Low-carbohydrate, high-protein score and mortality in a northern Swedish population-based cohort

Eur J Clin Nutr. 2012 Jun;66(6):694-700. doi: 10.1038/ejcn.2012.9. Epub 2012 Feb 15.


Background/objective: Long-term effects of carbohydrate-restricted diets are unclear. We examined a low-carbohydrate, high-protein (LCHP) score in relation to mortality.

Subjects/methods: This is a population-based cohort study on adults in the northern Swedish county of Västerbotten. In 37,639 men (1460 deaths) and 39,680 women (923 deaths) from the population-based Västerbotten Intervention Program, deciles of energy-adjusted carbohydrate (descending) and protein (ascending) intake were added to create an LCHP score (2-20 points). Sex-specific hazard ratios (HR) were calculated by Cox regression.

Results: Median intakes of carbohydrates, protein and fat in subjects with LCHP scores 2-20 ranged from 61.0% to 38.6%, 11.3% to 19.2% and 26.6% to 41.5% of total energy intake, respectively. High LCHP score (14-20 points) did not predict all-cause mortality compared with low LCHP score (2-8 points), after accounting for saturated fat intake and established risk factors (men: HR for high vs low 1.03 (95% confidence interval (CI) 0.88-1.20), P for continuous = 0.721; women: HR for high vs low 1.10 (95% CI 0.91-1.32), P for continuous = 0.229). For cancer and cardiovascular disease, no clear associations were found. Carbohydrate intake was inversely associated with all-cause mortality, though only statistically significant in women (multivariate HR per decile increase 0.95 (95% CI 0.91-0.99), P = 0.010).

Conclusion: Our results do not support a clear, general association between LCHP score and mortality. Studies encompassing a wider range of macronutrient consumption may be necessary to detect such an association.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Cardiovascular Diseases / mortality
  • Cause of Death*
  • Cohort Studies
  • Diet, Carbohydrate-Restricted*
  • Dietary Carbohydrates / pharmacology*
  • Dietary Fats / administration & dosage
  • Dietary Proteins / pharmacology*
  • Energy Intake*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Neoplasms / mortality
  • Proportional Hazards Models
  • Risk Factors
  • Sweden / epidemiology


  • Dietary Carbohydrates
  • Dietary Fats
  • Dietary Proteins