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, 10 (1), 913

The Effect of High Carbohydrate-to-fat Intake Ratios on Hypo-HDL-cholesterolemia Risk and HDL-cholesterol Levels Over a 12-year Follow-up


The Effect of High Carbohydrate-to-fat Intake Ratios on Hypo-HDL-cholesterolemia Risk and HDL-cholesterol Levels Over a 12-year Follow-up

Hye Ah Lee et al. Sci Rep.


Considering the strong correlation between carbohydrate and fat intake, we defined and assessed the association of the carbohydrate-to-fat ratio with the high-density lipoprotein cholesterol (HDL-c) level using 12-year follow-up data from the community-based cohort of the Korean Genome Epidemiology Study. We evaluated the long-term changes in HDL-c levels according to quartiles of carbohydrate-to-fat ratio using a mixed model. We also assessed the effect of the carbohydrate-to-fat ratio on the prevalence and incidence of hypo-HDL-cholesterolemia. Of 6,627 subjects, the prevalence of undiagnosed hypo-HDL-cholesterolemia at baseline was 35.3% (n = 2,339). Among the disease-free subjects, 56.8% developed hypo-HDL-cholesterolemia (incidence = 92/1,000 person-years). The prevalence and incidence of hypo-HDL-cholesterolemia were higher in females than in males. The highest carbohydrate-to-fat ratio quartile, which was characterized by high and low intake of carbohydrate and fat, was consistently associated with a lower HDL-c level during the 12-year follow up. Moreover, those in the highest quartile had a 1.14-fold greater risk of incident hypo-HDL-cholesterolemia than those in the lowest quartile, with a significant dose-response relationship. We found that high and low intake of carbohydrate and fat, respectively, was consistently associated with a low HDL-c level over a prolonged period. More research is needed to promote appropriate intake of macronutrients.

Conflict of interest statement

The authors declare no competing interests.


Figure 1
Figure 1
Change in HDL-c levels from baseline to the final follow-up according to carbohydrate-to-fat ratio quartile. High-density lipoprotein cholesterol (HDL-c) levels were transformed to standardized values based on the mean and standard deviation of HDL-c levels s of the subjects who participated in each follow-up survey. Values are least-squared means with 95% confidence intervals. The least-squared mean change in HDL-c levels was estimated for each carbohydrate-to-fat ratio quartile at each follow up using a mixed model assuming a random intercept with a compound symmetric structure. Estimates were obtained from a model that included the quartile of carbohydrate-to-fat ratio, follow-up time point, sex, age, rural residence, education level, physical activity, total energy intake at baseline, current smoking (at each follow-up), alcohol intake (at each follow up), body mass index (at each follow up), and the interaction between carbohydrate-to-fat ratio quartile and follow-up time point. In the stratified analysis by sex, the variable sex was naturally excluded from the covariates.

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