Carbohydrate quality is important for cardiometabolic health, but validated and pragmatic metrics to define it are not established. We assessed the ability of 4 metrics to identify healthier carbohydrate-rich products in the US, including, per each 10g of carbohydrate: (a) ≥1g fiber (10:1 carb:fiber ratio), (b) ≥1g fiber and <1g free sugar (10:1:1 carb:fiber:free sugar), (c) ≥1g fiber and <2g free sugar (10:1:2 carb:fiber:free sugar); and (d) ≥1g fiber and, per each 1 g of fiber, <2g free sugar (10:1 carb:fiber, 1:2 fiber:free sugar; or 10:1|1:2).


We utilized national data from NHANES 2013-2016 plus the linked Food and Nutrient Database for Dietary Studies (FNDDS).Overall and for 12 food categories standardized to 100g, we assessed how each metric identified differences in calories, total fat, saturated fat, protein, sugar, fiber, sodium, potassium, magnesium, folate, and 8 vitamins/minerals.


Among 2208 carbohydrate-rich products, more met the 10:1 and 10:1|10:2 ratios, followed by 10:1:2 and 10:1:1, with variation by product category (Table 1). The 10:1 and 10:1|10:2 ratios each identified products with significantly lower calories, fat, free sugar, and sodium, and higher protein, fiber, potassium, magnesium, iron, vitamin B6, vitamin E, zinc and iron (Table 2).The 10:1:2 and 10:1:1 ratios performed better for identifying products with lower calories and free sugar, but not as well for the other nutrients above.


Among simple, pragmatic metrics, the 10:1 carb:fiber ratio and the 10:1|10:2 carb:fiber|fiber:free sugar ratio similarly identified carbohydrate-rich products with higher nutritional quality.Other metrics that further restricted free sugar also identified products with lower calories and free sugar, but did not perform as well otherwise. These novel findings inform dietary guidance for consumers, policy strategies, and industry reformulations to identify and promote healthier carbohydrate-rich foods.