Abstract
This study aimed to investigate the association between individual and combinations of macronutrients with premature death, CVD and dementia. Sex differences were investigated. Data were utilised from a prospective cohort of 120963 individuals (57 % women) within the UK Biobank, who completed ≥ two 24-h diet recalls. The associations of macronutrients, as percentages of total energy intake, with outcomes were investigated. Combinations of macronutrients were defined using k-means cluster analysis, with clusters explored in association with outcomes. There was a higher risk of death with high carbohydrate intake (hazard ratios (HR), 95 % CI upper v. lowest third 1·13 (1·03, 1·23)), yet a lower risk with higher intakes of protein (upper v. lowest third 0·82 (0·76, 0·89)). There was a lower risk of CVD with moderate intakes (middle v. lowest third) of energy and protein (sub distribution HR (SHR), 0·87 (0·79, 0·97) and 0·87 (0·79, 0·96), respectively). There was a lower risk of dementia with moderate energy intake (SHR 0·71 (0·52, 0·96)). Sex differences were identified. The dietary cluster characterised by low carbohydrate, low fat and high protein was associated with a lower risk of death (HR 0·84 (0·76, 0·93)) compared with the reference cluster and a lower risk of CVD for men (SHR 0·83 (0·71, 0·97)). Given that associations were evident, both as single macronutrients and for combinations with other macronutrients for death, and for CVD in men, we suggest that the biggest benefit from diet-related policy and interventions will be when combinations of macronutrients are targeted.
Highlights
In the UK, the burden of disease due to poor diets is estimated to be 10 % of the total disease burden[1]
Sex differences were identified in the associations between individual macronutrients and outcomes; these differences were only reflected in the multiple adjusted cluster analyses for men, where men with diets characterised by low carbohydrate, low fat and high protein intake had a lower risk of Cardiovascular disease (CVD)
The present study identified a range of associations between energy and macronutrient intake and all-cause mortality, CVD and dementia, with some differences by sex identified
Summary
In the UK, the burden of disease due to poor diets is estimated to be 10 % of the total disease burden[1]. Evidence of the relationship between diet and disease has been used to set dietary recommendations for energy and macronutrients, globally and in the UK[9]. These recommended values provide an insight into what a standard diet for a ‘healthy’ individual should be made up of, in terms of energy, carbohydrates, fats and protein. In order to implement effective food policies and set relevant guidelines, the risk between poor diets and disease needs to be frequently monitored, in relation to diseases contributing the highest burden. Given there is a vascular component to dementia, it is plausible that disease risk would be influenced by dietary intake in a similar manner to CVD[12]. The treatment options for dementia are currently limited; the identification of modifiable risk factors to prevent dementia is urgently needed
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