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Association of Low-Carbohydrate and Low-Fat Diets With Mortality Among US Adults
JAMA Internal Medicine ( IF 39.0 ) Pub Date : 2020-04-01 , DOI: 10.1001/jamainternmed.2019.6980
Zhilei Shan 1 , Yanjun Guo 2, 3 , Frank B Hu 1, 3, 4 , Liegang Liu 5, 6 , Qibin Qi 1, 7
Affiliation  

Importance It is crucial to incorporate quality and types of carbohydrate and fat when investigating the associations of low-fat and low-carbohydrate diets with mortality. Objective To investigate the associations of low-carbohydrate and low-fat diets with total and cause-specific mortality among US adults. Design, Setting, and Participants This prospective cohort study used data from the US National Health and Nutrition Examination Survey from 1999 to 2014 from 37 233 adults 20 years or older with 24-hour dietary recall data. Data were analyzed from July 5 to August 27, 2019. Exposures Overall, unhealthy, and healthy low-carbohydrate-diet and low-fat-diet scores based on the percentage of energy as total and subtypes of carbohydrate, fat, and protein. Main Outcomes and Measures All-cause mortality from baseline until December 31, 2015, linked to National Death Index mortality data. Results A total of 37 233 US adults (mean [SD] age, 49.7 [18.3] years; 19 598 [52.6%] female) were included in the present analysis. During 297 768 person-years of follow-up, 4866 total deaths occurred. Overall low-carbohydrate-diet and low-fat-diet scores were not associated with total mortality. The multivariable-adjusted hazard ratios for total mortality per 20-percentile increase in dietary scores were 1.07 (95% CI, 1.02-1.11; P = .01 for trend) for unhealthy low-carbohydrate-diet score, 0.91 (95% CI, 0.87-0.95; P < .001 for trend) for healthy low-carbohydrate-diet score, 1.06 (95% CI, 1.01-1.12; P = .04 for trend) for unhealthy low-fat-diet score, and 0.89 (95% CI, 0.85-0.93; P < .001 for trend) for healthy low-fat-diet score. The associations remained similar in the stratification and sensitivity analyses. Conclusions and Relevance In this study, overall low-carbohydrate-diet and low-fat-diet scores were not associated with total mortality. Unhealthy low-carbohydrate-diet and low-fat-diet scores were associated with higher total mortality, whereas healthy low-carbohydrate-diet and low-fat-diet scores were associated with lower total mortality. These findings suggest that the associations of low-carbohydrate and low-fat diets with mortality may depend on the quality and food sources of macronutrients.

中文翻译:

低碳水化合物和低脂肪饮食与美国成年人死亡率的关联

重要性 在调查低脂肪和低碳水化合物饮食与死亡率的关联时,考虑碳水化合物和脂肪的质量和类型至关重要。目的 调查低碳水化合物和低脂肪饮食与美国成年人的总死亡率和病因特异性死亡率之间的关联。设计、设置和参与者 这项前瞻性队列研究使用了 1999 年至 2014 年美国国家健康和营养检查调查的数据,这些数据来自 37233 名 20 岁或以上的成年人,具有 24 小时的饮食回忆数据。数据分析时间为 2019 年 7 月 5 日至 8 月 27 日。 暴露 总体、不健康和健康的低碳水化合物饮食和低脂肪饮食评分基于能量占碳水化合物、脂肪和蛋白质的总量和亚型的百分比。主要结果和测量从基线到 2015 年 12 月 31 日的全因死亡率,与国家死亡指数死亡率数据相关联。结果 共有 37 233 名美国成年人(平均 [SD] 年龄,49.7 [18.3] 岁;19 598 [52.6%] 名女性)被纳入本分析。在 297768 人年的随访中,共有 4866 人死亡。总体低碳水化合物饮食和低脂肪饮食评分与总死亡率无关。对于不健康的低碳水化合物饮食评分,饮食评分每增加 20 个百分点,总死亡率的多变量调整风险比为 1.07(95% CI,1.02-1.11;趋势 P = .01),0.91(95% CI, 0.87-0.95;趋势 P < .001)健康低碳水化合物饮食评分为 1.06(95% CI,1.01-1.12;趋势 P = .04),不健康低脂饮食评分为 0.89(95 % CI,0.85-0.93;趋势P < .001)健康低脂饮食评分。在分层和敏感性分析中,这些关联仍然相似。结论和相关性 在本研究中,总体低碳水化合物饮食和低脂肪饮食评分与总死亡率无关。不健康的低碳水化合物饮食和低脂肪饮食评分与较高的总死亡率相关,而健康的低碳水化合物饮食和低脂肪饮食评分与较低的总死亡率相关。这些发现表明,低碳水化合物和低脂肪饮食与死亡率的关联可能取决于常量营养素的质量和食物来源。而健康的低碳水化合物饮食和低脂肪饮食评分与较低的总死亡率相关。这些发现表明,低碳水化合物和低脂肪饮食与死亡率的关联可能取决于常量营养素的质量和食物来源。而健康的低碳水化合物饮食和低脂肪饮食评分与较低的总死亡率相关。这些发现表明,低碳水化合物和低脂肪饮食与死亡率的关联可能取决于常量营养素的质量和食物来源。
更新日期:2020-04-01
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