166
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Dietary carbohydrate intake and mortality: a prospective cohort study and meta-analysis

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Summary

          Background

          Low carbohydrate diets, which restrict carbohydrate in favour of increased protein or fat intake, or both, are a popular weight-loss strategy. However, the long-term effect of carbohydrate restriction on mortality is controversial and could depend on whether dietary carbohydrate is replaced by plant-based or animal-based fat and protein. We aimed to investigate the association between carbohydrate intake and mortality.

          Methods

          We studied 15 428 adults aged 45–64 years, in four US communities, who completed a dietary questionnaire at enrolment in the Atherosclerosis Risk in Communities (ARIC) study (between 1987 and 1989), and who did not report extreme caloric intake (<600 kcal or >4200 kcal per day for men and <500 kcal or >3600 kcal per day for women). The primary outcome was all-cause mortality. We investigated the association between the percentage of energy from carbohydrate intake and all-cause mortality, accounting for possible non-linear relationships in this cohort. We further examined this association, combining ARIC data with data for carbohydrate intake reported from seven multinational prospective studies in a meta-analysis. Finally, we assessed whether the substitution of animal or plant sources of fat and protein for carbohydrate affected mortality.

          Findings

          During a median follow-up of 25 years there were 6283 deaths in the ARIC cohort, and there were 40 181 deaths across all cohort studies. In the ARIC cohort, after multivariable adjustment, there was a U-shaped association between the percentage of energy consumed from carbohydrate (mean 48·9%, SD 9·4) and mortality: a percentage of 50–55% energy from carbohydrate was associated with the lowest risk of mortality. In the meta-analysis of all cohorts (432 179 participants), both low carbohydrate consumption (<40%) and high carbohydrate consumption (>70%) conferred greater mortality risk than did moderate intake, which was consistent with a U-shaped association (pooled hazard ratio 1·20, 95% CI 1·09–1·32 for low carbohydrate consumption; 1·23, 1·11–1·36 for high carbohydrate consumption). However, results varied by the source of macronutrients: mortality increased when carbohydrates were exchanged for animal-derived fat or protein (1·18, 1·08–1·29) and mortality decreased when the substitutions were plant-based (0·82, 0·78–0·87).

          Interpretation

          Both high and low percentages of carbohydrate diets were associated with increased mortality, with minimal risk observed at 50–55% carbohydrate intake. Low carbohydrate dietary patterns favouring animal-derived protein and fat sources, from sources such as lamb, beef, pork, and chicken, were associated with higher mortality, whereas those that favoured plant-derived protein and fat intake, from sources such as vegetables, nuts, peanut butter, and whole-grain breads, were associated with lower mortality, suggesting that the source of food notably modifies the association between carbohydrate intake and mortality.

          Related collections

          Most cited references 15

          • Record: found
          • Abstract: found
          • Article: not found

          CONSORT 2010 statement: updated guidelines for reporting parallel group randomized trials.

          The CONSORT (Consolidated Standards of Reporting Trials) statement is used worldwide to improve the reporting of randomized, controlled trials. Schulz and colleagues describe the latest version, CONSORT 2010, which updates the reporting guideline based on new methodological evidence and accumulating experience.
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Associations of fats and carbohydrate intake with cardiovascular disease and mortality in 18 countries from five continents (PURE): a prospective cohort study

            The relationship between macronutrients and cardiovascular disease and mortality is controversial. Most available data are from European and North American populations where nutrition excess is more likely, so their applicability to other populations is unclear.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Plant-based foods and prevention of cardiovascular disease: an overview.

               Frank Hu (2003)
              Evidence from prospective cohort studies indicates that a high consumption of plant-based foods such as fruit and vegetables, nuts, and whole grains is associated with a significantly lower risk of coronary artery disease and stroke. The protective effects of these foods are probably mediated through multiple beneficial nutrients contained in these foods, including mono- and polyunsaturated fatty acids, n-3 fatty acids, antioxidant vitamins, minerals, phytochemicals, fiber, and plant protein. In dietary practice, healthy plant-based diets do not necessarily have to be low in fat. Instead, these diets should include unsaturated fats as the predominant form of dietary fat (eg, fats from natural liquid vegetable oils and nuts), whole grains as the main form of carbohydrate, an abundance of fruit and vegetables, and adequate n-3 fatty acids. Such diets, which also have many other health benefits, deserve more emphasis in dietary recommendations to prevent chronic diseases.
                Bookmark

                Author and article information

                Journal
                101699003
                46113
                Lancet Public Health
                Lancet Public Health
                The Lancet. Public health
                2468-2667
                11 October 2018
                17 August 2018
                September 2018
                20 January 2019
                : 3
                : 9
                : e419-e428
                Affiliations
                Cardiovascular Division, (S B Seidelmann MD, B Claggett PhD, S Cheng MD, M Henglin BA, A Shah MD, S D Solomon MD) and Channing Division of Network Medicine (E B Rimm ScD, W C Willett MD), Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA; Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA (L M Steffen PhD, A R Folsom MD); and Department of Epidemiology and Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA (E B Rimm, W C Willett)
                Author notes

                Contributors

                SBS led all stages of the work with the academic guidance of SDS, WCW, EBR, SC, AS, LMS, ARF, and BC. SDS and the advisory group provided counsel in the study design and data interpretation. MH aided data analysis and preparation of figures. All authors contributed to drafting and critical revision of the manuscript for intellectual content.

                Correspondence to: Dr Scott D Solomon, Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA ssolomon@ 123456rics.bwh.harvard.edu
                Article
                NIHMS989986
                10.1016/S2468-2667(18)30135-X
                6339822
                30122560

                This is an Open Access article under the CC BY-NC-ND 4.0 license.

                Categories
                Article

                Comments

                Comment on this article