Abstract

Background: Low carbohydrate diets, which restrict carbohydrate in favour of increased protein or fat intake, or both, are a popular weight-loss strategy. However, it remains unclear whether a high-carbohydrate is more metabolically harmful or a high-fat or high protein is more metabolically harmful, and the optimal amount of carbohydrates and fat and protein has not been determined. The aim of our study was to examine the role of carbohydrate and fat and protein intake in Metabolic Syndrome (MetS) in a Chinese population. Methods: This study is a cross-sectional component of Prospective Urban Rural Epidemiology (PURE)-China study, which recruited over 46,000 participants from 70 rural and 45 urban communities between 2005 and 2009. Dietary intake of 43,494 individuals was recorded using validated food frequency questionnaires. MetS was defined according to The 2016 guidelines for prevention and treatment of dyslipidemia in Chinese adults, as having any 3 of the following 5 criteria: elevated blood pressure (BP) (systolic BP more than 130 mm/Hg or diastolic BP more than 85 mm/Hg or treatment of hypertension); low high-density lipoprotein cholesterol < 1.00 mmol/dl; triglycerides more than 1.7 mmol/dl; increased waist circumference (more than 90 cm in males or more than 85 cm in females); or fasting glucose more than 6.1 mmol/dl or having antidiabetic medication. Multivariate logistic regression model was used to examine the association between snoring habits and MetS. Participants were divided into quintiles of nutrients intake (carbohydrate, fats, and protein) based on percentage of energy provided by nutrients. We assessed the associations between consumption of carbohydrate, total fat, and each type of fat with MetS risk. Odds ratio (OR) is calculated by using multivariable logistic regression. Results: Among 43,494 participants, after adjusted for age, sex, smoke and drink status, education, waist-to-hip, physical activity, urban and rural, and energy intake, multiple logistic regression showed that both higher carbohydrate and protein intake was associated with a decreased risk of MetS (highest [quintile 5] vs lowest [quintile 1]) category, OR 0.82 [95% 0.75–0.89], ptrend < 0.001 and 0.75 [95% 0.62–0.91], ptrend < 0.001). Total fat and saturated and unsaturated fats were not significantly associated with risk of MetS. Conclusion: High carbohydrate and high protein intake was associated with lower risk of MetS. Total fat and types of fat were not associated with lower MetS. Chinese dietary guidelines should be reconsidered in light of these findings.

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