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Low-Carbohydrate Diets and All-Cause Mortality: A Systematic Review and Meta-Analysis of Observational Studies

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  • Hiroshi Noto
  • Atsushi Goto
  • Tetsuro Tsujimoto
  • Mitsuhiko Noda

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.

Suggested Citation

  • Hiroshi Noto & Atsushi Goto & Tetsuro Tsujimoto & Mitsuhiko Noda, 2013. "Low-Carbohydrate Diets and All-Cause Mortality: A Systematic Review and Meta-Analysis of Observational Studies," PLOS ONE, Public Library of Science, vol. 8(1), pages 1-10, January.
    • Handle: RePEc:plo:pone00:0055030
    DOI: 10.1371/journal.pone.0055030
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    References listed on IDEAS

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    1. Hiroshi Bando, 2019. "Clinical Spread of Low Carbohydrate Diet (LCD)," Current Research in Diabetes & Obesity Journal, Juniper Publishers Inc., vol. 10(3), pages 1-3, April.
    2. Ema Borsi & Costela Lacrimioara Serban & Cristina Potre & Ovidiu Potre & Salomeia Putnoky & Miruna Samfireag & Raluca Tudor & Ioana Ionita & Hortensia Ionita, 2021. "High Carbohydrate Diet Is Associated with Severe Clinical Indicators, but Not with Nutrition Knowledge Score in Patients with Multiple Myeloma," IJERPH, MDPI, vol. 18(10), pages 1-14, May.
    3. Lukas Schwingshackl & Georg Hoffmann, 2014. "Comparison of High vs. Normal/Low Protein Diets on Renal Function in Subjects without Chronic Kidney Disease: A Systematic Review and Meta-Analysis," PLOS ONE, Public Library of Science, vol. 9(5), pages 1-13, May.
    4. Antonio Paoli, 2014. "Ketogenic Diet for Obesity: Friend or Foe?," IJERPH, MDPI, vol. 11(2), pages 1-16, February.
    5. Hiroshi Bando, 2019. "Clinical Spread of Low Carbohydrate Diet (LCD)," Current Research in Diabetes & Obesity Journal, Juniper Publishers Inc., vol. 10(3), pages 62-64, April.

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