Low-Carbohydrate Diet and Mortality in Type 2 Diabetes

USA: Greater adherence to LCD (low-carbohydrate diet) patterns is significantly associated with lower cancer, cardiovascular, and total mortality among type 2 diabetes (T2D) patients, new research has pointed out. LCD patterns emphasize high-quality sources of macronutrients.

"A combination of healthy versions of the low-carbohydrate diet with other healthy lifestyle behaviours following diabetes diagnosis may confer additional health benefits," the researchers wrote in their study published in the journal Diabetes Care.

The study was conducted by Yang Hu, Chan School of Public Health, Boston, MA, and colleagues to prospectively assess the association between postdiagnosis LCD patterns and mortality among patients with type 2 diabetes.

For this purpose, the researchers calculated an overall total LCD score (TLCDS) based on the percentage of energy as total carbohydrates among diabetes patients within the Nurses' Health Study and Health Professionals' Follow-up Study. Also, animal (ALCDS), vegetable (VLCDS), unhealthy (ULCDS), and healthy LCDS (HDCDS) were further derived that stressed different quality and sources of macronutrients. The association between the LCD score and mortality was assessed using Multivariable-adjusted Cox models.

Study Findings

• Among 10,101 incident type 2 diabetes cases contributing 139,407 person-years during follow-up, 4,595 deaths were documented, of which 1,389 cases were attributed to CVD (cardiovascular disease) and 881 to cancer.
• The pooled multivariable-adjusted hazard ratios (HRs) of total mortality per 10-point increment of postdiagnosis LCDS were 0.87 for TLCDS, 0.76 for VLCDS, and 0.78 for HLCDS.
• HLCDS and VLCDS were also associated with significantly lower CVD and cancer mortality.
• Each 10-point increase of VLCDS, TLCDS, and HLCDS from prediagnosis to postdiagnosis period was linked with 25%, 12%, and 25% lower total mortality, respectively.
• No significant associations were observed between ALCDS and ULCDS.

"For low-carbohydrate diets that stressed macronutrient intake from healthy plant-based foods, the inverse associations were stronger, and these LCDs were also linked with significantly lower CVD and cancer mortality," the team added. "Low-carbohydrate diets that emphasized animal fat or protein were not notably associated with any study outcomes."

To conclude, greater adherence to LCD patterns among people with type 2 diabetes is significantly associated with lower cancer, cardiovascular, and overall mortality. When combined with other healthy lifestyle choices, an amplification in risk reduction was observed.

Reference

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; Low-Carbohydrate Diet Scores and Mortality Among Adults With Incident Type 2 Diabetes. Diabetes Care 2023; dc222310. https://doi.org/10.2337/dc22-2310