Low-Carbohydrate-Diet Score and the Risk of Coronary Heart Disease in Women
Open accessAbstract
BACKGROUND: Low-carbohydrate diets have been advocated for weight loss and to prevent obesity, but the long-term safety of these diets has not been determined. METHODS: We evaluated data on 82,802 women in the Nurses' Health Study who had completed a validated food-frequency questionnaire. Data from the questionnaire were used to calculate a low-carbohydrate-diet score, which was based on the percentage of energy as carbohydrate, fat, and protein (a higher score reflects a higher intake of fat and protein and a lower intake of carbohydrate). The association between the low-carbohydrate-diet score and the risk of coronary heart disease was examined. RESULTS: During 20 years of follow-up, we documented 1994 new cases of coronary heart disease. After multivariate adjustment, the relative risk of coronary heart disease comparing highest and lowest deciles of the low-carbohydrate-diet score was 0.94 (95% confidence interval [CI], 0.76 to 1.18; P for trend=0.19). The relative risk comparing highest and lowest deciles of a low-carbohydrate-diet score on the basis of the percentage of energy from carbohydrate, animal protein, and animal fat was 0.94 (95% CI, 0.74 to 1.19; P for trend=0.52), whereas the relative risk on the basis of the percentage of energy from intake of carbohydrates, vegetable protein, and vegetable fat was 0.70 (95% CI, 0.56 to 0.88; P for trend=0.002). A higher glycemic load was strongly associated with an increased risk of coronary heart disease (relative risk comparing highest and lowest deciles, 1.90; 95% CI, 1.15 to 3.15; P for trend=0.003). CONCLUSIONS: Our findings suggest that diets lower in carbohydrate and higher in protein and fat are not associated with increased risk of coronary heart disease in women. When vegetable sources of fat and protein are chosen, these diets may moderately reduce the risk of coronary heart disease.
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Legumes inclusive of soy and dietary pulses are associated with reductions in incident CHD and CVD, with a dose-response gradient where ≥4 servings (100 g) per week is associated with a ~17-22% risk reduction.
“studies have shown that legumes inclusive of soy and dietary pulses are associated with reductions in incident CHD and CVD with evidence of a dose response gradient, where ≥4 servings (100 g) per week is associated with a ~17-22% risk reduction.[55][56][57]”
From Portfolio Dietary Pattern and Cardiovascular Disease: A Systematic Review and Meta-analysis of Controlled Trials (2018) · cites this paper as [56]
The Discussion (page unavailable) addresses vegetable protein and CHD risk, but says its association became nonsignificant after multivariate adjustment. Searches for legumes, soy, pulses, four servings or 100 g per week, and a 17–22% risk reduction found no passage assessing the claimed food-specific association or dose–response gradient. (LLM, conf=0.76)
Experimental — accuracy not yet measuredThe cardiovascular effects of low-carbohydrate diets are not well established.
“Low-carbohydrate diets have become a popular strategy for weight loss and weight management in recent years; however, their cardiovascular effects are unknown.”
From Effects of Low-Carbohydrate and Low-Fat Diets: A Randomized Trial (2014) · cites this paper as [2]
Prospective cohort studies have yielded conflicting findings on the link between low-carbohydrate dietary patterns and cardiovascular disease risk.
“Prospective cohort studies have produced conflicting results regarding the association between low-carbohydrate dietary patterns and risk for CVD (2, 3).”
From Effects of Low-Carbohydrate and Low-Fat Diets: A Randomized Trial (2014) · cites this paper as [2]
Consumption of non-hydrogenated vegetable oils appears superior to consumption of animal fats.
“Consumption of non-hydrogenated vegetable oils appears to be superior to consumption of animal fats (162).”
From Food Consumption and its Impact on Cardiovascular Disease: Importance of Solutions Focused on the Globalized Food System (2015) · cites this paper as [162]
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“Notably, a high-glycemic diet induces a consistently significantly stronger effect on the development of type 2 diabetes [35,75], coronary heart disease [ 38 ,39], and stroke [40], especially among those with greater adiposity (BMI > 23 or BMI > 25), (all 3 diseases: P for interaction < 0.05).”
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Self-citationThe effect of a dietary portfolio compared to a DASH-type diet on blood pressure
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- Authors
- Halton, T. L., Willett, W. C., Liu, S., Manson, J. E., Albert, C. M., Rexrode, K., & Hu, F. B.
- Affiliations
- Harvard University (US)
- University of California, Los Angeles (US)
- Brigham and Women's Hospital (US)
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2006-11-09
- Volume
- 355
- Issue
- 19
- Pages
- 1991-2002
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W1974134773
- Cited by
- 519
- References
- 28
- Citations by year
- 2026: 18 · 2025: 22 · 2024: 33 · 2023: 21 · 2022: 29 · 2021: 38 · 2020: 29 · 2019: 15 · 2018: 17 · 2017: 17 · 2016: 15 · 2015: 21 · 2014: 30 · 2013: 27 · 2012: 29
- FWCI
- 21.71
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- American Heart Association
- General Mills
- National Institutes of Health (DK58845, CA 87969)
- National Heart, Lung, and Blood Institute (HL60712, R01HL060712, HL34594, R01HL034594)
- National Cancer Institute (CA-87969, P01CA087969)
- National Institute of Diabetes and Digestive and Kidney Diseases (R01DK058845, DK58845, P30DK040561)
- 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, coronary artery disease, women, dietary fat, dietary protein, vegetable fats, plant proteins, glycemic load, diet score, Nurses' Health Study
- MeSH terms
- Adult, Energy Intake, Coronary Disease, Diet Surveys, Dietary Carbohydrates, Dietary Fats, Dietary Proteins, Female, Follow-Up Studies, Humans, Lipids, Middle Aged, Myocardial Infarction, Surveys and Questionnaires, Risk, Vegetables, Proportional Hazards Models, Diet, Carbohydrate-Restricted
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