Study acknowledges need for “culturally appropriate food choices” when assessing carbohydrates

24 Mar 2023 --- Researchers are advocating for a new Carbohydrate Food Quality Score (CFQS) model that takes a holistic approach to evaluate carbohydrate quality in a “more culturally inclusive” way that encompasses different diets and budgets. Instead of other current benchmarking systems that solely focus on carbohydrates, sugar and dietary fiber content, the new model includes other nutrient and cultural considerations.

The study, published in Nutrients, scored carbohydrate foods from American ethnic groups to show how assessing culturally and economically diverse eating patterns can be integrated with dietary recommendations.

“The CFQS provides a vehicle that affirms with each individual’s values, socioeconomics, food and cultural traditions and provides a scale to help address nutritional concerns about the diet,” explains co-author Julie Miller Jones, professor emerita at the St. Catherine University in St. Paul, US. 

“It can reassure consumers of the role of carbohydrate foods for constructing healthy eating patterns while affirming equitable, nutritious and culturally appropriate food choices to influence health.”

The CFQS model scores non-grain carbohydrate foods on fiber, free sugars, sodium and potassium.Shortcomings of national dietary recommendations 
The authors note that although dietary guidelines emphasize the importance of total nutritional patterns and quality, many tools categorize individual foods as either “good” or “bad.” They also run the risk of being unclear, such as in the case of statements like “eat a rainbow” when referring to consuming a variety of fruit and vegetables. 

“Unlike other approaches to evaluating carbohydrate quality, the CFQS evaluates the contribution of under-consumed dietary components like potassium, dietary fiber and whole grains and over-consumed nutrients like sodium, predominantly found in carbohydrate-containing foods, especially grains,” notes Rodriguez. 

“This nuance is significant, as it sheds light on the fact that carbohydrate-containing foods contain many important nutrients beyond carbohydrates. Furthermore, this tool is the only carbohydrate quality index that aligns with the Dietary Guidelines for Americans (DGA).”

The DGA has been criticized for failing to prioritize human health and addressing racial disparities within nutrition. The next DGA for 2025-2030 is underway, with a new emphasis on ultra-processed foods and food-based strategies to help prevent or manage overweight and obesity. 

Evaluating carbohydrate quality 
An earlier publication in Nutrients described the development of the scoring system. It scores non-grain carbohydrate foods based on four nutrients – fiber, free sugars, sodium and potassium – with a maximum of four points. 

The grain group is assessed on the same nutrients and includes whole grains, giving these products a possible maximum score of five points. 

“The new CFQS recognizes that carbohydrate foods are not homogenous and nuance is needed when communicating this to consumers,” states co-author Judy Rodriguez, professor at the University of North Florida. 

“For example, while potatoes and grain-based foods are considered ‘carb foods’ and contribute important nutrients to the diet, their nutrient profiles and quality vary. The CFQS can help identify those foods that can be chosen frequently as dietary staples.” 

Modeling menus with carbohydrates 
The researchers used the CFQS models to score carbohydrate foods commonly found in the four largest recorded ethnic groups in the US: African American, Latino/Latin American, Asian American and Native American. 

The authors scored carbohydrate foods from American ethnic groups to show how culturally inclusive food patterns can be integrated.They used these scores to demonstrate how culturally inclusive food patterns can be integrated with dietary recommendations and the CFQS models. 

With modeling software, the researchers developed four one-day models based on the CFQS models: “healthy US,” “healthy Mediterranean style,” “healthy vegetarian” and “budget-conscious.” All menus amounted to around 2,000 kcal and included three meals and two snacks. 

The researchers prioritized carbohydrate foods with a score of three or higher. Still, they included food products with a lower score to demonstrate their nutritional contributions to healthy, diverse, affordable and culturally appropriate food patterns.

Need for further research  
A 36-year study on 119,315 participants demonstrated that healthy eating patterns advised by the DGA reduced the risk of dying prematurely. 

The authors note that they could not show the effects of implementing CFQS models on specific health outcomes. Future research is needed on the health impacts of higher-scoring CFQS dietary patterns compared to lower-scoring practices.

Moreover, the research team notes that the CFQS models only assess four or five nutrients, while foods possess many qualities that can impact health. 

Additional research into other key factors is critical, such as the bioavailability of nutrients, the content of other nutrients and contributions from bioactive phytonutrients (e.g., antioxidants, prebiotics and probiotics).

The authors conclude that a greater understanding of how non-Western staple carbohydrate foods can impact nutrition and health within culturally inclusive diets could help improve dietary guidance. Additionally, they highlight that CFQS models could support the DGA goals to enhance diet quality with a “more systematic” method to identify food quality. 

By Jolanda van Hal