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Both low and high percentages of carbohydrate were associated with increased mortality. Minimal risk was at 50-55% of energy from carbohydrates.
This study, which utilised a cohort of 15,428 U.S. adults from the Atherosclerosis Risk in Communities study (ARIC), investigated the association between all-cause mortality and percentage energy from carbohydrate (%CHO). An additional seven multinational prospective studies were included in a meta-analysis. The study also assessed whether the substitution of animal or plant sources of fat and protein for carbohydrate affected mortality. In the ARIC cohort there was a U-shaped association between %CHO and mortality with the lowest risk at 50-55% CHO. In the meta-analysis of all cohorts both low carbohydrate (<40%; Hazard Ratio 1.2) and high (>70%; Hazard Ratio 1.23) conferred greater mortality, consistent with the U-shaped association. The results varied by the source of the fat and protein replacing the carbohydrate; mortality increased when carbohydrates were replaced with animal fat or protein (1.18) and decreased when replaced with plant-based fat and protein (0.82)
Seidelmann S, Claggett B, Cheng S et al. Dietary carbohydrate and mortality: a prospective cohort study and meta-analysis. The Lancet Public Health Aug 2018