Low-carbohydrate, high-protein score and mortality in a northern Swedish population-based cohort

Nilsson, Lena; Winkvist, Anna; Eliasson, Mats; Jansson, J.-H.; Hallmans, Göran; Johansson, Ingegerd; Lindahl, Bernt; Lenner, Per; Guelpen, Bethany Van

doi:10.1038/ejcn.2012.9

Cited by 55 publications

(55 citation statements)

References 27 publications

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“…Four cohort studies using the low-carbohydrate score [7], [10], [11], [32] and two using the LC-HP score [11], [12] showed a significant increase associated with low-carbohydrate diets (relative risk range 1.12–25.0). One diet quality study suggested 0.27 shorter years of life in 10 years, which was statistically significant.…”

Section: Resultsmentioning

confidence: 99%

Low-Carbohydrate Diets and All-Cause Mortality: A Systematic Review and Meta-Analysis of Observational Studies

et al. 2013

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ObjectiveLow-carbohydrate diets and their combination with high-protein diets have been gaining widespread popularity to control weight. In addition to weight loss, they may have favorable short-term effects on the risk factors of cardiovascular disease (CVD). Our objective was to elucidate their long-term effects on mortality and CVD incidence.Data sourcesMEDLINE, EMBASE, ISI Web of Science, Cochrane Library, and ClinicalTrials.gov for relevant articles published as of September 2012. Cohort studies of at least one year’s follow-up period were included.Review methodsIdentified articles were systematically reviewed and those with pertinent data were selected for meta-analysis. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) for all-cause mortality, CVD mortality and CVD incidence were calculated using the random-effects model with inverse-variance weighting.ResultsWe included 17 studies for a systematic review, followed by a meta-analysis using pertinent data. Of the 272,216 people in 4 cohort studies using the low-carbohydrate score, 15,981 (5.9%) cases of death from all-cause were reported. The risk of all-cause mortality among those with high low-carbohydrate score was significantly elevated: the pooled RR (95% CI) was 1.31 (1.07–1.59). A total of 3,214 (1.3%) cases of CVD death among 249,272 subjects in 3 cohort studies and 5,081 (2.3%) incident CVD cases among 220,691 people in different 4 cohort studies were reported. The risks of CVD mortality and incidence were not statistically increased: the pooled RRs (95% CIs) were 1.10 (0.98–1.24) and 0.98 (0.78–1.24), respectively. Analyses using low-carbohydrate/high-protein score yielded similar results.ConclusionLow-carbohydrate diets were associated with a significantly higher risk of all-cause mortality and they were not significantly associated with a risk of CVD mortality and incidence. However, this analysis is based on limited observational studies and large-scale trials on the complex interactions between low-carbohydrate diets and long-term outcomes are needed.

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Section: Resultsmentioning

confidence: 99%

Low-Carbohydrate Diets and All-Cause Mortality: A Systematic Review and Meta-Analysis of Observational Studies

et al. 2013

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“…385 Few longitudinal studies have reported on total protein intake and CHD events, with generally null results. 189, 386 This is not surprising: similar to total fat or total carbohydrate, total protein represents the sum of very different foods (red meats, processed meats, milk, cheese, yogurt, fish, nuts, legumes, etc.) with widely divergent health effects.…”

Section: Nutrients and Cardiometabolic Healthmentioning

confidence: 99%

Dietary and Policy Priorities for Cardiovascular Disease, Diabetes, and Obesity

2016

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Suboptimal nutrition is a leading cause of poor health. Nutrition and policy science have advanced rapidly, creating confusion yet also providing powerful opportunities to reduce the adverse health and economic impacts of poor diets. This review considers the history, new evidence, controversies, and corresponding lessons for modern dietary and policy priorities for cardiovascular diseases, obesity, and diabetes. Major identified themes include the importance of evaluating the full diversity of diet-related risk pathways, not just obesity and blood lipids; focusing on foods and overall diet patterns, rather than single isolated nutrients; recognizing the complex influences of different foods on long-term weight regulation, rather than simply counting calories; and characterizing and implementing evidence-based strategies, including policy approaches, for lifestyle change. Evidence-informed dietary priorities include increased fruits, nonstarchy vegetables, nuts, legumes, fish, vegetable oils, yogurt, and minimally processed whole grains; and fewer red meats, processed (e.g., sodium-preserved) meats, and foods rich in refined grains, starch, added sugars, salt, and trans fat. More investigation is needed on cardiometabolic effects of phenolics, dairy fat, probiotics, fermentation, coffee, tea, cocoa, eggs, specific vegetable and tropical oils, vitamin D, individual fatty acids, and diet-microbiome interactions. Little evidence to-date supports cardiometabolic relevance of other popular priorities: e.g., local, organic, grass-fed, farmed/wild, non-GMO. Evidence-based personalized nutrition appears to depend more on non-genetic characteristics (e.g., physical activity, abdominal adiposity, gender, socioeconomic status, culture) than genetic factors. Food choices must be strongly supported by clinical behavior change efforts, health systems reforms, novel technologies, and robust policy strategies, including those targeting economic incentives, schools and workplaces, neighborhood environments, and the food system. Scientific advances provide crucial new insights on optimal targets and best practices to reduce burdens of diet-related cardiometabolic diseases.

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“…The study found that individuals often substituted carbohydrates with animal protein, thus resulting in the overall increase in protein intake. In contrast, in a northern Swedish population-based cohort, one study found no general association between a low-carbohydrate, high-protein score and mortality [59]. An advantage of the Swedish cohorts over the American cohorts is that the nationwide data linkage in Sweden allows for virtually complete follow-up and objective ascertainment of cardiovascular outcomes.…”

Section: Protein Intake Aging and Disease In Humansmentioning

confidence: 99%

Protein and amino acid restriction, aging and disease: from yeast to humans

Mirzaei

Suárez

Longo

2014

Trends in Endocrinology & Metabolism

213

167

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Many of the effects of dietary restriction (DR) on longevity and health span in model organisms have been linked to reduced protein and amino acid (AA) intake and the stimulation of specific nutrient signaling pathways. Studies in yeast have shown that addition of serine, threonine, and valine in media promotes cellular sensitization and aging by activating different but connected pathways. Protein or essential AA restriction extends both lifespan and healthspan in rodent models. In humans, protein restriction (PR) has been associated with reduced cancer, diabetes, and overall mortality. Thus, interventions aimed at lowering the intake of proteins or specific AAs can be beneficial and have the potential to be widely adopted and effective in optimizing healthspan.

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Low-carbohydrate, high-protein score and mortality in a northern Swedish population-based cohort

Cited by 55 publications

References 27 publications

Low-Carbohydrate Diets and All-Cause Mortality: A Systematic Review and Meta-Analysis of Observational Studies

Low-Carbohydrate Diets and All-Cause Mortality: A Systematic Review and Meta-Analysis of Observational Studies

Dietary and Policy Priorities for Cardiovascular Disease, Diabetes, and Obesity

Protein and amino acid restriction, aging and disease: from yeast to humans

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