Plant-based low-carb diet linked to lower mortality risk in type 2 diabetes
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Key takeaways:
- Adults with type 2 diabetes have a lower risk for death if they eat more plant-based low-carb foods.
- Plant-based and healthy low-carb foods also lower the risk for CVD and cancer mortality.
Low-carbohydrate diets centered on macronutrients from whole grains, fruit and vegetables are associated with a lower mortality risk for people with type 2 diabetes, according to study data.
“It is well established that maintaining a higher diet quality is important for human health,” Yang Hu, ScD, research associate in the department of nutrition at the Harvard T.H. Chan School of Public Health, told Healio. “Our findings reaffirmed this notion and demonstrated that a high-quality version of low-carbohydrate diet might confer significantly more health benefits than a lower-quality version.”
Hu and colleagues collected data from participants in the Nurses’ Health Study and the Health Professionals Follow-up Study of adults without diabetes at baseline who developed type 2 diabetes during follow-up. A food frequency questionnaire was conducted every 4 years in both studies. Participants received a ranking score ranging from 0 for highest intake to 10 for lowest intake for 11 categories of fat, carbohydrates or protein. Researchers calculated five different low-carb diet scores based on the questionnaire responses. The total low-carb diet score was calculated based on the total sum of fat, protein and carbohydrate ranks. The vegetable low-carb diet score included only vegetable fat and protein, whereas the animal low-carb diet score included only animal fat and protein. The unhealthy low-carb diet score was calculate using the ranked sum of animal protein and animal fat consumption along with the reverse rank of high-quality carbohydrate intake, whereas the heathy low-carb diet score was the ranked sum of vegetable protein and vegetable fat intake and the reverse rank of low-quality carbohydrates. Mortality data were collected from vital records, the National Death Index and reports from the participants’ next of kin or postal service. All-cause, cardiovascular disease and cancer mortality were analyzed.
The findings were published in Diabetes Care.
There were 10,101 people who developed type 2 diabetes included in the study, of whom 4,595 died during follow-up. Of the deaths observed, 1,389 were CVD deaths and 881 were cancer deaths.
Each 10-point increase in total low-carb diet score was associated with a 13% decreased risk in all-cause mortality. Each 10-point increase in vegetable low-carb diet score cut the risk for all-cause mortality by 24%, and each 10-point increase in healthy low-carb diet score decreased all-cause mortality risk by 22%. Higher vegetable low-carb and healthy low-carb diet scores were also associated with lower risks for cancer and CVD mortality.
Each 10-point increase from prediabetes to post-diabetes diagnosis in total low-carb diet score was associated with a decrease in all-cause mortality risk (HR = 0.88; 95% CI, 0.83-0.93) and CVD mortality risk (HR = 0.9; 95% CI, 0.81-1), but not cancer mortality risk. Each 10-point increase in vegetable low-carb diet score from pre-diagnosis to post-diagnosis decreased the risk for all-cause mortality (HR = 0.75; 95% CI, 0.7-0.81), CVD mortality (HR = 0.81; 95% CI, 0.71-0.92) and cancer mortality (HR = 0.82; 95% CI, 0.7-0.96). Each 10-point increase from pre-diagnosis to post-diagnosis in healthy low-carb diet score lowered the risk for all-cause mortality (HR = 0.75; 95% CI, 0.7-0.81), CVD mortality (HR = 0.79; 95% CI, 0.69-0.9) and CVD mortality (HR = 0.83; 95% CI, 0.71-0.97). No decreased mortality risks were observed for animal or unhealthy low-carb diet scores.
A reduced risk for all-cause mortality was observed among adults who replaced potatoes, refined grain, added sugar and total refined carbohydrates with vegetable fat and vegetable protein. However, carbohydrate replacement was not associated with a change in CVD and cancer mortality risk.
“Clinicians may find our results useful when providing dietary recommendations to diabetes patients,” Hu said. “Switching to and maintaining a plant-based low-carbohydrate diet after diabetes diagnosis may confer long-term health benefits to the patients. Our findings support current guidelines from international bodies and professional groups such as the American Diabetes Association that endorse carbohydrate restriction as a legitimate therapeutic strategy for people with type 2 diabetes.”
For more information:
Yang Hu, ScD, can be reached at yanghu@hsph.harvard.edu.
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