Low-carbohydrate diets and mortality in older Asian people: a 15-year follow-up from a prospective cohort study

Ce Sun, Wei-Sen Zhang, Chao-Qiang Jiang, Ya-Li Jin, Xue-Qing Deng, Jean Woo, Kar-Keung Cheng, Tai-Hing Lam, G Neil Thomas, Lin Xu

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The long-term effects of a low-carbohydrate diet (LCD) on mortality, accounting for the quality and source of the carbohydrate, are unclear. Hence, we examined the associations of LCDs with all-cause and cause-specific mortality in a prospective cohort study. A total of 20,206 participants (13.8% diabetes) aged 50+ years were included. Overall, vegetable-based and meat-based LCD scores were calculated based on the percentage of energy as total and subtypes of carbohydrates, fat, and protein. Cox regression analysis was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs). During 294,848 person-years of follow-up, 4624 deaths occurred, including 3661 and 963 deaths in participants without and with diabetes, respectively. In all participants, overall LCD score was not associated with all-cause and cause-specific mortality, after multivariable adjustment. However, for the highest versus the lowest quartiles of vegetable-based LCD, the adjusted HRs (95%CIs) of all-cause and CVD mortality were 1.16 (1.05-1.27) and 1.39 (1.19-1.62), respectively. The corresponding values for highest versus lowest quartiles of meat-based LCD for all-cause and CVD mortality were 0.89 (0.81-0.97) and 0.81 (0.70-0.93), respectively. Similar associations were found in participants without diabetes. In patients with diabetes, the adjusted HR (95%CI) of CVD mortality for the highest versus the lowest quartiles of vegetable-based LCD was 1.54 (1.11-2.14). Although there were no significant associations with overall LCD score, we found that the vegetable-based LCD score was positively, whereas the meat-based LCD score was negatively, associated with all-cause and CVD mortality in older Asian people.

Original languageEnglish
Article number1406
Number of pages17
Issue number7
Publication statusPublished - 28 Mar 2022

Bibliographical note

Funding Information:
Funding: This work was supported by the Natural Science Foundation of China (81941019). The Guangzhou Biobank Cohort Study was funded by the University of Hong Kong Foundation for Educational Development and Research, the Health Medical Research Fund (Grant number: HMRF/ 13143241) in Hong Kong; the Guangzhou Public Health Bureau, and the Guangzhou Science and Technology Bureau, Guangzhou, China, and the University of Birmingham, Birmingham, UK.

Publisher Copyright:
© 2022 by the authors. Licensee MDPI, Basel, Switzerland.


  • Aged
  • Cardiovascular Diseases
  • Diet, Carbohydrate-Restricted
  • Follow-Up Studies
  • Humans
  • Prospective Studies
  • Risk Factors
  • Vegetables
  • low-carbohydrate diet
  • mortality
  • older people
  • diabetes

ASJC Scopus subject areas

  • Food Science
  • Nutrition and Dietetics


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