Low-Carbohydrate Diets and Mortality in Older Asian People: A 15-Year Follow-Up from a Prospective Cohort Study

Abstract

The long-term effects of a low-carbohydrate diet (LCD) on mortality, accounting for the quality and source of the carbohydrate, are unclear. Hence, we examined the associations of LCDs with all-cause and cause-specific mortality in a prospective cohort study. A total of 20,206 participants (13.8% diabetes) aged 50+ years were included. Overall, vegetable-based and meat-based LCD scores were calculated based on the percentage of energy as total and subtypes of carbohydrates, fat, and protein. Cox regression analysis was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs). During 294,848 person-years of follow-up, 4624 deaths occurred, including 3661 and 963 deaths in participants without and with diabetes, respectively. In all participants, overall LCD score was not associated with all-cause and cause-specific mortality, after multivariable adjustment. However, for the highest versus the lowest quartiles of vegetable-based LCD, the adjusted HRs (95%CIs) of all-cause and CVD mortality were 1.16 (1.05–1.27) and 1.39 (1.19–1.62), respectively. The corresponding values for highest versus lowest quartiles of meat-based LCD for all-cause and CVD mortality were 0.89 (0.81–0.97) and 0.81 (0.70–0.93), respectively. Similar associations were found in participants without diabetes. In patients with diabetes, the adjusted HR (95%CI) of CVD mortality for the highest versus the lowest quartiles of vegetable-based LCD was 1.54 (1.11–2.14). Although there were no significant associations with overall LCD score, we found that the vegetable-based LCD score was positively, whereas the meat-based LCD score was negatively, associated with all-cause and CVD mortality in older Asian people.

Low-carbohydrate diet and risk of cardiovascular disease, cardiovascular and all-cause mortality: a systematic review and meta-analysis of cohort studies

“…Finally, 17 publications were included for this meta-analysis. 8,12–15,17–21,29–33,41,42 Seven publications (13 studies) reported effect sizes for CVD, 8,12–17 3 (3 studies) for CHD, 12,13,16 2 (2 study) for stroke, 14,31 12 (16 studies) for all-cause mortality, 8,15,17–21,30,32,33,41,42 and 8 (10 studies) for cardiovascular mortality. 8,12,15,17,21,30,41,42…”

“…Finally, 17 publications were included for this meta-analysis. 8,[12][13][14][15][17][18][19][20][21][29][30][31][32][33]41,42 Seven publications (13 studies) reported effect sizes for CVD, 8,12-17 3 (3 studies) for CHD, 12,13,16 2 (2 study) for stroke, 14,31 12 (16 studies) for allcause mortality, 8,15,[17][18][19][20][21]30,32,33,41,42 and 8 (10 studies) for cardiovascular mortality. 8,12,15,17,21,30,41,42 Characteristics of studies Furthermore, the sample size (from 924 to 371 159) varied widely across these 17 studies.…”

Beneficial Effects of Low Carbohydrate Diet (LCD) with Recently Emerged Solid Evidence

“…Regarding the long-term efficacy of LCD on mortality, the quality and source of carbohydrates have been investigated in a prospective cohort study. The protocol included 20,206 cases (including 13.8% with diabetes), and vegetable-and meat-based LCD scores were calculated for hazard ratios (HRs) [15]. Concerning the data from the highest vs. lowest quartiles, vegetable-based LCD showed HRs of 1.16 and 1.30 for all-cause and CVD mortality, respectively.…”