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Diabetes care
04 01, 2023;46 (4): 874-884.

Low-Carbohydrate Diet Scores and Mortality Among Adults With Incident Type 2 Diabetes.

Yang Hu, Gang Liu, Edward Yu, Biqi Wang, Clemens Wittenbecher, JoAnn E Manson, Eric B Rimm, Liming Liang, Kathryn Rexrode, Walter C Willett, Frank B Hu, Qi Sun
Author Information
  1. Yang Hu: Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA. ORCID
  2. Gang Liu: Department of Nutrition and Food Hygiene, Huazhong University of Science and Technology School of Public Health, Wuhan, China.
  3. Edward Yu: Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA.
  4. Biqi Wang: Department of Medicine, University of Massachusetts Medical School, Worcester, MA.
  5. Clemens Wittenbecher: Chalmers University of Technology, Göteborg, Sweden.
  6. JoAnn E Manson: Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA.
  7. Eric B Rimm: Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA.
  8. Liming Liang: Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA.
  9. Kathryn Rexrode: Division of Women's Health, Department of Medicine, Brigham and Women's Hospital, Boston, MA.
  10. Walter C Willett: Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA.
  11. Frank B Hu: Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA.
  12. Qi Sun: Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA. ORCID
PMID: 36787923 DOI: 10.2337/dc22-2310

Abstract

OBJECTIVE: The current study aims to prospectively examine the association between postdiagnosis low-carbohydrate diet (LCD) patterns and mortality among individuals with type 2 diabetes (T2D).
RESEARCH DESIGN AND METHODS: Among participants with incident diabetes identified in the Nurses' Health Study and Health Professionals Follow-up Study, an overall total LCD score (TLCDS) was calculated based on the percentage of energy as total carbohydrates. In addition, vegetable (VLCDS), animal (ALCDS), healthy (HLCDS), and unhealthy (ULCDS) LCDS were further derived that emphasized different sources and quality of macronutrients. Multivariable-adjusted Cox models were used to assess the association between the LCDS and mortality.
RESULTS: Among 10,101 incident T2D cases contributing 139,407 person-years during follow-up, we documented 4,595 deaths of which 1,389 cases were attributed to cardiovascular disease (CVD) and 881 to cancer. The pooled multivariable-adjusted hazard ratios (HRs, 95% CIs) of total mortality per 10-point increment of postdiagnosis LCDS were 0.87 (0.82, 0.92) for TLCDS, 0.76 (0.71, 0.82) for VLCDS, and 0.78 (0.73, 0.84) for HLCDS. Both VLCDS and HLCDS were also associated with significantly lower CVD and cancer mortality. Each 10-point increase of TLCDS, VLCDS, and HLCDS from prediagnosis to postdiagnosis period was associated with 12% (7%, 17%), 25% (19%, 30%), and 25% (19%, 30%) lower total mortality, respectively. No significant associations were observed for ALCDS and ULCDS.
CONCLUSIONS: Among people with T2D, greater adherence to LCD patterns that emphasize high-quality sources of macronutrients was significantly associated with lower total, cardiovascular, and cancer mortality.

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Grants

  1. R01 DK126698/NIDDK NIH HHS
  2. R01 DK119268/NIDDK NIH HHS
  3. U01 CA167552/NCI NIH HHS
  4. R01 ES022981/NIEHS NIH HHS
  5. UM1 CA167552/NCI NIH HHS
  6. R01 HL060712/NHLBI NIH HHS
  7. R21 AG070375/NIA NIH HHS
  8. R01 DK120870/NIDDK NIH HHS
  9. P01 CA087969/NCI NIH HHS
  10. R01 HL034594/NHLBI NIH HHS
  11. UM1 CA186107/NCI NIH HHS
  12. R01 HL035464/NHLBI NIH HHS
  13. U2C DK129670/NIDDK NIH HHS
  14. R01 HL088521/NHLBI NIH HHS

MeSH Term

Animals
Humans
Diabetes Mellitus, Type 2
Follow-Up Studies
Prospective Studies
Diet, Carbohydrate-Restricted
Cardiovascular Diseases
Neoplasms
Diet
Journal Article Research Support, N.I.H., Extramural
Article has an altmetric score of 509

Word Cloud

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