New Terminology and Guidelines for Fibre Intake

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Fibre is a complex food fraction and pharmaceutical and food manufacturers are producing new ranges of products, using research data on fibre to produce functional or therapeutic foods that target specific groups of consumers or patients; this can lead to confusion for the nurse or consumer when trying to understand current health education and the benefit from a higher fibre intake in their diet. If the nurse understands the current issues and new terminology surrounding fibre, she or he will be ideally placed to help and guide the patient with diverticular disease.

The term 'dietary fibre' was described by Hipsley (1953) and it refers to the material that is derived from plant cell walls. Burkitt and Trowell (1975) suggested that the large quantities of unrefined plant foods, with their cell walls intact, which rural Africans ate compared with their western counterparts, were the link in bowel disease, and identified the plant cell wall as the protective factor. To identify these components, Trowell et al. (1976) used the original term that Hipsley (1953) coined - 'dietary fibre'. Trowell and his colleagues (1976) proposed a definition of dietary fibre that became acceptable by most as a convenient working definition at that time.

When proposing new definitions of dietary fibre it is important to consider the indigestibility of these materials; the original term was a complex mixture and the component polysaccharides had a range of chemical and physical properties. Certainly, in the late 1970s, researchers did not readily have the availability of isolated cell wall materials to feed to people to study the mechanism of action.

Burkitt's original hypothesis focused on the effects of indigestible fibre in the colon and its effect on faecal bulk and consistency, intraintestinal pressures, diverticular disease, transit times, atonia, and the effect of bacterial metabolism and bowel cancer. Through research it was seen that substantial proportions of all the components of the plant cell wall, with the exception of lignin, which is a non-carbohydrate, were fermented by microflora in the colon.

At a meeting of a European working party, a newer definition of dietary fibre was proposed. Based on non-digestibility, it states that fibre is:

The part of the oligosaccharides (shorter chain) and polysaccharides, and their hydrophilic derivatives which cannot be decomposed, by human digestive enzymes, to absorbable components in the upper alimentary tract; it includes lignin.

In 1987 Englyst et al. had redefined the term 'dietary fibre' by introducing the new terminology NSPs or non-starch polysaccharides. NSPs are categorized as carbohydrates and are considered to be an important constituent of healthy nutrition. Although seen as a carbohydrate, NSP is similar to a starch. Although starch in the diet is used for energy, NSP passes into the colon, where it ferments to produce short chain fatty acids; it is then excreted to help form most of the faecal bulk (Sullivan, 2000). In estimating dietary intake of NSP as part of dietary fibre intake, measurements of NSPs can be analysed in the laboratory. This allows an estimation of dietary fibre intake, appropriate food labelling and informed food choice (Department of Health or DoH, 1991). In 1991 the DoH published Dietary Reference Values for Food, Energy and Nutrients for the United Kingdom which described the use of dietary reference values. The Englyst (1994) method of measurement is now used in measuring and this supersedes the older method described by Southgate and Durnin (1970). A recommended daily amount of NSP is 18 g for adults, varying between 12 and 24 g. Realistically, however, in the UK the amount of NSP consumed daily is around 11-13 g, of which 40% is cereal and about 50% is vegetable (DoH, 1991).

The most recent figures from the National Food Survey in 1997, conducted by the Ministry of Agriculture, Food and Fisheries (MAFF, 1997), shows an average consumption of 13.8 g NSP in men and women (Table 11.1). This survey is conducted annually from a random sample of 8000 families across the UK who keep a diary for 7 days of all food bought into the home for human consumption, and an account is also kept of the food and drink consumed outside the home.

Table 11.1 Consumption of non-polysaccharides (NSPs) in adults

Source

NSP (g/day)

MAFF (1997)

13.8

Emmett et al. (1993)

Males: 15.5-16.4

Females: 14.3-15.3

Bingham et al. (1990)

Males: 11.2

Females: 12.5

From Davies (1999).

From Davies (1999).

If, therefore, it seems that the public are not consuming enough health-promoting fibre in the form of NSPs, which has a valuable effect in the prevention and management of a variety of diseases, including bowel dysfunctions and bowel cancer, are fibre supplements the answer? Bulking agents can enhance the intake of NSPs but consumption in this form is not in line with the recommendations of the COMA (Committee on Medical Aspects of Food Policy) panel. It was from the working groups on the COMA panel that the 1991 DoH paper came. NSPs should be derived from a variety of foods with their make-up consisting of a naturally integrated component rather than supplements or enriched NSP products (DoH, 1991).

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