Ĭonsistently around the world, traditional diets of legumes, other vegetables, and coarse grains are being replaced by diets typically higher in animal fat and plant-derived oils, added sugars, animal-source foods, and refined carbohydrates. Modelling dietary intakes for protection against Alzheimer’s disease is suggestive that protein intake should be around 6% in middle-aged individuals, increasing to 17% thereafter. However, whether there is a single optimal lifelong macronutrient distribution is also questionable. Further insight may be gained following an intervention study in which people will eat diets differing in macronutrient composition for 6 months. A carbohydrate content of 50–55% has been associated with a low risk of mortality in a modern Western setting. In developed countries, there is concern that refined carbohydrates are contributing to the aetiology of non-communicable disease, and perhaps the inclusion of refined foods modifies the AMDR. The higher contribution of carbohydrate given by the World Health Organization compared with the listed countries may be due to observations of good health associated with traditional diets containing unrefined sources of carbohydrate-containing foods. The range for each macronutrient is relatively wide, allowing for dietary diversity. Some examples of health authorities’ guidance are given in Table 1. However, despite the apparent health benefits of following high-starch diets based on root vegetables, legumes and unrefined grains, the proportions of macronutrients provided by such diets would generally be regarded as incongruous with an acceptable macronutrient distribution range (AMDR). From an evolutionary viewpoint, humans are well adapted to digesting starch. Using a similar low-fat (7–15%) dietary approach in which starchy foods were encouraged, together with whole grains, legumes, vegetables and fruits, overweight or obese patients with comorbidities lost weight and improved metabolic risk factors over 12 months. The carbohydrate in rice and potato is predominantly starch, with starch-based diets providing 12% protein, 7% fat and 81% carbohydrate used to good effect in improving markers of health over 7 days. High-carbohydrate diets have also been used for the treatment of diabetes and vascular disorders, as described by Kempner and colleagues using a rice-based diet. In contrast, the diet of Irish farm workers, principally potato and skim milk, provided 12% protein, 1% fat, and 87% carbohydrate this diet was temporally associated with an exceptionally low rate of death from diabetes mellitus. This dietary pattern was consistent with low dental caries and it was proposed that it was cardioprotective, although this was subsequently found to be an erroneous assumption. For example, the animal-based diet of an Alaskan Inuit group was found to comprise 33% protein, 41% fat and 26% carbohydrate. When expressed as a percentage of energy to the diet, human populations have historically survived on diets with greatly differing proportions of these macronutrients. It is elusive as to whether there is a combination of macronutrients that provides optimal health. To maintain longevity and health, a combination of these macronutrients is required in our diet. Fat is composed of glycerol and fatty acids protein is an agglomeration of amino acids and carbohydrate is simple sugars occurring either as monosaccharides or chains of connected monosaccharides (e.g., starch) whose bonds are either hydrolysed in the human small intestine to monosaccharides or are resistant to hydrolysis (dietary fibre). The macronutrients, fat, protein and carbohydrate provide energy and essential components to sustain life.
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