Potential Role in Etiology of Disease

D L Topping and L Cobiac, CSIRO Health Sciences and Nutrition, Adelaide, SA, Australia

© 2005 Elsevier Ltd. All rights reserved.

have serious negative socioeconomic impacts, and their prevention through appropriate dietary and lifestyle change is the optimal strategy to minimize personal and community costs. This strategy is believed to have contributed substantially to economic growth in countries where it has been applied.

Obesity is a fairly visible problem that tends to overshadow other considerations. Energy intake in excess of expenditure is the root cause of obesity, and dietary carbohydrates are implicated specifically in the development of overweight. Exclusion of carbohydrates is attracting attention as a weight control strategy but this ignores the fact that digestible carbohydrates (including starch) provide the same amount of energy per gram as protein and less than 45% of the energy of fat and 60% of the energy of alcohol. Furthermore, it overlooks the many early comparative population studies that showed that several low-risk groups ate high-starch diets compared to high-risk populations that consumed processed foods high in refined carbohydrates and fat and low in fiber. With time, dietary fiber (rather than the whole diet) received specific attention, and many studies were conducted on the health benefits. This may have contributed to some of the current lack of clarity of the role of fiber and complex carbohydrates in health promotion. It may be compounded by the inadequacy of population data linking fiber (and also starches) to disease processes for important conditions such as color-ectal cancer. Only recently have good population data emerged for a protective role for fiber in this condition. This is in marked contrast to the well-established therapeutic and preventive action of fiber in constipation and diverticular disease. Furthermore, it is critical to determine what is meant by the term 'dietary fiber' because other food components may contribute to the major effects ascribed to fiber. This is important when considering the apparent protection conferred by whole grains against disease risk, especially because a health claim is permitted in the United States for their consumption.

Noninfectious diseases cause much morbidity and mortality in developed countries in Europe, the Americas, Asia, and Australasia. They are expected to increase due to an alarming increase in obesity, with its attendant risk of diabetes, coronary heart disease (CHD), and some cancers. Equally important, they are becoming an issue in developing countries through greater affluence. In every case, they

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