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JAMA Intern Med. 2020 Jan 21. doi: 10.1001/jamainternmed.2019.6980. [Epub ahead of print]

Association of Low-Carbohydrate and Low-Fat Diets With Mortality Among US Adults.

Shan Z1, Guo Y2,3, Hu FB1,3,4, Liu L5,6, Qi Q1,7.

Author information

1
Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
2
Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
3
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
4
Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
5
Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
6
MOE Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
7
Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York.

Abstract

Importance:

It is crucial to incorporate quality and types of carbohydrate and fat when investigating the associations of low-fat and low-carbohydrate diets with mortality.

Objective:

To investigate the associations of low-carbohydrate and low-fat diets with total and cause-specific mortality among US adults.

Design, Setting, and Participants:

This prospective cohort study used data from the US National Health and Nutrition Examination Survey from 1999 to 2014 from 37 233 adults 20 years or older with 24-hour dietary recall data. Data were analyzed from July 5 to August 27, 2019.

Exposures:

Overall, unhealthy, and healthy low-carbohydrate-diet and low-fat-diet scores based on the percentage of energy as total and subtypes of carbohydrate, fat, and protein.

Main Outcomes and Measures:

All-cause mortality from baseline until December 31, 2015, linked to National Death Index mortality data.

Results:

A total of 37 233 US adults (mean [SD] age, 49.7 [18.3] years; 19 598 [52.6%] female) were included in the present analysis. During 297 768 person-years of follow-up, 4866 total deaths occurred. Overall low-carbohydrate-diet and low-fat-diet scores were not associated with total mortality. The multivariable-adjusted hazard ratios for total mortality per 20-percentile increase in dietary scores were 1.07 (95% CI, 1.02-1.11; P = .01 for trend) for unhealthy low-carbohydrate-diet score, 0.91 (95% CI, 0.87-0.95; P < .001 for trend) for healthy low-carbohydrate-diet score, 1.06 (95% CI, 1.01-1.12; P = .04 for trend) for unhealthy low-fat-diet score, and 0.89 (95% CI, 0.85-0.93; P < .001 for trend) for healthy low-fat-diet score. The associations remained similar in the stratification and sensitivity analyses.

Conclusions and Relevance:

In this study, overall low-carbohydrate-diet and low-fat-diet scores were not associated with total mortality. Unhealthy low-carbohydrate-diet and low-fat-diet scores were associated with higher total mortality, whereas healthy low-carbohydrate-diet and low-fat-diet scores were associated with lower total mortality. These findings suggest that the associations of low-carbohydrate and low-fat diets with mortality may depend on the quality and food sources of macronutrients.

PMID:
31961383
PMCID:
PMC6990856
[Available on 2021-01-21]
DOI:
10.1001/jamainternmed.2019.6980

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