The Impact of Carbohydrate Quality on Gut Health: Insights from the NHANES

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2025 Feb 13

PMID 39946401

Authors

Lanshuo Hu

Xuanchun Huang

Shan Liu

Lihui Fang

Jiaqi Zhang

Xudong Tang

Affiliations

Soon will be listed here.

Abstract

Background: High- and low-quality carbohydrate diets are linked to gut health. However, their specific relationship with constipation or diarrhea is unclear. This study uses 2005-2010 NHANES data to examine the relationship between carbohydrate quality and constipation and diarrhea, and to identify suitable populations for different carbohydrate diets.

Methods: Chronic constipation was defined as BSFS types 1 and 2, and chronic diarrhea as types 6 and 7. Dietary intake data were provided by the FPED, using data from the NHANES database. Subjects recalled foods and beverages consumed in the past 24 hours, and intake was averaged and divided into quartiles (Q). After adjusting for covariates, associations between high- and low-quality carbohydrate diets and constipation or diarrhea were assessed using weighted RCS curves and multivariate logistic regression. Results were expressed as weighted ORs and 95% CIs, with subgroup analyses performed.

Results: A total of 11,355 people participated, with 10,488 in the constipation group and 10,516 in the diarrhea group. Multiple regression showed that high-quality carbohydrates were negatively associated with constipation (OR: 0.852, 95% CI: 0.796-0.912, P = 0.0001). Low-quality carbohydrates were positively associated with constipation (OR: 1.010, 95% CI: 1.002-1.018, P = 0.0295). There was no significant direct association between carbohydrate quality and diarrhoea (P = 0.5189, P = 0.8278). Segmented regression results showed a non-significant association between low quality carbohydrate intake above 40.65 servings/day and constipation, while quality carbohydrate intake above 3.84 servings/day was not significantly associated with diarrhoea. Subgroup analyses showed differences in carbohydrate quality and constipation or diarrhoea across populations.

Conclusions: High-quality carbohydrates lowered constipation risk by 33.7% and reduced diarrhea risk with intake up to 3.84 servings/day. In contrast, low-quality carbohydrates increased constipation risk by 83.4%, with risk stabilizing beyond 40.65 servings/day. These effects varied across groups, suggesting that better carbohydrate quality supports gut health, especially in sensitive individuals.

References

Liu X, Li M, Jian C, Wei F, Liu H, Li K . Polysaccharide Alleviates Constipation in the Elderly Via Modification of Gut Microbiota and Fecal Metabolism. Rejuvenation Res. 2022; 25(6):275-290. DOI: 10.1089/rej.2022.0039. View

Schwingshackl L, Hoffmann G, Lampousi A, Knuppel S, Iqbal K, Schwedhelm C . Food groups and risk of type 2 diabetes mellitus: a systematic review and meta-analysis of prospective studies. Eur J Epidemiol. 2017; 32(5):363-375. PMC: 5506108. DOI: 10.1007/s10654-017-0246-y. View

Dalile B, Van Oudenhove L, Vervliet B, Verbeke K . The role of short-chain fatty acids in microbiota-gut-brain communication. Nat Rev Gastroenterol Hepatol. 2019; 16(8):461-478. DOI: 10.1038/s41575-019-0157-3. View

Du C, Adjepong M, Zan M, Cho M, Fenton J, Hsiao P . Gender Differences in the Relationships between Perceived Stress, Eating Behaviors, Sleep, Dietary Risk, and Body Mass Index. Nutrients. 2022; 14(5). PMC: 8912409. DOI: 10.3390/nu14051045. View

Mayer E, Naliboff B, Craig A . Neuroimaging of the brain-gut axis: from basic understanding to treatment of functional GI disorders. Gastroenterology. 2006; 131(6):1925-42. DOI: 10.1053/j.gastro.2006.10.026. View

Eswaran S, Muir J, Chey W . Fiber and functional gastrointestinal disorders. Am J Gastroenterol. 2013; 108(5):718-27. DOI: 10.1038/ajg.2013.63. View

Hawkins M, Keirns N, Helms Z . Carbohydrates and cognitive function. Curr Opin Clin Nutr Metab Care. 2018; 21(4):302-307. DOI: 10.1097/MCO.0000000000000471. View

Biniszewska O, Jacenik D, Tarasiuk A, Fichna J . Current and future pharmacotherapies for the management of constipation-predominant irritable bowel syndrome. Expert Opin Pharmacother. 2024; 25(8):1039-1049. DOI: 10.1080/14656566.2024.2366993. View

Jalanka J, Major G, Murray K, Singh G, Nowak A, Kurtz C . The Effect of Psyllium Husk on Intestinal Microbiota in Constipated Patients and Healthy Controls. Int J Mol Sci. 2019; 20(2). PMC: 6358997. DOI: 10.3390/ijms20020433. View

10.

Kiecolt-Glaser J, Wilson S, Bailey M, Andridge R, Peng J, Jaremka L . Marital distress, depression, and a leaky gut: Translocation of bacterial endotoxin as a pathway to inflammation. Psychoneuroendocrinology. 2018; 98:52-60. PMC: 6260591. DOI: 10.1016/j.psyneuen.2018.08.007. View

11.

Anderson J, Baird P, Davis Jr R, Ferreri S, Knudtson M, Koraym A . Health benefits of dietary fiber. Nutr Rev. 2009; 67(4):188-205. DOI: 10.1111/j.1753-4887.2009.00189.x. View

12.

Peppas G, Alexiou V, Mourtzoukou E, Falagas M . Epidemiology of constipation in Europe and Oceania: a systematic review. BMC Gastroenterol. 2008; 8:5. PMC: 2258300. DOI: 10.1186/1471-230X-8-5. View

13.

Slavin J . Dietary fiber and body weight. Nutrition. 2005; 21(3):411-8. DOI: 10.1016/j.nut.2004.08.018. View

14.

Firth J, Marx W, Dash S, Carney R, Teasdale S, Solmi M . The Effects of Dietary Improvement on Symptoms of Depression and Anxiety: A Meta-Analysis of Randomized Controlled Trials. Psychosom Med. 2019; 81(3):265-280. PMC: 6455094. DOI: 10.1097/PSY.0000000000000673. View

15.

Camilleri M, Ford A, Mawe G, Dinning P, Rao S, Chey W . Chronic constipation. Nat Rev Dis Primers. 2017; 3:17095. DOI: 10.1038/nrdp.2017.95. View

16.

Algera J, Demir D, Tornblom H, Nybacka S, Simren M, Storsrud S . Low FODMAP diet reduces gastrointestinal symptoms in irritable bowel syndrome and clinical response could be predicted by symptom severity: A randomized crossover trial. Clin Nutr. 2022; 41(12):2792-2800. DOI: 10.1016/j.clnu.2022.11.001. View

17.

Costa L, Mendes M, Oliveira A, Magalhaes K, Shivappa N, Hebert J . Dietary inflammatory index and its relationship with gut microbiota in individuals with intestinal constipation: a cross-sectional study. Eur J Nutr. 2021; 61(1):341-355. DOI: 10.1007/s00394-021-02649-2. View

18.

Gillespie K, Kemps E, White M, Bartlett S . The Impact of Free Sugar on Human Health-A Narrative Review. Nutrients. 2023; 15(4). PMC: 9966020. DOI: 10.3390/nu15040889. View

19.

Barber T, Kabisch S, Pfeiffer A, Weickert M . The Health Benefits of Dietary Fibre. Nutrients. 2020; 12(10). PMC: 7589116. DOI: 10.3390/nu12103209. View

20.

Knowles S, Apputhurai P, Palsson O, Bangdiwala S, Sperber A, Mikocka-Walus A . The epidemiology and psychological comorbidity of disorders of gut-brain interaction in Australia: Results from the Rome Foundation Global Epidemiology Study. Neurogastroenterol Motil. 2023; 35(6):e14594. DOI: 10.1111/nmo.14594. View