Low-carbohydrate, high-protein score and mortality in a northern Swedish population-based cohort

Background/Objective: Long-term effects of carbohydrate-restricted diets are unclear. We examined a low-carbohydrate, high-protein (LCHP) score in relation to mortality. Subjects/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). Conclusion: 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.