Yonsei University College of Medicine, Seoul 03722, Republic of Korea.
Biostatistics Collaboration Unit, Department of Research Affairs, Yonsei University College of Medicine, Seoul 03722, Republic of Korea.
Clin Nutr ESPEN. 2024 Oct;63:805-812. doi: 10.1016/j.clnesp.2024.08.008. Epub 2024 Aug 17.
BACKGROUND & AIMS: The effect of dietary macronutrient balance on longevity and metabolic health remains a subject of considerable interest. We aimed to investigate the association of carbohydrate-to-protein and carbohydrate-to-fat ratios with all-cause and cardiovascular mortalities.
In this population-based study, data from the Korean Genome and Epidemiology Study were integrated with those from national data sources, including mortality records from the Korea National Statistical Office. The primary outcomes were all-cause and cardiovascular mortalities. Carbohydrate-to-protein and carbohydrate-to-fat ratios were evaluated based on dietary habits assessed through a food frequency questionnaire. Harrell's C-index was employed to determine optimal cut-off points for carbohydrate-to-protein and carbohydrate-to-fat ratios. Cox proportional hazards regression models were used to assess associations.
A total of 143,050 participants aged ≥40 years were included in the analyses. Compared with individuals with non-elevated carbohydrate-to-protein ratios (<5.2), those with elevated carbohydrate-to-protein ratios (>9.9) exhibited a higher all-cause mortality (hazard ratio 1.09, 95% confidence interval 1.01-1.17); however, no correlation between carbohydrate-to-protein ratio and cardiovascular mortality (hazard ratio 1.13, 95% confidence interval 0.96-1.32) was observed. Compared with those with non-elevated carbohydrate-to-fat ratios (<5.1), those with higher carbohydrate-to-fat ratios (>7.1) exhibited increased all-cause (hazard ratio 1.08, 95% confidence interval 1.00-1.16) and cardiovascular (hazard ratio 1.27, 95% confidence interval 1.06-1.52) mortalities.
Our findings regarding macronutrient ratios and their association with mortality suggest that reducing excessive carbohydrate intake and increasing the consumption of protein and fats may have beneficial effects on longevity and cardiovascular health. Further studies are needed to understand the underlying mechanisms of these effects.
膳食宏量营养素平衡对长寿和代谢健康的影响仍然是一个备受关注的话题。本研究旨在探讨碳水化合物与蛋白质以及碳水化合物与脂肪的比值与全因和心血管死亡率之间的关联。
在这项基于人群的研究中，我们整合了韩国基因组与流行病学研究的数据以及来自国家数据源的数据，包括韩国国家统计局的死亡率记录。主要结局为全因和心血管死亡率。根据通过食物频率问卷评估的饮食习惯，评估碳水化合物与蛋白质以及碳水化合物与脂肪的比值。Harrell's C 指数用于确定碳水化合物与蛋白质以及碳水化合物与脂肪比值的最佳截断点。使用 Cox 比例风险回归模型评估相关性。
共纳入 143050 名年龄≥40 岁的参与者。与非升高的碳水化合物与蛋白质比值（<5.2）相比，升高的碳水化合物与蛋白质比值（>9.9）者的全因死亡率更高（风险比 1.09，95%置信区间 1.01-1.17）；然而，碳水化合物与蛋白质比值与心血管死亡率之间没有相关性（风险比 1.13，95%置信区间 0.96-1.32）。与非升高的碳水化合物与脂肪比值（<5.1）相比，升高的碳水化合物与脂肪比值（>7.1）者的全因（风险比 1.08，95%置信区间 1.00-1.16）和心血管（风险比 1.27，95%置信区间 1.06-1.52）死亡率更高。
我们关于宏量营养素比值及其与死亡率关联的研究结果表明，减少过量的碳水化合物摄入并增加蛋白质和脂肪的摄入可能对长寿和心血管健康有益。需要进一步的研究来了解这些影响的潜在机制。
