Abstract
Objective:
We have evaluated the effects on mortality of habitual low carbohydrate–high-protein diets that are thought to contribute to weight control.
Design:
Cohort investigation.
Setting:
Adult Greek population.
Subjects methods:
Follow-up was performed from 1993 to 2003 in the context of the Greek component of the European Prospective Investigation into Cancer and nutrition. Participants were 22 944 healthy adults, whose diet was assessed through a validated questionnaire. Participants were distributed by increasing deciles according to protein intake or carbohydrate intake, as well as by an additive score generated by increasing decile intake of protein and decreasing decile intake of carbohydrates. Proportional hazards regression was used to assess the relation between high protein, high carbohydrate and the low carbohydrate–high protein score on the one hand and mortality on the other.
Results:
During 113 230 persons years of follow-up, there were 455 deaths. In models with energy adjustment, higher intake of carbohydrates was associated with significant reduction of total mortality, whereas higher intake of protein was associated with nonsignificant increase of total mortality (per decile, mortality ratios 0.94 with 95% CI 0.89 –0.99, and 1.02 with 95% CI 0.98 –1.07 respectively). Even more predictive of higher mortality were high values of the additive low carbohydrate–high protein score (per 5 units, mortality ratio 1.22 with 95% CI 1.09 –to 1.36). Positive associations of this score were noted with respect to both cardiovascular and cancer mortality.
Conclusion:
Prolonged consumption of diets low in carbohydrates and high in protein is associated with an increase in total mortality.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$259.00 per year
only $21.58 per issue
Rent or buy this article
Prices vary by article type
from$1.95
to$39.95
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Ainsworth BE, Haskell WL, Leon AS, Jacobs Jr DR, Montoye HJ, Sallis JF et al. (1993). Compendium of physical activities: classification of energy costs of human physical activities. Med Sci Sports Exerc 25, 71–80.
Astrup A, Meinert Larsen T, Harper A (2004). Atkins and other low-carbohydrate diets: hoax or an effective tool for weight loss? Lancet 364, 897–899.
Centers for Disease Control and Prevention (CDC) (2004). Department of Health and Human Services. Morbility and Mortality weekly report. Trends in intake of energy and macronutrients – United States – 1971–2000, 53 (04), 80–82 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5304a3.htm(Assessed: January 20, 2006).
Chen TY, Smith W, Rosenstock JL, Lessnau KD (2006). A life-threatening complication of Atkins diet. Lancet 367, 958.
Dansinger ML, Gleason JA, Griffith JL, Selker HP, Schaefer EJ (2005). Comparison of the Atkins, Ornish, Weight Watchers, and Zone diets for weight loss and heart disease risk reduction: a randomized trial. JAMA 293, 43–53.
Foster GD, Wyatt HR, Hill JO, McGuckin BG, Brill C, Mohammed BS et al. (2003). A randomized trial of a low-carbohydrate diet for obesity. N Engl J Med 348, 2082–2090.
Gnardellis C, Trichopoulou A, Katsouyanni K, Polychronopoulos E, Rimm EB, Trichopoulos D (1995). Reproducibility and validity of an extensive semiquantitative food frequency questionnaire among Greek school teachers. Epidemiology 6, 74–77.
Goldbohm RA, van't Veer P, van den Brandt PA, van'Hof MA, Brants HA, Sturmans F et al. (1995). Reproducibility of a food frequency questionnaire and stability of dietary habits determined from five annually repeated measurements. Eur J Clin Nutr 49, 420–429.
Kelemen LE, Kushi LH, Jacobs Jr DR, Cerhan JR (2005). Associations of dietary protein with disease and mortality in a prospective study of postmenopausal women. Am J Epidemiol 161, 239–249.
Knoops KT, de Groot LC, Kromhout D, Perrin AE, Moreiras-Varela O, Menotti A et al. (2004). Mediterranean diet, lifestyle factors, and 10-year mortality in elderly European men and women: the HALE project. JAMA 292, 1433–1439.
Lara-Castro C, Garvey WT (2004). Diet, insulin resistance and obesity: zoning in on data for Atkins dieters living in South Beach. J Clin Endocrinol Metab 89, 4197–4205.
McCullough M, Feskanich D, Stampfer M, Giovanucci EL, Rimm EB, Hu FB et al. (2002). Diet quality and major chronic disease risk in men and women: moving toward improved dietary guidance. Am J Clin Nutr 76, 1261–1271.
Riboli E, Hunt KJ, Slimani N, Ferrari P, Norat T, Fahey M et al. (2002). European Prospective Investigation into Cancer and Nutrition (EPIC): study populations and data collection. Public Health Nutr 5, 1113–1124.
Samaha FF, Iqbal N, Seshadri P, Chicano KL, Daily DA, McGrory J et al. (2003). A low-carbohydrate as compared with a low-fat diet in severe obesity. N Engl J Med 348, 2074–2081.
Smith-Warner S, Spiegelman D, Adami HO, Beeson WL, van den Brandt PA, Folsom AR et al. (2001). Types of dietary fat and breast cancer: a pooled analysis of cohort studies. Int J Cancer 92, 767–774.
St Jeor ST, Howard BV, Prewitt TE, Bovee V, Bazarre T, Eckel RH (2001). Dietary protein and weight reduction: a statement for healthcare professionals from the Nutrition Committee of Council on Nutrition, Physical Activity, and Metabolism of the American Heart Association. Circulation 104, 1869–1874.
Stanton R, Crowe T (2006). Risks of a high-protein diet outweigh the benefits. Nature 440 (7086), 868.
Steffen L, Nettleton JA (2006). Carbohydrates: how low can you go? Lancet 267, 880–881.
Swan G (2004). Findings from the latest National Diet and Nutrition Survey. Proc Nutr Soc 63, 505–512.
Trichopoulou A, Bamia C, Trichopoulos D (2005a). Mediterranean diet and survival among patients with coronary heart disease in Greece. Arch Intern Med 165 (8), 929–935.
Trichopoulou A, Costacou T, Bamia C, Trichopoulos D (2003). Adherence to a Mediterranean diet and survival in a Greek population. N Engl J Med 348, 2599–2608.
Trichopoulou A, Georga K (eds) (2004). Composition Tables of Simple and Composite Foods. Parisianos: Athens, Greece, pp 1–158.
Trichopoulou A, Gnardellis C, Lagiou A, Benetou V, Trichopoulos D (2000). Body mass index in relation to energy intake and expenditure among adults in Greece. Epidemiology 11, 333–336.
Trichopoulou A, Orfanos P, Norat T, Bueno-de-Mesquita B, Ocke MC, Peeters PH et al. (2005b). Modified Mediterranean diet and survival: EPIC-elderly prospective cohort study. BMJ 330, 991–997.
Trichopoulou A, Psaltopoulou T, Orfanos P, Trichopoulos D (2006). Diet and physical activity in relation to overall mortality amongst adult diabetics in a general population cohort. J Intern Med 259 (6), 583–591.
Truby H, Baic S, deLooy A, Fox KR, Livingstone MB, Logan CM et al. (2006). Randomised controlled trial of four commercial weight loss programmes in the UK: initial findings from the BBC ‘diet trials’. BMJ 332 (7553), 1309–1314.
Tsai CJ, Leitzmann M, Willett W, Giovannucci E (2004). Dietary protein and the risk of cholecystectomy in a cohort of US women. The Nurses' Health Study. Am J Epidemiol 160, 11–18.
Volek J, Westman E (2002). Very-low-carbohydrate weight-loss diets revisited. Cleve Cl J Med 69, 849–858.
Wacholder S, Schatzkin A, Freedman LS, Kipnis V, Hartman A, Brown CC (1994). Can energy adjustment separate the effects of energy from those of specific macronutrients? Am J Epidemiol 140, 848–855.
Willett WC (2004). Reduced-carbohydrate diets: no roll in weight management? Ann Intern Med 140, 836–837.
Willett W, Stampfer M (1998). Implications of total energy intake for epidemiological analyses. In: Willett W (ed). Nutritional Epidemiology, 2nd edn, Oxford University Press: New York, US, pp 273–301.
Willett WC, Sampson L, Browne ML, Stampfer MJ, Rosner B, Hennekens CH et al. (1988). The use of a self-administered questionnaire to assess diet four years in the past. Am J Epidemiol 127, 188–199.
World Cancer Research Fund (1997). Food, nutrition and the prevention of cancer: a global perspective. American Institute for Cancer Prevention: Washington, DC, pp. 92–361.
World Health Organization (1992). International Statistical Classification of Diseases and Related Health Problems (ICD, vol 1,2,3). 10th revision, Geneva, Switzerland.
Yang E, Kerver J, Park Y, Kayitsinga J, Allison D, Song W (2003). Carbohydrate intake and biomarkers of glycemic control among US adults: the third National Health and Nutrition Examination Survey (NHANES III). Am J Clin Nutr 77, 1426–1433.
Acknowledgements
This work was supported by the Europe Against Cancer Program of the European Commission, the Greek Ministry of Health, the Greek Ministry of Education, and an unrestricted grant to the University of Athens in honour of ‘Vasilios and Nafsika Tricha’ (all supporting the collection and management of the data).
Author information
Authors and Affiliations
Corresponding author
Additional information
Guarantor: A Trichopoulou.
Contributors: AT is the principal investigator of the Greek EPIC project and has the supervising responsibility for all aspects of this project. TP is the physician directly involved in the implementation of this study. PO is the coordinator for data analysis. C-CH and DT are the epidemiology consultants.
Rights and permissions
About this article
Cite this article
Trichopoulou, A., Psaltopoulou, T., Orfanos, P. et al. Low-carbohydrate–high-protein diet and long-term survival in a general population cohort. Eur J Clin Nutr 61, 575–581 (2007). https://doi.org/10.1038/sj.ejcn.1602557
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/sj.ejcn.1602557
Keywords
This article is cited by
-
Starch intake, amylase gene copy number variation, plasma proteins, and risk of cardiovascular disease and mortality
BMC Medicine (2023)
-
Low-carbohydrate diets containing plant-derived fat but not animal-derived fat ameliorate heart failure
Scientific Reports (2023)
-
Impact of low-carbohydrate diet on serum levels of leptin and adiponectin levels: a systematic review and meta-analysis in adult
Journal of Diabetes & Metabolic Disorders (2022)
-
An Update on the Effects of Plant-Based Diets on Cardiometabolic Factors in Adults with Type 2 Diabetes Mellitus
Current Cardiovascular Risk Reports (2022)
-
A genome-wide association study on adherence to low-carbohydrate diets in Japanese
European Journal of Clinical Nutrition (2022)