American Diabetes Association
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Low-carbohydrate diet scores and mortality among adults with incident type 2 diabetes

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posted on 2023-02-15, 01:37 authored by 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


OBJECTIVE The present study aims to prospectively examine the association between post-diagnosis low carbohydrate diet (LCD) patterns and mortality among individuals with type 2 diabetes (T2D).

RSEARCH DESIGN AND METHODS Among participants with incident diabetes identified in the Nurses’ Health Study and Health Professionals Follow-Up Study, an overall total low carbohydrate diet score (TLCDS) was calculated based on the percentage of energy as total carbohydrates. In addition, vegetable (VLCDS), animal (ALCDS), healthy (HLCDS), and unhealthy LCDS (ULCDS) were further derived that emphasized different sources and quality of macronutrients. Multivariable-adjusted Cox model 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 points increment of post-diagnosis 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 points increase of TLCDS, VLCDS, and HLCDS from pre-diagnosis to post-diagnosis 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. 


The NHS, HPFS, and the current analysis are supported by grants (UM1 CA186107, P01 CA87969, R01 HL034594, U01 CA167552, R01 HL035464, R01 HL60712, R01 DK120870, R01 DK126698, R01 DK119268, U2C DK129670, DK119268, R01 ES022981, and R21 AG070375) from the National Institutes of Health. The funding sources did not participate in the design or conduct of the study; collection, management, analysis or interpretation of the data; or preparation, review, or approval of the manuscript.


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