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Cited by 55Diet and metabolism studiesNutritional Studies and DietDietary Effects on Health

Low carbohydrate diet and all cause and cause-specific mortality

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Akter, Shamima, Mizoue, Tetsuya, Nanri, Akiko, Goto, Atsushi, Noda, Mitsuhiko, Sawada, Norie, Yamaji, Taiki, Iwasaki, Motoki +35 more·2021·Clinical Nutrition
DOI 10.1016/j.clnu.2020.09.022
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Abstract

BACKGROUND: 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. OBJECTIVE: 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. DESIGN: 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. RESULTS: 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. CONCLUSIONS: 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.

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  • Large cohort studies suggest higher mortality at lower carbohydrate levels, but this association disappears when plant-based protein is substituted for animal-based sources of protein.

    “Large cohort studies suggest higher mortality at lower carbohydrate levels, but this association disappears when plant-based protein is substituted for animal-based sources of protein”

    From Lifestyle Medicine for Obesity in the Era of Highly Effective Anti-Obesity Treatment (2025) · cites this paper as [189]

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Authors
Akter, S., Mizoue, T., Nanri, A., Goto, A., Noda, M., Sawada, N., Yamaji, T., Iwasaki, M., Inoue, M., Tsugane, S., Tsugane, S., Sawada, N., Iwasaki, M., Ninue, M., Yamaji, T., Goto, A., Shimazu, T. T., Charvat, H., Budhathoki, S., Muto, M., Suzuki, H., Miamizono, T., Kobayashi, Y., Iriei, M., Doi, M., Katagiri, M., Tagami, T., Sou, Y., Uehara, M., Hakubo, Y., Yamagishi, Noda, M., Mizoue, T., Kawauchi, Y., Nakamura, K., Takachi, R., Ishihara, J., Iso, H., Sovue, T., Sito, I., Yasuda, N., Mimura, M., & Sakata, K.
Affiliations
  • National Center for Global Health and Medicine (JP)
  • Fukuoka Women's University (JP)
  • National Cancer Centre Japan (JP)
Corresponding author
Akter, Shamima
ORCID
Venue
Clinical Nutrition
Publisher
Elsevier BV
Published
2021-04
Volume
40
Issue
4
Pages
2016-2024
ISSN
0261-5614 (ISSN-L)
DOI
10.1016/j.clnu.2020.09.022
OpenAlex
W3088196660
Cited by
55
References
50
Citations by year
2026: 3 · 2025: 15 · 2024: 9 · 2023: 14 · 2022: 8 · 2021: 6
FWCI
4.21
Type
journal article
Language
en
Open access
Licence
Locations
  • Clinical Nutrition (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
Funders
  • National Cancer Center Research and Development Fund (23-A-31, 26-A-2, 29-A-4)
  • Ministry of Health, Labour and Welfare of Japan
Topics
  • Health Sciences › Medicine › Physiology › Diet and metabolism studies
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
  • Health Sciences › Medicine › Physiology › Dietary Effects on Health
Keywords
low-carbohydrate diet, macronutrient composition, all-cause mortality, cause-specific mortality, cardiovascular mortality, heart disease mortality, cerebrovascular disease mortality, plant proteins, animal protein, animal fats, vegetable fats, U-shaped relationship, Asian populations, Japanese adults
MeSH terms
Adult, Aged, Cardiovascular Diseases, Cause of Death, Cerebrovascular Disorders, Female, Heart Diseases, Humans, Japan, Middle Aged, Prospective Studies, Cohort Studies, Diet, Carbohydrate-Restricted

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