Background
Noncommunicable diseases (NCDs) are the world’s leading cause of death, responsible for an estimated 41 million of the 55 million deaths in 2019. Modifiable risk factors such as unhealthy diets, physical inactivity, tobacco use, and harmful use of alcohol are major risk factors for NCDs, and the quality of carbohydrates in the diet have been extensively explored as a potential modulator of dietary risk.
Carbohydrates are found in a wide variety of primarily plant-based foods and are the principal source of energy in the diets of many people. The concept of carbohydrate “quality” is an important indicator of diet quality and refers to the nature and composition of carbohydrates including how quickly they are metabolized and release glucose into the body, proportion of sugars, and amount of dietary fibre. Consumption of poor quality carbohydrates is often associated with poor overall dietary quality and may have a negative health impact, while consumption of high-quality carbohydrates is often associated with high overall dietary quality and a positive health impact. Dietary fibre in particular has been associated with good health.
Although the inclusion of dietary fibre and high-quality carbohydrates in the diet from fruits, vegetables, whole grains and pulses has long been recommended to improve and maintain cardiometabolic and overall health, current intakes are generally low at the global level.
WHO has previously issued updated guidance on free sugars intake, but further updated guidance on carbohydrate quality is needed. WHO has therefore developed recommendations on carbohydrate intake in accordance with the current WHO guideline development process, which includes an assessment of systematically compiled scientific evidence and considerations of factors relevant to the implementation of the recommendations.
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