Department of Nutrition, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China.
Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, Hefei, Anhui, China.
Eur J Nutr. 2022 Sep;61(6):3149-3160. doi: 10.1007/s00394-022-02877-0. Epub 2022 Apr 8.
To investigate the associations between carbohydrate intake and the risk of overall and specific-cause mortality in a prospective cohort study.
Diet was measured using 24 h dietary recalls. Underlying cause of death was identified through linkage to the National Death Index. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazards regression.
During a median follow-up of 7.1 years among 35,692 participants who aged 20-85 years, a total of 3854 deaths [783 cardiovascular disease (CVD)-specific and 884 cancer-specific death] were identified. Carbohydrate intake was not associated with risk of overall mortality (multivariable-adjusted HR comparing extreme quartiles 1.03, 95% CI 0.94, 1.13, p = 0.799), while higher fiber intake was associated with lower mortality risk (HR 0.86, 95% CI 0.77, 0.95, p = 0.004). Replacing 5% of energy from carbohydrate with both plant fat and plant protein was associated with 13% (95% CI 8%, 17%) and 13% (95% CI 3%, 22%) lower risk of total and CVD mortality, respectively. Whereas a positive or null association was found when replacing carbohydrate with both animal fat and animal protein. Higher carbohydrate-to-fiber ratio was associated with increased risk of overall (HR 1.20, 95% CI 1.09, 1.33, p < 0.001) and cancer-specific (HR 1.17, 95% CI 0.95, 1.44, p = 0.031) mortality.
Our findings suggested that high fiber diet or diet with low carbohydrate-to-fiber ratio was associated with lower long-term death risk, and provided evidence for the health benefit from dietary substitution of both plant fat and plant protein for carbohydrate.
在一项前瞻性队列研究中，调查碳水化合物摄入量与全因和特定原因死亡率风险之间的关联。
使用 24 小时膳食回忆来测量饮食。通过与国家死亡索引链接来确定根本死因。使用 Cox 比例风险回归估计风险比（HR）和 95%置信区间（CI）。
在 35692 名年龄在 20-85 岁的参与者中，中位随访 7.1 年后，共发生 3854 例死亡[783 例心血管疾病（CVD）特异性和 884 例癌症特异性死亡]。碳水化合物摄入量与总体死亡率风险无关（极端四分位距比较的多变量调整 HR 1.03，95%CI 0.94，1.13，p=0.799），而较高的纤维摄入量与较低的死亡率风险相关（HR 0.86，95%CI 0.77，0.95，p=0.004）。用植物脂肪和植物蛋白替代 5%的能量来源的碳水化合物，分别与总死亡率和 CVD 死亡率降低 13%（95%CI 8%，17%）和 13%（95%CI 3%，22%）相关。而用动物脂肪和动物蛋白替代碳水化合物时，观察到阳性或无关联。碳水化合物与纤维的比值较高与全因（HR 1.20，95%CI 1.09，1.33，p<0.001）和癌症特异性（HR 1.17，95%CI 0.95，1.44，p=0.031）死亡率风险增加相关。
我们的研究结果表明，高纤维饮食或碳水化合物与纤维比值较低的饮食与较低的长期死亡风险相关，并为用植物脂肪和植物蛋白替代碳水化合物的饮食替代提供了健康益处的证据。
