02 Sep High Carbohydrate Diet Associated With Increased Risk of Mortality
MedicalResearch.com Interview with:
Dr. Mahshid Dehghan, PhD
Investigator- Nutrition Epidemiology Program
Population Health Research Institute
Senior Research Associate – Department of Medicine
MedicalResearch.com: What is the background for this study?
Response: For decades, dietary guidelines have largely focused on reducing total fat and saturated fat intake based on the idea that reducing fat consumption should reduce the risk of CVD. But this did not take into account what nutrients replace saturated fats in the diet. Given that carbohydrates are relatively inexpensive, reducing fats (especially saturated fat) is often accompanied by increased carbohydrate consumption. This approach continues to influence health policy today. The guidelines were developed some 4 decades back mainly using data from some Western countries (such as Finland) where fat and saturated fat intakes were very high (eg total fat intake was >40% of caloric intake and saturated fats was >20% of caloric intake). It is not clear whether the harms seen at such high levels applies to current global intakes or countries outside North America and Europe where fat intakes are much lower.
The PURE (Prospective Urban Rural Epidemiology) study is a large international cohort study of more than 157,000 people aged 35 to 70 years from 18 low-income, middle-income, and high-income countries on 5 continents. In this study, 135,335 individuals with dietary information and without cardiovascular disease at baseline were included in the study. Standardized questionnaires were used to collect information about demographics, socio-economic factors, lifestyle behaviors, health history and medication use. Standardized case-report forms were used to record data on major cardiovascular events and mortality during follow-up, which were adjudicated centrally in each country by trained physicians using standard definitions. The participants were followed-up for 7.5 years, during which time 4784 major cardiovascular events and 5796 deaths were recorded.
MedicalResearch.com: What are the main findings?
Response: The study showed that contrary to popular belief, increased consumption of dietary fats is associated with a lower risk of death. Those with a high fat intake (about 35% of daily energy intake) had a 23% lower risk of mortality, and an 18% lower risk of stroke compared to low intake group (11% energy). The association with lower mortality was seen for all major types of fats.
By contrast, a diet high in carbohydrate (>60%) was associated with a 28% higher risk of death. Total fat and individual types of fat were not associated with risk of heart attacks or deaths from cardiovascular disease.
MedicalResearch.com: What should clinicians and patients take away from your report?
Response: Moderation (as opposed to very low or very high intakes) in consumption of both fats and carbohydrates is to be preferred.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: Dietary guidelines should be reconsidered in light of findings from the present study, especially in low and middle income countries. Relaxing current restrictions on fat consumption while emphasizing limiting carbohydrate consumption (when high) is likely to reduce mortality.
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Citation: ESC 2017 abstract
Associations of fats and carbohydrate intake with cardiovascular disease and mortality in 18 countries from five continents (PURE): a prospective cohort study
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