Department of Epidemiology and Prevention, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan.
Department of Epidemiology and Prevention, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan.
Clin Nutr. 2021 Apr;40(4):2016-2024. doi: 10.1016/j.clnu.2020.09.022. Epub 2020 Sep 23.
Evidence is limited regarding the association between low-carbohydrate diet (LCD) score and mortality among Asians, a population that consumes a large amount of carbohydrates.
The present study examined the association between low-carbohydrate diet (LCD) score (based on percentage of energy as carbohydrate, fat, and protein) and the risk of total and cause-specific mortality among Asians.
This study was a prospective cohort study in Japan with follow-up for a median of 16.9 years involving 43008 men and 50646 women aged 45-75 years. Association of LCD score, LCD score based on animal sources of protein and fat, and LCD score based on plant sources of protein and fat with risk of mortality was assessed using Cox proportional hazards model.
A U-shaped association was observed between LCD score and total mortality: the multivariable-adjusted hazard ratios (HRs) (95% CI) of total mortality for lowest through highest scores were 1.00, 0.95 (0.91, 1.01), 0.93 (0.88, 0.98), 0.93 (0.88, 0.98), and 1.01 (0.95, 1.07) (P-non-linearity <0.01). A similar association was found for mortality from cardiovascular disease (CVD) and heart disease. LCD score based on carbohydrate, animal protein, and animal fat also showed a U-shaped association for total mortality (P-non-linearity <0.01). In contrast, LCD score based on carbohydrate, plant protein, and plant fat was linearly associated with lower total (HR, 0.89; 95% CI: 0.83, 0.94 for highest versus lowest quintile), CVD [0.82 (0.73, 0.92)], heart disease [0.83 (0.71, 0.98)], and cerebrovascular disease [0.75 (0.62, 0.91) mortality.
Both LCD with high animal protein and fat and high-carbohydrate diet with low animal protein and fat were associated with higher risk of mortality. Meanwhile, LCD high in plant-based sources of protein and fat was associated with a lower risk of total and CVD mortality.
在亚洲人群中，碳水化合物摄入量较高，目前有关低碳水化合物饮食（LCD）评分与死亡率之间关联的证据有限。
本研究旨在探讨亚洲人群中基于碳水化合物、脂肪和蛋白质能量百分比的低碳水化合物饮食（LCD）评分与全因和死因特异性死亡率之间的关系。
本研究是一项在日本进行的前瞻性队列研究，中位随访时间为 16.9 年，共纳入 43008 名年龄在 45-75 岁的男性和 50646 名女性。使用 Cox 比例风险模型评估 LCD 评分、基于动物来源的蛋白质和脂肪的 LCD 评分以及基于植物来源的蛋白质和脂肪的 LCD 评分与死亡率风险之间的关联。
LCD 评分与全因死亡率之间呈 U 型关联：最低至最高评分的多变量校正后的全因死亡率风险比（HR）（95%CI）分别为 1.00、0.95（0.91，1.01）、0.93（0.88，0.98）、0.93（0.88，0.98）和 1.01（0.95，1.07）（P-非线性<0.01）。心血管疾病（CVD）和心脏病的死亡率也存在类似的关联。基于碳水化合物、动物蛋白质和动物脂肪的 LCD 评分也与全因死亡率呈 U 型关联（P-非线性<0.01）。相反，基于碳水化合物、植物蛋白质和植物脂肪的 LCD 评分与较低的全因死亡率呈线性相关（HR，0.89；95%CI：最高五分位与最低五分位相比，0.83，0.94）、CVD[0.82（0.73，0.92）]、心脏病[0.83（0.71，0.98）]和脑血管病[0.75（0.62，0.91）]。
高动物蛋白和脂肪的 LCD 和低动物蛋白和脂肪的高碳水化合物饮食均与较高的死亡率相关。同时，富含植物来源的蛋白质和脂肪的 LCD 与总死亡率和 CVD 死亡率降低相关。
