Total dietary carbohydrate, sugar, starch and fibre intakes in the European Prospective Investigation into Cancer and Nutrition
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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A healthy dietary pattern of the subjects, including omnivores, was supported by higher intake of total carbohydrates, mainly starch and fibre, compared with intakes recorded in the European Prospective Investigation into Cancer and Nutrition study.
“A healthy dietary pattern of the subjects (omnivores included) was also supported by the higher intake of total carbohydrates, mainly starch and fibre, compared with the intakes recorded in the European Prospective Investigation into Cancer and Nutrition study.47”
From High-level adherence to a Mediterranean diet beneficially impacts the gut microbiota and associated metabolome (2016) · cites this paper as [47]
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Chuang, S.-C., Vermeulen, R. C. H., Sharabiani, M. T. A., Sacerdote, C., Hosnijeh, F. S., Berrino, F., Krogh, V., Palli, D., Panico, S., Tumino, R., et al. (2011) · Biomarkers · doi:10.3109/1354750x.2011.599042 · Cited by 46 · see citing works
Men with prostate cancer make positive dietary changes following diagnosis and treatment
AVERY, K. N. L., Donovan, J., Gilbert, R., Davis, M., Emmett, P. M., Down, L., Oliver, S. E., Neal, D. E., Hamdy, F. C., & Lane, J. A. (2013) · Cancer Causes & Control · doi:10.1007/s10552-013-0189-x · Cited by 45 · see citing works
“While baseline total energy and carbohydrate intakes in this cohort were similar to those of men in the UK EPIC cohort [23, 24], they were also still broadly representative of the UK general population [25].”
ResultDiarrhea in Critically Ill Patients
de Brito-Ashurst, I., & Preiser, J. (2016) · Journal of Parenteral and Enteral Nutrition · doi:10.1177/0148607116651758 · Cited by 43 · see citing works
Nutrient-wide association study of 92 foods and nutrients and breast cancer risk
Heath, A. K., Muller, D. C., van den Brandt, P. A., Papadimitriou, N., Critselis, E., Gunter, M. J., Vineis, P., Weiderpass, E., Fagherazzi, G., Boeing, H., et al. (2020) · Breast Cancer Research · doi:10.1186/s13058-019-1244-7 · Cited by 43 · see citing works
Binou, P., Yanni, A. E., Stergiou, A., Karavasilis, K., Konstantopoulos, P. S., Perrea, D. N., Tentolouris, N., & Karathanos, V. Τ. (2020) · European Journal of Nutrition · doi:10.1007/s00394-020-02265-6 · Cited by 39 · see citing works
“Specifically, the average bread consumption in Europe is about 170 g per day per capita [5].”
BackgroundY, S. E., M, M. N., J, M, B. E., A, N. T., & S, S. M. (2015) · African Journal of Pure and Applied Chemistry · doi:10.5897/ajpac2015.0643 · Cited by 38 · see citing works
“Crude fiber decreases the absorption of cholesterol from the gut in addition to delaying the digestion and conversion of starch to simple sugars, an important factor in the management of diabetes (Cust et al., 2009).”
BackgroundYu, E. Y.-W., Wesselius, A., Mehrkanoon, S., Goosens, M., Brinkman, M. T., van den Brandt, P. A., Grant, E. J., White, E., Weiderpass, E., Calvez‐Kelm, F. L., et al. (2021) · BMC Medicine · doi:10.1186/s12916-021-01931-8 · Cited by 35 · see citing works
“Starchy vegetables can raise blood sugar levels faster than non-starchy vegetables, resulting in an increased glycaemic loading and insulin response, and may thereby resist the suggested inverse association between vegetables and bladder cancer [73].”
BackgroundAtzler, J. J., Sahin, A. W., Gallagher, E., Zannini, E., & Arendt, E. K. (2021) · European Food Research and Technology · doi:10.1007/s00217-021-03762-6 · Cited by 33 · see citing works
Ocké, M., Larrañaga, N., Grioni, S., van den Berg, S. W., Ferrari, P., Salvini, S., Benetou, V., Linseisen, J., Wirfält, E., Rinaldi, S., et al. (2009) · European Journal of Clinical Nutrition · doi:10.1038/ejcn.2009.72 · Cited by 33 · see citing works
“Further details regarding energy intake from fat, including various types of fatty acids, carbohydrates, protein and alcohol are described elsewhere in this Supplement (Cust et al., 2009; Halkjær et al., 2009; Linseisen et al., 2009; Sieri et al., 2009).”
BackgroundThe InterAct Consortium (2016) · Diabetologia · doi:10.1007/s00125-016-4090-5 · Cited by 32 · see citing works
“Cereal fibre was derived from the ENDB by adding the fibre content of cerealbased products, including bread, rice, wheat-based pasta, crisp bread, rusks and breakfast cereals [31].”
MethodYanni, A. E., Stamataki, N. S., Konstantopoulos, P. S., Stoupaki, M. G., Abeliatis, A., Nikolakea, I., Perrea, D. N., Karathanos, V. Τ., & Tentolouris, N. (2016) · European Journal of Nutrition · doi:10.1007/s00394-016-1315-9 · Cited by 31 · see citing works
Eleazu, C., & Ironua, C. (2013) · AFRICAN JOURNAL OF BIOTECHNOLOGY · doi:10.5897/ajb12.2935 · Cited by 28 · see citing works
Hodges, C., Archer, F., Chowdhury, M., Evans, B. L., Ghelani, D. J., Mortoglou, M., & Guppy, F. M. (2019) · Foods · doi:10.3390/foods9010023 · Cited by 28 · see citing works
“Dietary carbohydrates are a fundamental constituent of a balanced diet, contributing between 40–70% of energy intake [1], with people relying heavily on staple foods, such as pasta and rice for energy [2,3].”
BackgroundSantos, J. L., Krause, B. J., Cataldo, L. R., Vega, J. A., Salas‐Pérez, F., Mennickent, P., Gallegos, R., Milagro, F. I., Prieto-Hontoria, P. L., Riezu‐Boj, J. I., et al. (2020) · Nutrients · doi:10.3390/nu12092790 · Cited by 28 · see citing works
“Starch, as the storage molecule of carbohydrates in plants, is considered one of the major contributors of energy intake in human diets [2,3], while current recommendations encourage reductions in added sugar consumption.”
BackgroundSasakabe, T., Haimoto, H., Umegaki, & Wakai (2011) · Diabetes Metabolic Syndrome and Obesity · doi:10.2147/dmso.s19635 · Cited by 26 · see citing works
Metabolic response to amylose-rich wheat-based rusks in overweight individuals
Vetrani, C., Sestili, F., Vitale, M., Botticella, E., Giacco, R., Griffo, E., Costabile, G., Cipriano, P., Tura, A., Pacini, G., et al. (2018) · European Journal of Clinical Nutrition · doi:10.1038/s41430-018-0136-8 · Cited by 25 · see citing works
Román, L., Jiménez‐Munoz, L., Jakobsen, L. M. A., & Corredig, M. (2024) · Food Hydrocolloids · doi:10.1016/j.foodhyd.2024.110830 · Cited by 26 · see citing works
Binou, P., Stergiou, A., Kosta, O. A., Tentolouris, N., & Karathanos, V. Τ. (2023) · European Journal of Nutrition · doi:10.1007/s00394-023-03133-9 · Cited by 24 · see citing works
“Wheat bread, a staple food daily consumed by various populations across the earth [24], is a main contributor to the postprandial glycaemia as a carbohydrate rich food; therefore, its enrichment with HT could have positive glucose postprandial effects.”
BackgroundKröger, J., Ferrari, P., Jenab, M., Bamia, C., Touvier, M., Bueno-de-Mesquita, H. B., Fahey, M. T., Benetou, V., Schulz, M., Wirfält, E., et al. (2009) · European Journal of Clinical Nutrition · doi:10.1038/ejcn.2009.85 · Cited by 24 · see citing works
“Descriptive analyses of this kind would complement studies on food sources of single nutrients or food components, as described in this supplement (Cust et al., 2009; Halkjær et al., 2009; Jenab et al., 2009; Linseisen et al., 2009; Olsen et al., 2009; Sieri et al., 2009; Welch et al., 2009), by investigating a group…”
BackgroundRijnaarts, I., de Roos, N. M., Wang, T., Zoetendal, E. G., Top, J. L., Timmer, M., Bouwman, E. P., Hogenelst, K., Witteman, B. J. M., & de Wit, N. J. W. (2020) · Public Health Nutrition · doi:10.1017/s1368980020002980 · Cited by 23 · see citing works
“In the Netherlands, median fibre intake is around 18 g for women and 22 g for men(18,19).”
BackgroundModification of appetite by bread consumption: A systematic review of randomized controlled trials
Gonzalez-Anton, C., Artacho, R., Ruiz‐López, M. D., Gil, Á., & Mesa, M. D. (2015) · Critical Reviews in Food Science and Nutrition · doi:10.1080/10408398.2015.1084490 · Cited by 21 · see citing works
Bread baking Review: Insight into Technological Aspects in order to Preserve Nutrition
Bredariol, P., & Vanin, F. M. (2021) · Food Reviews International · doi:10.1080/87559129.2021.1878211 · Cited by 20 · see citing works
“Starch is one of the main sources of energy in bread and is one of the main sources of energy in the human diet.([43]) During its digestion, the breakdown of its molecules and release of glucose for absorption in the intestine occurs.”
BackgroundRijnaarts, I., de Roos, N. M., Zoetendal, E. G., de Wit, N. J. W., & Witteman, B. J. M. (2021) · Journal of Human Nutrition and Dietetics · doi:10.1111/jhn.12941 · Cited by 19 · see citing works
Kazarian, A. A., Hilder, E. F., & Breadmore, M. C. (2010) · The Analyst · doi:10.1039/c0an00010h · Cited by 17 · see citing works
Rossi, M., Turati, F., Λάγιου, Π., Trichopoulos, D., Vecchia, C. L., & Trichopoulou, A. (2014) · European Journal of Nutrition · doi:10.1007/s00394-014-0702-3 · Cited by 17 · see citing works
“Indeed, data from the EPIC study suggest that the Greek diet considered in this study is characterized by a much lower level of total carbohydrate [5] and GL [33] compared to the Italian and the Dutch diets.”
ResultKaartinen, N. E., Knekt, P., Kanerva, N., Valsta, L. M., Eriksson, J. G., Rissanen, H. A., Jääskeläinen, T., & Männistö, S. (2016) · Scandinavian Journal of Public Health · doi:10.1177/1403494815622860 · Cited by 17 · see citing works
de Wit, N. J. W., Esser, D., Siebelink, E., Fischer, A., Sieg, J., & Mes, J. J. (2019) · Food & Function · doi:10.1039/c8fo01649f · Cited by 16 · see citing works
Schwedhelm, C., Iqbal, K., Schwingshackl, L., Agogo, G. O., Boeing, H., & Knüppel, S. (2019) · Nutrition Journal · doi:10.1186/s12937-019-0440-8 · Cited by 15 · see citing works
Nutritional composition and antioxidant activities of Curculigo pilosa (Hypoxidaceae) rhizome
Sofidiya, M. O. (2011) · AFRICAN JOURNAL OF BIOTECHNOLOGY · doi:10.5897/ajb11.1335 · Cited by 15 · see citing works
“Diet high in fibre may also protect against cardiovascular disease, colorectal cancer and obesity (Cust et al., 2009).”
BackgroundPeng, Z., Cheng, L., Meng, K., Shen, Y., Wu, D., & Shu, X. (2022) · Current Research in Food Science · doi:10.1016/j.crfs.2022.09.023 · Cited by 14 · see citing works
Fiber intake modulates the association of alcohol intake with breast cancer
Romieu, I., Ferrari, P., Chajès, V., de Batlle, J., Biessy, C., Scoccianti, C., Dossus, L., Boutron‐Ruault, M., Bastide, N. M., Overvad, K., et al. (2016) · International Journal of Cancer · doi:10.1002/ijc.30415 · Cited by 14 · see citing works
“Estimation of dietary fiber intake has been described previously.(10) In brief, dietary fiber was defined by the AOAC (Association of Official Agricultural Chemists) gravimetric method for Total Dietary Fiber,(11) and includes soluble and insoluble forms (including lignin) of non-starch polysaccharides and resistant s…”
MethodTannock, G. W. (2023) · Microbiology and Molecular Biology Reviews · doi:10.1128/mmbr.00127-22 · Cited by 14 · see citing works
Touranlou, F. A., Hashemi, M. B., Ghavami, V., & Sany, S. B. T. (2024) · Comprehensive Reviews in Food Science and Food Safety · doi:10.1111/1541-4337.13411 · Cited by 12 · see citing works
Microbial metabolites derived from colonic fermentation of non-digestible compounds
Tabernero, M., & de Cedrón, M. G. (2017) · Current Opinion in Food Science · doi:10.1016/j.cofs.2017.03.005 · Cited by 12 · see citing works
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Cr-enriched yeast: beyond fibers for the management of postprandial glycemic response to bread
Yanni, A. E., Stamataki, N. S., Stoupaki, M. G., Konstantopoulos, P. S., Pateras, I. M. C., Tentolouris, N., Perrea, D. N., & Karathanos, V. Τ. (2016) · European Journal of Nutrition · doi:10.1007/s00394-016-1190-4 · Cited by 12 · see citing works
Kanehara, R., Goto, A., Kotemori, A., Mori, N., Nakamura, A., Sawada, N., Ishihara, J., Takachi, R., Kawano, Y., Iwasaki, M., et al. (2019) · Nutrients · doi:10.3390/nu11030554 · Cited by 12 · see citing works
“Moreover, according to previous studies on estimations of sugar intakes [9,10], amount and source of dietary sugar consumption among Japanese populations may differ from that among European populations.”
Stamataki, N. S., Yanni, A. E., & Karathanos, V. Τ. (2016) · Food & Function · doi:10.1039/c6fo00440g · Cited by 12 · see citing works
Moreira-Rosário, A., Pinheiro, H., Calhau, C., & Azevedo, L. F. (2016) · BMJ Open · doi:10.1136/bmjopen-2016-013098 · Cited by 11 · see citing works
Binou, P., Stergiou, A., Kosta, O. A., Tentolouris, N., & Karathanos, V. Τ. (2022) · European Journal of Nutrition · doi:10.1007/s00394-022-02913-z · Cited by 10 · see citing works
“Wheat bread is a staple food, largely consumed by different population groups of all ages, that is classified as a high glycaemic index (GI) product due to its porous matrix and highly gelatinized starch content [17, 18].”
BackgroundHealth aspects of dietary fibre
Slavin, J. L. (2013) · Elsevier eBooks · doi:10.1533/9780857095787.1.61 · Cited by 9 · see citing works
A Nutritional Evaluation of Plant-Based Meat and Sausage Analogues
Brodersen, L., Rimbach, G. H., Seidel, U., Rinne, P., Hasler, M., Bosy‐Westphal, A., & Jans, K. (2025) · Foods · doi:10.3390/foods14213674 · Cited by 8 · see citing works
Avaliação da ingestão energética e em macronutrientes da população adulta portuguesa
Pinhão, S., Poínhos, R., Franchini, B., Afonso, C., Teixeira, V. H., Moreira, P. A. M., Oliveira, B. M. P. M., de Almeida, M. D. V., & Correia, F. (2016) · Revista Portuguesa de Saúde Pública · doi:10.1016/j.rpsp.2016.06.004 · Cited by 8 · see citing works
Moshtaghian, H., Louie, J. C. Y., Charlton, K. E., Probst, Y., Gopinath, B., Mitchell, P., & Flood, V. M. (2016) · Journal of Human Nutrition and Dietetics · doi:10.1111/jhn.12425 · Cited by 8 · see citing works
Christensen, L. H., Hjorth, M. F., Krych, Ł., Licht, T. R., Lauritzen, L., Magkos, F., & Roager, H. M. (2022) · Frontiers in Nutrition · doi:10.3389/fnut.2022.947349 · Cited by 7 · see citing works
“When considering that roughly 25–50% of caloric intake of typical diets comes from starch (22), and that the ability of the human host to degrade starch varies tremendously (8), it is likely that interactions between starch and amylase in the upper gastrointestinal tract have a substantial impact on glucose and body w…”
BackgroundThe eating rate of bread predicted from its sensory texture and physical properties
Heuven, L. A. J., Dekker, M., Renzetti, S., & Bolhuis, D. P. (2024) · Food & Function · doi:10.1039/d4fo04297b · Cited by 6 · see citing works
Kempf, K., Röhling, M., Kolb, H., & Martin, S. (2023) · Nutrients · doi:10.3390/nu15051301 · Cited by 6 · see citing works
“In Europe, it provides up to 30% of the daily carbohydrate consumption in women and up to 37% in men [1].”
BackgroundInfluentialÖstman, E. M., Samigullin, A., Heyman‐Lindén, L., Andersson, K. E., Björck, I., Öste, R., & Humpert, P. M. (2020) · PLoS ONE · doi:10.1371/journal.pone.0234237 · Cited by 5 · see citing works
“At the same time carbohydrate-rich foods with a high GI and a high glycemic load (GL), which became widespread throughout the 20th century paralleled by an increasing prevalence of obesity and T2D [22], are very popular and commonly available to the consumer [23].”
BackgroundJohnson, I. T. (2012) · Wiley eBooks · doi:10.1002/9781119946045.ch8 · Cited by 5 · see citing works
Dual biological role of glycoside hydrolase family fifty-seven glycogen branching enzymes
Xiang, G. (2021) · doi:10.33612/diss.195152904 · Cited by 5 · see citing works
Marangoni, F., Brignoli, O., Cricelli, C. A., & Poli, A. (2016) · European Journal of Nutrition · doi:10.1007/s00394-016-1215-z · Cited by 4 · see citing works
“Other published information concerns non-population-representative cohorts, such as that recruited in EPIC (mainly blood donors living in five Italian towns) [13], which reported intakes ranging from 95.”
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Use of Fortified Bread for Addressing Vitamin D Deficiency
Iossifidis, S., Vaiou, M., Challa, A. S., Migdanis, A., Migdanis, I., Moula, A. I., Παπαγεωργίου, Μ., Kokkinos, G., Deligiorgis, D., Varitimidis, S. E., et al. (2021) · Advances in experimental medicine and biology · doi:10.1007/978-3-030-78771-4_42 · Cited by 2 · see citing works
Dietary Fiber: Composition and Health Effects by Microbiota
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Determination Of Nutrients And Anti-nutrients Contents Of Phoenix Dactylifera
Muhammad, D., Siddan, A. A., Abubakar, S. M., Gadanya, A. M., Maigari, F. U., & Abubakar, A. (2020) · Jewel Journal of Medical Sciences · doi:10.56167/jjms.2020.0101.07 · Cited by 2 · see citing works
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Elaboração de manual sobre fibras alimentares e constipação intestinal
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“Although there are currently no dietary reference values for starch intake, the average intake of starch in our sample (g/day) was within the values reported across several adult populations in Nordic, Southern and Central European countries (Cust et al. 2009; Lemming and Pitsi 2022).”
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Importance of palm's heart for pregnant women
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Diet, intermediate risk markers and risk of type 2 diabetes
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Genetic Determinants of Carbohydrate Consumption
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- Authors
- Cust, A. E., Skilton, M. R., van Bakel, M. M. E., Halkjær, J., Olsen, A., Agnoli, C., Psaltopoulou, T., Buurma, E., Sonestedt, E., Chirlaque, M. D., Rinaldi, S., Tjønneland, A., Jensen, M. K., Clavel-Chapelon, F., Boutron-Ruault, M. C., Kaaks, R., Nöthlings, U., Chloptsios, Y., Zylis, D., Mattiello, A., Caini, S., Ocké, M. C., van der Schouw, Y. T., Skeie, G., Parr, C. L., Molina-Montes, E., Manjer, J., Johansson, I., McTaggart, A., Key, T. J., Bingham, S., Riboli, E., & Slimani, N.
- Affiliations
- The University of Melbourne (AU)
- Lyon 1 Université (FR)
- Danish Cancer Society (DK)
- Fondazione IRCCS Istituto Nazionale dei Tumori (IT)
- National Institute for Public Health and the Environment (NL)
- Lund University (SE)
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (ES)
- Centre international de recherche sur le cancer (FR)
- Aalborg University Hospital (DK)
- German Cancer Research Center (DE)
- Christian-Albrechts-Universität zu Kiel (DE)
- National and Kapodistrian University of Athens (GR)
- University of Naples Federico II (IT)
- Istituto per lo Studio e la Prevenzione Oncologica (IT)
- UiT The Arctic University of Norway (NO)
- University of Oslo (NO)
- Umeå University (SE)
- University of Cambridge (GB)
- University of Oxford (GB)
- Corresponding author
- Cust, A E
- ORCID
- Venue
- European Journal of Clinical Nutrition
- Published
- 2009-11
- Volume
- 63
- Issue
- S4
- Pages
- S37-S60
- ISSN
- 0954-3007 (ISSN-L)
- 1476-5640
- OpenAlex
- W2144414406
- Cited by
- 109
- References
- 52
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 6 · 2023: 5 · 2022: 7 · 2021: 11 · 2020: 7 · 2019: 6 · 2018: 7 · 2017: 6 · 2016: 13 · 2015: 7 · 2014: 7 · 2013: 4 · 2012: 7
- FWCI
- 6.36
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- European Journal of Clinical Nutrition (publishedVersion)
- PubMed (publishedVersion)
- Lund University Publications (Lund University) (submittedVersion)
- Rivm Repository (Netherlands National Institute for Public Health and the Environment) (submittedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion)
- Funders
- Wellcome Trust
- Cancer Research UK
- National Institute for Health and Care Research
- British Heart Foundation
- European Commission
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Health Sciences › Nursing › Nutrition and Dietetics › Food composition and properties
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diet, Metabolism, and Disease
- Keywords
- carbohydrate intake, dietary fiber intake, dietary sugar, dietary starch, bread consumption, fruit consumption, physical activity, smoking status, alcohol consumption, EPIC cohort
- MeSH terms
- Adult, Aged, Alcohol Drinking, Energy Intake, Diet, Diet Surveys, Dietary Carbohydrates, Dietary Fiber, Europe, Female, Humans, Male, Middle Aged, Prospective Studies, Sex Factors, Smoking, Starch, Exercise, Diet Records, Confounding Factors, Epidemiologic, Dietary Sucrose
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