Associations of low-carbohydrate and low-fat intakes with all-cause mortality in subjects with prediabetes with and without insulin resistance

Background & aims: We investigated the associations of low-carbohydrate and low-fat diets with allcause mortality in people with prediabetes according to insulin resistance status using data from the National Health and Nutrition Examination Survey (NHANES).& nbsp; Methods: We analyzed the NHANES participants with prediabetes from 2005 to 2008, and their vital status was linked to the National Death Index through the end of 2011. Low-carbohydrate and low-fat diets were defined as <40% and <30% of calories from carbohydrate and fat, respectively. The homeostasis model assessment of insulin resistance (HOMA-IR) was used to determine insulin resistance. Weighted Cox proportional hazards regression models were used to compare the hazard ratios for the associations of low-carbohydrate and low-fat diets with all-cause mortality.& nbsp; Results: Among the 1687 participants with prediabetes, 96 of them had died after a median follow-up of 4.5 years. Participants with a HOMA-IR >3.0 had an increase in all-cause mortality compared with those who had a HOMA-IR <3.0 (HR 1.797, 95% CI 1.110 to 2.909, p 1/4 0.019). Participants with <40% of calories from carbohydrate and >30% from fat (3.75 per 1000 person-years) had a lower all-cause mortality rate compared with those who had >40% from carbohydrate and >30% from fat (10.20 per 1000 person-years) or >40% from carbohydrate and <30% from fat (8.09 per 1000 person-years), with statistical significance observed in those who had a HOMA-IR <3.0.& nbsp; Conclusions: A low-carbohydrate intake (<40%) was associated with a lower all-cause mortality rate in people with prediabetes.& nbsp; (c) 2020 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

Automated summary

This study utilizing NHANES data found that low-carbohydrate and low-fat diets were associated with reduced all-cause mortality in individuals with prediabetes, particularly in those with lower insulin resistance.