoulou, Y Chloptsios & D Zylis

  6. National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands

    E Buurma & M C Ocké

  7. Department of Clinical Sciences, Lund University, Malmö, Sweden

    E Sonestedt

  8. Epidemiology Department, Murcia Health Council, Murcia and CIBER Epidemiología y Salud Pública (CIBERESP), Spain

    M D Chirlaque

  9. Department of Clinical Epidemiology, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark

    M K Jensen

  10. Inserm ERI 20, Institut Gustave Roussy, Villejuif, France

    F Clavel-Chapelon & M C Boutron-Ruault

  11. Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany

    R Kaaks

  12. Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany

    U Nöthlings

  13. Epidemiology Section, Institute for Experimental Medicine, University of Kiel, Kiel, Germany

    U Nöthlings

  14. Department of Clinical and Experimental Medicine, University of Naples, Federico II, Naples, Italy

    A Mattiello

  15. Molecular and Nutritional Epidemiology Unit, ISPO, Florence, Italy

    S Caini

  16. Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands

    Y T van der Schouw

  17. Institute of Community Medicine, University of Tromsø, Tromsø, Norway

    G Skeie

  18. Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway

    C L Parr

  19. Andalusian School of Public Health, Granada and CIBER Epidemiología y Salud Pública (CIBERESP), Spain

    E Molina-Montes

  20. Department of Surgery, Malmö University Hospital, Malmö, Sweden

    J Manjer

  21. Department of Nutritional Research, University of Umeå, Umeå, Sweden

    I Johansson

  22. Department of Public Health and Primary Care, MRC Centre for Nutritional Epidemiology in Cancer Prevention and Survival, University of Cambridge, Cambridge, UK

    A McTaggart & S Bingham

  23. Cancer Epidemiology Unit, University of Oxford, Oxford, UK

    T J Key

  24. Diet and Cancer Group, MRC Mitochondrial Biology Unit, Cambridge, UK

    S Bingham

  25. Department of Epidemiology, Public Health and Primary Care, Imperial College, London, UK

    E Riboli

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Corresponding author

Correspondence to A E Cust.

Additional information

Guarantor: AE Cust.

Contributions: AEC carried out the statistical analysis, preparation of tables and figures, and wrote the paper, taking into account comments from all co-authors. NS was the overall coordinator of this project and of the EPIC nutritional databases (ENDB) project. MRS, MvB, JH, AO, CA, TP, EB, ES, MDC were members of the writing group and gave input on the statistical analysis, drafting of the manuscript and interpretation of results. The other EPIC authors were local EPIC collaborators involved in the collection of dietary and other data, and in the ENDB project. ER is the overall coordinator of the EPIC study. All co-authors provided comments and suggestions on the manuscript and approved the final version.

Appendix

Appendix

Tables A1a, A1b, A1c and A1d

Table a1a Fully adjusteda mean daily intakes of total carbohydrates (g/day) by centre, ordered from south to north, gender and age group
Full size table
Table a1b Fully adjusteda mean daily intakes of total sugars (g/day) by centre, ordered from south to north, gender and age group
Full size table
Table a1c Fully adjusteda mean daily intakes of total starch (g/day) by centre, ordered from south to north, gender and age group
Full size table
Table a1d Fully adjusteda mean daily intakes of total fibre (g/day) by centre, ordered from south to north, gender and age group
Full size table

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Cust, A., Skilton, M., van Bakel, M. et al. Total dietary carbohydrate, sugar, starch and fibre intakes in the European Prospective Investigation into Cancer and Nutrition. Eur J Clin Nutr 63 (Suppl 4), S37–S60 (2009). https://doi.org/10.1038/ejcn.2009.74

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Keywords

  • dietary carbohydrates
  • dietary sugars
  • dietary starch
  • dietary fibre
  • EPIC
  • 24-h dietary recall

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