The association of energy and macronutrient intake with all-cause mortality, cardiovascular disease and dementia: findings from 120 963 women and men in the UK Biobank

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 120 963 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 center dot 13 (1 center dot 03, 1 center dot 23)), yet a lower risk with higher intakes of protein (upper v. lowest third 0 center dot 82 (0 center dot 76, 0 center dot 89)). There was a lower risk of CVD with moderate intakes (middle v. lowest third) of energy and protein (sub distribution HR (SHR), 0 center dot 87 (0 center dot 79, 0 center dot 97) and 0 center dot 87 (0 center dot 79, 0 center dot 96), respectively). There was a lower risk of dementia with moderate energy intake (SHR 0 center dot 71 (0 center dot 52, 0 center dot 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 center dot 84 (0 center dot 76, 0 center dot 93)) compared with the reference cluster and a lower risk of CVD for men (SHR 0 center dot 83 (0 center dot 71, 0 center dot 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.

Automated summary

This study using data from UK Biobank found that high carbohydrate intake increases the risk of death, while higher protein intake reduces the risk. Moderate intake of energy and protein can lower the risk of cardiovascular disease, and moderate energy intake can reduce the risk of dementia. Sex differences were identified, and targeting combinations of macronutrients in dietary policy and interventions may provide the greatest benefits.