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Low-carbohydrate diets and all-cause mortality: a systematic review and meta-analysis of observational studies.

Abstract

OBJECTIVE

Low-carbohydrate diets and their combination with high-protein diets have been gaining widespread popularity to control weight. In addition to weight loss, they may have favorable short-term effects on the risk factors of cardiovascular disease (CVD). Our objective was to elucidate their long-term effects on mortality and CVD incidence.

DATA SOURCES

MEDLINE, EMBASE, ISI Web of Science, Cochrane Library, and ClinicalTrials.gov for relevant articles published as of September 2012. Cohort studies of at least one year's follow-up period were included.

REVIEW METHODS

Identified articles were systematically reviewed and those with pertinent data were selected for meta-analysis. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) for all-cause mortality, CVD mortality and CVD incidence were calculated using the random-effects model with inverse-variance weighting.

RESULTS

We included 17 studies for a systematic review, followed by a meta-analysis using pertinent data. Of the 272,216 people in 4 cohort studies using the low-carbohydrate score, 15,981 (5.9%) cases of death from all-cause were reported. The risk of all-cause mortality among those with high low-carbohydrate score was significantly elevated: the pooled RR (95% CI) was 1.31 (1.07-1.59). A total of 3,214 (1.3%) cases of CVD death among 249,272 subjects in 3 cohort studies and 5,081 (2.3%) incident CVD cases among 220,691 people in different 4 cohort studies were reported. The risks of CVD mortality and incidence were not statistically increased: the pooled RRs (95% CIs) were 1.10 (0.98-1.24) and 0.98 (0.78-1.24), respectively. Analyses using low-carbohydrate/high-protein score yielded similar results.

CONCLUSION

Low-carbohydrate diets were associated with a significantly higher risk of all-cause mortality and they were not significantly associated with a risk of CVD mortality and incidence. However, this analysis is based on limited observational studies and large-scale trials on the complex interactions between low-carbohydrate diets and long-term outcomes are needed.

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  • Authors+Show Affiliations

    ,

    Department of Diabetes and Metabolic Medicine, Center Hospital, National Center for Global Health and Medicine, Tokyo, Japan. noto-tky@umin.net

    , ,

    Source

    PloS one 8:1 2013 pg e55030

    MeSH

    Cardiovascular Diseases
    Cause of Death
    Cohort Studies
    Diet, Carbohydrate-Restricted
    Humans
    Odds Ratio
    Risk Factors

    Pub Type(s)

    Journal Article
    Meta-Analysis
    Research Support, Non-U.S. Gov't
    Review
    Systematic Review

    Language

    eng

    PubMed ID

    23372809

    Citation

    Noto, Hiroshi, et al. "Low-carbohydrate Diets and All-cause Mortality: a Systematic Review and Meta-analysis of Observational Studies." PloS One, vol. 8, no. 1, 2013, pp. e55030.
    Noto H, Goto A, Tsujimoto T, et al. Low-carbohydrate diets and all-cause mortality: a systematic review and meta-analysis of observational studies. PLoS ONE. 2013;8(1):e55030.
    Noto, H., Goto, A., Tsujimoto, T., & Noda, M. (2013). Low-carbohydrate diets and all-cause mortality: a systematic review and meta-analysis of observational studies. PloS One, 8(1), pp. e55030. doi:10.1371/journal.pone.0055030.
    Noto H, et al. Low-carbohydrate Diets and All-cause Mortality: a Systematic Review and Meta-analysis of Observational Studies. PLoS ONE. 2013;8(1):e55030. PubMed PMID: 23372809.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Low-carbohydrate diets and all-cause mortality: a systematic review and meta-analysis of observational studies. AU - Noto,Hiroshi, AU - Goto,Atsushi, AU - Tsujimoto,Tetsuro, AU - Noda,Mitsuhiko, Y1 - 2013/01/25/ PY - 2012/11/07/received PY - 2012/12/18/accepted PY - 2013/2/2/entrez PY - 2013/2/2/pubmed PY - 2013/7/28/medline SP - e55030 EP - e55030 JF - PloS one JO - PLoS ONE VL - 8 IS - 1 N2 - OBJECTIVE: Low-carbohydrate diets and their combination with high-protein diets have been gaining widespread popularity to control weight. In addition to weight loss, they may have favorable short-term effects on the risk factors of cardiovascular disease (CVD). Our objective was to elucidate their long-term effects on mortality and CVD incidence. DATA SOURCES: MEDLINE, EMBASE, ISI Web of Science, Cochrane Library, and ClinicalTrials.gov for relevant articles published as of September 2012. Cohort studies of at least one year's follow-up period were included. REVIEW METHODS: Identified articles were systematically reviewed and those with pertinent data were selected for meta-analysis. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) for all-cause mortality, CVD mortality and CVD incidence were calculated using the random-effects model with inverse-variance weighting. RESULTS: We included 17 studies for a systematic review, followed by a meta-analysis using pertinent data. Of the 272,216 people in 4 cohort studies using the low-carbohydrate score, 15,981 (5.9%) cases of death from all-cause were reported. The risk of all-cause mortality among those with high low-carbohydrate score was significantly elevated: the pooled RR (95% CI) was 1.31 (1.07-1.59). A total of 3,214 (1.3%) cases of CVD death among 249,272 subjects in 3 cohort studies and 5,081 (2.3%) incident CVD cases among 220,691 people in different 4 cohort studies were reported. The risks of CVD mortality and incidence were not statistically increased: the pooled RRs (95% CIs) were 1.10 (0.98-1.24) and 0.98 (0.78-1.24), respectively. Analyses using low-carbohydrate/high-protein score yielded similar results. CONCLUSION: Low-carbohydrate diets were associated with a significantly higher risk of all-cause mortality and they were not significantly associated with a risk of CVD mortality and incidence. However, this analysis is based on limited observational studies and large-scale trials on the complex interactions between low-carbohydrate diets and long-term outcomes are needed. SN - 1932-6203 UR - https://www.unboundmedicine.com/medline/citation/23372809/full_citation L2 - http://dx.plos.org/10.1371/journal.pone.0055030 DB - PRIME DP - Unbound Medicine ER -