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



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


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.


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).


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.

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This study was supported by Nordic Health Whole Grain Food (HELGA)/NordForsk and Visare Norr, Northern County Councils. We thank the participants in the Västerbotten Intervention Program for their valuable contribution to medical research. We also acknowledge Professor Göran Broström of the Department of Statistics, Umeå University, for excellent statistical advice.

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Correspondence to L M Nilsson.

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Nilsson, L., Winkvist, A., Eliasson, M. et al. Low-carbohydrate, high-protein score and mortality in a northern Swedish population-based cohort. Eur J Clin Nutr 66, 694–700 (2012).

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  • diet
  • survival
  • macronutrients
  • protein intake
  • carbohydrate intake
  • cohort study

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