Background:
Data on the long-term association between low-carbohydrate diets and mortality are sparse.
Objective:
To examine the association of low-carbohydrate diets with mortality during 26 years of follow-up in women and 20 years in men.
Design:
Prospective cohort study of women and men who were followed from 1980 (women) or 1986 (men) until 2006. Low-carbohydrate diets, either animal-based (emphasizing animal sources of fat and protein) or vegetable-based (emphasizing vegetable sources of fat and protein), were computed from several validated food-frequency questionnaires assessed during follow-up.
Setting:
Nurses' Health Study and Health Professionals' Follow-up Study.
Participants:
85 168 women (aged 34 to 59 years at baseline) and 44 548 men (aged 40 to 75 years at baseline) without heart disease, cancer, or diabetes.
Measurements:
Investigators documented 12 555 deaths (2458 cardiovascular-related and 5780 cancer-related) in women and 8678 deaths (2746 cardiovascular-related and 2960 cancer-related) in men.
Results:
The overall low-carbohydrate score was associated with a modest increase in overall mortality in a pooled analysis (hazard ratio [HR] comparing extreme deciles, 1.12 [95% CI, 1.01 to 1.24]; P for trend = 0.136). The animal low-carbohydrate score was associated with higher all-cause mortality (pooled HR comparing extreme deciles, 1.23 [CI, 1.11 to 1.37]; P for trend = 0.051), cardiovascular mortality (corresponding HR, 1.14 [CI, 1.01 to 1.29]; P for trend = 0.029), and cancer mortality (corresponding HR, 1.28 [CI, 1.02 to 1.60]; P for trend = 0.089). In contrast, a higher vegetable low-carbohydrate score was associated with lower all-cause mortality (HR, 0.80 [CI, 0.75 to 0.85]; P for trend ≤ 0.001) and cardiovascular mortality (HR, 0.77 [CI, 0.68 to 0.87]; P for trend < 0.001).
Limitations:
Diet and lifestyle characteristics were assessed with some degree of error. Sensitivity analyses indicated that results were probably not substantively affected by residual confounding or an unmeasured confounder. Participants were not a representative sample of the U.S. population.
Conclusion:
A low-carbohydrate diet based on animal sources was associated with higher all-cause mortality in both men and women, whereas a vegetable-based low-carbohydrate diet was associated with lower all-cause and cardiovascular disease mortality rates.
Primary Funding Source:
National Institutes of Health.
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Author, Article and Disclosure Information
From Simmons College, Harvard School of Public Health, Boston, Massachusetts, and National University of Singapore, Singapore.
Acknowledgment: The authors thank Dr. Tricia Y. Li for statistical and programming support.
Grant Support: By the National Institutes of Health (grants CA87969, HL60712, and CA95589).
Disclosures: None disclosed. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M10-0297.
Reproducible Research Statement:Study protocol and data set: Not available. Statistical code: Available from Dr. Fung (e-mail, teresa.
Corresponding Author: Teresa T. Fung, ScD, Department of Nutrition, Simmons College, 300 The Fenway, Boston, MA 02115; e-mail, teresa.
Current Author Addresses: Dr. Fung: Department of Nutrition, Simmons College, 300 The Fenway, Boston, MA 02115.
Dr. van Dam: Department of Epidemiology and Public Health, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597.
Dr. Hankinson: Channing Laboratory, 181 Longwood Avenue, Boston, MA 02115.
Dr. Stampfer: Department of Epidemiology, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115.
Drs. Willett and Hu: Department of Nutrition, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115.
Author Contributions: Conception and design: T.T. Fung, R.M. van Dam, F.B. Hu.
Analysis and interpretation of the data: T.T. Fung, R.M. van Dam, S.E. Hankinson, M. Stampfer, F.B. Hu.
Drafting of the article: T.T. Fung.
Critical revision of the article for important intellectual content: T.T. Fung, R.M. van Dam, S.E. Hankinson, M. Stampfer, W.C. Willett, F.B. Hu.
Final approval of the article: T.T. Fung, R.M. van Dam, S.E. Hankinson, M. Stampfer, F.B. Hu.
Statistical expertise: R.M. van Dam.
Obtaining of funding: T.T. Fung, F.B. Hu.
Administrative, technical, or logistic support: W.C. Willett, F.B. Hu.
Collection and assembly of data: S.E. Hankinson, F.B. Hu.
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