title: Low-carbohydrate, high-protein score and mortality in a northern Swedish population-based cohort.
abstract: OBJECTIVE
  Long-term effects of carbohydrate-restricted diets are unclear. We examined a low-carbohydrate, high-protein (LCHP) score in relation to mortality.
  
  
  METHODS
  This is a population-based cohort study on adults in the northern Swedish county of Västerbotten. In 37,639 men (1460 deaths) and 39,680 women (923 deaths) from the population-based Västerbotten Intervention Program, deciles of energy-adjusted carbohydrate (descending) and protein (ascending) intake were added to create an LCHP score (2-20 points). Sex-specific hazard ratios (HR) were calculated by Cox regression.
  
  
  RESULTS
  Median intakes of carbohydrates, protein and fat in subjects with LCHP scores 2-20 ranged from 61.0% to 38.6%, 11.3% to 19.2% and 26.6% to 41.5% of total energy intake, respectively. High LCHP score (14-20 points) did not predict all-cause mortality compared with low LCHP score (2-8 points), after accounting for saturated fat intake and established risk factors (men: HR for high vs low 1.03 (95% confidence interval (CI) 0.88-1.20), P for continuous = 0.721; women: HR for high vs low 1.10 (95% CI 0.91-1.32), P for continuous = 0.229). For cancer and cardiovascular disease, no clear associations were found. Carbohydrate intake was inversely associated with all-cause mortality, though only statistically significant in women (multivariate HR per decile increase 0.95 (95% CI 0.91-0.99), P = 0.010).
  
  
  CONCLUSIONS
  Our results do not support a clear, general association between LCHP score and mortality. Studies encompassing a wider range of macronutrient consumption may be necessary to detect such an association.
authors.affiliation: Department of Public Health and Clinical Medicine, Nutritional Research, Umeå University, Umeå, Sweden. lena.nilsson@nutrires.umu.se
authors.forename: L M
authors.initials: LM
authors.lastname: Nilsson
authors.forename: A
authors.initials: A
authors.lastname: Winkvist
authors.forename: M
authors.initials: M
authors.lastname: Eliasson
authors.forename: J-H
authors.initials: JH
authors.lastname: Jansson
authors.forename: G
authors.initials: G
authors.lastname: Hallmans
authors.forename: I
authors.initials: I
authors.lastname: Johansson
authors.forename: B
authors.initials: B
authors.lastname: Lindahl
authors.forename: P
authors.initials: P
authors.lastname: Lenner
authors.forename: B
authors.initials: B
authors.lastname: Van Guelpen
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000401:mortality; D002423:Cause of Death; D015331:Cohort Studies; D050528:Diet, Carbohydrate-Restricted; D004040:Dietary Carbohydrates / Q000494:pharmacology*; D004041:Dietary Fats / Q000008:administration & dosage; D004044:Dietary Proteins / Q000494:pharmacology*; D002149:Energy Intake; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality; D016016:Proportional Hazards Models; D012307:Risk Factors; D013548:Sweden / Q000453:epidemiology
chemical_list: D004040:Dietary Carbohydrates; D004041:Dietary Fats; D004044:Dietary Proteins