Low carbohydrate diet and all cause and cause-specific mortality

Shamima Akter; Tetsuya Mizoue; Akiko Nanri; Atsushi Goto; Mitsuhiko Noda; Norie Sawada; Taiki Yamaji; Motoki Iwasaki; Manami Inoue; Shoichiro Tsugane; Japan Public Health Center-based Prospective Study Group

doi:10.1016/j.clnu.2020.09.022

Low carbohydrate diet and all cause and cause-specific mortality

Clin Nutr. 2021 Apr;40(4):2016-2024. doi: 10.1016/j.clnu.2020.09.022. Epub 2020 Sep 23.

Collaborators

Japan Public Health Center-based Prospective Study Group:
S Tsugane⁶, N Sawada⁶, M Iwasaki⁶, M Ninue⁶, T Yamaji⁶, A Goto⁶, T T Shimazu⁶, H Charvat⁶, S Budhathoki⁶, M Muto⁶, H Suzuki⁷, T Miamizono⁸, Y Kobayashi⁹, M Iriei¹⁰, M Doi¹¹, M Katagiri¹², T Tagami¹³, Y Sou¹⁴, M Uehara¹⁵, Y Hakubo¹⁶, Yamagishi¹⁷, M Noda¹⁸, T Mizoue¹⁸, Y Kawauchi¹⁹, K Nakamura²⁰, R Takachi²¹, J Ishihara²², H Iso²³, T Sovue²³, I Sito²⁴, N Yasuda²⁵, M Mimura²⁶, K Sakata²⁷

Affiliations

¹ Department of Epidemiology and Prevention, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan. Electronic address: sakter@hosp.ncgm.go.jp.
² Department of Epidemiology and Prevention, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan.
³ Department of Food and Health Sciences, Fukuoka Women's University, Fukuoka, Japan.
⁴ Center for Public Health Sciences, National Cancer Center, Tokyo, Japan.
⁵ Department of Diabetes Metabolism and Endocrinology, Ichikawa Hospital, International University of Health and Welfare, Chiba, Japan.
⁶ National Cancer Center, Tokyo, Japan.
⁷ Iwate Prefectural Ninohe Public Health Center, Iwate, Japan.
⁸ Akita Prefectural Yokote Public Health Center, Akita, Japan.
⁹ Nano Prefectural Saku Public Health Center, Nano, Japan.
¹⁰ Yinawa Prefectural Chubu Public Health Center, Okayawa, Japan.
¹¹ Ibaraki Prefectal Mito Public Health Center, Ibaraki, Japan.
¹² Niigata Prefecturar Nagaoca Public Health Center,Niigata, Japan.
¹³ Uchi Prefectural Choo-Hisashi Public Health Center, Kochi, Japan.
¹⁴ Kawasaki Prefectural Kamigato Public Health Center, Kawasaki, Japan.
¹⁵ Yinawa Prefectural Miyako Public Health Center, Okayawa, Japan.
¹⁶ National Cerebral and Cardiovasculal Center, Osaka, Japan.
¹⁷ University of Ukuba, Ibaraki, Japan.
¹⁸ National Center for Global Health and Medicine, Tokyo, Japan.
¹⁹ Tokyo Medical and Dental University, Tokyo, Japan.
²⁰ Nigata University, Niigata, Japan.
²¹ Nara Women's University, Nara, Japan.
²² Azabu University, Kanagawa, Japan.
²³ Osaka University, Osaka, Japan.
²⁴ Ehime University, Ehime, Japan.
²⁵ Kochi University, Uchi, Japan.
²⁶ Keio University, Tokyo, Japan.
²⁷ Iwate Medical University, Iwate, Japan.

PMID: 33046262
DOI: 10.1016/j.clnu.2020.09.022

Abstract

Background: Evidence is limited regarding the association between low-carbohydrate diet (LCD) score and mortality among Asians, a population that consumes a large amount of carbohydrates.

Objective: The present study examined the association between low-carbohydrate diet (LCD) score (based on percentage of energy as carbohydrate, fat, and protein) and the risk of total and cause-specific mortality among Asians.

Design: This study was a prospective cohort study in Japan with follow-up for a median of 16.9 years involving 43008 men and 50646 women aged 45-75 years. Association of LCD score, LCD score based on animal sources of protein and fat, and LCD score based on plant sources of protein and fat with risk of mortality was assessed using Cox proportional hazards model.

Results: A U-shaped association was observed between LCD score and total mortality: the multivariable-adjusted hazard ratios (HRs) (95% CI) of total mortality for lowest through highest scores were 1.00, 0.95 (0.91, 1.01), 0.93 (0.88, 0.98), 0.93 (0.88, 0.98), and 1.01 (0.95, 1.07) (P-non-linearity <0.01). A similar association was found for mortality from cardiovascular disease (CVD) and heart disease. LCD score based on carbohydrate, animal protein, and animal fat also showed a U-shaped association for total mortality (P-non-linearity <0.01). In contrast, LCD score based on carbohydrate, plant protein, and plant fat was linearly associated with lower total (HR, 0.89; 95% CI: 0.83, 0.94 for highest versus lowest quintile), CVD [0.82 (0.73, 0.92)], heart disease [0.83 (0.71, 0.98)], and cerebrovascular disease [0.75 (0.62, 0.91) mortality.

Conclusions: Both LCD with high animal protein and fat and high-carbohydrate diet with low animal protein and fat were associated with higher risk of mortality. Meanwhile, LCD high in plant-based sources of protein and fat was associated with a lower risk of total and CVD mortality.

Keywords: Cancer mortality; Cardiovascular disease mortality; Low carbohydrate diet; Mortality.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Cardiovascular Diseases / mortality*
Cause of Death
Cerebrovascular Disorders / mortality*
Cohort Studies
Diet, Carbohydrate-Restricted / methods*
Diet, Carbohydrate-Restricted / statistics & numerical data*
Female
Heart Diseases / mortality*
Humans
Japan / epidemiology
Middle Aged
Prospective Studies