Background: It remains largely unknown whether a low-carbohydrate diet is associated with cardiovascular disease and all-cause mortality, and also if low-carbohydrate diets consisting of different nutrients could have different effects on these outcomes in people with type 2 diabetes.
Objective: This prospective observational study investigated which lifestyle habits were associated with an increased risk of health outcomes.
Methods: The study participants comprised 731 Japanese outpatients with type 2 diabetes and no evident cardiovascular disease history. Lifestyle habits, including diet, were assessed with questionnaires at baseline and at years 2 and/or 5, and their mean values were calculated using the average value of lifestyle factors from baseline to the date of onset of an event or the end of follow-up. A multivariable Cox proportional hazards model was used to determine the relationships between each lifestyle habit and the primary endpoint events, comprising cardiovascular events and all-cause mortality.
Results: During the mean follow-up period of 7.5 ± 2.4 years, composite primary endpoint events occurred in 55 participants. Multivariate Cox models showed a significant positive association between the mean proportion of carbohydrate intake and the primary endpoint incidence (hazard ratio = 1.06; 95% CI, 1.02-1.10; P = .005); in addition, the mean total low-carbohydrate diet score, animal low-carbohydrate diet score, and mean proportion of saturated fatty acid intake showed significant inverse associations with the incidence of the primary endpoint.
Conclusion: Our data demonstrated that a higher proportion of carbohydrate intake, particularly with reduced consumption of animal-derived fat/protein, was correlated with an increased risk of cardiovascular disease and all-cause mortality. These data underscore the need to consider dietary components in people with type 2 diabetes.
Keywords: all-cause mortality; animal-derived fat/protein; carbohydrate intake; cardiovascular disease.
© The Author(s) 2025. Published by Oxford University Press on behalf of the Endocrine Society. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com. See the journal About page for additional terms.