Cited by 109Nutritional Studies and DietFood composition and propertiesDiet, Metabolism, and Disease

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

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·2009·European Journal of Clinical Nutrition

DOI 10.1038/ejcn.2009.74

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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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The role of amylose content on the structure and rheological properties of pea protein-starch systems during pressurized hydrothermal processing
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Positive contribution of hydroxytyrosol-enriched wheat bread to HbA1c levels, lipid profile, markers of inflammation and body weight in subjects with overweight/obesity and type 2 diabetes mellitus
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 27
“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.”
Background
Specific food group combinations explaining the variation in intakes of nutrients and other important food components in the European Prospective Investigation into Cancer and Nutrition: an application of the reduced rank regression method
Kröger, 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
“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…”
Background
Increasing dietary fibre intake in healthy adults using personalised dietary advice compared with general advice: a single-blind randomised controlled trial
Rijnaarts, 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
“In the Netherlands, median fibre intake is around 18 g for women and 22 g for men(18,19).”
Background
Modification 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
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
“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.”
Background
Development and validation of the FiberScreen: A short questionnaire to screen fibre intake in adults
Rijnaarts, 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 20
Capillary electrophoretic separation of mono- and di-saccharides with dynamic pH junction and implementation in microchips
Kazarian, A. A., Hilder, E. F., & Breadmore, M. C. (2010) · The Analyst · doi:10.1039/c0an00010h · Cited by 17
Relation of dietary glycemic load with ischemic and hemorrhagic stroke: a cohort study in Greece and a meta-analysis
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
“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.”
Result
Dietary carbohydrate quantity and quality in relation to obesity: A pooled analysis of three Finnish population-based studies
Kaartinen, 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
Extrinsic wheat fibre consumption enhances faecal bulk and stool frequency; a randomized controlled trial
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
Meal analysis for understanding eating behavior: meal- and participant-specific predictors for the variance in energy and macronutrient intake
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
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 16
“Diet high in fibre may also protect against cardiovascular disease, colorectal cancer and obesity (Cust et al., 2009).”
Background
Retaining a large amount of resistant starch in cooked potato through microwave heating after freeze-drying
Peng, 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
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
“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…”
Method
Understanding the gut microbiota by considering human evolution: a story of fire, cereals, cooking, molecular ingenuity, and functional cooperation
Tannock, G. W. (2023) · Microbiology and Molecular Biology Reviews · doi:10.1128/mmbr.00127-22 · Cited by 15
Concentration of polycyclic aromatic hydrocarbons (PAHs) in bread and health risk assessment across the globe: A systematic review and meta‐analysis
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
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 13
Glycemic index, glycemic load and carbohydrate intake in association with risk of renal cell carcinoma
Zhu, J., Tu, H., Matin, S. F., Tannir, N. M., Wood, C. G., & Wu, X. (2017) · Carcinogenesis · doi:10.1093/carcin/bgx083 · Cited by 12
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
Validity and Reproducibility of a Self-Administered Food Frequency Questionnaire for the Assessment of Sugar Intake in Middle-Aged Japanese Adults
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
“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.”
Non-cereal ingredients for the attenuation of glycaemic response to bread: a review of the clinical evidence
Stamataki, N. S., Yanni, A. E., & Karathanos, V. Τ. (2016) · Food & Function · doi:10.1039/c6fo00440g · Cited by 12
Can wheat germ have a beneficial effect on human health? A study protocol for a randomised crossover controlled trial to evaluate its health effects
Moreira-Rosário, A., Pinheiro, H., Calhau, C., & Azevedo, L. F. (2016) · BMJ Open · doi:10.1136/bmjopen-2016-013098 · Cited by 11
Positive postprandial glycaemic and appetite-related effects of wheat breads enriched with either α-cyclodextrin or hydroxytyrosol/α-cyclodextrin inclusion complex
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
“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].”
Background
Health aspects of dietary fibre
Slavin, J. L. (2013) · Elsevier eBooks · doi:10.1533/9780857095787.1.61 · Cited by 9
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
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
Trends in added sugar intake and food sources in a cohort of older Australians: 15 years of follow‐up from the Blue Mountains Eye Study
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
Prevotella abundance and salivary amylase gene copy number predict fat loss in response to wholegrain diets
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
“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…”
Background
The 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
Impact of a Low-Insulin-Stimulating Bread on Weight Development—A Real Life Randomised Controlled Trial
Kempf, K., Röhling, M., Kolb, H., & Martin, S. (2023) · Nutrients · doi:10.3390/nu15051301 · Cited by 6
“In Europe, it provides up to 30% of the daily carbohydrate consumption in women and up to 37% in men [1].”
BackgroundInfluential
A novel nutritional supplement containing amino acids and chromium decreases postprandial glucose response in a randomized, double-blind, placebo-controlled study
Östman, 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
“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].”
Background
Dietary Fiber
Johnson, I. T. (2012) · Wiley eBooks · doi:10.1002/9781119946045.ch8 · Cited by 6
Dual biological role of glycoside hydrolase family fifty-seven glycogen branching enzymes
Xiang, G. (2021) · doi:10.33612/diss.195152904 · Cited by 5
Lifestyle and specific dietary habits in the Italian population: focus on sugar intake and association with anthropometric parameters—the LIZ (Liquidi e Zuccheri nella popolazione Italiana) study
Marangoni, F., Brignoli, O., Cricelli, C. A., & Poli, A. (2016) · European Journal of Nutrition · doi:10.1007/s00394-016-1215-z · Cited by 4
“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.”
BackgroundMethod
Mapping the climate impact of rye bread production in Sweden: insights into cultivation, packaging, and surplus management for sustainable food systems
Hildersten, S., Bartek, L., Brancoli, P., Eriksson, M., Karlsson, H., & Strid, I. V. (2025) · Frontiers in Sustainable Food Systems · doi:10.3389/fsufs.2025.1528862 · Cited by 3
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
Dietary Fiber: Composition and Health Effects by Microbiota
Watanabe, S. (2024) · Food science and nutrition · doi:10.5772/intechopen.115113 · Cited by 2
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
Evaluation of Nutritional Composition of Ripe Date Fruit (Phoenix Dactylifera L.) pulp and Seed grown in Nigeria
Olabinjo, O. O., Omowunmi, S. M., & Samuel, B. O. (2022) · International Journal of Environment Agriculture and Biotechnology · doi:10.22161/ijeab.75.12 · Cited by 2
Elaboração de manual sobre fibras alimentares e constipação intestinal
Costa, S. M. B., Medeiros, L. H., Zugaib, J. C. D. M., Souza, L. S. D., Betting, E. T., & de Barros, S. P. (2017) · Nutrição Brasil · doi:10.33233/nb.v16i3.1103 · Cited by 2
Fiber
Johnson, I. T. (2020) · Elsevier eBooks · doi:10.1016/b978-0-323-66162-1.00031-7 · Cited by 2
Is Starch Intake Associated With Periodontal Status? An 11‐Year Longitudinal Analysis Among Finnish Adults
Jangda, F. H., Suominen, A. L., Lundqvist, A., Männistö, S., Golkari, A., & Bernabé, E. (2024) · Journal Of Clinical Periodontology · doi:10.1111/jcpe.14072 · Cited by 1
“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).”
Beyond Glucose Thresholds: Nutrition, Glycaemic Dynamics and Vascular Dysfunction in Gestational Diabetes Mellitus
Valero, P., Costa, S. M. B., Rudge, M. V. C., Silva, K., van der Beek, E. M., & Sobrevía, L. (2026) · Handbook of experimental pharmacology · doi:10.1007/164_2026_823 · Cited by 1
Importance of palm's heart for pregnant women
Kushi, E. N., Belachew, T., & Tamiru, D. (2023) · Journal of Nutritional Science · doi:10.1017/jns.2022.112 · Cited by 1
Diet, intermediate risk markers and risk of type 2 diabetes
Sluijs, I. (2011) · Utrecht University Repository (Utrecht University) · Cited by 1
Reply to Conlon et al.
Guglielmetti, S., & Riso, P. (2015) · Journal of Nutrition · doi:10.3945/jn.114.209890 · Cited by 1
The role of sweet and savoury taste in food intake and food preferences
Griffioen-Roose, S. (2012) · doi:10.18174/191459 · Cited by 1
Fatty acids and sugars in commercial baked goods
Garcia-Estepa, R., García‐Villanova, B., Guera-Hernández, E., & Contreras‐Calderón, J. (2013) · Acta Alimentaria · doi:10.1556/aalim.42.2013.2.5
Genetic Determinants of Carbohydrate Consumption
Eny, K. M. (2010) · TSpace (University of Toronto)
Carbohydrates in the diet of Finnish adults : Focus on intake assessment and associations with other dietary components and obesity
Kaartinen, N. E. (2018) · Työväentutkimus Vuosikirja

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: Cust, A E
Skilton, M R
Halkjær, J
Olsen, A
Agnoli, C
Sonestedt, E
Chirlaque, M D
Rinaldi, S
Tjønneland, A
Jensen, M K
Kaaks, R
Nöthlings, U
Mattiello, A
Caini, S
Ocké, M C
Skeie, G
Parr, C L
Manjer, J
Johansson, I
Key, T J
Slimani, N
Venue: European Journal of Clinical Nutrition
Publisher: Springer Science and Business Media LLC
Published: 2009-11
Volume: 63
Issue: S4
Pages: S37-S60
ISSN: 0954-3007 (ISSN-L)
1476-5640
DOI: 10.1038/ejcn.2009.74
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
Licence: www.springer.com/tdm (tdm)
www.springer.com/tdm (vor)
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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Total dietary carbohydrate, sugar, starch and fibre intakes in the European Prospective Investigation into Cancer and Nutrition

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