Summary
This prospective analysis of three large U.S. cohorts (42,720 men and 155,753 women, followed 1986–2019) found that the association between low-carbohydrate or low-fat diets and coronary heart disease risk depends critically on macronutrient quality. Healthy versions of both LCD and LFD patterns—emphasising plant-based or whole-grain sources—were associated with reduced CHD risk (hazard ratios 0.85 and 0.87, respectively), whilst unhealthy versions emphasising refined carbohydrates or animal products were associated with increased risk. Metabolomic profiling supported these findings, linking healthy diet patterns to more favourable lipid profiles.
Regional applicability
These findings are directly applicable to United Kingdom populations, as dietary pattern associations with cardiovascular disease are broadly consistent across Western nations with similar food environments. However, UK implementation would need to account for different food availability, cultural dietary practices, and the role of UK-specific nutritional guidance (e.g. NICE, Eatwell Guide) in supporting healthy versions of LCD and LFD patterns.
Key measures
Five LCD and five LFD indices derived from food frequency questionnaire assessments; multimetabolite scores developed via elastic net regression; coronary heart disease incidence; hazard ratios with 95% confidence intervals; metabolomic markers including triglycerides and HDL cholesterol
Outcomes reported
The study examined associations between low-carbohydrate diet (LCD) and low-fat diet (LFD) patterns, stratified by macronutrient quality, and coronary heart disease incidence over up to 33 years of follow-up in three large U.S. cohorts. Metabolomic indices were developed to objectively assess diet-disease associations.
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