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[Online ahead of print]

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

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

Zhilei Shan et al. JAMA Intern Med.

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.

Conflict of interest statement

Conflict of Interest Disclosures: Dr Shan reported receiving grants from The Young Scientists Fund of the National Natural Science Foundation of China during the conduct of the study. Dr Hu reported receiving grants from the California Walnut Commission and personal fees from Standard Process, Metagenics, and Diet Quality Photo Navigation outside the submitted work. Dr Liu reported receiving grants from the National Key Research and Development Program of China and grants from the National Natural Science Foundation of China during the conduct of the study. Dr Qi reported receiving grants from the National Heart, Lung, and Blood Institute during the conduct of the study. No other disclosures were reported.

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