Triglyceride-Lowering Response to Plant Sterol and Stanol Consumption.

Phytosterols (PS) have long been recognized for their cholesterol-lowering action, however, recent work has highlighted triglyceride (TG)-lowering responses to PS that may have been overlooked in previous human interventions and mechanistic animal model studies. This review assesses the current state of knowledge regarding the effect of dietary PS supplementation on blood TG concentrations by examining the average therapeutic response, potential mechanisms, and metabolic and genetic factors that may contribute to inter-individual variability. Data from human intervention trials demonstrates that, compared to baseline concentrations, PS supplementation results in a variable TG-lowering response ranging from 0.8 to 28%. It is evident that hypertriglyceridemic individuals (>1.7 mmol/L) have a greater TG-lowering response to PS (11-28%) than subjects with normal plasma TG concentrations (0.8-7%). Although a genetic basis for the variable TG-lowering effects of PS is probable, there are only limited studies to draw on. The available data suggest that polymorphisms in the apolipoprotein E (apoE) gene may affect responsiveness, with PS-induced reductions in TG more readily evident in apoE2 than apoE3 or E4 subjects. Although only a minimal number of animal model studies have been conducted to specifically examine the mechanisms whereby PS may reduce blood TG concentrations, it appears that there may be multiple mechanisms involved including interruption of intestinal fatty acid absorption and modulation of hepatic lipogenesis and very low density lipoprotein packaging and secretion. In summary, the available data suggest that PS may be an effective therapy to lower blood TG, particularly in hypertriglyceridemic individuals. However, before PS can be widely recommended as a TG-lowering therapy, studies that are specifically powered and designed to fully access therapeutic responses and the mechanisms involved are required.

Consumption of wheat bran modified by autoclaving reduces fat mass in hamsters.

PURPOSE: To investigate the effect that wheat bran modified by autoclaving (MWB) had on reducing fat accumulation in hamsters fed a hypercholesterolemia- and obesity-inducing diet. METHODS: Male hamsters (n = 45) were randomized into 3 groups and fed a hypercholesterolemia- and obesity-inducing diet with or without 10% standard wheat bran or MWB for 28 days. Our outcome measures included body composition measured by DXA, oxygen consumption and plasma lipids and glucose concentrations. RESULTS: Animals fed the MWB diet had lower % fat mass (49.8 vs. 53.4%; p = 0.02) and higher % lean body mass (47.2 vs. 44.1%; p = 0.02) compared with controls despite no differences in food intake or weight gain. Additionally, plasma glucose tended to be lower (6.9 vs. 8.5 mmol/l; p < 0.08) in the MWB animals compared with controls. CONCLUSIONS: Our data suggest that the compositional changes in autoclaved wheat bran, specifically solubility of phenolic antioxidants and fiber, may have contributed to the lower fat accumulation in our animals. Further study is needed to determine whether the exact mechanism involved increased lipolysis and energy utilization from adipose.

Impact of Plant Protein Intakes on Nutrient Adequacy in the US.

There is an increasing interest in plant-based diets and higher levels of plant proteins due to rising concerns around health and environmental sustainability issues. We determined the effects of increasing quartiles of plant protein in the diet on nutrient adequacy using a large nationally representative observational dataset. Twenty-four-hour dietary-recall data from NHANES 2013-2018 from 19,493 participants aged 9+ years were used to assess nutrient intakes. Nutritional adequacy was assessed by estimating the percentage of the population with intakes below the EAR or above the AI. A quartile trend was assessed using regression and the significance was set at Pquartile trend < 0.05. With increasing quartiles of plant protein, the adequacy decreased for calcium, potassium, and vitamin D and increased for copper and magnesium for adolescents. Among the adults aged 19-50 years, the adequacy decreased for protein, choline, selenium, vitamin B12, and zinc and increased for copper, folate, iron, magnesium, thiamin, and vitamin C with increasing quartiles of plant protein. The adequacy for calcium, vitamin A, and zinc decreased and it increased for copper, folate, magnesium, thiamin, and vitamin C with increasing quartiles of plant protein among adults aged 51+ years. The results indicate that diets of mixed protein sources (from both animals and plants) are the most nutritionally adequate.

Consumption of low-fat dairy foods for 6 months improves insulin resistance without adversely affecting lipids or bodyweight in healthy adults: a randomized free-living cross-over study.

BACKGROUND: Given the highly debated role of dairy food consumption in modulating biomarkers of metabolic syndrome, this study was conducted to examine the influence of long-term (6 month) dairy consumption on metabolic parameters in healthy volunteers under free-living conditions without energy restriction. METHODS: Twenty-three healthy subjects completed a randomized, crossover trial of 12 months. Participants consumed their habitual diets and were randomly assigned to one of two treatment groups: a high dairy supplemented group instructed to consume 4 servings of dairy per day (HD); or a low dairy supplemented group limited to no more than 2 servings of dairy per day (LD). Baseline, midpoint, and endpoint metabolic responses were examined. RESULTS: Endpoint measurements of body weight and composition, energy expenditure, blood pressure, blood glucose, and blood lipid and lipoprotein responses did not differ (p > 0.05) between the LD and HD groups. HD consumption improved (p < 0.05) plasma insulin (-9%) and insulin resistance (-11%, p = 0.03) as estimated by HOMA-IR compared with the LD group. CONCLUSIONS: Study results suggest that high dairy consumption (4 servings/d) may improve insulin resistance without negatively impacting bodyweight or lipid status under free-living conditions. TRIAL REGISTRATION: Clinical Trials.gov: NCT01761955.

Gazing into the crystal ball: future considerations for ensuring sustained growth of the functional food and nutraceutical marketplace.

Over the last decade the concept of functional foods and nutraceuticals (FFN) has gained support from various stakeholders including the food industry, scientific and academic community, government institutions or regulators, producers and consumers. However, as one begins to evaluate the global FFN industry, several issues emerge including (i) a lack of consensus across jurisdictions for acknowledging safe and efficacious FFN, (ii) challenges regarding the classification of novel food-derived bioactives as FFN or drugs, and (iii) a disconnect between nutrient requirements and dosages of FFN required to facilitate health benefits. The objectives of the present review are to discuss the role of existing stakeholders within the FFN marketplace and identify performance indicators for growth within the FFN sector. In addition, the following report provides feasible resolutions to present and future challenges facing the global FFN industry to ensure sustained long-term growth.

Effect of increasing plant protein intake on protein quality and nutrient intake of US adults.

Three cycles of NHANES (2013-2018) were used to assess protein intake, protein quality (protein digestibility-corrected amino acid score; PDCAAS), protein cost, and nutrient intakes across quartiles of plant protein intake (Q1: <28.2%; Q2: 28.2% to <32.1%; Q3: 32.1 to <36.2%; Q4: ≥36.2%) over a 24 h period (≥19 years, n = 14 888). Grains represented the primary source of plant protein across quartiles and increased from 5.01% (Q1) to 13.5% (Q4). Across all the USDA's Food and Nutrient Database for Dietary Studies (FNDDS) food groups, grains were the most economical source of protein (24.3-26 g protein/$1). Legumes were the most economical plant-based protein (28-37.7 g protein/$1) within the "Protein Foods" FNDDS group. Absolute protein intake (96.6 g/day) and PDCAAS (0.91) of diets were progressively lower from Q1 to 72.0 g/day and 0.8 in Q4, respectively. Modelling the replacement of 50% of amino acids from grains in the diet with amino acids from legumes increased the PDCAAS by 10% in Q4. Intake levels of fibre, folate, iron, and zinc, were higher in Q2-Q4 compared to Q1 but had lower intakes of vitamins B12 and D. Amino acid complementation is required to effectively integrate higher levels plant protein into US diets.

Pulse grain consumption and obesity: effects on energy expenditure, substrate oxidation, body composition, fat deposition and satiety.

Pulses have been identified as important components of a healthy diet. Assessment of pulse grains' nutritional composition alongside data from available preclinical and clinical trials suggests that pulses can modulate biological processes that lead to obesity. Components of pulse grains, including pulse-derived fibre and resistant starch, have been shown to alter energy expenditure, substrate trafficking and fat oxidation as well as visceral adipose deposition. Although mechanistic studies are scarce, studies have indicated that fibres found in pulses can have an impact on the expression of genes that modulate metabolism. Arginine and glutamine may produce thermogenic effects as major components of pulse grain proteins. Finally, evidence suggests that pulse-derived fibres, trypsin inhibitors and lectins may reduce food intake by inducing satiety via facilitating and prolonging cholecystokinin secretion. Nonetheless, the aforementioned data remain controversial and associations between dietary pulse grains and energy intake require further study. Given the available evidence, it can be concluded that pulses could be useful as functional foods and food ingredients that combat obesity.

Regulatory approval of plant sterols in Canada: implications for health care and clinical practice.

Health Canada's recent approval of plant sterols as food ingredients to decrease low-density lipoprotein cholesterol (LDL-C) is believed to be a significant step toward improving Canadians' cardiovascular health and reducing the economic burden of heart disease. When dyslipidemic patients consume plant sterols at a recommended daily dose of 2 g, they can reduce LDL-C by 10% to 15%, with no deleterious effects on high-density lipoprotein cholesterol. A 10% LDL-C reduction in response to plant sterol consumption is projected to reduce heart disease risk by 25%. Because they are available without a prescription, plant sterols are an option for dietitians who wish to provide cholesterol-lowering guidance beyond traditional dietary advice (i.e., lowering saturated fat intake and restricting dietary cholesterol). In addition, plant sterols can be used in combination with a statin or when statin use is contraindicated, and they have recently emerged as a potentially valuable triglyceride-lowering option. However, the projected improvement in public health and health care savings will be realized only if impediments to daily use are removed. One such impediment is the higher cost of fortified food products, such as yogurt and margarine. If the cost of plant sterol food products is to decline, cost-effective sources must be investigated and a larger range of foods containing plant sterols must be made available.

The Special Issue on "The Nutritional Value of Pulses and Whole Grains": A Continued Endeavor to Delineate Their Benefits for Today and Addressing the Challenges of the Future.

Dietary patterns are increasingly focusing on the interplay between nutritional adequacy, reduction of chronic disease, and environmental sustainability [...].

Whole and fractionated yellow pea flours reduce fasting insulin and insulin resistance in hypercholesterolaemic and overweight human subjects.

The objective of the present study was to compare whole pea flour (WPF) to fractionated pea flour (FPF; hulls only) for their ability to reduce risk factors associated with CVD and diabetes in overweight hypercholesterolaemic individuals. Using a cross-over design, twenty-three hypercholesterolaemic overweight men and women received two-treatment muffins/d containing WPF, FPF or white wheat flour (WF) for 28 d, followed by 28 d washout periods. Daily doses of WPF and FPF complied with the United States Department of Agriculture's recommended level of intake of half a cup of pulses/d (approximately 50 g/d). Dietary energy requirements were calculated for each study subject, and volunteers were only permitted to eat food supplied by the study personnel. Fasting insulin, body composition, urinary enterolactone levels, postprandial glucose response, as well as fasting lipid and glucose concentrations, were assessed at the beginning and at the end of each treatment. Insulin concentrations for WPF (37·8 (SEM 3·4) pmol/ml, P = 0·021) and FPF (40·5 (SEM 3·4) pmol/ml, P = 0·037) were lower compared with WF (50·7 (SEM 3·4) pmol/ml). Insulin homeostasis modelling assessment showed that consumption of WPF and FPF decreased (P < 0·05) estimates of insulin resistance (IR) compared with WF. Android:gynoid fat ratios in women participants were lower (P = 0·027) in the WPF (1·01 (sem 0·01) group compared with the WF group (1·06 (SEM 0·01). Urinary enterolactone levels tended to be higher (P = 0·087) in WPF compared with WF. Neither treatment altered circulating fasting lipids or glucose concentrations. In conclusion, under a controlled diet paradigm, a daily consumption of whole and fractionated yellow pea flours at doses equivalent to half a cup of yellow peas/d reduced IR, while WPF reduced android adiposity in women.

Role of Food Industry in Promoting Healthy and Sustainable Diets.

Sustainable food systems are often defined by greenhouse gases, land use, effects on biodiversity, and water use. However, this approach does not recognize the reason food is produced-the provision of nutrients. Recently, the relationship between diets and sustainability has been recognized. Most accepted models of 'sustainable diets' focus on four domains: public health, the environment, food affordability, and cultural relevance. Aligned with the FAO's perspective, truly sustainable diets comprise foods that are affordable, nutritious, developed with ingredients produced in an environmentally friendly manner, and consumer preferred. Identifying solutions to address all four domains simultaneously remains a challenge. Furthermore, the recent pandemic exposed the fragility of the food supply when food accessibility and affordability became primary concerns. There have been increasing calls for more nutrient-dense and sustainable foods, but scant recognition of the consumer's role in adopting and integrating these foods into their diet. Dietary recommendations promoting sustainable themes often overlook how and why people eat what they do. Taste, cost, and health motivate consumer food purchase and the food system must address those considerations. Sustainable foods are perceived to be expensive, thus marginalizing acceptance by the people, which is needed for broad adoption into diets for impactful change. Transformational change is needed in food systems and supply chains to address the complex issues related to sustainability, taste, and cost. An emerging movement called regenerative agriculture (a holistic, nature-based approach to farming) provides a pathway to delivering sustainable foods at an affordable cost to consumers. A broad coalition among academia, government, and the food industry can help to ensure that the food supply concurrently prioritizes sustainability and nutrient density in the framework of consumer-preferred foods. The coalition can also help to ensure sustainable diets are broadly adopted by consumers. This commentary will focus on the challenges and opportunities for the food industry and partners to deliver a sustainable supply of nutrient-dense foods while meeting consumer expectations.

An examination of contributions of animal- and plant-based dietary patterns on the nutrient quality of diets of adult Canadians.

Dietary guidance and Canada's 2019 Food Guide encourage increased consumption of plant-based foods as a source of dietary protein. However, there is an absence of recent data on protein and nutrient intakes and quality of Canadian dietary patterns that might occur with increased plant protein intakes. This study compared food sources and nutrient intakes of Canadian adults within groups of increasing plant protein-containing diets. The CCHS 2015 Public-Use Microdata File of single 24-hour dietary recalls of males and females ≥19 years (n = 6498) or ≥70 years (n = 1482) were examined. Respondents were allocated into 4 groups defined by their protein intake percentage coming from plant-based foods (i.e., group 1: 0-24.9%, group 2: 25-49.9%, group 3: 50-74.9%, group 4: 75-100%). Protein intake in adults averaged 63.3% animal and 36.7% plant protein. Where plant protein contributed >50% protein, higher intakes of carbohydrate, dietary fibre, folate, dietary folate equivalents, iron and magnesium (p < 0.001) but lower intakes of total and saturated fat, protein, vitamin D, vitamin B12, riboflavin and niacin (p < 0.0001) were reported. In contrast, group 1 had higher total and saturated fat, protein, vitamin B12, thiamin, niacin, and zinc, but lower carbohydrate, dietary fibre, and magnesium. Balancing plant- with animal-based protein foods leads to healthier dietary patterns with more favourable nutritional properties when compared with diets based on either high animal or high plant protein content. Novelty: Combinations of animal- and plant-based proteins improve nutrient quality of Canadian diets. The source of protein influences diet quality.

The effect of increasing intakes of plant protein on the protein quality of Canadian diets.

The 2015 Canadian Community Health Survey was used to investigate the protein content and protein quality of the diets consumed by adults (≥19 years) when plant protein is increased. Individuals (n = 6498) were allocated to quartiles of increasing proportions of protein from plant foods (Quartile 1: 0-24.9%; Quartile 2: 25%-49.9%; Quartile 3: 50-74.9%; Quartile 4: 75-100%). The Protein Digestibility Corrected Amino Acid Score (PDCAAS) of diets were estimated using indispensable amino acid concentrations of foods and an assumed digestibility coefficient of 0.8. Corrected protein intakes were determined by aggregating foods consumed over 24 hours and as the sum of corrected protein consumed at eating events within six 4-hour time intervals. Most individuals (51%) consumed 25-49.9% of protein from plant foods. Cereal-based foods represented the majority of plant protein consumed. PDCAAS of diets remained ≥0.87 for quartiles 1-3, but decreased (p < 0.0001) to 0.71 ± 0.018 in quartile 4 vs. quartile 2 (0.96 ± 0.004). Corrected protein intakes in quartile 2 (80.66 ± 1.21 g/day; 1.07 ± 0.03 g protein/kg body weight) decreased to 37.13 ± 1.88 g/day (0.54 ± 0.03 g/kg body weight) in quartile 4 (p < 0.0001). Aggregated daily corrected protein intake strongly correlated (r = 0.99; p < 0.001) with the sum of corrected protein consumed within time intervals. Intra-time interval analysis revealed that the relative proportions of animal and plant proteins changed at eating events over 24 hours and did not reflect the allocation to quartiles based on the daily proportion of plant protein consumption. Various tools should be explored and developed to assist Canadians in effectively incorporating plant protein foods into dietary patterns. Novelty: Corrected protein intakes decreased as plant protein consumption increased. PDCAAS was ≥0.87 for diets with ≤74.9% plant protein.

Pulse Intake Improves Nutrient Density among US Adult Consumers.

The objective was to examine trends in pulse (dry beans, dry peas, chickpeas and lentils) intake over a 10-year period and to compare nutrient intakes of pulse consumers and non-consumers to better understand the impact of pulse consumption on diet quality in the US population. NHANES 2003-2014 data for respondents (≥19 years) with 2 days of intake was used to evaluate trends in pulse intake. Pulse consumers were identified as those NHANES respondents who consumed pulses on one or both days. Differences in energy adjusted nutrient intakes between non-consumers and consumers were assessed. There were no significant trends in pulse intakes for the total population or for pulse consumers over the 10-year period. In 2013-2014, approximately 27% of adults consumed pulses with an intake of 70.9 ± 2.5 g/day over 2 days, just slightly <0.5 cup equivalents/day. At all levels of consumption, consumers had higher (p < 0.01) energy adjusted intakes of fiber, folate, magnesium. Higher energy adjusted intakes for potassium, zinc, iron and choline and lower intakes of fat were observed for consumers than for non-consumers at intakes ≥69.4 ± 1.01 g/day. These data suggest that pulse consumption in the US population may result in better diet quality with diets that are more nutrient dense than those without pulses.

Policosanols as nutraceuticals: fact or fiction.

Policosanols (PC) are very long chain aliphatic alcohols derived from the wax constituent of plants. In the early 1990s, researchers at Dalmer Laboratories in La Habana Cuba isolated and produced the first PC supplement from sugarcane wax. The original PC supplement has been approved as a cholesterol-lowering drug in over 25 countries throughout the Caribbean and South America. Cuban studies claim that 1 to 20 mg/day of the original PC supplement are effective at producing significant reductions in total cholesterol (TC) and low density lipoprotein cholesterol (LDL-C). These studies also show that PC supplements are potent antioxidants, promote proper arterial endothelial cell function, inhibit platelet aggregation and thrombosis, and serve as effective treatments for intermittent claudication. However, for the most part, those studies reporting therapeutic efficacy of PC were carried out by one research group situated in Cuba. Conversely, research groups outside of Cuba have failed to validate the cholesterol-lowering and antioxidant efficacy of PC. Cuban researchers, however, continue to claim that the efficacy is attributed to the unique purity and composition of the original PC preparation, a mixture not found in PC products used by external research groups. The absence of independent and external studies confirming the therapeutic benefits of PC in disease prevention and treatment raises questions regarding their true efficacy.

Evaluating the Lipid-Lowering Effects of α-lipoic Acid Supplementation: A Systematic Review.

Dietary supplementation of α-lipoic acid, an 8-carbon organosulfur compound, has been widely reported to lower blood glucose concentration and/or improve insulin sensitivity in previous randomized controlled trials. Although animal model studies further report fairly consistent lipid lowering in both blood and tissue pools in response to α-lipoic acid supplementation, results from human studies are mixed. According to PRISMA guidelines, we conducted a systematic review of published randomized controlled studies (RCTs) to assess the efficacy of α-lipoic acid supplementation as a strategy to improve dyslipidemia, with a focus on serum lipid endpoints including TC, low density lipoprotein cholesterol (LDL-C), HDL-C, and TG. PubMed, EMBASE, Cochrane Evidence-Based Medicine Reviews, Proquest, Web of Science, and Scopus were searched to identify RCTs that reported the effects of α-lipoic acid on blood lipid concentrations from 1970 to 2017. We included RCTs reporting blood lipid responses in adults supplemented with oral α-lipoic acid versus a placebo or control for at least one month. Studies were reviewed and data were extracted by two independent study authors. Seventeen studies were deemed eligible for inclusion. Overall, mean percent changes in blood lipid endpoints in response to α-lipoic acid varied considerably between studies for total cholesterol (-10.5 to +13.9), low-density lipoprotein cholesterol (-19.67 to +9.06), high-density lipoprotein cholesterol (-12.5 to +29.20), and triglycerides (-38.57 to +17.0). Results of this systematic review suggest little consistent benefit on serum lipids in response to α-lipoic acid supplementation. Further well-controlled studies designed and powered to detect improvements in blood lipids in hypercholesterolemic individuals are warranted (PROSPERO registration number: CRD42018105933).

Comparison of methodologies used to define the protein quality of human foods and support regulatory claims.

Protein quality (PQ) is the capacity of a protein to meet the amino acid (AA) requirements of an individual. There are several methodologies for determining the PQ of foods. The protein efficiency ratio is an animal growth bioassay. The protein-digestibility-corrected AA score considers the AA requirements of a reference population, and the true nitrogen digestibility coefficient for each ingredient. The digestible indispensable AA score is based on true ileal AA digestibility and better represents bioavailability of AAs. In vitro techniques for assessment of PQ are available but require validation against a greater range of protein sources. Isotopic methods, such as the indicator AA oxidation and dual tracer techniques measure AA relative bioavailability and digestibility, respectively, but require sophisticated equipment, and may not be cost nor time effective for the industry to adopt. The present review discusses advantages and disadvantages of methodologies for determining PQ of food for humans focused on methods that are or could be adopted by regulatory agencies. Understanding the framework and resources available for PQ determination will help in the selection of appropriate methods depending on the application. Novelty Understanding the framework and resources available for PQ determination will help in the selection of appropriate methods depending on the application.

Destigmatizing Carbohydrate with Food Labeling: The Use of Non-Mandatory Labelling to Highlight Quality Carbohydrate Foods.

Dietary carbohydrates are components of healthy foods, but many carbohydrate foods have recently been stigmatized as primary causes of diet-related risk factors for chronic disease. There is an opportunity to enhance efforts within the food landscape to encourage the consumption of higher quality carbohydrate foods. The use of labelling is one strategy that permits consumers to identify healthy carbohydrate foods at the point-of-purchase. This review discusses the regulatory frameworks and examples of associated non-mandatory food labelling claims that are currently employed to highlight healthy carbohydrate foods to consumers. The existing labelling frameworks discussed here align with established measures of carbohydrate quality, such as 1. dietary fibre nutrient content claims and associated dietary fibre-based health claims; 2. the presence of whole carbohydrate foods and ingredients that are intact or reconstituted, such as whole grains; and 3. low glycemic index and glycemic response claims. Standards from Codex Alimentarius, and regulations from Australia and New Zealand, Canada, Europe, and the United States will be used to illustrate the means by which food labelling can be used by consumers to identify quality carbohydrate foods.

Red algal cellular biomass lowers circulating cholesterol concentrations in Syrian golden hamsters consuming hypercholesterolaemic diets.

Preliminary evidence suggests that consumption of Porphyridium cruentum (PC) biomass results in hypocholesterolaemic effects; however, mechanisms responsible have not been elucidated. The aim of the present study was to determine whether PC biomass lowers circulating cholesterol concentrations, dose dependently, in hamsters fed hypercholesterolaemic diets for 28 d and determine whether cholesterol biosynthesis is affected. Biomass added to diets at 2.5, 5 and 10% resulted in 14, 38 and 53% reductions (P < 0.001) in total plasma cholesterol, respectively, compared with a control diet. Similarly, non-HDL-cholesterol concentrations in the 5 and 10% PC groups were reduced (P < 0.001) 28 and 45%, respectively, v. controls. These effects were unrelated to cholesterol fractional synthesis rate (FSR), as this did not differ between either treatment or control animals. PC consumption had no effect on food intake, plasma glucose concentrations or energy expenditure, but percentage of body fat was lower (P < 0.001) in the 5 and 10% PC groups compared with controls. These data show that PC reduces total plasma cholesterol and non-HDL-cholesterol when incorporated into the diet at levels as low as 2.5%. The mechanism of action for this reduction may be related to increased excretion since food intakes and cholesterol FSR were not reduced in the animals receiving the PC. In conclusion, the use of PC biomass reduces circulating cholesterol, dose dependently, in hypercholesterolaemic hamsters but not via reductions in cholesterol FSR. There is potential for the use of this biomass as a functional ingredient to aid in the management of blood cholesterol concentrations.

Positioning the Value of Dietary Carbohydrate, Carbohydrate Quality, Glycemic Index, and GI Labelling to the Canadian Consumer for Improving Dietary Patterns.

The objectives of this qualitative study was to: (1) understand Canadian consumers' knowledge and perception of dietary carbohydrates, carbohydrate quality, and the glycemic index (GI); and (2) determine Canadian's receptiveness to GI labelling to assist with identifying and consuming foods of higher carbohydrate quality. Focus groups were recruited in Vancouver, Toronto, and Montreal and grouped according to body mass index (BMI) (NBW, normal body weight; PO, previously obese; and OW/OB, overweight/obese) and diagnosis with prediabetes and diabetes (PO (Vancouver) and OW/OB (Montreal and Toronto). Subjects in all groups linked excess consumption of carbohydrate with weight gain. PO and OW/OB groups were conflicted between perceived negative consequences and feelings of pleasure associated with carbohydrate consumption. Subjects were largely unfamiliar with the term 'carbohydrate quality', but were often associated with classifying carbohydrates as 'good' or 'bad'. The concept of the GI resonated well across groups after exposure to corresponding educational materials. However, NBW groups largely felt that the GI was irrelevant to their dietary choices as they did not have a history of diabetes. PO and OW/OB groups associated the GI with diabetes management. The concept of a GI labelling program to help facilitate healthier carbohydrate choices was well received across all groups, especially when the low GI was interpreted as giving permission to consume foods they enjoyed eating. Results suggest that the GI could be used as a consumer-facing labelling program in Canada and assist with de-stigmatizing carbohydrate foods by helping to facilitate the consumption of carbohydrate foods that align with healthy dietary patterns.