Reimagining Carbohydrate Food Guidance with a Holistic and Inclusive Approach

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A new paper published in Nutrients introduces a holistic, culturally inclusive approach to carbohydrate food guidance called the Carbohydrate Food Quality Score (CFQS).

Prevailing approaches to dietary recommendations in the United States often need to pay more attention to the importance of considering cultural foods, especially regarding carbohydrate food guidance. Instead, they focus only on carbohydrates, sugar, and dietary fiber, ignoring other vital nutrients and cultural considerations. The CFQS provides a more nuanced and holistic approach to evaluating the nutritional value of carbohydrate-containing foods and aligns closely with the Dietary Guidelines for Americans.

This approach evaluates the contribution of under-consumed dietary components like potassium, dietary fiber, and whole grains, and overconsumed nutrients like sodium, predominantly found in carbohydrate-containing foods, especially grains. The CFQS acknowledges the heterogeneity, nutrient, and cultural diversity across the carbohydrate food category and includes other nutrients like sodium, potassium, and whole grains in the scoring system.

“The new CFQS recognizes that carbohydrate foods are not homogenous, and nuance is needed when communicating this to consumers,” stated Judy Rodriguez, PhD, RDN, Professor Emerita, Department of Nutrition and Dietetics, University of North Florida, and co-author of the study. “For example, while potatoes and grain-based foods are considered ‘carb foods’ and contribute important nutrients to the diet, their nutrient profiles and quality vary. The CFQS can help identify those foods that can be chosen frequently as dietary staples.”

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The CFQS creates two scoring systems: non-grain foods (CFQS-4) and grain-based foods (CFQS-5). CFQS-4 is scored on a 4-point scale based on the amounts of carbohydrates, sugar, sodium, and potassium. CFQS-5 is scored on a 5-point scale using the same four components as CFQS-4, plus whole grains. It also provides a spectrum of carbohydrate food choices rather than binary classifiers like 'good' or 'bad.' It eliminates confusion and aligns with the Dietary Guidelines for Americans by recognizing other essential nutrients that are under or over-consumed in the American diet and predominantly delivered through carbohydrate-containing foods.

Moreover, the CFQS supports health equity among all Americans, providing a flexible tool that can be applied across different budgets, lifestyles, and cultures. As such, it can help practitioners guide and reassure patients about the role of carbohydrate foods in healthy eating patterns while affirming equitable, nutritious, and culturally appropriate food choices to support a healthy lifestyle.